JPINFV
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Of course this makes any comparison a moot point. Your BLS level has more education than our ALS level.
BLS Ambulance Staffing
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Of course this makes any comparison a moot point. Your BLS level has more education than our ALS level.
JPINFV
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Yet the patient still sees a physician or mid level at the end of the transport. Amazing that a patient that is not sick enough for a paramedic is still sick enough to see a physician.
Originally Posted by Melbourne MICA
Our BLS guys do three years minimum education (now uni based ) with a degree qualification at the end of it. When I did it it was in-house three years full time, probably about 42 weeks (6 semesters)face to face in school education with on-road instructor training all through the course.
Yet some of the U.S. EMT-Bs are still dumbfounded as to why their 110 hour cert is criticized.
Sasha
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Where did I call anyone stupid?
There's a difference between stupidity and being uneducated.
And no, not every patient gets a monitor and an IV, but every patient deserves an ALS assesment.
Melbourne MICA
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Bls
But surely JP and Venty there are services with a roughly equivalent level of training and education for their BLS ground troops if I can use the military analogy again?
When I first started back in 19...., we did a bit but not that much though it was still three years at school (from just 10 weeks or so back in the 70's/ early eighties). We have added a fair bit to the "BLS" plate since - drugs and procedures and of course upgraded the curriculum of the training programme.
Our BLS guys now do IV's, fluid resus, adrenaline IM (anaphylaxis) and IV (arrests), hypos with glucagon, resp stuff (no IV meds though just neb masks), Ceph for meningococal, LMA.s, Laryngo blades NP/OP, BVM for airways etc. A fair bit more. Having said that the authority to practice matrix in our guidleines (determines who is allowed to do what) has BLS 55 procedures, drugs etc and MICA 110 -that's everything in the book for us MICA types.
And like your situation our BLS recruits are now Uni based, many straight out of high school, first job - a few haven't even got their drivers license yet!!!!!
So the base of knowledge has improved but the on-road and maturity thing has gone out the window. Not to say some of the younger ones can't excel.
But it's hard to see how even a mature EMT-B with bugger all education can make the big calls. Once again not to say some don't have the wherwithall to keep themselves sharp and up to date. There must be some excellent basics out there as there are amongst our ALS (BLS) guys.
(By the same token we have some shockers as well - so bad you wouldn't let them treat your pet hamster let alone a real live human. And on occasion they rock up to your MICA job where the pt is Ok just needs BLS+transport and you go....."oh s..t - on second thoughts kids we'll take the pt".
However, if it's true what a lot of you guys are saying that the bottom line standard, even the majority staffing level in many counties is made up with B's that must scare the crap out of you. What do the ED docs and the general public think?
MM
But surely JP and Venty there are services with a roughly equivalent level of training and education for their BLS ground troops if I can use the military analogy again?
When I first started back in 19...., we did a bit but not that much though it was still three years at school (from just 10 weeks or so back in the 70's/ early eighties). We have added a fair bit to the "BLS" plate since - drugs and procedures and of course upgraded the curriculum of the training programme.
Our BLS guys now do IV's, fluid resus, adrenaline IM (anaphylaxis) and IV (arrests), hypos with glucagon, resp stuff (no IV meds though just neb masks), Ceph for meningococal, LMA.s, Laryngo blades NP/OP, BVM for airways etc. A fair bit more. Having said that the authority to practice matrix in our guidleines (determines who is allowed to do what) has BLS 55 procedures, drugs etc and MICA 110 -that's everything in the book for us MICA types.
And like your situation our BLS recruits are now Uni based, many straight out of high school, first job - a few haven't even got their drivers license yet!!!!!
So the base of knowledge has improved but the on-road and maturity thing has gone out the window. Not to say some of the younger ones can't excel.
But it's hard to see how even a mature EMT-B with bugger all education can make the big calls. Once again not to say some don't have the wherwithall to keep themselves sharp and up to date. There must be some excellent basics out there as there are amongst our ALS (BLS) guys.
(By the same token we have some shockers as well - so bad you wouldn't let them treat your pet hamster let alone a real live human. And on occasion they rock up to your MICA job where the pt is Ok just needs BLS+transport and you go....."oh s..t - on second thoughts kids we'll take the pt".
However, if it's true what a lot of you guys are saying that the bottom line standard, even the majority staffing level in many counties is made up with B's that must scare the crap out of you. What do the ED docs and the general public think?
MM
Wasn't this thread about first responders be allowed on a ambulance?
Oh sorry I forgot every thread here reverts into a pissing match between ALS and BLS.
If you read Melbourne MICA's post you will see what is considered a "First Responder" and who responds in the ambulances where he is.
To read what others in different countries think of the U.S. system should make some think about improving EMS in their area and not keep justifying the same very low standards.
I agree, this would be the perfect opportunity to conduct a study.
With the highly educated EMS systems around the world Australia, Canada...does their educational standards directly correlate to better patient outcomes?
I am for education in any field, just out of curiosity I would like to see how their patient outcomes stack up against the majority of trained US system providers.
With the highly educated EMS systems around the world Australia, Canada...does their educational standards directly correlate to better patient outcomes?
I am for education in any field, just out of curiosity I would like to see how their patient outcomes stack up against the majority of trained US system providers.
For trauma, the OPALS studies did provide good results but, again, the BLS provider had almost a year of college education.
In a few other countries such as the U.K., EMS providers have already expanded their roles into community health.
Some Canadian Paramedics also have enough education which includes specialized ICU experiences and can do specialty transports for adults, peds and neonates without being just the stretcher fetcher for the RNs and RRTs.
In a few other countries such as the U.K., EMS providers have already expanded their roles into community health.
Some Canadian Paramedics also have enough education which includes specialized ICU experiences and can do specialty transports for adults, peds and neonates without being just the stretcher fetcher for the RNs and RRTs.
Melbourne MICA
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Bls
Just regarding your original post - this was the original thread
"How do you staff your BLS ambulances? Do you do 2 emt's, three emts's? What is the training level of the driver? Do you allow/have first responders on the ambulance?"
And sorry - you are right to an extent and that's my fault - I tend to waffle and go off in tangents a fair bit.
Anyway your point is a fair one. Is the "better" training/education curriculum equating with better outcomes?
For MICA in Melbourne some yes's. RSI in head injured pts -Seattles trial back in about 93 flopped -ours hasn't - significantly improved outcomes and very high success rates on procedures. Cardiac arrest survival to hospital - ours is now above 30% if I remember correctly maybe better than that.
Some trauma wins in pts with bad ISS scores considered non survivable - big hospital trauma centre study last year - pts survived apparently because of MICA interventions particularly decompressions, RSI, etc.
The BLS guys must be considered a part in all of this as they often arrive before we do. But what worries us is their key role may go downhill because of dilution of experience, no experience, too many young students and a lack of emphasis on on-road training and tutelage. Hands on stuff.
We have two crew on all BLS cars. Many many students - about 50% of our BLS staff now. They have some or all of their "ALS" training skills from uni like the qualified guys but no time on road and for some apparently little interest in their own performance or an appreciation of the the pt - no sense of advocacy.
So once again I have gone off on a tangent, written way too much. I hope at least the earlier paragraph answers your query.
Cheers
MM
Just regarding your original post - this was the original thread
"How do you staff your BLS ambulances? Do you do 2 emt's, three emts's? What is the training level of the driver? Do you allow/have first responders on the ambulance?"
And sorry - you are right to an extent and that's my fault - I tend to waffle and go off in tangents a fair bit.
Anyway your point is a fair one. Is the "better" training/education curriculum equating with better outcomes?
For MICA in Melbourne some yes's. RSI in head injured pts -Seattles trial back in about 93 flopped -ours hasn't - significantly improved outcomes and very high success rates on procedures. Cardiac arrest survival to hospital - ours is now above 30% if I remember correctly maybe better than that.
Some trauma wins in pts with bad ISS scores considered non survivable - big hospital trauma centre study last year - pts survived apparently because of MICA interventions particularly decompressions, RSI, etc.
The BLS guys must be considered a part in all of this as they often arrive before we do. But what worries us is their key role may go downhill because of dilution of experience, no experience, too many young students and a lack of emphasis on on-road training and tutelage. Hands on stuff.
We have two crew on all BLS cars. Many many students - about 50% of our BLS staff now. They have some or all of their "ALS" training skills from uni like the qualified guys but no time on road and for some apparently little interest in their own performance or an appreciation of the the pt - no sense of advocacy.
So once again I have gone off on a tangent, written way too much. I hope at least the earlier paragraph answers your query.
Cheers
MM
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Is your trial on RSI and decompression in trauma patients concluded? If yours has positive findings I am sure everyone wiould be interested in that.
As far as save rates for out of hospital cardiac arrest. What would be the criteria? ROSC or to discharge? I know some areas have different criteria.
I guess now I'm guilty of hijacking too. My apologies.
As far as save rates for out of hospital cardiac arrest. What would be the criteria? ROSC or to discharge? I know some areas have different criteria.
I guess now I'm guilty of hijacking too. My apologies.
Melbourne MICA
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No apologies necessary.
The decompression findings followed on from the study by the hospital itself. They were actually looking at what they could do to improve outcomes for such pts in ED.
But they couldn't account for the bad ISS score pts surviving so they re-examined the data. They discovered a correlation between these pts surviving and MICA interventions pre-hospital especially expeditious and even prophylactic decompressions. They are currently setting up a new study to have a second look. It was good win for EMS - we need these types of positive findings big time as I'm sure you are aware.
The RSI trial finished about early 08. Only preliminary results have been released. They were excellent based on the outcomes markers specified as the endpoint of the trial.
The arrest survival rates were to the hospital door. So yes ROSC with good obs on arrival at ED. It still may have made no difference in the end but we were holding up our end. I'll try and get an accurate figure for you.
I guess the most important point about all of this is the skill, precision and consistency of the operators because of or despite education and training.
Everyone is trying to find out where the best balance is. Our service has gone heavily into education ( there are dollar issues in this which can't be overlooked ie they don't have to pay for it any more the students do).
But their rush to put bums on seats because their response times are crap by creating a whole heap of new ambo branches is a flawed approach. Uni trained kids with little longterm interest in ambulance, take lots of sickies on weekends so they can maintain their social calendar and generally look out of water dealing with tough community med emergency situations - they have no life experience. Besides the bar has been lowered to accommodate all the recruitment numbers the service (and the government) want. heaps have failed and incredibly the government says put them through anyway. They need the publicity. All sound familiar?
Cheers
MM
DavethetrainWreck
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In new Jersey they are changing the law to a mandatory two EMTs per BLS rig. However First Responders will still be allowed to ride the Ambulance as a third person they will also be allowed to drive the rig while the two EMTS in are the back with a critical patient. I think upgrading the standard of care is a great idea. However the formula of having a CFR-D as a driver and an EMT for patient
care has worked just fine for most volunteer squads considering the shortage of certified personnel.
care has worked just fine for most volunteer squads considering the shortage of certified personnel.
BLSBoy
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Theres no shortage of certified personnel. Theres a shortage of those who want to do it for free.
emtwacker710
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In NYS you have to have a minimum of a EMT-Basic and a driver available for the rig to roll. CFRs can practice but not provide the only care en route to the hospital.
First Responder's Life in Canada
So up here we generally have 4 levels of care: EMR/FMR (First responder), Primary Care Paramedic (EMT-Ambulance), Advanced Care Paramedic, and Critical Care Paramedic. Due to the difference in Scope, EMR's are not allowed to work on-car with Advanced/Critical care medics. That being said, an EMR can work alongside a PCP/EMT. Our BLS cars usually consist of 1 EMR and 1 PCP, or 2 PCP's. It is then up to the PCP/EMT to determine if their skills are required, or if the pt is stable and without IV, the EMR can attend.
EMR = 90hrs classroom
PCP/EMT-A = 500hrs classrooom, 50 hrs hospital clinical, 400hrs ambulance practicum
Adv Care Medic = 500hrs classroom, 300 hrs hospital, 480 hrs ambulance
Critical care Medic =500 hrs classrom, 250hrs hospital, 500 hrs ambulance.
Hope this can provide some insight.
First responders do ride on-car in various circumstances in Canada
So up here we generally have 4 levels of care: EMR/FMR (First responder), Primary Care Paramedic (EMT-Ambulance), Advanced Care Paramedic, and Critical Care Paramedic. Due to the difference in Scope, EMR's are not allowed to work on-car with Advanced/Critical care medics. That being said, an EMR can work alongside a PCP/EMT. Our BLS cars usually consist of 1 EMR and 1 PCP, or 2 PCP's. It is then up to the PCP/EMT to determine if their skills are required, or if the pt is stable and without IV, the EMR can attend.
EMR = 90hrs classroom
PCP/EMT-A = 500hrs classrooom, 50 hrs hospital clinical, 400hrs ambulance practicum
Adv Care Medic = 500hrs classroom, 300 hrs hospital, 480 hrs ambulance
Critical care Medic =500 hrs classrom, 250hrs hospital, 500 hrs ambulance.
Hope this can provide some insight.
First responders do ride on-car in various circumstances in Canada
ResTech
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Pennsylvania requires one EMT and the driver must be a State First Responder or ARC Emergency Responder as a minimum staff level. PA accepts the Red Cross Emergency Responder course as an equivalent.
If the driver is only CPR certified, then two EMT's or an EMT and a First Responder must be onboard.
If the driver is only CPR certified, then two EMT's or an EMT and a First Responder must be onboard.
HotelCo
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2 EMTs.
Both drive.
Both drive.
where i live, you must be at least a basic to even work on a rig. the only time you can go in w/o basic is if you're in school training to be a basic and you're on a clinical, and the care you provide would still be very limited. You would also be accompanied by a basic.