wow I don't show up for 24 hours and everyone goes crazy...... LOL
Ok I am not sure you all understood what I was going for or really ranting about. It was not a who's better then who and it sure as hell wasn't for all medics to jump on the bandwagon ( even some basics ) and start belittling the lower level of care. I was not looking to draw the lines and start an all out war here. although it makes me giggle a little because of all the heated back and forth.
Is it not true that Basics are needed? I am going to explain something with my limited knowledge and you all can retort.
I can almost assure you most of your als/medics aren't going to want or need to do an interfacility transport for a doctor visit, return from said doctor visit, returning to a nursing home from a higher level of care with no EQ or special precautions.
EMS- Do you medics want to or need to respond to every sick person, headache, and runny nose that gets a 911 call.
I am a dispatcher and I know for a fact that I have sent units on "BS" calls but I am not allowed to make that designation professionally because every call we receive we dispatch and as we should. I also know that working for one of the largest ambulance companies if not the largest in the greater southwestern region how short on medics we are. Which would lead to me to believe this is a nation wide trend.
I posed this same question to my trainer and supervisor and his answer went as fallows.... It would be impractical to send ALS on every call. Considering cost and man power its just impossible. It is far more expensive to equip a ALS unit then it is a BLS. the equipment and Meds alone are extremely expensive. Not to mention then you need the Medics to fill the units. You can see how many ALS units we have and how we are often short. There are times when BLS will suffice and ALS would be better posting for the next call we can utilize their abilities.
I agree with rid the standards are far to low for basics, especially considering the profession. I agree that education and the continuing of it should be very important to everyone in the profession.
Maybe its just the softy in me saying that we should all sit around the camp fire holding hands and singing kumbya. But I do believe that if there was a better relationship between all of us these issues would reach a conclusion. I also do agree there are numerous people out there making themselves out to be more then they are with their limited titles. Giving everyone a bad reputation and making it difficult to close these gaps.
You present a clear point, one that as a medic, I appreciate. There is a major over abuse of the system nationwide, but just as every ER RN out there can attest, you just have to deal with them. Just as ER's are starting to do more medical screening exams and getting people who have no business consuming ER resources out the doors, EMS can and in some places will follow. I actively inform pts. of the MSE possibility and have no hesitation dispelling the rumor of faster service by calling 911. This education alone has shown me a personal decrease in the number of unneccessary transports. But despite the call volume, I strongly believe, as do many others here, that each and every patient deserves a thorough assessment and diagnostic check utilizing all available resources in the pre-hospital environment. That cannot be performed proficiently by an EMT-B, sorry.
I have stayed out of this thread until now, because I have the definite ability to carry my stick to the pot and start stirring, but this needs to be addressed, because apparently some folks just don't get it.
First off, Interfacility transports to physician appointments, dialysis, and discharges back to the nursing home ARE NOT EMS CALLS. They are private transportation services. There is no medical service required and the only reason they are being taken by ambulance is due to an inability to sit upright unassisted. Or supposibly having that inability! I see very few dialysis patients actually lying in a bed during their treatment, yet hundreds of them are transported in Houston every single day by ambulance. Why? Because, these private companies fraud Medicare to pad their pockets. In reality, even bed confined patients can be transported by an non medical driver, even if they are on oxygen. Bottom line, probably a good 85% of these patients have no business in an ambulance (or vehicle the private company calls an ambulance). Drs. appts., same criteria. discharge from the ER, send 2 EMT's. Again, these calls are not EMERGENCY MEDICAL SERVICES calls, they are taxi calls with modified positioning for passenger transport.
Second, I realize the frustration of sending an ALS unit to a known B.S. call or frequent flyer, but the next time you are dispatching, take a look around you and ask yourself a question...............
Would you trust the person sitting next to you to make the official triage call as to what ambulance they send to you when your buddies call and say that you have been drinking and fell down? What do you think they would do? My guess would be send the BLS truck for the fallen down drunk, who in actuality has a closed head injury and starts seizing just seconds after the arrival of EMS.
See the problem? Now we aren't asking an EMT-B to make a triage and transport decision. We are asking a dispatcher who is not on scene, cannot make any objective observation, and has minimal if any EMS education. That doesn't work that well. You are blessed from the standpoint that you have some EMS knowledge, most dispatchers dont. Now through in the fact that you dispatch for multiple agencies, and if there is any police agencies involved in that dispatch center, I will guarantee that something WILL be overlooked and a poor decision made. Remember, a law enforcement officers duties and life will come before any issue an ambulance has on scene. It is for good reason I agree, but bottom line is that mutli agency dispatch is Darwinism at is best!
EMT-B's are needed, just not at the helm of a 911 truck. Sorry, but people deserve the best capabilities available. They deserve definitive interventions following a proficient assessment. An EMT-B cannot perform this, period, end of story. For all of you EMT-B's out there arguing this point, you can cry until you are blue in the face, you're preparatory training is insufficient to effectively delivery proficient pre-hospital care. In an assisting role, yes you all can be a priceless assest, but leading a crew on a 911 truck creates limitations to care that is and should be reasonably expected by the public. Sorry, can't sugar coat it any better than that............
Yes, that means a higher premium and price, yes that is difficult in some areas, impossible in few. However, I see so many agencies that use the "we can't afford it card", yet do not tax or bill. Sorry, you can't have your cake and eat it too!
It is expensive. Its only going to get worse. But it can be done. Community education and political action is key. We have to get out there and air our dirty laundry a little. Public perception is everything. Let them know the limitations and constraints. You would be surprised what Joe Q. Public is willing to pay for!
In the meantime, lets take 'em to the ER!
Keep it safe!
