Does EMS overtreat?

[Shishkabob]

What are your protocols for epinephrine?

What can you titrate to for a continuous infusion?

Can you run a continuous infusion for anaphylaxis?

How creative are your protocols for using several medications by continuous infusion and boluses to achieve a desired effect?

How many different diagnoses can you identify which aren't specifically listed in your protocols for the use of an epinephrine infusion?


Do you know what a physician can do with just a scapel which will exceed your protocosl?

How much pain management can you do with what limitations and how willing is your med control to exceed those limitations? How creative are you with pressors to achieve a certain level of pain management or comfort like what might be required for an intubated patient?

Shoot, I'm not even with MCHD like he is BUT:

1: Very varied

2: Standing orders alone, 2-10mcg/kg/min... however if more is needed (not likely considering the scenario) you can always call it in.

3: Yes

4: Very. Dopamine, Epi, Dobutamine, Levophed and Vasopressin for shock, just as an example.

5: Any we need to, as our guidelines have a "catch all" that says treat patient condition per appropriate way.

6:Not much, actually, considering I, and Fish, don't have 'scopes' in the sense you would argue.

And finally, as per pain management: 1-2mcg/kg twice without thinking about it, and we can RSI with subsequent doses of narcotics, and contact med control if we want to do something else.




I fail to see the point of your post though: It goes without saying that someone who CAN'T do anything they want, will be able to do less than someone who CAN do anything they want....

 

[Journey]

Shoot, I'm not even with MCHD like he is BUT:

1: Very varied

2: Standing orders alone, 2-10mcg/kg/min... however if more is needed (not likely considering the scenario) you can always call it in.

3: Yes

4: Very. Dopamine, Epi, Dobutamine, Levophed and Vasopressin for shock, just as an example.

5: Any we need to, as our guidelines have a "catch all" that says treat patient condition per appropriate way.

6:Not much, actually, considering I, and Fish, don't have 'scopes' in the sense you would argue.

And finally, as per pain management: 1-2mcg/kg twice without thinking about it, and we can RSI with subsequent doses of narcotics, and contact med control if we want to do something else.

Why don't you just post your protocols since you always seem to be bragging about them? Please share. You can copy and paste. And don't include those which the nurses set up for you at the hospital for you to monitor but not touch during transport.

 

[sredish]

You have to cover yourself. Don't worry about the dr's that think you're over treating. If he was smart he'd appreciate the efforts but if you expect the worse and hope for the best then you're covered. If you expect the best and get a surprise, you're opening yourself up to negligence.

 

[Shishkabob]

Why don't you just post your protocols since you always seem to be bragging about them? Please share. You can copy and paste.

Actually, I can't as it's a PDF, and considering it's 281 pages, I'd rather not waste my time "Prnt scrn, paste, save, upload".



Take it at face value or not at all. Your choice. But you have no room to demand 'proof' when you refuse to do it yourself.

 

[Journey]

Actually, I can't as it's a PDF, and considering it's 281 pages, I'd rather not waste my time "Prnt scrn, paste, save, upload".



Take it at face value or not at all. Your choice. But you have no room to demand 'proof' when you refuse to do it yourself.

There are free PDF editors which allow you to copy and paste.

I'm not the one bragging. I've also read several of your other posts which is also why I am inquiring.

 

[Shishkabob]

And don't include those which the nurses set up for you at the hospital for you to monitor but not touch during transport.

Hmm.. funny... I could have SWORN there's a section in my guidelines that state for medications not normally used in EMS, we are to call in to OUR medical control and get medication ranges to be used. and not rely on the sending facility.


Oh, and also how the Paramedic has ultimate control over patient care, even if an RN or RRT are on board.



But you'll just have to trust me on those.

 

[Journey]

Oh, and also how the Paramedic has ultimate control over patient care, even if an RN or RRT are on board.

That would have to be only to a specific situation. In some places the Paramedic will drive or sit up front while the team works on the patient in the back.

Usually RNs are placed on an ambulance because the equipment or medication is out of what a Paramedic can do. An RN would need to be very, very cautious about accepting any orders from you for a medication or a piece of equipment that you only know a few uses for. You may think you know it all but Linuss what will make you the most dangerous is that you may not yet know what you don't know.

 

[18G]

I agree that a dr will be more precise with making an actual diagnosis but as far as treatment I don't see much difference. Even if we don't have a precise diagnosis we are able to safely treat the S/S... end result is pretty much the same in the majority of day to day cases.

So a doctor makes a diagnosis that can only be managed in the hospital. So what is he gonna do out in the field? The same thing that we are and treat S/S and make pt. comfortable.

 

[Bieber]

Journey, you seem to spend a lot of time trying to make paramedics out to be a bunch of idiots who can barely find their way out of a paper bag. If you think we're so very incapable of anything but slapping on a bandage of driving as fast as possible to the hospital, wouldn't it make more sense to redirect all of that energy and time you spend trying to make us feel stupid towards trying to educate us? You point out all of these things we're incapable of doing, well fine, why don't you teach me how to use epi soaked patches for pulmonary bleeding and how to use a scalpel with more precision and skill?

My state requires all paramedics to also obtain an associate's as part of the program requirements, but I still don't feel like I've learned anywhere near as much as I should. So teach me, I'm willing and able to learn. But what I'm NOT able to do is sit by and listen to someone tell me how stupid I am without so much as offering to educate me. I'm all for increasing educational standards, but it's a moot point if the general consensus is to complain about how stupid paramedics are without offering solutions or education.

So how about instead of pointing out all these things we're ignorant of and pointing a finger at us saying "Nyah nyah! You don't know how to do this, dummy!" why don't you make a thread educating us on all of those things you just mentioned?

Be part of the solution or be part of the problem.

 

[firetender]

The Question Has Been Answered!

Just in case some of you missed this:

EMS and The Three Bears have a lot in common. We don't get it just right very often, usually we under treat or over treat, although the extent depends on the local protocols.

 

[Journey]

Journey, you seem to spend a lot of time trying to make paramedics out to be a bunch of idiots who can barely find their way out of a paper bag. If you think we're so very incapable of anything but slapping on a bandage of driving as fast as possible to the hospital, wouldn't it make more sense to redirect all of that energy and time you spend trying to make us feel stupid towards trying to educate us? You point out all of these things we're incapable of doing, well fine, why don't you teach me how to use epi soaked patches for pulmonary bleeding and how to use a scalpel with more precision and skill?

My state requires all paramedics to also obtain an associate's as part of the program requirements, but I still don't feel like I've learned anywhere near as much as I should. So teach me, I'm willing and able to learn. But what I'm NOT able to do is sit by and listen to someone tell me how stupid I am without so much as offering to educate me. I'm all for increasing educational standards, but it's a moot point if the general consensus is to complain about how stupid paramedics are without offering solutions or education.

So how about instead of pointing out all these things we're ignorant of and pointing a finger at us saying "Nyah nyah! You don't know how to do this, dummy!" why don't you make a thread educating us on all of those things you just mentioned?

Be part of the solution or be part of the problem.

All the negative words are yours. None of those words are in my posts. Maybe this bitterness is how you feel about EMS since your state requires an Associates degree.


The discussion was about physicians which you are not. I am not going to teach you something that is not within your scope of practice. I doubt if your state allows a field C-section. I have no idea what you know or do not know about pulmonary disorders or what you have in your protocols for instilling medications in the ETT. Nor should you always take medical advice off an anonymous internet forum to use as fact in your protocols without knowing the whole situation or having the education to compliment the skill. I teach alot of things but to those who have the appropriate foundation education to advance their skills and knowledge to the next level. You should also concentrate on perfecting the skills (ex. NG tubes) and medications you do have.

What state are you in that requires an Associates degree?

 

[Bieber]

All the negative words are yours. None of those words are in my posts. Maybe this bitterness is how you feel about EMS since your state requires an Associates degree.

The negative words are mine, but the implication was yours. What do you mean about "this bitterness is how you feel about EMS since your state requires an Associate's degree"?

The discussion was about physicians which you are not. I am not going to teach you something that is not within your scope of practice.

The discussion was about whether or not paramedics over treat, actually. In your first post, you cited inequalities in paramedic ability versus physician ability under similar conditions with similar equipment due to differences in levels of education. Which is true, paramedics DON'T have the same level of education as physicians. But if a physician, or more correctly, if an authorized person with a higher level of education can be more useful with the same equipment as a paramedic, and provide better care to patients, then what we need is people willing and able to teach paramedics and be part of the advancement of our education--not to bash us. We know our limitations. We're all quite aware, I believe, or the deficiencies in EMS education in this country. I'm asking for solutions, I'm asking you to be part of the solution by contributing to furthering our education, NOT to tell me to operate outside of my protocols. I know my protocols and I will always operate within them.

I doubt if your state allows a field C-section. I have no idea what you know or do not know about pulmonary disorders or what you have in your protocols for instilling medications in the ETT. Nor should you always take medical advice off an anonymous internet forum to use as fact in your protocols without knowing the whole situation or having the education to compliment the skill.

I agree, see above.

I teach alot of things but to those who have the appropriate foundation education to advance their skills and knowledge to the next level. You should also concentrate on perfecting the skills (ex. NG tubes) and medications you do have.

What do you mean when you say "but to those who have the appropriate foundation education"?

 

[Fish]

This thread went from 0-11 all during the time of my post workout nap.

Journey,

Different Paramedic systems allow different things, Epi is infact infused here, cardiac drugs are infact bolus'd to effect before we hook them up to a drip.

You have got to remember, we have 3-20 min transports, most of that stuff you rattle'd off a Dr. would not get done that quickly. He would still be working on what an EMT and Paramedic does. Nobody here is hating on Docs that would be rediculous, I think every Paramedic by nature loves a Dr. seeing as we are the extension of one. I simply brought up something for discussion. Around here we have a high scope, and have an awesome working relationship with Hospitals and there ER MDs, our respect for each other is VERY high.

 

[18G]

Journey obviously has a personal agenda given his condescending remarks about EMS.

 

[Veneficus]

This made me giggle......

By no means was I down playing what an MD does, but give a Doc EPi and what more can he do with it than I? Same with every other med/piece of equipment we carry. Are you not from the US? Don't get so defensive and bent out of shape over another persons opinion, you put something up for discussion and here you have it.

What can I do with epi?

Well...

I can nebulize it.

I can mix it with local anesthetic or anesthesia agents and inject it IM or SQ in order to potentiate the effects over a longer time.

I can saturate bandages with it and either dress a wound or insert the roll into the wound to help control bleeding.

I can inject it near the wound in order to aid in bleeding control long term.

I can spray it on the wound to do the same in the short term.

I can inject it SQ and IM for anaphylaxis or even just an allergic reaction or hypersensitivity reaction.

I can hang it as a drip for anaphylaxis, and inotropic effect, especially stacked with dopamine.

I can give it to a patient in order to replace catecholamines lost to adrenal insufficency.

For chronotropic effect or CNS disorders as well.

That's all I can think of off the top of my head and it is late. What can you do with it?

Oh, I can give it for cardiac arrest too. not that I would choose to because I know it does more harm than good.

 

[18G]

Oh, I can give it for cardiac arrest too. not that I would choose to because I know it does more harm than good.

Unless your a state recognized EMS physician you will not have any choice but to administer it because you have standing orders that tell you to administer it and its a standard of care.

And if you are a EMS physician, why wold you not administer it? There is debate that it may do harm but there is also data that says it increases ROSC. You don't have the right to pick and choose what your gonna do and not do out of the protocols you are bound to follow.

I would like to see you call medical command for orders to withhold epi during an arrest.

 

[ah2388]

hes a medical student..soon to be CCsurg/Anest resident...as i recall

it appears that the overwhelming attitude in this thread is that paramedics are "equal" to physicians. The difference in education alone dictates that medics are less equipped to make decisions. Factor into consideration that the type of individual that is attracted to becoming a MD vs. paramedic in the united states...and this argument becomes borderline ridiculous.

It isnt uncommon that medics in the prehospital environment administer the same or similar care as would a physician in the ED. However, to think we are on par with them is absurd..

 

[Veneficus]

why wold you not administer it? There is debate that it may do harm but there is also data that says it increases ROSC.

Because it constricts the arterioles in the brain, so unless you are planning to keep the heart going for organ donation, the ROSC isn't worth much.

I have yet to be turned down for any request for orders I make. (which is all day long, since I can't sign anything myself )

 

[Shishkabob]

it appears that the overwhelming attitude in this thread is that paramedics are "equal" to physicians. However, to think we are on par with them is absurd..

I don't recall anyone saying that

 

[Veneficus]

From post 11.

I don't think that having a DR instead of a Medic(in most EMS systems) would be better, What is a DR without all of the diagnostic tools of a Hospital(Labs, xray, CT)? They would basically be limited to the same treatment as a Medic and only be able to do the same diagnostics as a Medic because the same tools and equipment that are available to us would be available to them. Dr.s are higher trained, and higher paid, because once we reach their Relm of the ER, they have the knowledge and ability to use all of the Hosp. resources and interpret them.(We dont) Among many other things, that they do.

As was said, the idea that a doctor can do no more than a medic is absurd.

A doctor is not beholden to various data gathering tools to function.

And is in no way limited to the protocol based treatments of a medic, nor would always want to use them.

From diagnostics, to medications, to knives, the same tools in the hands of a doctor are exponentially more useful than in the hands of a medic.