Experience

[firemedic31075]

Well I've been working as a medic for about 3 months now and the way my dept. works is you go through a 3 week orientation then get assigned to a rescue car. And you have to be on the rescue for about 6 months then you can go to the engine as the paramedic by yourself. Now they put you on the resue with a senior medic for that time to boost your experience level. Heres the problem, im stationed in a very low income area where the residents dial 911 for just about anything and everything. We probably run a true ALS call maybe once a month if I get lucky. I'm starting to get frustrated with the constant BLS calls, I know its part of the job but how am I supposed to get any experience with critical patients if 99% of the calls are not even worthy of a BLS unit. I do alot of studying but theres only so much you can get from a book.
Any comments or suggestions??

 

[MedicPrincess]

What types of calls are you getting that "aren't even worthy of a BLS unit?"

I came from a county service, where my truck was in the downtown area and "served" the homeless population, multiple NH, detox, the "projects", and the psych place. We also covered a good portion of the beach. I am now in a different service, and primarily "serve" middle-upper to high level income citizens....and I haven't seen a homeless person in my district yet (sometimes I believe they have an ordinance in place regarding the home challeneged and not being allowed).

What I am getting at is I have some, albeit minimal in comparison to many, expierience the call for everything....my worst being the 911 call for a broken fingernail.

Perhaps, if we know some of the calls you are determining not worth a BLS unit, then we could help you to look at them in a different perspective..... I can even lend you my glasses if you like..... they are a pretty rose color.

 

[Jon]

I'm from suburban Philadelphia, and see the same attitude in some city medics.

I see patients who are using EMS as a taxi. I also get a HPI and PMH on these patients, and if needed, preform interventions to help them.

I know one service that instuted a strict QA/QI program a few years back, and saw their calls go to 80% ALS... becuase they operated under the attitude that they can do a lot of the work the ED is going to do, before they get to the ED.. so they'd start IV lines, get labs, and treat their patients... if they were having resp. diff, they usually got a nebulizer, and if they were an asthmatic having a bad attack, they got steroids in the field. It was THOUGHT to reduce hospital stay time and wait time, and it meant that the service could justify 2 medics on the truck.

 

[JPINFV]

Just because you cut back on the number of BS calls doesn't mean that there will be an increase in serious calls. Sure, the ratio will go up, but if you're averaging 1 ALS call a month, then you will still only be averaging 1 ALS call a month. Unless, of course, the department decides to cut back on the number of ambulances.

 

[VentMedic]

When I hear comments about BS patients, it becomes clear that the paramedic in the U.S. will not be utilized as they are in other countries. The plans that have been laid out to have Paramedics trained in community health will never fly in the U.S. until paramedics start thinking more broadly as health care professionals and not just there for the "really cool stuff". Any plans for clinic oriented triage to alleviate ED load is going to have to rely on other healthcare professionals if Paramedics can not broaden their education and knowledge of the problems around them to learn how they can be the solution to a growing problem.

Unfortunately when you assume every patient is BS, you may miss some very important information in your assessment that will give your credibility in the ED a big negative.

Use this time to perfect your interviewing, assessing and reporting skills. It will not be wasted as it becomes second nature for when you do have that call worthy of your "talents".

 

[MSDeltaFlt]

When I hear comments about BS patients, it becomes clear that the paramedic in the U.S. will not be utilized as they are in other countries. The plans that have been laid out to have Paramedics trained in community health will never fly in the U.S. until paramedics start thinking more broadly as health care professionals and not just there for the "really cool stuff". Any plans for clinic oriented triage to alleviate ED load is going to have to rely on other healthcare professionals if Paramedics can not broaden their education and knowledge of the problems around them to learn how they can be the solution to a growing problem.

Unfortunately when you assume every patient is BS, you may miss some very important information in your assessment that will give your credibility in the ED a big negative.

Use this time to perfect your interviewing, assessing and reporting skills. It will not be wasted as it becomes second nature for when you do have that call worthy of your "talents".

Truer words have never been said. Also, get in the habit of making the pt prove they DON'T need something done. That way you decrease the chances of missing something. Missing something is not good. Believe me.

 

[Flight-LP]

Well I've been working as a medic for about 3 months now and the way my dept. works is you go through a 3 week orientation then get assigned to a rescue car. And you have to be on the rescue for about 6 months then you can go to the engine as the paramedic by yourself. Now they put you on the resue with a senior medic for that time to boost your experience level. Heres the problem, im stationed in a very low income area where the residents dial 911 for just about anything and everything. We probably run a true ALS call maybe once a month if I get lucky. I'm starting to get frustrated with the constant BLS calls, I know its part of the job but how am I supposed to get any experience with critical patients if 99% of the calls are not even worthy of a BLS unit. I do alot of studying but theres only so much you can get from a book.
Any comments or suggestions??

Honestly, if you are truly seeking quality experience and not doing this just to promote your Firefighting career, then gain experience outside of a fire based EMS service. The reality is that many fire based services do not remotely care about anything EMS except for revenue and their budget. There are very few fire based services that offer a progressive level of EMS care. Just a thought based off of my humbled opinion..................

 

[CFRBryan347768]

The reality is that many fire based services do not remotely care about anything EMS except for revenue and their budget. There are very few fire based services that offer a progressive level of EMS care. Just a thought based off of my humbled opinion..................

i dont think this is necessarily true....yes it is your opinion but what makes you believe that? Every station/county/state is different

 

[JPINFV]

i dont think this is necessarily true....yes it is your opinion but what makes you believe that? Every station/county/state is different

• The IAFC EMS Section would like to see substantiation on why there is an increase in training hours and how the new hour level was determined.

• While the IAFC EMS Section supports higher education and the aim of increased professionalism in EMS, it is concerned that the general move toward college-based courses, the increase in hours and resulting financial impact will adversely affect departments’ ability (especially volunteer departments) to meet the goals of the standards.

• Will the increase in education standards further impact the pool of people who can complete the requirements?

Re: Formal Comments on the National EMS Education Standards, Draft 1.0
-International Association of Fire Chiefs.
http://www.iafc.org/associations/4685/files/ems_NtlEMSeduStandardsSectionComments070731.pdf


It doesn't help claims that EMS Based Fire Suppression is a good thing if one of the leadership groups thinks that paramedics shouldn't be just as educated as every other primary health care provider (i.e. RNs and RTs) because their fire fighters might have trouble completing it. No, that's not entirely accurate. Degrees are good, as long as the fire service has an exemption.

 

[triemal04]

International Association of Fire Chiefs is a union. Percentage wise, they have a much, much smaller membership than IAFF, and proportionately less real power. As well, something that is convienently ignored by some people, while the national can say whatever they want, it is still up to the local's and individual departments to set their own policy and standards. While technically both IAFF and IAFC could try and enforce whatver policy they wanted (and if this was going to happen it would have long, long ago) neither will on many issues. Why? Because there would be a drastic drop in membership, something that no union likes to see.

Why do I bring this up? Because the national offices of IAFC and IAFF do not have any real control over the actions of the locals. They can say whatever they want, lobby for whatever they want, but each individual fire department will still do it's own thing. So, saying that every state/county/department is different...well...that's true...and...uh...JPINFV swings and misses again. Is it :censored::censored::censored::censored:ty that the part of the union that does much of the lobbying has that view? Sure. But does it mean that each feels that way and acts that way? No. Hasn't, and won't be like that.

 

[JPINFV]

Woa, good thing this is about the National EMS Education Standards and not what each state/county/department is doing or not doing. I wonder if we can get some EMS schools to throw together some dumb downed FF1 and FF2 courses so that all the paramedics who don't give a damn about fire fighting won't have to work hard to keep their job. Then we can be just like the fire departments.

 

[triemal04]

Woa, good thing this is about the National EMS Education Standards and not what each state/county/department is doing or not doing. I wonder if we can get some EMS schools to throw together some dumb downed FF1 and FF2 courses so that all the paramedics who don't give a damn about fire fighting won't have to work hard to keep their job. Then we can be just like the fire departments.

Strike two!

CFRBryan made a comment that each local area was different...which they are. He was responding to a comment about how many indicidual departments provide poor quality EMS. You made a comment that didn't apply to that and I explained why. As I said, the national leadership can say and lobby for whatever they want, but each department runs itself as they see fit. Thus, some fire departments will have lousy EMS systems, some will have good ones. (and actually, the thread was originally about experience levles and B(L)S calls, then turned into lousy fire-based EMS) Now, if you want to talk about the national standards for EMS education...great, but I do believe there is another thread somewhere here about that.

And, while they aren't run by schools that only offer EMS education, there are plenty of places that offer piss-poor firefighter training. As well, there are places that offer a combo that is horrible.

Ready for the next pitch?

JPINFV, look, you've got great medical knowledge...being pre-med I'd hope so...but you don't have all that much real world experience. You worked as a basic in a non-emergent interfacility transport service in SoCal for...how long? My point being, 1) don't base everything you think of on LA and LA County, 2) don't think that you know everything there is about the EMS systems and structures in the US, and 3) don't think that you know much of anything about the fire service beyond what's in the papers (we've done this before if you remember). Southern Cali is crap for fire-based EMS, I'll agree on that. The rest of California isn't that much better. But working there for a limited amount of time does not make you an authority on EMS in America, the fire service in America, and the role's that unions play in both.

Of course I'm not an expert either, I've just had a wider range of experience and time to see how things work. And there's people here that have been around longer than I've been alive and know more. See my point?

 

[Ops Paramedic]

The majority of our transports at my service, are also basic, but i average about 2-4 ALS calls per 12 hr shift.
Yes, we have people who abuse the EMS system by phoning in and saying they have a heart attack to get the ambo there, only t find upon your arrival that the patient is waitng outside with her suirecases packed wanting a lift to hospital for elective surgery in a day's time! This is the reason why our ALS is on fly cars, as it a scares recources. This way way they can go to many calls, asses, and if they d not need to interveen, they are avaible for the next call. Some services have transport bus/ambo, rigged with chairs, equipped with BLS kit and staffed as such, to caiter for these BLS call where mainly transport only is required.

For Vent,My course included Primary Health Care I & II. The other ALS coureses don't, they have a bit of a laugh at us sometimes. However, with this knoweldge and info, you can certainly educate the community, which lead to a decrease is these BLS calls. eg. The dehidrated kid who has been having vomting & diarhea for a day. If the mother knew that she can make her own rehidration solution with household goods and administer it, and that she can use civilian transport if she goes within an hour or two after commencement of D&V, she would not need to phone the ambo, or even just by using two different chopping boards for prepearing meat and vegatables, this whole episode could have been prevented...

You will only be a good ALS if you completely master BLS.

 

[VentMedic]

For Vent,My course included Primary Health Care I & II. The other ALS coureses don't, they have a bit of a laugh at us sometimes. However, with this knoweldge and info, you can certainly educate the community, which lead to a decrease is these BLS calls. eg.

And who are you going to get to educate the public? Some of those in EMS on the street closest to the public are only interested if it bleeds. Community education? Community health? I don't see that in the U.S. for a long time except in a few very dedicated systems. The systems that are volunteer EMS probably do the most community education with their fairs for support.