EMS is public safety.

[DrParasite]

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

really? I've seen London, it's not an empty husk. cities burn, and sooner or later, the fire will go out.

there is a very old firefighter saying: all fires go out eventually.

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

Or people drive themselves to the hospital. Or get friends to do it. Or take taxis.

or they don't. any they die at home, or get worse and die at home. in which case, you have pockets of dead bodies just waiting for the funeral home to pick up the body.

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.

I have, and think they are awesome. but they aren't self transported, they are transported by a ghetto taxi, ie, someone driving them and dropping them off, not them hoping in the car and going by themself. and it doesn't address medical calls, just trauma ones.

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.

no arguments there.

Mostly that's because mostly people in EMS are doing it until something better comes along.

no arguments on this either

 

[JPINFV]

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.

You, of course, have evidence that EMT or paramedic level ambulance is better than Home Boy Ambulance service (tm)?

http://www.ncbi.nlm.nih.gov/pubmed/8611068

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.

...because the streets were littered with people dying every day prior to organized civilian EMS?

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.

I'll help you out. As EMS currently stands, it is not a profession. The truth may be hard to bear, but it shouldn't be hard to say.

 

[MrBrown]

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

Yes, but you come from a nation of Convict out casts who would want to follow anything you do?

/taking the piss

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.

That IS the most horrifying sequence of words Brown has ever read!

 

[DrParasite]

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

all fires go out eventually

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

your right. and if you take away the gas company no one has heat in the winter, or the electric company no one has power. doesn't make the PSEG guys public safety though, despite that without them, you have conditions that become untenable for residents

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

hmmmm, worked sunday in the suburbs, finished the night with 7 jobs, one with a 60 yom in SVT who had his AICD go off, and around midnight had a lady having a CVA. would either have died without EMS care? ehhhh, well, the one was in SVT could have gone in a cab (but i don't think the cabbie can push amiodirone or cardiovert), the the CVA lady could have gone in a cab, but having the doc ready with a brain attack team standing by probably helped her our a little.

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.

sure, tell me that when your family member is the one that isn't on the national radar.

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.

while I agree with that study, that's due to philly GSW victims waiting upwards of an hour for an ambulance to become available and respond to calls. And philly isn't an EMS department that I would use to compare anything, because it's pretty much a disaster that is grossly understaffed and mismanaged.

 

[Too Old To Work]

really? I've seen London, it's not an empty husk. cities burn, and sooner or later, the fire will go out.

Silly position since a lot of people died in those fires. After all you're all about saving lives, aren't you?

or they don't. any they die at home, or get worse and die at home. in which case, you have pockets of dead bodies just waiting for the funeral home to pick up the body.
I have, and think they are awesome. but they aren't self transported, they are transported by a ghetto taxi, ie, someone driving them and dropping them off, not them hoping in the car and going by themself. and it doesn't address medical calls, just trauma ones.

Remember, time is muscle, time is brain. So, the faster we transport the better. Or should I say the faster anyone transports the better. I've seen both medical and trauma patients drive themselves to the hospital. Not that I recommend it.

 

[usalsfyre]

hmmmm, worked sunday in the suburbs, finished the night with 7 jobs, one with a 60 yom in SVT who had his AICD go off, and around midnight had a lady having a CVA. would either have died without EMS care? ehhhh, well, the one was in SVT could have gone in a cab (but i don't think the cabbie can push amiodirone or cardiovert), the the CVA lady could have gone in a cab, but having the doc ready with a brain attack team standing by probably helped her our a little.

Strokes, STEMIs and serious traumas present to the ED via POV all the time. It may involve a slight delay, but they still get the care they need. And if "seconds count", why aren't trauma surgeons, cardiologist and neurologist running code three to the hospital from home?

sure, tell me that when your family member is the one that isn't on the national radar.

I'm not saying I would want it to be my family member. I'm saying emotion-based "what if it was you" arguments fail miserably in the face of facts and reason.

 

[DrParasite]

Strokes, STEMIs and serious traumas present to the ED via POV all the time. It may involve a slight delay, but they still get the care they need. And if "seconds count", why aren't trauma surgeons, cardiologist and neurologist running code three to the hospital from home?

ummm, because they are already in the hospital, occasionally running from the on call rooms when they get a page for a seconds count response?

and good sumaritans stop burglaries, help women in distress, and in texas, shoot dangerous people who are threatening life and property. just because it happens, doesn't mean we should get rid of those who are trained and equipped to handle the emergency.

 

[usafmedic45]

Policing is not about arresting people, it is getting people to voluntarily comply with the law using the least amount of intervention possible.

So is being a moderator on the forum. Unfortunately, in both settings, some people just don't learn and forcible restraint or other heavy handed measures need to be applied. It's a good lesson and more people should learn it.

 

[usalsfyre]

ummm, because they are already in the hospital, occasionally running from the on call rooms when they get a page for a seconds count response?

You need to brush up on community-based medicine. The vast majority of attending physicians in this country take call from home. The only place you find in-house docs in the above categories is academic centers (and the majority of stroke, STEMI and trauma centers are not academic).

and good sumaritans stop burglaries, help women in distress, and in texas, shoot dangerous people who are threatening life and property. just because it happens, doesn't mean we should get rid of those who are trained and equipped to handle the emergency.

I don't think we should either. But you have to have good, well constructed arguments when the budget ax comes around. Nothing you've presented here is a well constructed argument.

 

[Melclin]

I should have just hit myself in the head with a moderately sized hammer instead of reading this thread.

All this "package, load and go....*fist bump* we got em to the doc alive" bullsh*t makes me wanna vomit.

I'm ganna go and get drunk and forget that this level of stupidity exists.

 

[Too Old To Work]

I should have just hit myself in the head with a moderately sized hammer instead of reading this thread.

All this "package, load and go....*fist bump* we got em to the doc alive" bullsh*t makes me wanna vomit.

I'm ganna go and get drunk and forget that this level of stupidity exists.

So, you don't get your patients to the hospital alive? Is that what you're getting at?

 

[MrBrown]

Brown thinks what Oz is trying to say is that unfortunately the "load and go red lights and sirens golden hour saving lives in the street trauma cardiac arrest look at how our great medical knowledge and capability from our 100 hour course" mentality only seems to exist in the US?

*Brown throws up a little

 

[JPINFV]

Strokes, STEMIs and serious traumas present to the ED via POV all the time. It may involve a slight delay, but they still get the care they need. And if "seconds count", why aren't trauma surgeons, cardiologist and neurologist running code three to the hospital from home?

More importantly, if seconds count why do we allow station based deployment? After all, what sort of response could be quicker than a crew strategically positioned in random parking lots, waiting in the cab for the call? If seconds count, then any sort of station is detrimental to patients.

 

[Smash]

Yes, but you come from a nation of Convict out casts who would want to follow anything you do?

/taking the piss

That IS the most horrifying sequence of words Brown has ever read!

Ahhh... but I don't come from such a place... Be careful that the toes you step on today are not connected to the arse you'll have to kiss tomorrow h34r: :lol:

I have to agree, I can't ever imagine 100 hours being considered "too much" of anything!

I'm still confused what this whole thread is about though.

 

[the_negro_puppy]

 

[Melclin]

We do things other than take pulses.

So, you don't get your patients to the hospital alive? Is that what you're getting at?

I know your joking, but I feel like expanding on my point a little...

Brown thinks what Oz is trying to say is that unfortunately the "load and go red lights and sirens golden hour saving lives in the street trauma cardiac arrest look at how our great medical knowledge and capability from our 100 hour course" mentality only seems to exist in the US?

This, and I hate that for so many people in EMS, the pt having a pulse on arrival at ED is the only outcome measure they think or care about.

How about putting thought into things like health promotion, falls prevention, building coping capacity to prevent inappropriate ambulance attendances, pain relief, reduced time of hospital/ED stay, disease specific outcomes measures.... honestly the list doesn't end.

 

[MrBrown]

The attitude of some people makes Brown so horrendously unquantifiably disgusted it makes Brown want to vomit to the point it would be unhealthy as Brown would become dehydrated and depleted of essential electrolytes Brown would become mortally obtunded and die.

Brown can no longer willingly participate because it makes Browns head explode.

*Brown takes Oz, Negro and Smash to the pub .... come lads, let us forget this thread ever existed

 

[Sasha]

People never get better in an ambulance, their diseases and not cured, their injuries are not fixed, however, they are stabilized and safely and rapidly transported to a place were they do get health care.

I'm starting to think you've never stepped foot on an ambulance before.

 

[Too Old To Work]

If people continue to have this attitude like you do, then the above statement will continue to be true, which is horrifying. True, they are stabilized and in many cases that's all that can be done without surgery, but there are many, MANY times when stabilization and THEN CARE can actually be done in the ambulance.

I'm starting to think you've never stepped foot on an ambulance before.

The act of "stabilization" means that at a minimum the patient does not deteriorate and may in fact get better. That does not mean that we do nothing, but it does mean that we very rarely cure someone. I can treat CHF very effectively, I can treat hypoglycemia very effectively, I can treat an Asthma flare very effectively. In no case can I fix the underlying cause of any of those conditions. In fact, for the most part, neither can medicine. We can treat, we can stabilize, we can relieve pain and suffering in many cases.

So, depending on how you define it, people do or don't "get better" in the ambulance. By that same definition, people "get worse" in the ambulance as well.

Back to the case of diabetics. It's pretty routine now in my system to treat a hypoglycemic Type I Diabetic and then have them refuse transport to the hospital. As long as they meet our systems criteria for refusing transport, they are free to do so. We haven't cured them, although we have treated and alleviated the acute crisis which prompted our call. Is the patient better? Inarguably. Is the patient "cured"? Not at all.

 

[Sasha]

Of course you get better on an ambulance. Going from AMS due to hypoglycemia to a normal blood sugar is getting better. Going from respiratory distress to breathing easy is getting better. Going from a 10/10 pain to a more manageable 5/10 is getting better. From bleeding to not bleeding is getting better.

There is no cure for asthma or diabetes, or CAD, or afib or many diseases that you get called for. You can manage the symptoms to make them better, a lot of the time that is achieved on an ambulance.