EMT-Basic IV

[Foxbat]

Florida provides 24/7 to every citizen in the state and that includes communities a lot smaller than 10,000

Without funding by county or state?
Are medic fly-cars utilized, or there is a medic on every ambulance?

 

[Ridryder911]

Without funding by county or state?
Are medic fly-cars utilized, or there is a medic on every ambulance?

Actually, if properly billed and managed it can be done with very little tax revenue and yes, a Paramedic on each unit.

R/r 911

 

[EMTinNEPA]

I look forward to hearing practical plans for taking a BLS station and transitioning them to ALS in a small, rural community.

Ok, here's an idea. Enter into a partnership with an ALS private service that does IFTs... i.e., a company with a buttload of money. Have them staff a paramedic on your ambulance 24/7 while you provide a volunteer driver. In return, let them have a decent portion of the bill, and maybe a bit of administrative pull. Sure, they may lose money, but who cares? They're providing ALS services, and they more than make up for it with the transports, which are their bread and butter. My service has this arrangement with a local volunteer service and it works excellently.

 

[spisco85]

My town had the option of having the agency I work for provide 12 hours of guaranteed paramedic coverage or having 12 hours of guaranteed basic coverage.

Their choice? The basic coverage which cost the town 1/5 of what the paramedic coverage would have cost.

Their reasoning? They wanted the town's ambulance's to be used and the local hospital fly medics, are sometimes available. These fly medics are outstanding and cover a county and a half with four per shift.

Sucks for my town.

 

[Foxbat]

Sure, they may lose money, but who cares?

I was under impression that private companies really care about profits. Sure, thay can earn money from IFTs, but what makes them do 911 calls in an area which would only make them lose money?

 

[EMTinNEPA]

I was under impression that private companies really care about profits. Sure, thay can earn money from IFTs, but what makes them do 911 calls in an area which would only make them lose money?

But they aren't losing money in the grand scheme. They make up for it with transports. My god, private services doing something out of the goodness of their hearts?!? SAY IT ISN'T SO!!

 

[Foxbat]

I guess I misunderstood.
Do you mean that:
a)company does 911 in this area and does IFTs in the same area, and therefore gains money by covering this area, or
b)company loses money from operating in this area but earns money by doing IFTs in other places?

 

[EMTinNEPA]

I guess I misunderstood.
Do you mean that:
a)company does 911 in this area and does IFTs in the same area, and therefore gains money by covering this area, or
b)company loses money from operating in this area but earns money by doing IFTs in other places?

I mean that it doesn't matter if they lose money by staffing a paramedic 24/7 if the call volume doesn't warrant it because they can easily make up for it by doing IFTs in this area (and others).

Keep in mind, though, two transported ALS calls per day will pay for the truck to be there.

There are three services in my area that do it. One staffs paramedics for a service and makes up for the money spent by doing IFTs other places. My service lets the paramedic and volunteer handle most of the 911 calls because having the volunteer driver and the volunteer service pay for the truck, they actually save money by just paying for the paramedic. The third is a hospital-based chase truck that staffs EMTs on the local volunteer units. If there are no volunteers, the paid guys take it. If volunteers are there, they take it. See? Everybody's happy.

 

[CAOX3]

I was under impression that private companies really care about profits. Sure, thay can earn money from IFTs, but what makes them do 911 calls in an area which would only make them lose money?

They never do anything for free. They will always have their best interests in mind. That interest may be your EMS contract as soon as your residents cant afford another tax increase. Then they slide in on their white horse and its ball game over.

 

[EMTinNEPA]

They never do anything for free. They will always have their best interests in mind. That interest may be your EMS contract as soon as your residents cant afford another tax increase. Then they slide in on their white horse and its ball game over.

And would that really be such a bad thing? The town would have ALS service 24/7 from EMS professionals. At least they would be decent enough to help you until volunteer EMS gradually fades away instead of coming in a forcibly taking over.

 

[CAOX3]

And would that really be such a bad thing? The town would have ALS service 24/7 from EMS professionals. At least they would be decent enough to help you until volunteer EMS gradually fades away instead of coming in a forcibly taking over.

Only if your an employee of the town and are the one losing your job.

 

[daedalus]

You didnt say that, you said "based on cold hard evidence". Which is different from best available research. MAST trousers was based on best available research, how did that work out.

My attitude is disappointing, Im sorry if the truth hurts.

Best available research is cold hard science. Also, the MAST system was certainly part of science. It was tried and it failed. That is what science is, for example, Newtonian physics is wrong (replaced by Relativity), yet we still use it to make basic predictions because it works at the crude level. There will be a day when we come up with something better than Relativity. This is science, always dynamic, and humble. We diligently work to disprove things once accepted and strive for better theories, while using what works best at the time.

Definition of science:

a method of learning about the [biology] by applying the principles of the scientific method, which includes making empirical observations, proposing hypotheses to explain those observations, and testing those hypotheses in valid and reliable ways

Source- nasa.gov

The very definition of science is application of research.

 

[Level1pedstech]

I asked for scientific evidence and this is what you post? It seems like you are evading my question by runnng to a trauma surgeon and asking him I it's ok. Here is a hint, if someone asks for evidence to support your treatment one day and you come back to that person saying so and so said it was ok, you will have lost respect as a provider and you will facv the consequences of whatever you have done.

CAOX3, my county bases many practices on best available medical research. Your attitude is disapponting.

What can I say Im just a simple guy trying to add my two cents. I dont run to anyone for anything, in my simple way of thinking it made sense to ask providers of different levels where I work. I presented the information and asked for opinion not approval. I then passed on the information for the people who might find it interesting. I dont need approval from anyone I work with, to be honest I dont really care I have my time in and dont fell the need to prove jack. My certification from the state says it all. If you are so much into disproving IV therapy in the pre hospital setting show me what you have and I would be glad to pass the information along. Im sure it would be appreciated. I wont turn in my equipment (yes like many rural volunteer providers I respond POV most of the time) until the state accepts your proof of why we should stop the practice.

 

[Ridryder911]

What can I say Im just a simple guy trying to add my two cents. I dont run to anyone for anything, in my simple way of thinking it made sense to ask providers of different levels where I work. I presented the information and asked for opinion not approval. I then passed on the information for the people who might find it interesting. I dont need approval from anyone I work with, to be honest I dont really care I have my time in and dont fell the need to prove jack. My certification from the state says it all. If you are so much into disproving IV therapy in the pre hospital setting show me what you have and I would be glad to pass the information along. Im sure it would be appreciated. I wont turn in my equipment (yes like many rural volunteer providers I respond POV most of the time) until the state accepts your proof of why we should stop the practice.

Wow! Did you read your statement? Did you really want to present yourself this way? I would assume no one that acclaims to be in the medical field to want to describe themselves competent because they passed a 10'th grade level State test.

I just read some of you posts. Since you like asking others instead of seeking information and education yourself (there's usually a verb for that) ask them what the liability is of you carrying equipment with you? How much medical malpractice do you have?

Now, I ask you this. What is benefit does the patient get by your IV treatment? Since there is only really two reasons to establish intravenous therapy in the prehospital setting (from the National Curriculum) 1) Fluid therapy 2) Route for medication administration. Please, I hope you do not respond with an embarrassing statement such as "fluid resuscitation" because I will refer you back to your medical peers to ask them about the "debunk" of that and how that has been disproved nearly a decade and a half ago. So now I ask, what medicines do you administer? If you do administer, of course you should be monitoring them... So now I ask what true therapeutic treatments are you providing other than just doing a skill?

In medicine, one should be able to justify their actions or lack of actions. That is just part of life. If you can not then possibly what you are doing should not be done or the person should not be providing the action. Yeah, it is a simple as that.

R/r 911

* There are tons of literature on the reason(s) IV therapy should not even be performed in prehospital setting.

 

[VentMedic]

My certification from the state says it all. If you are so much into disproving IV therapy in the pre hospital setting show me what you have and I would be glad to pass the information along. Im sure it would be appreciated. I wont turn in my equipment (yes like many rural volunteer providers I respond POV most of the time) until the state accepts your proof of why we should stop the practice.

Many states still have central lines, pericardiocentesis and pedi (or Adult) ETI in the Paramedic scope of practice but that does mean because the state has written it into the statutes that every Paramedic should be allowed to perform these procedures. The medical directors will have say in what their providers can perform based on the need and confidence. If their providers were to take the "entitlement" attitude, there would probably be even less skills performed in the field by providers. We could ETI for both pedi and adults as an example. Just because it is in your scope, if the provider is not properly educated/trained and maintained, ETI is dangerous to the patient.

 

[Level1pedstech]

I guess I could have replied a bit more professionally, I apologise. I don't like being backed into a corner or called out because there are questions and concerns with the practice of performing IV therapy in the field. I have taken the required training,passed the state test and I follow a strict set of protocols.

Do you think I am some sort of privateer running around with an ambulance worth of gear in my trunk just waiting to put myself in a situation where I can harm someone and open myself and my department up to liability. I really dislike that impression people get of rural providers that have to practice without the big city tools and toys but get the job done just as well as our big city counterparts. I am covered under my department just as if I went to the station and responded in a department vehicle. In all my years with my department I cant think of any patient that has been harmed or come after us for malpractice.

Does my ability to preform the skill mean that all patients get fluid therapy or even a line for med access, it all depends on what the protocols call for. In the ER almost everyone gets a line for anticipation of need. I think far more people get lines in the ER than would get them in the field under the guidelines we follow. We can only put up NS and once again that's following specific protocols.

I have always been very careful not to overstep my scope of practice both in the field and in the ER. In the ten years I have been a provider the largest chunk of my time has been used trying to be the best educated provider I can be. I don't claim to have all the education and knowledge of some of the folks that post here but I hope to get there one day.

 

[EMTinNEPA]

Only if your an employee of the town and are the one losing your job.

My solution was to how a volunteer BLS-only service could provide ALS in a rural setting.

 

[Foxbat]

* There are tons of literature on the reason(s) IV therapy should not even be performed in prehospital setting.

IV therapy, as in fluid replacement, or as in administering any medications via IV route?

 

[Ridryder911]

IV therapy, as in fluid replacement, or as in administering any medications via IV route?

All. Choose a decade, there was a push to remove IV therapy from EMS roles alike the intubation debate now. Acclaiming it took an average of > 10 minutes to establish an IV. Multiple academic studies acclaiming such. Even discussion that IV's not even be established in the ED due to time delay and be started in the O.R. Thus it is why it is essential to really review on how and why studies are performed.

We have swung the pendulum from one extreme to another with IV's. Yes, there is a happy middle. The main emphasis all treatments we do should be able to be justifiable. It being placing a splint, oxygen or even starting an IV.

R/r 911

 

[ResTech]

Rid has a point... studies can be performed and sometimes results swayed to support one groups position. A study could be performed with results saying we should do away with EMS all together.