"EMS System": "dim net", "brilliant scattering", or both?

[mycrofft]

Given a finite supply of people, money and man-hours, and a large territory with EMS needs to cover, we do not have the wherewithall for infinte expansion of ACLS to every place that needs it in a timely fashion. It is a zero-sum game if certification and training are confined to regulated, paid sources.

The question seems to be how much resource to devote to each level of EMS deployment?

For this poll, let us posit three levels:

1. Self and Bystander First Aid (unassisted CPR, layperson AED, and rudimentary /improvisational splinting and bandaging). Taught to neophytes, through Scouting programs, at schools, CERT programs, etc.

2. EMT-Basic (Device-assisted CPR, professional AED's, device-assisted splinting and bandaging, extrication training short of fire dept level, transport in specalized vehicle; no IV, no airways other than OP and NP.

3. ACLS: Full-on paramedic or higher.

Factors to consider: the majority of the geography of the USA is rural/wilderness, tha majority of the population is crowded into urban centers mostly on the coasts and the Missour/Mississippi drainage (OK, Great Lakes too!). Consider the likely degree of emergency of calls to each area, and effects of delay due to distance and need for secondary transport to high-end defintive care for tough cases.

So, if this was a board game and you had to set your blue, green and red markers on the map, how would you apportion them? Make the hard decisions, not just idealistic ones. (Say, the blue 1st aiders are worth two points, the green EMT's five, and the paramedics ten, denoting level of competence, resources to support and train, and inverse description of the % of people who can pass the course). Your total point value is finite.

Then, think about how this affects the relative importance of each level of response, the division of monies, the necesary level of brilliance of the students, etc.

(The post's title compares the extremes: many first-aiders and EMT's all over the place, versus far fewer but higher-capabililtes Paramedics).

OK, GO. (If you find or make a game like this, bring it up, OK?).

 

[redcrossemt]

EMT's are pretty much just first aiders, with some additional assessment skills, maybe a few more tricks than what you mention. It'd be nice to have a lot of EMT's -- they can assist patients directly, know when ALS is needed and when it isn't, and assist paramedics in the transportation and care of patients. In my world, less paramedics means more experience and higher standards means better paramedics.

I voted for few first aiders... at least paid first aiders/first responders... would like to see everyone with a duty to act be at the EMT level or higher. However, I think public access CPR/defibrillation/first aid is great, and we should train as many lay responders as possible.

 

[Seaglass]

Assuming that first aiders are just civilians who've had a first aid course, not actually paid staff/volunteers responding to incidents...

Having tons of first aiders in the community is great. In fact, I think everyone should take that course and CPR at some point.

However, in my ideal world, not everyone would be an EMT. While a basic first aid course really doesn't contain all that much information to forget, EMT skills get pretty rusty if not used. A lot of them also depend on having gear which your average (sane!) civilian isn't going to buy and replace as it expires. So I'd say reserve EMT and up for people who actually plan on using it.

Likewise, too many medics=not enough chances to use skills, which then get rusty. Medics are definitely necessary, but when you have an entire firetruck full of them where only the most senior ever actually get patient contact, I don't see the point. So I wouldn't encourage all EMTs to become medics--only the ones that actually like healthcare and have the aptitude.

 

[rescue99]

Assuming that first aiders are just civilians who've had a first aid course, not actually paid staff/volunteers responding to incidents...

Having tons of first aiders in the community is great. In fact, I think everyone should take that course and CPR at some point.

However, in my ideal world, not everyone would be an EMT. While a basic first aid course really doesn't contain all that much information to forget, EMT skills get pretty rusty if not used. A lot of them also depend on having gear which your average (sane!) civilian isn't going to buy and replace as it expires. So I'd say reserve EMT and up for people who actually plan on using it.

Likewise, too many medics=not enough chances to use skills, which then get rusty. Medics are definitely necessary, but when you have an entire firetruck full of them where only the most senior ever actually get patient contact, I don't see the point. So I wouldn't encourage all EMTs to become medics--only the ones that actually like healthcare and have the aptitude.

Actually, the least senior medic usually gets "stuck" in the back of the bus on FD's around here. Pecking order...very important right of passage I guess. Sad ain't it?

 

[Seaglass]

Actually, the least senior medic usually gets "stuck" in the back of the bus on FD's around here. Pecking order...very important right of passage I guess. Sad ain't it?

Yeah, really. For the department I know which requires every firefighter to become a medic, if anyone wants to have lots of patient contact, they're not going to get much competition. Otherwise, everyone does the minimum amount of time on the bus, and winds up deferring to the most senior medic present when it's an engine response to a medical call. And engine responses are really common.

 

[mycrofft]

Sorry about my absence.

EMT's are not first-aiders, as I had to point out the other way around recently ("First responder" and first aiders are NOT EMT's, get out of my equipment kits!").

"First aid" supplies are devoid of airways, traction splints, oxygen apparatus, BVM's, suction, spinal immobilization devices, and poirbably a few I don't remember. At least they ought to be, since first aid training does not cover those areas. (I have seen off the store shelf first aid kits with antihistamine and aspirin tablets, the old Johnson and Johnson "S"-tube oral airways [can you say "gag me"?], ipecac, "burn cream" and other stuff over the years, but they do not conform with first aid training.

I guess this subject is too complicated for those other people. "Phaff!" I say.

 

[Seaglass]

I have seen off the store shelf first aid kits with antihistamine and aspirin tablets, the old Johnson and Johnson "S"-tube oral airways [can you say "gag me"?], ipecac, "burn cream" and other stuff over the years, but they do not conform with first aid training.

You want scary old first aid kits? I once found one in my grandmother's house that included morphine, as well as codeine mixed with another drug which I can't remember at the moment. Everything expired well before I was born. God knows where she got it, but she was in the habit of bringing drugs back from vacations to exotic places after they became prescription-only in America.

 

[mycrofft]

Seaglass, good thing she wasn't arrested!!

Give those out and you'll NEED more paramedics.