Ethics Question: BLS Turfing

[medicsb]

Considering that the paramedic scope of practice is useless for the majority of calls, why not replace paramedics with AEMTs who can admin fentanyl and zofran? (There's no reason an AEMT could not.) And then use paramedics in fly-cars for life-threatening and more acute stuff.

It's funny, but there seems to be a shift in some circles from "we need more paramedics so we can treat life threatening emergencies quicker" to we need "more paramedics so we can treat all pain and nausea".

If you want to justify your existence with comfort care, then be willing to give up the meat of your scope of practice. Sure, comfort care is important (and I'm not saying it should not be done) but it does NOT require the caregiver to be able to intubate, cardiovert, cric, needle decompress, pace, give antiarrhytmics, etc., etc. Ultimately, pain and nausea does not justify the costs associated with a paramedic's scope of practice.

 

[unleashedfury]

Considering that the paramedic scope of practice is useless for the majority of calls, why not replace paramedics with AEMTs who can admin fentanyl and zofran? (There's no reason an AEMT could not.) And then use paramedics in fly-cars for life-threatening and more acute stuff.

It's funny, but there seems to be a shift in some circles from "we need more paramedics so we can treat life threatening emergencies quicker" to we need "more paramedics so we can treat all pain and nausea".

If you want to justify your existence with comfort care, then be willing to give up the meat of your scope of practice. Sure, comfort care is important (and I'm not saying it should not be done) but it does NOT require the caregiver to be able to intubate, cardiovert, cric, needle decompress, pace, give antiarrhytmics, etc., etc. Ultimately, pain and nausea does not justify the costs associated with a paramedic's scope of practice.

Being a Pa Resident you feel my pain, the AEMT scope has been laid out and a foundation set, the local council director quite frankly stated that the AEMT in Pa will probably never be seen in his tenure due to the fact that they been kicking it around for years and no one ever decided to move forward on it. Also more rural squads are fearing the fact of sending volly's to advanced training and associated costs with training.

 

[usalsfyre]

If you want to justify your existence with comfort care, then be willing to give up the meat of your scope of practice. Sure, comfort care is important (and I'm not saying it should not be done) but it does NOT require the caregiver to be able to intubate, cardiovert, cric, needle decompress, pace, give antiarrhytmics, etc., etc. Ultimately, pain and nausea does not justify the costs associated with a paramedic's scope of practice.

To put forth a REALLY unpopular opinion, the majority of paramedics are vastly under-qualified to do the majority of those things anyway.

 

[RocketMedic]

Total agreement. I think a large part of the avoidance of pain management is a lack of education as to how to safely and effectively do it.

Let's face it, running an AHA ACLS code is easy. Sure, a few tasks might be hard, but the whole thing is easy. Same with CVA and STEMI- take vitals, recognize, slam in nitro and ASA if appropriate and drive fast. There's not too much to worry about there unless things get odd, and then, it's a formulaic, drilled approach.

Managing pain, nausea, and other vague complaints is far more difficult because we're generally not trained for it.

 

[abckidsmom]

Total agreement. I think a large part of the avoidance of pain management is a lack of education as to how to safely and effectively do it.

Let's face it, running an AHA ACLS code is easy. Sure, a few tasks might be hard, but the whole thing is easy. Same with CVA and STEMI- take vitals, recognize, slam in nitro and ASA if appropriate and drive fast. There's not too much to worry about there unless things get odd, and then, it's a formulaic, drilled approach.

Managing pain, nausea, and other vague complaints is far more difficult because we're generally not trained for it.

I agree with usalsfyre, but not so much your "easy" argument. It's easy to do anything in a mediocre way.

STEMI? Meh, if the machine calls it, great, if not, oh well. I just sat in a class with craigalanevans for 8 hours today. I'm 20 years into my career, and he gave me at least a months worth of material to process. My mind is spinning with details that I really didn't know before.

Did I take good care of sick people before? Yeah, better than most, I'd say with a bit of ego. Today I learned that there is SO, SO much room for improvement on my game.

I think that medics get bored with the boring stuff because meh, it's just stuff. Not exciting, no lives to be saved here, carry on.

But sniffing out the complicated, non-dramatic, maybe boring issue with your unique perspective of the patient IN THEIR HOME ENVIRONMENT is a thing that really can't be beat. And if you don't make the patients comfortable and happy, they're going to be too busy taking deep breaths to push down their nausea to really talk to you about what's going on.

 

[Brevi]

Patients with significant pain, those who are nauseated or who are actively vomiting should be cared for, and transported, via ALS when at all possible.

 

[RocketMedic]

Total agreement.