Call for ALS?

[CAOX3]

I say we just put MDs on all ambulances, then we will never have this discussion again.

Then I can retire at 60%.

Sasha dont assume you know my educational background.

By the way when uneducated people teach its training.

When educated people teach its education.

The majority of EMs proffesionals are trained not educated.

When that changes maybe I will consider it, I doubt I will see it in my lifetime though.

I enjoy more traditional education, and I having taken full advantage of my tuition reimbursment.

This is fun.

 

[emtfarva]

An als assement might be good, but I know a place where they can get an even better assement then any paramedic can give. And just to let you know, most of the AMI that my partner and I have transfered to a stemi center came by their own vehicle. And those weird knee pn MI's also came to the hosp by own vehicle.

 

[Sasha]

An als assement might be good, but I know a place where they can get an even better assement then any paramedic can give. And just to let you know, most of the AMI that my partner and I have transfered to a stemi center came by their own vehicle. And those weird knee pn MI's also came to the hosp by own vehicle.

You speak for only the small percentage of such patients that you see. Not everyone else.

Of course, a better assesment will be done at the hospital. But what if an EMT talks that knee pain into a refusal because they think it's a "BS, drug seeking call"? When will that knee pain GET to the hospital?

Why are you content to just drive the ambulance and not provide patient care?

 

[VentMedic]

I say we just put MDs on all ambulances, then we will never have this discussion again.

Been there and done that already. We did have MDs on several 911 ALS trucks during the 70s and 80s as well as on the specialty teams such as Flight and CCT. However, with a lot of hard work it was demonstrated that Paramedics could perform advanced skills and assessments.

Now you want to set us back to that time and undo the work those before you have done? That would also include Rid and myself since we were part of that earlier generation of Paramedics who were taught that there was a future for EMS.

 

[Veneficus]

The point I was trying to make clear was the more theoretical knowledge(aka formal education) you have about the sciences of health and disease the more likely you are to identify health concerns. Not just acute emergences, but overall health.

From the practical side, yes, some medics over estimate the knowledge they have. Some also accidentally equate experience or training as education.
All providers miss findings. I have seen more than my fair share of medics who are not thorough or skillful in their Dx. But from the point of the basic, because of the skills based approach, a Dx may not even be possible for them to make. Not for lack of effort or desire, from lack of formal knowledge. It is nothing to be ashamed about. We are all part of the team and have different functions. I have posted several times my defense of the basic level providers as well as the need for them. But the more education you have, the more likely you are to notice problems.

I would guess that many basics don’t misdiagnose, because they are not diagnosing. They are assessing whether or not there is a life threatening condition relating to airway, breathing or circulation. These are not the only life threatening conditions. Some will affect the patient sooner than others. Some conditions may become life threatening if left untreated, which is the hazard in statements like “12 didn’t require service.” If no other interventions they may have required the service of a physical exam & history, risk stratification and disposition.

On other threads it has been argued that all patients should get a ride to the hospital. I will not revisit that argument except to point out that healthcare in the US must change. We no longer have the money to pay to continue doing things how we have been. Part of that reform will require lessening the amount of patients seen in the ED by caring for minor problems or problems that can wait in the field. The only field providers available without an already documented established need for a visiting nurse or physician is EMS.
Ems constantly pays lip service to prevention. Indisputably the best healthcare is that which prevents illness. Second to that is preventing illness from progressing. For its own sake EMS must accept this change in role, but it is also the greatest benefit to the patient.

A basic who walks into an ED with a patient and says “I don’t know what is wrong” is better for a patient than a basic who says “don’t worry it is nothing” and that is what touched off the argument. But in the next 10 years basics may not have the option to transport everyone to the ED.

 

[emtbill]

Can anyone recommend a good text to read that might expand our knowledge of the signs and symptoms (and what we can do about them) of medical conditions less commonly taught in most paramedic programs?

 

[medic417]

Can anyone recommend a good text to read that might expand our knowledge of the signs and symptoms (and what we can do about them) of medical conditions less commonly taught in most paramedic programs?

First review the major Paramedic Texts such as Mosby, Brady, and AAOS. Each one provides information that the others miss. Also a search of the web sites from those texts will find many other texts that may prove beneficial. Another help is look over the ER docs shoulder and see what reference he/she is looking into. Or ask him/her.

 

[Veneficus]

Can anyone recommend a good text to read that might expand our knowledge of the signs and symptoms (and what we can do about them) of medical conditions less commonly taught in most paramedic programs?

Robins and Coltran pathologic basis of disease

Harrison's textbook of internal medicine

Sabiston textbook of surgery

 

[daedalus]

Robins and Coltran pathologic basis of disease

Harrison's textbook of internal medicine

Sabiston textbook of surgery

add: DeGowins Diagnostic Examination.

(not directed at anyone)Oh, and by the way, as a current basic, I will say strongly that Basics cannot and do not diagnose or even create a list of potential diagnosis. We simply do not have the knowledge to do that. A high school student's guess is as good as a Basic's most of the time. This is something I struggle with. I pick up patients and do the assessment required of me and I want so badly to say "oh! this is definitely pneumonia!" But I cannot. It frustrates me.

 

[emtbill]

How about something that's not 1000 pages?

 

[reaper]

How about something that's not 1000 pages?

2000 be better?

 

[Sasha]

How about something that's not 1000 pages?

I'm currently reading a pharmacology text book to try and teach myself.

If you really want a good understanding of a subject you're not going to get it out of a short "Pharmacology for dummies" book or one chapter out of a paramedic book. It's gonna be lengthy because there's so much to know and understand but in the end you will be better for it.

 

[EMTinNEPA]

Blah blah blah

UMMM what to say and how to say it. That is stupid. Sorry but knee pain can be indicative of many things and warrants an ALS response. As to the ill person almost ever code I have worked was dispatched as an ill person but I guess they did not deserve an ACLS attempt to save their lives per your system. :wacko:

If every code you've ever worked went out as an "ill person", maybe the flaw lies with your dispatch system. Try not throwing stones unless you know your own house is perfect.

Sorry every patient deserves an ALS exam. And again in reality ALS should be the minimum of patient care on every ambulance. Even the stubbed toe call could be masking some other real problem that at the basic level would be missed. I have had more than one patient thats only sign/symptom with BLS exam was big toe pain that turned out to be having an acute MI.

Yes, and I have a history of depression. Therefore, if I decided to abuse the system and call 911 for transport to the hospital, even if I denied any other signs of symptoms, I should tie up one of the four (on a good day) ALS trucks in the entire county because there is a slight chance that my depression is an abnormal presentation of a giant pink rhinoceros who poops rainbow-flavored marshmallows about to fly out of my nose, which would compromise my airway and result in, well... my death. Since there isn't a person on that truck with those nine magic letters on their shoulder, any ride on a BLS truck would be an automatic death sentence, eh? Well, I guess I should just forget about the four jobs I work as an EMT and just go back to medic school. Then once I graduate, I should refuse to work anywhere that doesn't staff two medics since I'd be doing my patients an injustice.

Now if your service chooses not to have the best which would be two Paramedics per ambulance but runs an Basic/Paramedic ambulance then after an ALS exam care could be given by the basic allowing the Paramedic to drive. But an ALS exam is warranted on all calls.

It's not about what my service choses to do, it's about available resources. Since there is currently a medic shortage in my area and half the full-timers at every service I've ever worked for have been EMTs who are full-time simply because they've been there since the days of Johnny and Roy and have been too lazy to move up, the Good Ole Boys system and the "We've Always Done It This Way" Ideaology is keeping ANY progress from being made.

And I know this because I was actually FIRED from what used to be my main department for daring to criticize the current system.

Quit wasting time blabbering about how things SHOULD be and, oh, I dunno, try to do something so it actually HAPPENS. But only if you're one of the Good Ole Boys since us "newbies" aren't allowed to know anything, be any good at our jobs, or have any opinions.

 

[EMTinNEPA]

And what in the blue hell has gotten into everybody on this forum the past few days? I'm sick and tired of sitting here watching Basics try to justify their existence to paramedics and paramedics or medic students being offended and setting up strawman arguments like "Oh, I guess ALS is useless". It's freaking ridiculous. This is exactly what is wrong with EMS. Everybody is out to discredit or belittle everybody else. For Christ's sake, Basics and Medics are supposed to WORK TOGETHER. Basics... PARAMEDICS KNOW MORE THAN YOU. Paramedics... YOU WERE ALL EMT-Bs ONCE, DON'T FORGET WHERE YOU CAME FROM.

So, until one of you stops complaining and actually does something to...

A. increase the level of education for an EMT-Basic
B. magically give the world more paramedics, or
C. Both

...please, for the love of all that is holy, do me a favor...

SHUT UP, STOP WHINING, AND GET A LIFE!!

 

[Meursault]

Gods, parts of this thread are awful. medic417, you sound like you took Rid's old posts and completely excised the sense of humor and proportion. Everybody who's dragging out the BLS/ALS dead horse for another round of flogging, search for some of the old threads and reflect carefully on whether you actually have anything to contribute to the discussion.
For everybody else: Weren't we talking about the criteria for requesting an ALS intercept or simultaneously dispatching ALS about... 13 pages ago?

 

[ffemt8978]

And that's enough of this one.