Does EMS overtreat?

[Bieber]

What state are you from that requires an Associates degree?

Kansas.

See above post from Linuss. Texas only requires about 600 hours of training to be a Paramedic. Linuss is defending his state by saying there are others that require less which is a very sad statement for U.S. EMS.

In many places it seems EMS education requires no prerequisites and the sciences such as Anatomy and Physiology, Pharmacology and pathophysiology are watered down to just overviews. If you do not have an adequate understanding of just these basic foundation classes it would be difficult to build an advanced understanding. Just doing a skill is not always good enough or at least it shouldn't be.

You are one hundred percent correct and I completely agree with you, which is why I am doing everything I can to increase my education (chipping away at my Bachelor's and thinking about PA school) and why I also advocate for increased educational standards across the board for EMS. I am completely behind you that we need to have a stronger educational foundation in EMS, but not all states are created equal and not all schools provide only the bare minimum just like not all providers stop at the bare minimum. I respect physicians and their knowledge, and only want the gap between the knowledge base of physician and a paramedic to get smaller.

 

[Fish]

it appears that the overwhelming attitude in this thread is that paramedics are "equal" to physicians...

This was never said, I 100% am aware of the distance between Medics and Doctors. I am very close with the Drs in our Healthcare system, i am talking going out to lunch with them, training with them and I ask them for advice and knowledge based questions all day long because I respect them and recognize the extreme amount of knowledge base that they have above my own, let alone 6+ more years of schooling. I simply brought up something for discussion earlier in this thread. Veneficus and Journey brought things to my attention I wasn't aware of, however I have no clue as to why they are even apart of this forum seeing as it is clear they do not respect the EMS perfession and Veneficus himself does not feel we have a purpose.

 

[Fish]

This was never said, I 100% am aware of the distance between Medics and Doctors. I am very close with the Drs in our Healthcare system, i am talking going out to lunch with them, training with them and I ask them for advice and knowledge based questions all day long because I respect them and recognize the extreme amount of knowledge base that they have above my own, let alone 6+ more years of schooling. I simply brought up something for discussion earlier in this thread. Veneficus and Journey brought things to my attention I wasn't aware of, however I have no clue as to why they are even apart of this forum seeing as it is clear they do not respect the EMS perfession and Veneficus himself does not feel we have a purpose.

*profession not perfession

 

[Journey]

Veneficus and Journey brought things to my attention I wasn't aware of, however I have no clue as to why they are even apart of this forum seeing as it is clear they do not respect the EMS perfession and Veneficus himself does not feel we have a purpose.

Just showing you there is so much more to the vast world of medicine. The lack of respect comes when some of the statements such as those about doctors were made to make some believe a physician has less skills and knowledge than a Paramedic.

There are Paramedics on the forums of other professions such as nursing and one could ask the same thing about their presence.

 

[ffemt8978]

Thread reopened.

If it gets closed again, the members causing it will receive a 90 day vacation from the forum.

 

[JPINFV]

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.

The amount of variance allowed in protocols really varies from area to area. Not every place requires lock step adherence to the protocol cook book. However, considering that Epi is still the standard of care, I do agree that it would be hard for the average paramedic to justify not giving it. Atropine, now, at least has a fighting chance since it's been removed from the AHA guidelines.

However, the ability to deviate from protocols on scene means little to how much power a paramedic has to influence protocols. An emergency medical physician will always know more about emergency medicine in general than a paramedic. However, there's nothing really stopping a paramedic from having some sort of interest in a specific area and becoming THE expert in that area. You see it all the time, especially online now that people have a platform. Tom Bouthillet runs a great blog about prehospital 12 leads. As another example, Miami-Dade Fire Rescue runs an anti-venom service for the local hospitals. Patient gets bit, goes to hospital, hospital calls MDFR, MDFR specialty trained paramedics pick the anti-venom from their stores, and goes and administers it to the patient including supervising hospital staff in reconstituting the anti-venom and administration. So, what's stopping you (generic "you") from being the Tom Bouthillet for resuscitation science or respiratory emergencies, or environmental emergencies? The medical director can't be some savant who's current on every little advancement in emergency services, but everyone can be the expert in their area of interest in prehospital emergency medicine, and inturn play their part in pushing protocols for that area of interest.

 

[ffemt8978]

Veneficus and Journey brought things to my attention I wasn't aware of, however I have no clue as to why they are even apart of this forum seeing as it is clear they do not respect the EMS perfession and Veneficus himself does not feel we have a purpose.

Having a respect for the EMS profession is not a requirement to be a contributing member here...it's not even a requirement to be in EMS to be a member.

We are an open forum about EMS related discussions, which means that we have members all the way up and down the chain. We have doctors, nurses, PA's, paramedics, EMT's, patients, family members of patients, and people interested in EMS as members. Each one joins for their own reasons, and has their own viewpoints about EMS and it's affect on their life.

The only people NOT welcome here are spammers and those who repeatedly demonstrate they can't abide by our rules.

 

[Fish]

some of the statements such as those about doctors were made to make some believe a physician has less skills and knowledge than a Paramedic.
.

100% False, This was Never said.



Venecitus best of luck to you in Medical school, and thank you for helping to close the gap in the shortage of MDs, what is your specialty going to be, family practice, emergency medicene, cardiology?

 

[Veneficus]

This was never said, I 100% am aware of the distance between Medics and Doctors. I am very close with the Drs in our Healthcare system, i am talking going out to lunch with them, training with them and I ask them for advice and knowledge based questions all day long because I respect them and recognize the extreme amount of knowledge base that they have above my own, let alone 6+ more years of schooling. I simply brought up something for discussion earlier in this thread. Veneficus and Journey brought things to my attention I wasn't aware of, however I have no clue as to why they are even apart of this forum seeing as it is clear they do not respect the EMS perfession and Veneficus himself does not feel we have a purpose.

I am not antiEMS.

Actually I take a lot of crap for being proEMS from the doctors. But it doesn't mean that being proEMS is just coddling people and telling them what a great job they are always doing. When people do good work I like to celebrate it too. But showing up and doing the same things from the 1970s is not good work.

I like to talk about real issues facing EMS, not what boots or pants are best.

I like to offer my perspectives to EMS as I am a former provider and instructor of such. (technically my cards are still current, and I put forth the effort to keep them so)

I like to share the insights that I have gotten, without charge, so that others in EMS can help it be better.

But I do get frustrated with the attitude and lack of desire for advancement at times. (more so as of late)

I sometimes take a hardline position that I don't really advocate to point out the flaw in other peoples positions or to demonstrate what there is to lose if EMS providers don't get their act together and advance into a profession.

When I started in EMS, one of the things that was taught, was that paramedics are not doctors. They like to recite that when it comes to taking responsibility but then turn right around and claim to be as good when talking about thier exploits or effectiveness. I find that rather agitating and think it should be saved as a pick up line, not put forth when talking about EMS with other practicioners.

 

[18G]

A Paramedic is no where near that of a physician and I don't recall anyone suggesting that they were. It was said that the same limited interventions would be performed in the field by either a Medic or a physician while working in the common, everyday EMS system in the US.

 

[ah2388]

A Paramedic is no where near that of a physician and I don't recall anyone suggesting that they were. It was said that the same limited interventions would be performed in the field by either a Medic or a physician while working in the common, everyday EMS system in the US.

no one is disputing the idea that a physician may perform similar treatments as a medic in the prehospital environment, I think the take home point here is that physicians will generally make better decisions related to "when" to use these treatments as compared to a medic.

 

[Veneficus]

A Paramedic is no where near that of a physician and I don't recall anyone suggesting that they were. It was said that the same limited interventions would be performed in the field by either a Medic or a physician while working in the common, everyday EMS system in the US.

I don't think that is true though.

There are many interventions, especially medication uses, for things found on the common EMS ambulance that are readily performed by doctors that paramedics cannot perform.

A doctor also has considerable diagnostic capability from physical exam findings, as well as advanced interpretation and correlation of various devices such as an EKG.

The unlimited license to practice medicine also allows the use of equipment carried by EMS in ways not spelled out in EMS protocol.

As some examples, if EMS carries an OB kit with a scalpel and an ET tube, A physician can place a surgical airway even if EMS is not permitted.

A physician can remove a foreign body, where EMS is largely restricted in that.

A physician can perform a pericardial or pleural drainage with an IV catheter if so called upon.

I covered the use of Epi already, but another good example is mag sulfate. that drug is seriously underutilized in EMS. I have even suggested and pushed it for sedation. (with permission from med control)

I think medics can be more than they are currently. But I also think the idea that a physician is limited to what a medic can do in the field with the same equipment is just inaccurate.

 

[Melclin]

Its obviously a questions of economics.

It would be awesome if an interventional cardiologist turned up outside your house in a giant flying cath lab for every chest pain call. But there are a few issues with that.

Obviously a doctor on an can do more than a paramedic but I think the question of "How much more?" and "To what effect?" are reasonable questions to ask when presented with the bill for replacing our 2500 paramedics with doctors. I realise that's not really being suggested, but I'm just extending the idea a little for the purposes of discussion.

I think its reasonable to suggest that given the limitations placed on us by time, equipment and a highly risk adverse society, a doctor's extensive training is a little superfluous in most areas of ambulance.

That said, a paramedic's training, especially in America is woefully inadequate to meet the demands of the future (and quite probably, the present).

To provide a different perspective, paramedics here are more educated than they need be in some ways and less educated in many others. By virtue of how our university entry system works, the popularity of the degree and the courses before it going back probably almost 20 years, you get quite a few high achievers becoming paramedics. You then however, get an education system that is apologetic for teaching you anything other than guidelines or "need to know" facts, because our system is essentially designed to protect the lowest common denominator by restricting practice. As such, the high achievers skill atrophies or they never really bother developing them in the first place. You have a system full of people capable of much broader scope (if only the programs were put in place to allow it) held back by a few idiots. There are of course economic and administrative issues that complicate matters to no end, but there you go.

 

[Veneficus]

Its obviously a questions of economics.

It would be awesome if an interventional cardiologist turned up outside your house in a giant flying cath lab for every chest pain call. But there are a few issues with that.

Obviously a doctor on an can do more than a paramedic but I think the question of "How much more?" and "To what effect?" are reasonable questions to ask when presented with the bill for replacing our 2500 paramedics with doctors. I realise that's not really being suggested, but I'm just extending the idea a little for the purposes of discussion.

I think its reasonable to suggest that given the limitations placed on us by time, equipment and a highly risk adverse society, a doctor's extensive training is a little superfluous in most areas of ambulance.

That said, a paramedic's training, especially in America is woefully inadequate to meet the demands of the future (and quite probably, the present).

To provide a different perspective, paramedics here are more educated than they need be in some ways and less educated in many others. By virtue of how our university entry system works, the popularity of the degree and the courses before it going back probably almost 20 years, you get quite a few high achievers becoming paramedics. You then however, get an education system that is apologetic for teaching you anything other than guidelines or "need to know" facts, because our system is essentially designed to protect the lowest common denominator by restricting practice. As such, the high achievers skill atrophies or they never really bother developing them in the first place. You have a system full of people capable of much broader scope (if only the programs were put in place to allow it) held back by a few idiots. There are of course economic and administrative issues that complicate matters to no end, but there you go.

So what is the fix?