imurphy
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No distance problem now that I've moved here. Now it's just saving the money to afford it!
Call for ALS?
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medic417
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I see. Hope you find the money soon.
imurphy
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Tell me about it!! Probably by next year unless I win the lottery!
medic417
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Hmmm...the Education Advocate is endorsing on-line programs for the learning of EMS.
:wacko:
medic417
The Truth Provider
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Actually I thought he was in another land and would be unable to go to a college.
But actually online for the book part is no differenet than any university anymore. Many universitys allow almost entire degrees online.
You still attend in person classes for skills and testing. I noticed when pulling them up that Percom is actually tied to a college program.
In Texas there are also some online Paramedic programs at universitys but they require multiple classes on campus each month along with the online part.
Also many online classes require more personal research which helps a person retain more as the more effort to take in and the more senses used in taking in knowledge the more you retain.
So yes I advocate education and there is quality online education.
RESQ_5_1
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Well, I'm considered BLS here in Canada. But, here are a few of the interventions I'm allowed by protocol and training:
Chest Pain: IV, O2, ASA, Nitro, ECG.
Aaphylaxis: O2, IV, Epi (after OLMC), Bronchiodilators.
Breathing Problems: Auscultation of lung sounds, Bronchiodilators, O2.
Pain Management: Unfortunately, only Entonox.
Regardless, I have gone to a call for PE. And, I have transported pts with suspected DVT. I have been educated to recognize these, and to treat appropriately. Our PE call actually came over from dispatch as a fall (since that's what the pt did before coding in front of us). However, other than interpreting 12 leads (which I can obtain and have actually been trained to read), there aren't very many more interventions or assessments that paramdics can do that I can't.
Chest Pain: IV, O2, ASA, Nitro, ECG.
Aaphylaxis: O2, IV, Epi (after OLMC), Bronchiodilators.
Breathing Problems: Auscultation of lung sounds, Bronchiodilators, O2.
Pain Management: Unfortunately, only Entonox.
Regardless, I have gone to a call for PE. And, I have transported pts with suspected DVT. I have been educated to recognize these, and to treat appropriately. Our PE call actually came over from dispatch as a fall (since that's what the pt did before coding in front of us). However, other than interpreting 12 leads (which I can obtain and have actually been trained to read), there aren't very many more interventions or assessments that paramdics can do that I can't.
Wow this discussion has exploded. Healthy debate is good.
I would like to address some of you complaints here.
A full ALS workup for a party with DVT? Interesting.
Guillain Barre is untreatable and I doubt you carry immunoglobulin. Typhus I am not eve going to dignify that with an answer.
Sickle cell, No, Unless difficulty breathing is present, signs of possible CVA. Thats a small percentage.
Osteomalacia, good one. Because recognition in the field has saved millions of lives worldwide.
Ill give you late stage sepsis but thats a stretch.
Acute tonsillitis, intubated with a surgical airway in the field, I would enjoy reading the data that brought you to this conclusion and the frequency in which this is the prefered tx.
Meningitis, AlS suspicion, can you charge for that? Would you just do a spinal tap or a cat scan on the way to the hopital.
It all depends on the presentation of the pt. Its called ASSESSMENT.
All your examples could warrent an ALS intervention, I am not arguing that.
I am just questioning the frequency in which they do.
Ridryder911
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In question to ALS intervention; anytime that I need to or every time the patient requires intervention.
For example, sickle cell patients complain of multiple problems usually joint pain, general malaise, fever, etc.. With obtaining history I will start infusing fluids and analgesia. Ruling out Guillain- Barre is difficult as noted but I have had to intubate such a patient in the prehospital setting. The same as differentiating Bell's Palsy vs. a CVA; ( check cranial nerve 7; lesion of CN VII which occurs at or beyond the stylomastoid foramen is commonly referred to as a Bell's Palsy) This matters as if the patient needs immediate transport to a Stroke Center or routine transport to a local ER.
Again emphasis should be upon building, requiring and demanding better patient assessment. I am now beginning to enforce the "you did not check or know that?" attitude. People will respond if asked or better yet demanded to. Peer pressure can be a good thing when used appropriately.
Ironically, patient assesment is one of the few things in medicine that requires little to very little additional equipment other than brain power. So let us start demanding nothing more than an adequate assessment. Much of the techniques can be narrowed down and adapted for the prehospital setting.
R/r 911
For example, sickle cell patients complain of multiple problems usually joint pain, general malaise, fever, etc.. With obtaining history I will start infusing fluids and analgesia. Ruling out Guillain- Barre is difficult as noted but I have had to intubate such a patient in the prehospital setting. The same as differentiating Bell's Palsy vs. a CVA; ( check cranial nerve 7; lesion of CN VII which occurs at or beyond the stylomastoid foramen is commonly referred to as a Bell's Palsy) This matters as if the patient needs immediate transport to a Stroke Center or routine transport to a local ER.
Again emphasis should be upon building, requiring and demanding better patient assessment. I am now beginning to enforce the "you did not check or know that?" attitude. People will respond if asked or better yet demanded to. Peer pressure can be a good thing when used appropriately.
Ironically, patient assesment is one of the few things in medicine that requires little to very little additional equipment other than brain power. So let us start demanding nothing more than an adequate assessment. Much of the techniques can be narrowed down and adapted for the prehospital setting.
R/r 911
There seems to be a limited understanding of ALS, Myasthenia Gravis and Gullian Barre here. All these diseases can progress slowly or very rapidly. And, they can also have immediate respiratory crisis during the long term as well as profound hypo or hypertension. The anxiety level that also comes with one of these crisis must controlled to effectively ventilate these patients.
Similar emergent situations can occur with someone who has para or quadraplegia.
Meningitis: Hypotension, initiate a sepsis resuscitation with fluids and/or meds.
Sickle cell crisis: pain, fluids, airway management especially with presentation of an acute chest syndrome that may accompany and occasionally does with children or at least.
But what about the other things ALS provides?
Treatment for hypo and hypertension through meds
RESQ_5_1
Give adenosine for rapid SVT.
Treat VT before the code.
Stabilize BP in the MI or other cardiac event.
Treat a cardiac arrest with more than just CPR and the ability to maintain perfusion once ROSC is achieved as well as initiating hypothermia protocols.
Decompress a chest with a life threatening tension pneumothorax.
Treat seizures.
What can BLS do for the child seizing his/her quality of life away?
If one does not understand the potential of an effective ALS system, then chances are you do not have a good ALS system or too limited education to recognize what your ALS system is doing.
Similar emergent situations can occur with someone who has para or quadraplegia.
Meningitis: Hypotension, initiate a sepsis resuscitation with fluids and/or meds.
Sickle cell crisis: pain, fluids, airway management especially with presentation of an acute chest syndrome that may accompany and occasionally does with children or at least.
But what about the other things ALS provides?
Treatment for hypo and hypertension through meds
RESQ_5_1
Treatment for symptomatic bradycardia through meds and/or pacing before the patient codes.
Give adenosine for rapid SVT.
Treat VT before the code.
Stabilize BP in the MI or other cardiac event.
Treat a cardiac arrest with more than just CPR and the ability to maintain perfusion once ROSC is achieved as well as initiating hypothermia protocols.
Decompress a chest with a life threatening tension pneumothorax.
Treat seizures.
What can BLS do for the child seizing his/her quality of life away?
If one does not understand the potential of an effective ALS system, then chances are you do not have a good ALS system or too limited education to recognize what your ALS system is doing.
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Amen.
Exactley my point, any provider at any level can educate themselves in the practise of pt assessment, its not exclusive to the ALS provider.
Tx is based on assessmnet so if you are not able to assess a pt then the tools you have to treat them become irrelevent.
medic417
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Your right doctors also assess. As do many othe medical professionals with education. The paramedic level provides the minimum amout of education to attempt an assessment. Any education less than that and patients do not even come close to getting a true medical assessment.
I just don't think you get it. (or see many patients for that matter) Because BLS assessment is so limited and ALS assessment is less so, an ALS response has a better chance of noticing something is wrong. As Rid, Vent, Medic417 and countless others have said, EMS is no longer viable as a simple ride to the hospital. Recognizing chronic conditions which can cause morbidity and mortality does save lives and function, though maybe not in the glamorous way you desire. If just handling life and death was EMS's goal I could debate the usefulness of EMS in the US at all.
The idea that your value as a provider is measured by what procedures or treatments you can provide is almost laughable. It would be if it didn't cause damage to the EMS profession as a whole. Do you think that MIs are treated in the ED or by cardiology? How about fractures? ED or ortho? Sepsis by the ED or ICU intensivists? Trauma by ED or surgery? CVA by ED or neuro? By your logic the ED is pretty worthless too. Maybe we could have the outstanding assessment skills of BLS Dx the patients to the appropriate service? Tell me? What texts do basics use to learn their assessment? How much time do they spend on it? How often do they see sick enough patients to distinguish sick from not sick based on disease progression?
If EMS wasn't full of good people trying to advance themselves and they all believed as you do, I think I would give up advocating for them and accept the position of many of my peers and superiors. (Which in a few words is that providers are so undereducated and incapable they are little more than ambulance drivers who should be relegated to just loading the pt in the hearse and driving to the hospital where educated providers can help) Infact after some of the argument here, I think I'll walk in to the hospital tomorrow, admit I was wrong about EMS and argue with equal zeal against EMS.
I concede your point, ALS does nothing. Congratulations on your victory ambulance driver. I shall seek to make up for my serious lack of judgment regarding the capability and usefulness of EMS by demonstrating how little they know and do and help drive their vocational respect and pay even lower.(because it certanly is no more a profession than any skilled laborer) we could solve the provider shortage really simply, we'll just go down to unemployment round up everyone there, send them through a 110 hour basic course and post them all over the country in a pityful uniform paying them minimum wage w/o benefits.Then we could say we provided adequate healthcare for every town in America by your standards. Why not give them treat and release or refusal of transport capability too? Obviously their assessment is so good from that 110 hour course they are quite capable of deciding when people have a "true" emergency.
Did I say a provider is measured by the treatment they can perform,I dont think I did, on the contrary its about recognition not treatment, without recognition there is no treatment. End of story.
The Ed is worthless...Hmm did I state that? Wrong again.
Im not positive but I believe it was Brady Paramedic book. It was pretty much useless.
I see about 20 pts in a shift maybe 3 of them are truly sick, of the rest, maybe 5 actually nedded an ambualance, So that leaves about 12 that didnt even require service. Definitly grounds to staff all ambulances with paramedics. I see your point.
Then again I am probably wrong, they all needed an ALS intervention. Thats why the majority of them our discharged before I even finish my F'n paperwork.
So your argument doesnt fly with me. ALS plays a vital role in EMS, no one knows that better then me. To state that BLS plays no role, preach it to someone else.
The Ed is worthless...Hmm did I state that? Wrong again.
Im not positive but I believe it was Brady Paramedic book. It was pretty much useless.
I see about 20 pts in a shift maybe 3 of them are truly sick, of the rest, maybe 5 actually nedded an ambualance, So that leaves about 12 that didnt even require service. Definitly grounds to staff all ambulances with paramedics. I see your point.
Then again I am probably wrong, they all needed an ALS intervention. Thats why the majority of them our discharged before I even finish my F'n paperwork.
So your argument doesnt fly with me. ALS plays a vital role in EMS, no one knows that better then me. To state that BLS plays no role, preach it to someone else.
medic417
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They all deserve an ALS assessment so there is less chance of something being missed. If after ALS assessment and it is an dual staffed ambulance the basic could take the patient with the Paramedic driving. Your right not all callers need ALS interventions but they all deserve an ALS exam. Then they can even be denied transport if they do not have a need for immediate emergency care.
OP
OP
Sasha
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Jeez louise! Get down off your high BLS horse long enough to read where Rid, Vent, medic417 and Vene are trying to pound into your head that sometimes an advanced assessment is the best thing for that patient, not necessarily ALS intervention.
Why are you defending having less educated personnel take care of people? This is health care, not cosmetology (which, suprisingly, has more of a training requirement then a Basic EMT class.). How can you be so anti-education?
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Interesting point...
How many times have ALS providers misdiagnosed a patient, only to have it end up on the news later? How many times have BLS providers misdiagnosed a patient to have it end up on the news later?
I would like to see if anyone has any studies to back up the statements that ALS providers are less likely to miss something. I think the results might surprise some of you, but I could be wrong. While BLS may not know what is exactly wrong with the patient, they are more likely to transport to the hospital for definitive diagnosis (this is based solely off of the lack of news articles about BLS not transporting a patient and having it end up o the news as compared to ALS not transporting a patient and having it end up on the news)
medic417
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Careful, I think they require more hours than many Paramedic programs. SHhhhhh!!! don't let that leak out to the basics though they might rebel.
h34r:
medic417
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Actually while I have not seen any actual study on this subject based on news reports both are guilty of poor patient assessments way to often. I have seen articles listing both. Also in news reports it is hard to say what level of responder is accussed of what, as some reporters call us all EMS workers, others call us all ambulance drivers, still others call us all EMT's, and yet others call us all Paramedics regardless of actual level. Also the news only prints the attn grabbers they do not put out information when the EMT or Paramedic is cleared or if they do its back page small notice.
Based on more medical education common sense should suffice that ALS would be less likely to miss a problem than someone with less education. Now factor in laziness as there are many check collectors that have no business in EMS at any level. And as you said BLS pretty much has to transport all that request in most services, so even though they got no medical care and the EMT had no idea what was wrong, patient did get to hospital.
Another point to consider is the news involved because they died in the ambulance getting the same ACLS treatment the doctor would be attempting on the patient that the BLS crew brought in. Both die yet news jumps on the Paramedics despite the fact the patient actually had a better survival chance because drugs, etc were started sooner, and despite the fact the current CPR guidelines say not to do rolling CPR. The basics do not get accused of anything in that the actual death was at hospital even though they were already dead if CPR was being done in the ambulance.
But I would love to see a real study that actually factors in points such as above.
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And with higher levels of licensure comes higher expectations and responsibilites. One may not expect an EMT-B to pick up some things but it may be expected of a Paramedic. Do EMTs and Paramedics actually have the same expectations for identifying various medical conditions with the same accountibility? You can use the example of CNA and RN. Who would be held more accountable? The same expectations are not there so there is no fair way to make that comparison.
How many times have any licensed providers in healthcare screwed up and it has made news? There ARE many published studies there and a nationwide action has been put into place by increasing everyones' awareness, more education and retraining. How many in EMS review their own policies when they hear of a major incident happening somewhere? Often when I post a news item about an EMS provider accused of inadequate care, it is to learn something from it and not try to judge who's right or wrong. The others in healthcare are already taking notes and learning from mistakes or medical errors. What have those in EMS done?
So it appears that there are more wanting to be just an ambulance ride to the hospital. Any person working in a hospital at a lower level cert using these same arguments as some on the EMS forums who want only BLS would be laughed out of medicine. But, they would be welcomed in the EMT world. Fortunately healthcare has set its standards higher and EMS is not the role model.
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