EMS is public safety.

[Too Old To Work]

Sanitation saves more lives than EMS could ever hope to, as well as do more to impact public health than EMS could ever hope to. Using a pure definition of public safety, sanitation ensures the public's safety much more than EMS does.

Sanitation is public health, not public safety.

 

[JPINFV]

Sanitation is public health, not public safety.

Yes, but my point is that public health does more to ensure the safety of the public than EMS does.

By the way, are you of TOTWTYTR fame?
-the EMT-Medical Student...

 

[Anjel]

TO THE OP

Do you not realize that every time you post you get a million people telling you that you are wrong. When every single person says you are wrong, and basically you don't know much. You haven't been in the field long. Why don't you sit back and listen to others instead of making threads to start arguments.

You ask questions already knowing the answer you want to hear. And there is no other answers that could possibly be right.

 

[Smash]

What is going on here?

Why do I have to be a Doctor? Or do I have to be a cop? I can't keep up!

100 Hours? That's barely enough time to learn to make a good cup of coffee! It takes 7 years to become a paramedic...

I might just have to sit in the corner rocking until someone explains what is happening

 

[Too Old To Work]

Yes, but my point is that public health does more to ensure the safety of the public than EMS does.

By the way, are you of TOTWTYTR fame?
-the EMT-Medical Student...

No, public health does more to ensure the health of the public than EMS does. And that's questionable since much of public health is merely nannyism. Public health systems came into existence during the 18th century to curb contagious diseases such as Cholera, TB, Smallpox, and so on. Since most of those diseases have been eradicated (in the US), public health has morphed into a nagging nanny telling people to wear seat belts, not to smoke, not to drink sugary drinks, eat healthy, wear helmets, and vote for Democrats.

Except for Democrats, none of those are real threats to the public health.

Sanitation is part of public health, but not public safety. At least it shouldn't be.

EMS is a system designed to provide medical care in out of hospital settings and then provide transport to hospitals. We can debate if it's public safety, public health, an industry, or a hobby. Take your pick, depending on where you are, it's one or some combination of them all.

EMS is not designed, nor was it ever intended to focus on prevention, primary care, wellness, or any of the other things that people think it should be. When we try to expand into those areas, we run into other professions or industries that ARE intended to focus on those areas. If we don't think that those professions or industries are doing their jobs, then we should push them to do their jobs, not try to add to our duties to make up for their shortcomings.

 

[ShotMedic]

No, public health does more to ensure the health of the public than EMS does. And that's questionable since much of public health is merely nannyism. Public health systems came into existence during the 18th century to curb contagious diseases such as Cholera, TB, Smallpox, and so on. Since most of those diseases have been eradicated (in the US), public health has morphed into a nagging nanny telling people to wear seat belts, not to smoke, not to drink sugary drinks, eat healthy, wear helmets, and vote for Democrats.

Except for Democrats, none of those are real threats to the public health.

Sanitation is part of public health, but not public safety. At least it shouldn't be.

EMS is a system designed to provide medical care in out of hospital settings and then provide transport to hospitals. We can debate if it's public safety, public health, an industry, or a hobby. Take your pick, depending on where you are, it's one or some combination of them all.

EMS is not designed, nor was it ever intended to focus on prevention, primary care, wellness, or any of the other things that people think it should be. When we try to expand into those areas, we run into other professions or industries that ARE intended to focus on those areas. If we don't think that those professions or industries are doing their jobs, then we should push them to do their jobs, not try to add to our duties to make up for their shortcomings.

Hit the Nail right on the head! solid work, must really be an old salty dog

 

[JPINFV]

No, public health does more to ensure the health of the public than EMS does. And that's questionable since much of public health is merely nannyism. Public health systems came into existence during the 18th century to curb contagious diseases such as Cholera, TB, Smallpox, and so on. Since most of those diseases have been eradicated (in the US), public health has morphed into a nagging nanny telling people to wear seat belts, not to smoke, not to drink sugary drinks, eat healthy, wear helmets, and vote for Democrats.

Except for Democrats, none of those are real threats to the public health.

Sanitation is part of public health, but not public safety. At least it shouldn't be.

What public health is now and what it's successes in the past is a valid point, but isn't completely germane either. There's a valid interest in ensuring clear air, clean drinking water, and removal of solid and liquid waste, in order to decrease infectious and chronic diseases. Yes, that has largely been achieved and it's a valid question to ask where the goal should be now that we've largely achieved the original goal (i.e. not simply pouring the chamber pot out of the closest window). Similarly, as long as a large portion of certain health bills aren't being paid by the consumer, there's a valid argument for laws mandating helmets and seat belts. Personally, I don't care if someone decides to wear a seat belt or not. I care when my tax dollars goes to support medical care that would largely be prevented by the use of a seat belt (this is, of course, the slipper slope with single payer/nationalized health care, but that's for a different thread or PMs).

So, while yes the current agendas of public health agencies are past the original intent, I won't take those successes away from them.

EMS is a system designed to provide medical care in out of hospital settings and then provide transport to hospitals. We can debate if it's public safety, public health, an industry, or a hobby. Take your pick, depending on where you are, it's one or some combination of them all.

EMS is not designed, nor was it ever intended to focus on prevention, primary care, wellness, or any of the other things that people think it should be. When we try to expand into those areas, we run into other professions or industries that ARE intended to focus on those areas. If we don't think that those professions or industries are doing their jobs, then we should push them to do their jobs, not try to add to our duties to make up for their shortcomings.

It's a good point. The problem, though, is that EMS is really failing to prove that our cost is worth the benefits. This is especially true when the areas that most need paramedic level service is the areas least likely to get it, and the areas least likely to need paramedics (due to short transport times) are the areas most likely to need it. As long as the goal for EMS is to transport, then that's the context that it's going to be viewed in and reimbursed for. Sure, EMS could save health care a ton of money by helping to ensure that people access the proper health provider (and certain limited treat and release options which could go past what is often currently available), but that requires options besides leave the patient at home or go to the ER, which requires education on primary care, wellness, etc.

Just because EMS is not designed for those things doesn't mean it can't evolve to include those things. Evolution is important, especially since the vast majority of EMS calls aren't really warranted, and the vast majority of calls that are end up being just a horizontal taxi ride. If millions of dollars are being spent on EMS with essentially no return on investment, does that make EMS simply a "make work" program?

 

[Too Old To Work]

What public health is now and what it's successes in the past is a valid point, but isn't completely germane either. There's a valid interest in ensuring clear air, clean drinking water, and removal of solid and liquid waste, in order to decrease infectious and chronic diseases. Yes, that has largely been achieved and it's a valid question to ask where the goal should be now that we've largely achieved the original goal (i.e. not simply pouring the chamber pot out of the closest window). Similarly, as long as a large portion of certain health bills aren't being paid by the consumer, there's a valid argument for laws mandating helmets and seat belts. Personally, I don't care if someone decides to wear a seat belt or not. I care when my tax dollars goes to support medical care that would largely be prevented by the use of a seat belt (this is, of course, the slipper slope with single payer/nationalized health care, but that's for a different thread or PMs).

The answer then is to change the paradigm, but we won't do that. Why should the public have to pay for other people's poor choices? First it's helmets and seat belts (which I wear and think everyone should), then it's smoking or not smoking, then it's what you eat, what you drink. The "The public is paying" meme can be stretched endlessly and there are those who are trying to do just that.

So, while yes the current agendas of public health agencies are past the original intent, I won't take those successes away from them.

I'm not, but when an organization is designed to eradicate a type of threat and that threat is organized, then what? Create new "threats" for them to eradicate? Or disband the organization since it's achieved it's mission?

It's a good point. The problem, though, is that EMS is really failing to prove that our cost is worth the benefits. This is especially true when the areas that most need paramedic level service is the areas least likely to get it, and the areas least likely to need paramedics (due to short transport times) are the areas most likely to need it. As long as the goal for EMS is to transport, then that's the context that it's going to be viewed in and reimbursed for. Sure, EMS could save health care a ton of money by helping to ensure that people access the proper health provider (and certain limited treat and release options which could go past what is often currently available), but that requires options besides leave the patient at home or go to the ER, which requires education on primary care, wellness, etc.

It requires a top to bottom restructuring of medicine, not just EMS. That in it's turn requires a top to bottom restructuring of our society. I don't see EMS driving either of those.

Just because EMS is not designed for those things doesn't mean it can't evolve to include those things. Evolution is important, especially since the vast majority of EMS calls aren't really warranted, and the vast majority of calls that are end up being just a horizontal taxi ride. If millions of dollars are being spent on EMS with essentially no return on investment, does that make EMS simply a "make work" program?

This is our own fault. EMS as an entity has spent almost 40 years jumping up and down and telling people "Call us if you think it's an emergency or even if you're not sure." So they call us all the time. Some of them certainly know that they do not have an emergency, but since that demographic likely abuses all forms of entitlements, we are not going to fix it. The rest of it is people who are finally doing exactly what we've been telling them to do and now we complain that they call us for bull poop.

Let's get us to the point where every EMT can take an accurate blood pressure and recognize a cardiac arrest before we worry about expanding our scope of practice.

 

[JPINFV]

Let's get us to the point where every EMT can take an accurate blood pressure and recognize a cardiac arrest before we worry about expanding our scope of practice.

Well, yes, education standards (or lack there of) is the elephant in the room. As long as the education requirements for EMS are relative jokes, very little can be done to evolve EMS from, well, anything. It's hard, if not impossible, to change a system where some providers can barely follow cookbook protocols while other providers crave, and warrant, flexibility to essentially do anything when provided with an appropriately limited tool bag.

 

[Too Old To Work]

Well, yes, education standards (or lack there of) is the elephant in the room. As long as the education requirements for EMS are relative jokes, very little can be done to evolve EMS from, well, anything. It's hard, if not impossible, to change a system where some providers can barely follow cookbook protocols while other providers crave, and warrant, flexibility to essentially do anything when provided with an appropriately limited tool bag.

The 1994 EMT-B curriculum, followed by the dumbing down of the rest of EMS education is the proximate cause of many of the problems EMS is facing. Sadly, that curriculum was decontented to satisfy those who were worried that it would scare away it's members.

 

[JPINFV]

In regards to the 1994 EMT-B National Standard Curriculum,
"The following priorities from the 1990 consensus workshop
recommendations played a directing role in the revision of this EMT-Basic Curriculum:
...
Revise basic course to be no more than 110 hours in length."

...was probably some of the most horrifying sequence of words I've ever read.

 

[Too Old To Work]

In regards to the 1994 EMT-B National Standard Curriculum,
"The following priorities from the 1990 consensus workshop
recommendations played a directing role in the revision of this EMT-Basic Curriculum:
...
Revise basic course to be no more than 110 hours in length."

...was probably some of the most horrifying sequence of words I've ever read.

Yes. To do that they had to take the medicine out of EMT training. "Do without thinking" as an acquaintance of mine once said. As a result we have poorly educated EMTs, who don't understand any of the theoretical underpinnings of EMS, don't know how to speak to or like medical professionals, and as a result are treated like idiots. It also makes it hard to teach someone to become a paramedic since much of the basic education was never taught at the EMT level. But don't worry, no doubt the ALS level will be similarly dumbed down. :sad:

 

[usalsfyre]

I'd say it already has been dumbed down. When a paramedic, supposedly the highest level of pre-hospital provider, can't tell me what the alpha and beta branches of the adrenergic nervous system are responsible for, it's time to get scared (I had to have that conversation with an intern not too long ago).

 

[crazycajun]

I'd say it already has been dumbed down. When a paramedic, supposedly the highest level of pre-hospital provider, can't tell me what the alpha and beta branches of the adrenergic nervous system are responsible for, it's time to get scared (I had to have that conversation with an intern not too long ago).

It may be dumbed down in texas but here you can actually get a degree. It requires 98% of the same classes as an ADN-RN.

 

[usalsfyre]

It may be dumbed down in texas but here you can actually get a degree. It requires 98% of the same classes as an ADN-RN.

We have degrees here to, up to a B.S. specifically in paramedicine. I'll bet I can look in the Carolinas and find at least a few mills as well. It's a systemic, nationwide problem having to do with low standards. Pointing to one or two states only marginalizes the problem.

 

[JPINFV]

It may be dumbed down in texas but here you can actually get a degree. It requires 98% of the same classes as an ADN-RN.

So all courses in your state are essentially 98% RN, or just the ones that grant a degree, or just some of the ones that grants a degree?

 

[DrParasite]

My point exactly. You could further make the argument EMS isn't really essential to public safety (about to play devil's advocate here). Without police services modern cities descend into lawlessness, without sanitation you have wide spread disease and filth and without fire protection half the city burns down. Any of these results in the collapse of the city. Without EMS you have? Certainly not wide spread death and destruction. People would still find there way to hospitals, as they were able to before the 1960s. More deaths might occur, but not enough to cause complete collapse of civilization.

without fire protection half the city burns down? says who? fires will always go out. even if it's just a citizen with a garden hose, the fires will eventually go out. what happened before there were fire departments?

Take away sanitation, and you have people who pay private companies to take away their garbage.

without EMS, what happens? people die. people don't get to the hospital in a timely fashion. people bleed to death. ghetto taxis pick up shooting and stabbing victims and drop them at the ER steps instead of being transported in a vehicle designed for that purpose. Can you take a taxi? sure. but an ambulance should be quicker, make for a better ride, and in theory should be more comfortable. plus the taxi isn't going to carry the 350 lb person down 4 flights of stairs when the person starts to have chest pains and difficulty breathing.

So what are we if not essential? Well, right now nothing. We have a REALLY hard time selling our value on anything other than emotion. We have to potential however, to be cost savers by reducing hospital admissions, not to mention add to patients lives by delivering care in the home before it's needed. This requires more education and a change on focus, away from the "public safety" persona and the "us vs them" mentality that often goes along with it. It requires a realization that driving is a just something you do to get to a call as the majority of calls are not in the least time sensitive (should home health have CEVO?), and that our medical KNOWLEDGE is far more important than a few monkey skills.

how can you say we are not essential? the only reason you can is because everyone says they can do our job as a subset of their job. FD can do EMS. PD can do EMS. volunteers can do EMS. hospitals can do EMS. and of course, those for profit companies can do EMS, usually at a lower level of quality than everyone else.

it's kinda hard to say we are professionals, and necessary, when everyone else says they can do our job too as a side job to their full time job.

 

[Too Old To Work]

without fire protection half the city burns down? says who? fires will always go out. even if it's just a citizen with a garden hose, the fires will eventually go out. what happened before there were fire departments?

Whole cities burned to the ground. Several times over in the case of London. Duh.

Take away sanitation, and you have people who pay private companies to take away their garbage.

Or they don't. In which case you have pockets of pestilence.

without EMS, what happens? people die. people don't get to the hospital in a timely fashion. people bleed to death. ghetto taxis pick up shooting and stabbing victims and drop them at the ER steps instead of being transported in a vehicle designed for that purpose. Can you take a taxi? sure. but an ambulance should be quicker, make for a better ride, and in theory should be more comfortable. plus the taxi isn't going to carry the 350 lb person down 4 flights of stairs when the person starts to have chest pains and difficulty breathing.

Or people drive themselves to the hospital. Or get friends to do it. Or take taxis. Did you ever see those studies on trauma patients that self transported? Generally they do better than those transported by EMS and MUCH better than those transported by ALS.

it's kinda hard to say we are professionals, and necessary, when everyone else says they can do our job too as a side job to their full time job.

Which is our own fault. We've allowed EMS to become a skill set, not a trade or even a profession. We've made the education too easy (1994 curriculum) and done nothing to set standards of performance or competence. Every thing about EMS is controlled by some outside entity and most people in EMS don't care. Mostly that's because mostly people in EMS are doing it until something better comes along.

 

[crazycajun]

So all courses in your state are essentially 98% RN, or just the ones that grant a degree, or just some of the ones that grants a degree?

There are still a few certificate courses than run 12 to 14 months but DHEC who oversees EMS is wanting all paramedics to have a degree with the new system coming in place. Of course anyone with 5 or more years would be grandfathered in I presume but that is just my guess. I had no intentions on going back to school but one of the directors for DHEC insisted so at the age of 42 I am back in college. I posted my course curriculum somewhere on here. I will find it and send you the link.

 

[usalsfyre]

without fire protection half the city burns down? says who? fires will always go out. even if it's just a citizen with a garden hose, the fires will eventually go out. what happened before there were fire departments?

The Great London Fire, The Great Chicago Fire, The Great San Francisco Fire....

Take away sanitation, and you have people who pay private companies to take away their garbage.

Take away sanitation period and you have conditions that become untenable for residents. This wasn't a public vs private question.

without EMS, what happens? people die.

Of your last 50 patients, how many would have died without EMS care? Maybe one of mine.

people don't get to the hospital in a
timely fashion.

To wait on the wall for an hour? An extra 20 minutes so rarely makes a difference, the extra deaths wouldn't even be a blip on the national radar.

people bleed to death. ghetto taxis pick up shooting and stabbing victims and drop them at the ER steps instead of being transported in a vehicle designed for that purpose.

According to the study done in Philly not to long ago the ghetto "throw'em in the car" method KEEPS people from bleeding to death.

Can you take a taxi? sure. but an ambulance should be quicker,

Again with the time thing.

make for a better ride, and in theory should be more comfortable. plus the taxi isn't going to carry the 350 lb person down 4 flights of stairs when the person starts to have chest pains and difficulty breathing.

Agreed, but I can pay two guys minimum wage to run a stretcher taxi with no medical care provided.

how can you say we are not essential?

Because there's not a damn bit of data that says we are.

the only reason you can is because everyone says they can do our job as a subset of their job. FD can do EMS. PD can do EMS. volunteers can do EMS. hospitals can do EMS. and of course, those for profit companies can do EMS, usually at a lower level of quality than everyone else.

Look at say AMR in Arlington, Texas vs Detroit or DC Fire or Cleveland EMS. That's WAY to broad of a generalization to make.

it's kinda hard to say we are professionals, and necessary, when everyone else says they can do our job too as a side job to their full time job.

Agreed, but perhaps the reason it can be done as a side job is EMS, in it's current, US form, isn't essential?