Call for ALS?

[medic417]

While I generally agree with your points if not how you present them, triemal's point was that ALS would not deal that differently with DVT or GBS that much differently than BLS. Rickets? C'mon? You going to push Vitamin D in the field?

Cardiac, as with a host of other problems, is a different story, but is disingenuous to put out typhus presenting with knee pain as a scenario where ALS will "make the difference."

All of the Zebra examples you gave, if the CC is knee pain, are going to be treated by ALS the same as BLS. Transport, no? Don't pull out uncommon syndromes because you assume a Basic won't know enough to tell you what I just said here. Use good examples. That is the core of honest debate in this subject.

I did not post those "zebras" someone else did. I qouted that poster.

But I do maintain that any provider at Paramedic level can do more for their patient than just transport. Perhaps it will only be getting the IV, blood draw, and initial 12 lead. Perhaps it will be a vitamin injection. Perhaps it will be pain relief. Perhaps if someone with one of these non emergent chronic problems they may just need something to help them cope with the anxiety so I can do that with one of my anti-anxiety meds. My treatments may only band aid but at least gives them some benfit instead of laying there suffering. Our actions can speed the rate that they get definitive care and make a recovery.

Actually it has been discussed having Paramedics provide antibiotics. Some services actually do provide them already as well as a few other drugs to get patients started on road to recovery and have them follow up with their doctor on next business day to continue treatment.

 

[Summit]

I did not post those "zebras" someone else did. I qouted that poster.

But I do maintain that any provider at Paramedic level can do more for their patient than just transport. Perhaps it will only be getting the IV, blood draw, and initial 12 lead. Perhaps it will be a vitamin injection. Perhaps it will be pain relief. Perhaps if someone with one of these non emergent chronic problems they may just need something to help them cope with the anxiety so I can do that with one of my anti-anxiety meds. My treatments may only band aid but at least gives them some benfit instead of laying there suffering. Our actions can speed the rate that they get definitive care and make a recovery.

This seems like a valid argument to me.

BLS who are taught only to think in terms of sick/not sick as meaning dying/not dying might not see that quality of care argument as clearly.

And sorry for the confusion about the stripes.

 

[ffemt8978]

This seems like a valid argument to me.

BLS who are taught only to think in terms of sick/not sick as meaning dying/not dying might not see that quality of care argument as clearly.

And sorry for the confusion about the stripes.

I agree, but my challenge still remains...

 

[Summit]

I agree, but my challenge still remains...

I think your challenge is a good one.
I'm a basic. I'm not useless. I'm here to learn and to advocate.
I think you make a point that in the course of advocating the furthering of education and the increasing of standards, and in the course of clarifying our failings as a profession, we needn't purely beat down those we wish to raise up (unless they resist, then beat them with heavy spikey things).

 

[medic417]

I agree, but my challenge still remains...

"challenge" My post that summit qouted was educational not chest thumping what more would you like? I presented ways that we could treat and benfit the patient that is what it is about giving the patients the best. As a medical professional I refuse to settle to be a means of transportation. If a patient needs to be in the ambulance care will be started which can and will save time in the chain of medical care. Anyone that thinks just transportation is proper medical care needs to find a new profession.

 

[ffemt8978]

"challenge" My post that summit qouted was educational not chest thumping what more would you like? I presented ways that we could treat and benfit the patient that is what it is about giving the patients the best. As a medical professional I refuse to settle to be a means of transportation. If a patient needs to be in the ambulance care will be started which can and will save time in the chain of medical care. Anyone that thinks just transportation is proper medical care needs to find a new profession.

I never said it wasn't...my challenge is to everyone on this forum for any future topics, and not just isolated to this thread.

 

[Summit]

Anyone that thinks just transportation is proper medical care needs to find a new profession.

But first we have to get those "in charge" of the profession to stop thinking that.

 

[triemal04]

medic 417-
While you did not post any of the problems that were listed, you did bring up that knee pn could be indicative of a serious problem. (and then not explain, but that's another issue). Now that it has been explained for everyone to see, I honestly would like to hear your opinion on some things. Do you really consider starting an IV something that would start a pt recovering that much sooner? (yes, there are times when having a line in place on arrival at the ER is great and beneficial, but the simple presence of an IV, which can generally be obtained in well under a minute will not usually affect a pt's outcome. Especially in a pt that doesn't really need to be at an ER) The same can be said for a 12lead and blood draws; they absolutely have their place, don't get me wrong, but often times they have no effect on what happens to the pt.

Simply saying that we can do certain things without thinking about if those things really matter is almost as bad as saying that all pt's don't deserve an ALS assessment (yes, for the record, for as I'm concerned all do). Seriously, take someone with GBS as I posted last...what will you do for them, beyond recognition and prep for potential problems that will benefit them? There are many, many, many pt's that need care that is well beyond what a paramedic can do, and sometimes there is nothing we can do that is helpful to them, other than recognition of their problem, and knowledge about it.

 

[Veneficus]

Really? Like what? Let's take the case of a pt with Guillian-Barre Syndrome. Their only presenting symptom is some weakness to the lower extremities. No other problems. And no changes during transport. Beyond recognition, what magical treatement will YOU do?

OK, enough of the picking on people.

GB has some outlandish symptoms. The last pt I saw with it c/c was "falling down." Sometime in medic class (at least us non medic mill instructors) do teach some physio and patho physio, so when these outlandish symptoms appear medics are not at a loss for ideas. Often my students complain about me giving them too much in class.

The knowledge that this stuff is out there and "could be" what the patient has makes a big difference in pt advocacy. Especially when giving a report to the hospital. It causes providers to overtriage rather than undertriage. (ie err on the side of caution) The glimpse of how much there is to know breaks the "I passed class with a 100% and I know it all" mentality.

Everyone talks about how a good basic can assess for these things as well as a good medic. I call BS. Theorhetical knowledge must be used in conjunction with physical exam techniques in order to be effective. You have to know what is "normal" just as well as what is grossly abnormal. the higher your medical education the more detailed the history you look for.

For brevity allow me to cite one example: When was your last oral intake? What was it? How often do you eat? What do you eat? Do you defecate regularly? What is the consistency? The color? Has it changed? Rapid weight loss or gain?

that is way more information than the "L" in SAMPLE.

Used with your knowledge of nutrition, physiology, and patho phys,along with the signs and symptoms presented gives you a very accurate picture of what the problems could be or it may just create a pool of pertinant negatives. It may give you a clue to multiple pathologies, or one aggrivating another.

How many providers think that a CHF patient's only health problem is CHF? we talked about this on the furosimide thread.

The treatment you give is determined by many things, among them your protocols. I worked on a truck a few years ago that had ~ 50 meds in my bag of tricks and untold pieces of equipment. But sometimes, with the blessing of med command, something had to be made up. Without theorhetical knowledge, that cannot be done. It makes a provider less capable, a hard fact of life. I was once the FR who thought I knew as much as a basic, then I went to medic school, it was an eye opener. The more I learn, the smaller amount of total knowledge I seem to have.

As us old guys are obligated to teach, the younger ones are obligated to learn. It makes for more constructive conversation at any level when you come with a question rather than a demand.

 

[medic417]

But first we have to get those "in charge" of the profession to stop thinking that.

Talk to those in charge. You would be surprised at how receptive many medical directors are if approached with an educated proposal of changes. Don't walk in and say I want this skill. Sat we see XXX number of patient that could benefit from this procedure. Myselef and others at my level have recieved the education to perform. We would propose that we need to add this drug and this equipment to perform it properly. We would also welcome you providing us with additional information on it and then a test prior to implementation.

 

[triemal04]

Veneficus-
I'm pretty sure I asked this once before...why are you in Europe again? Why aren't you back here in the US? For the love of god man, get your butt back here and jump into fixing EMS with both feet! The sooner the better!

What you were saying is what I was trying to get across in my last few posts albiet maybe a bit poorly; recognition of a potential problem and knowledge about that problem are huge; the neccasary treatements may be beyond what we can do, but knowing about them is still appropriate. There are things that we won't have an effect on, unless we have that effect by going to the right hospital and then mentioning to a doc during our passdown that what's going on could be DVT, or GBS, or leukemia etc etc etc, so that the idea is planted in their heads early. Recognition of a problem is the most important thing we do; and it's done better at some levels than others.

 

[Veneficus]

While I generally agree with your points if not how you present them, triemal's point was that ALS would not deal that differently with DVT or GBS that much differently than BLS. Rickets? C'mon? You going to push Vitamin D in the field? .

The point of the example was not for the treatment, it was to recognize that there may be a more severe health concern than the pain or an orthopaedic insult. Hopefully any medic who passed the A&P requirement understands the lower limb is designed to support the body's weight. Based on this required part of medic education, which is not part of basic education, the medic should realize the problem may not be located in the knee.

As I have stated many times on many threads, more knowledge = better provider for the patient. Why take my word for it? Ask all the other providers also.

As for Rickets, it is a reemerging health problem around the world. It does have long term and serious health effects, and can mean the end of life for the elderly. Just look at the instance of hip fx from bone remodeling and the poor prognosis it is associated with. A provider with more education is likely to see a problem where a lesser educated provider doesn't. A vitmin D shot is not the only treatment, it is long term with physical therapy, and other disciplines. But recognizing it and bringing to attention can improve the quality of life for a patient or prevent death from a secondary injury.

Certaily no healthcare provider advocates not addressing all of a patients health problems? EMS is uniquely positioned to intercede prior to an emergency. (like a broken hip) this idea of sick/not sick, BLS/ALS, needs to go. The days of EMS only being for emergencies are over.

 

[Shishkabob]

Lets just solve all the problems with EMS, be done with this "better then thou because I have a different letter after EMT" attitude, and just make Doctors be the one and only care available.


I mean, honestly, those of you who want basics gone state reasons such as education. Who better then someone that has over 10 times more then a medic?


"But Basics miss might a totally obscure problem that medics won't, but can't do anything about either."

Whats to say the doctor or nurse at the ED, with more education then medics, won't miss it either? Or catch that which you missed?

 

[medic417]

Lets just solve all the problems with EMS, be done with this "better then thou because I have a different letter after EMT" attitude, and just make Doctors be the one and only care available.


I mean, honestly, those of you who want basics gone state reasons such as education. Who better then someone that has over 10 times more then a medic?

Lets do it. I would prefer a doctor taking care of my family. But that is not attainable. A Paramedic, heck 2 Paramedics on every ambulance is attainable. Yes it will take some time. Education standards for Paramedics will increase and the scope of practice will increase. Those that choose to ignore the writing on the wall will be left behind and be out of a job.

 

[Shishkabob]

I get your point of view, I honestly do. And it's not a bad idea. But some of you need to realize the fact that it won't happen ANY time soon, and also realize that until it does, you have no right, rhyme, or reason to disrespect ANYONE because their certificate says Basic instead of Paramedic.

 

[emtfarva]

Ok, How about we change education level for all levels.

Basics go through a two year course with 1 year clinical the standard of care will be paramedic level.
paramedics go through a 4 year course on top of basic with a 2 year clinical, thier level of care will be closer to PA or NP level.
will that slove things. then every Pt will get an Als assesment.
oh, wait, we can't do that, Medicare doesn't pay enough. nevermind.

 

[Veneficus]

Ok, How about we change education level for all levels.

Basics go through a two year course with 1 year clinical the standard of care will be paramedic level.
paramedics go through a 4 year course on top of basic with a 2 year clinical, thier level of care will be closer to PA or NP level.
will that slove things. then every Pt will get an Als assesment.
oh, wait, we can't do that, Medicare doesn't pay enough. nevermind.

no need to worry about medicare, pretty soon it won't be paying for much at all

 

[medic417]

Not attainable? Hmm, doesn't that just shoot your whole argument in the foot altogether about getting dual medics on EVERY truck in the ENTIRE country?

What about Anytown USA in the middle of Nebraska, who can not even afford 1 medic? Your plan isn't attainable there, no matter how hard you push.





I get your point of view, I honestly do. And it's not a bad idea. But some of you need to realize the fact that it won't happen ANY time soon, and also realize that until it does, you have no right, rhyme, or reason to disrespect ANYONE because their certificate says Basic instead of Paramedic.

I do not disrespect. I do ask that you realize how limited as group basics are as I as a medic realize I am.

I will not debate you on the any town as I have already told several ways any community could go ALS paid on previous topics.

And no my arguement on doctors on ambulances does not blow a hole in my opinion.

I do think the changes are coming within less than 10 years, hopefully much sooner. I have already seen many services, including some very poor areas with less than 200 calls ayear, go to at least one Paramedic and several go dual Paramedic.
For reimbursement it is just a matter of time before Medicare/Medicaid/Insurance require it.

Change is happening now and it is about to get a head of steam. Get on board or get out of the way.

 

[imurphy]

Ok. I've been reading this, and seriously, the EMT-B bashing! Why!

Everyone has to start somewhere. It's when people don't do anything above their B after a few years, that's who you have to worry about.

Personally, I did my first EMT in 2005 (US-NR). But, since I'm from Ireland, we don't have such an evolved EMS system. We only got "paramedics" in 2008. And they were EMT's untill they were just renamed with no extra training or scope of practice.

So, honestly, realise how good you have it here with a good system, which can of course improve. Personally I will be goign on to get my medic as soon as time and money allows, but it may take a year or so to get to that point. And honestly, I hope when I come out the other side I'm not a bitter "Basics-Know-Nothing" type paramedic!

 

[medic417]

Ok. I've been reading this, and seriously, the EMT-B bashing! Why!

Bashing there has been no bashing. There have some get their feelings hurt by honest answers, but no bashing.

Considering the distance you might consider an online program such as the following to continue your education.

www.techproservices.net


www.percomonline.com