degrees for all paramedics 10 year plan

[Veneficus]

You brought up ETI. Granted, there's a lot of situations it's overused in. But there are definite times when it is needed. Should we let those people die?

If more people are dying or being harmed than would die if it wasn't available. Then yes. Those unfortunate people will die.

One gigantic flaw I see in the current "let's make EMS more educated" campaign is that, in many ways, EMS is getting simpler.

This is not a flaw.

EMS is getting simpler because many of the treatments that were thought to help are being discovered not to help.

As well, there has been a shift in the mindset of the medical community from the 80s. Death is no longer the enemy. Not everyone benefits from aggresive resuscitations.

I have spoken before on the evolution of disease. That hold true again here. Because of more advanced medical care, safety standards, etc. there is a shift towards chronic disease which need to be managed, away from acute emergency.

The purpose of advanced education is to retool EMS providers to this new reality so they have a job.

I have really given up trying to convince people. I just type this stuff to try and help those who want to be better.

 

[RocketMedic]

I understand that, Veneficus, but I don't think that we should entirely focus our education, training, and most importantly our scopes of practice on chronic disease care.

Emergencies, real legitimate emergencies, still happen all the time. There's no reason to throw our capabilities to deal with those away.

 

[RocketMedic]

http://www.youtube.com/watch?v=nxpYuVr53zQ

I watched this, and was surprised at the difference and similarities between UK and US cardiac-arrest responses, and what works.

First, I think we can all agree that compressions work. Really well. There may be semantics in rate, number, and ratios, but compressions work.

I was surprised that the UK paramedics did not have a Lifepack or other manual monitor-defibrillator. Although an AED delivers similar capabilities in a full arrest, current AEDs don't allow us to treat things like SVT or perfusing V-tach, and I was surprised by that. I was also really surprised by the delayed IV. Also surprised by the OPA- here, it would have been at least a Combitube, likely an ETI.

Clearly, that crew did a great job. It's just interesting looking at the standards of care.

And yes, I do believe that pressors aren't super-effective. I do, however, think that American EMS may have an advantage in periarrest management, especially in rural or suburban areas.

 

[systemet]

I watched this, and was surprised at the difference and similarities between UK and US cardiac-arrest responses, and what works.

Me too. It's easy to criticise, but I'm surprised they chose to work the code between the bike racks like that. It seems like it would have been easier to drag the patient a couple of meters out. But it's difficult to judge how many people were crowded around, and I can understand why they might not want to interrupt the code to move the patient. I still think I would have.

Although an AED delivers similar capabilities in a full arrest, current AEDs don't allow us to treat things like SVT or perfusing V-tach, and I was surprised by that. I was also really surprised by the delayed IV. Also surprised by the OPA- here, it would have been at least a Combitube, likely an ETI.

Yet they clearly had decent ventilation. The patient didn't aspirate -- although this would have concerned me too. And though they report the patient as GCS3 in their radio patch, with the increasing level of consciousness during a (presumably) short transport, it might have been that drugs would be required to intubate.

With a longer transport, and in other systems, the patient might have been intubated +/- drugs post-arrest, hypothermia begun, and a post-arrest 12-lead done during transport. But it's hard to get a sense of how much time elapsed.

I'll admit to having been on a few scenes where the paramedic has had tunnelled in on intubating to the exclusion of all else. That mistake was avoided here.

And yes, I do believe that pressors aren't super-effective. I do, however, think that American EMS may have an advantage in periarrest management, especially in rural or suburban areas.

Maybe. It depends if the dopamine is being used properly and safely, which often it isn't. There's also a lack of prehospital research in this area.