Finally ! Someone who cares about BLS and EMT's

[reaper]

Here's a hint: go talk with a trauma surgeon and ask them what injury they hate to deal with the most! Their answer will most likely be a Pelvic fracture. More people die of pelvic fx's, because they are very hard to deal with. These Pt's need proper stabilization, IV fluids, pain management and constant monitoring.

Fevers: You may worry about seizures in peds Pt's with high fevers. I worry more about adults with high fevers. An elderly pt cannot compensate for a high fever, as much as a child can. The disease process that causes fevers in an adult are much more complicated and needs someone who can preform a proper assessment on them.

No offense here, but if this is the way you think about emergency medicine after 18 years as an EMT. Then the problem is staring right at you! You gave examples of Common "BLS" calls, that are in dire need of ALS assessment. Every call you go on should have a Paramedic assessing them. Then if they deem that it can be transported by the EMT, you can transport them.

This is what every pt should be entitled to!

 

[MrBrown]

Why must you American's be so obsessed with your BLS vs ALS?

Here's a newsflash, BLS: American style (120 hour course and a scope of practice which consists of oxygen and an AED (local differences aside please!)) is something out of about 1990 here.

Your BLS consists of zero medications (again, local differences aside please!), our BLS consists of at least eight different medications with no "medical control" required.

You guys get so hung up on "oh this is a BLS patient" well why? who is to say that the "BLS" patient with "abdo pain" doesn't have a pulsating AAA that's about to burst and turn him into an "ALS" patient?

Every patient is entitled to competent, thorough and knowledgable assessment and treatment of a proper, first world standard not some archaic 120 hour course flooze where the only two interventions he can possibly provide are an oxygen tank and a toaster.

Now, let's look at the much hearalded EMS Agenda for the Future National Scope of Practice Model:

EMT: Oxygen, aspirin, oral glucose, oral analegsia (tylenol?)

A-EMT: IV fluid, GTN, D50, naloxone, salbutamol nebules

Now, let's look at some first world, twenty first century EMS models of "basic life support":

NSW (Australia): Oxygen, adrenaline, D10, glucagon, GTN, aspirin, midazolam, salbutamol, methoxyflurane, ipatropium, promethazine, fentanyl

New Zealand: Oxygen, methoxyflurane, entonox, aspirin, paracetamol (tylenol), zofran, salbutamol, ipatropium, glucagon, GTN

Canada (NOCP): Oxygen, entonox, salbutamol, aspirin, GTN, glucagon, adrenaline

Does anybody see a difference here?

Until you guys abandon the archaic, long outdated misconception of your "BLS vs ALS" then I'm afraid the people who truly suffer will be your patients.

 

[BLSBoy]

Until you guys abandon the archaic, long outdated misconception of your "BLS vs ALS" then I'm afraid the people who truly suffer will be your patients.

Until we refuse to continue to allow the volunteers (at least in my area) to not only legislate themselves (nj first grade counsil) but convince the state legislators that a 120hr course is enough to "save a life", it will continue to stay like this.

Why?

Cause this is the way its always been done.<_<

 

[Aidey]

Until we refuse to continue to allow the volunteers (at least in my area) to not only legislate themselves (nj first grade counsil) but convince the state legislators that a 120hr course is enough to "save a life", it will continue to stay like this.

Why?

Cause this is the way its always been done.<_<

Not to rain on the parade even more, but it's going to be even harder to make any changes in the current political climate. Increased education means increased expenses. Tax payers are already paranoid they are being ripped off by health care, they are not going to be keen on yet another added expense. So far the argument "It works for the following X number of countries" has gotten us absolutely no where. Trying to use that argument to expand EMT education will fail miserably. I honestly don't know how we would ever be able to convince people that the change is needed because it is what is right, and not because of some grand scheme.

I'm not saying it's right, just that that is how people are going to see it.

 

[VentMedic]

Tax payers are paranoid they are being ripped off.

Ripped off? What about Medicare and John Q Public paying $600 - $800 for a BLS "taxi" ride where the providers can only do basic first aid and O2?

Residents in Florida and other parts of the country have been educated at election time about the difference between ALS and BLS or what the advantages of having a Paramedic on a truck can be.

 

[Aidey]

That line should have read "Taxpayers are paranoid they are being ripped off by the current reform". I'm not sure what happened to the rest of the sentence. Oops.

I was referring to the general feeling of getting screwed that everyone has when it comes to paying money to the government. Not anger over a specific issue, if that makes sense.

Obviously there are some issues with the cost vs what that money is really paying for. I don't disagree at all that in every aspect of health care there disproportionate payments for the service rendered (either over payment or under payment). Many people are uneducated though, and just generally hate paying taxes, no matter what they are for.

 

[VentMedic]

That line should have read "Taxpayers are paranoid they are being ripped off by the current reform". I'm not sure what happened to the rest of the sentence. Oops.

I was referring to the general feeling of getting screwed that everyone has when it comes to paying money to the government. Not anger over a specific issue, if that makes sense.

Obviously there are some issues with the cost vs what that money is really paying for. I don't disagree at all that in every aspect of health care there disproportionate payments for the service rendered (either over payment or under payment). Many people are uneducated though, and just generally hate paying taxes, no matter what they are for.

How does your state set up its tax distribution for EMS? Districts? Statute allocation? State ammendment?

How much do EMS providers know about how reimbursement works and what part of their funding comes from taxes or tax statute allocation?

Sometimes it seems some in EMS are less educated about these issues than the public who are concerned about their taxes. In areas like AZ and FL, senior citizen groups educate each other. The AARP does a great job in some of its publications. Some of the state websites are also great at providing information for their citizens. How many EMS providers even look at their state websites to see what legislation is pending next that might affect them.

How about just the levels for EMS providers? How many EMS providers even understand the levels within their own practice to explain to each other about getting a certification? From some of the posts on the various EMS forums, that even seems to be an issue with the instructors not knowing or not explaining it.

Very few EMS providers know enough about tax bills or EMS to even educate each other or the public about EMS.

 

[Shishkabob]

If you're going to diss the system, atleast get it right.

Your BLS consists of zero medications (again, local differences aside please!), our BLS consists of at least eight different medications with no "medical control" required.

Even WITH local differences aside, most Basics can still give a handful of drugs, none with med control required. Epi, nitro, oxygen, ASA, Glucose, albuterol, and one other I cannot remember for the life of me because now as a medic student I can give them all.

Let me say that again... Epi and nitro. Those aren't small drugs like Oxygen. Is it right that they should be able to give drugs that have such a profound impact without the necessary diagnostic equipment and education? Yes and no. Depends on the circumstance.

Every patient is entitled to competent, thorough and knowledgable assessment and treatment of a proper, first world standard not some archaic 120 hour course flooze where the only two interventions he can possibly provide are an oxygen tank and a toaster.

And this is something else that irks me.

It's one thing if you say a new grad with no further education, but QUIT combining all basics into one group and calling them uneducated.


News flash-- I'm a basic and I'm 1 class day from my final. Daedulus is a basic. L4L is a basic.

Hell, JPINIV is a basic. Is he not knowledgeable?

Don't lump people together. Diss the education, don't diss the people receiving it.

Now, let's look at the much hearalded EMS Agenda for the Future National Scope of Practice Model:

EMT: Oxygen, aspirin, oral glucose, oral analegsia (tylenol?)

A-EMT: IV fluid, GTN, D50, naloxone, salbutamol nebules

Now, let's look at some first world, twenty first century EMS models of "basic life support":

NSW (Australia): Oxygen, adrenaline, D10, glucagon, GTN, aspirin, midazolam, salbutamol, methoxyflurane, ipatropium, promethazine, fentanyl

New Zealand: Oxygen, methoxyflurane, entonox, aspirin, paracetamol (tylenol), zofran, salbutamol, ipatropium, glucagon, GTN

Canada (NOCP): Oxygen, entonox, salbutamol, aspirin, GTN, glucagon, adrenaline

Does anybody see a difference here?

Until you guys abandon the archaic, long outdated misconception of your "BLS vs ALS" then I'm afraid the people who truly suffer will be your patients.

Yes. The difference is your "Basics" can start IVs. If ours, as a whole, could start IVs, they'd be able to give more drugs. (Don't make the assumption I'm saying give all basics ability to do IVs...)






Disclaimer-- Always for requiring more education.

 

[JPINFV]

Every patient that goes to the ED is eventually seen by the physician or PA. Why does EMS think that just because someone stubbed a toe, they should get seen by the lowest level provider?

Two major differences. First off, the vast majority of PA's charts are going to be signed off by a physician. Second, unless you're in the middle of BFE where (rarely, but it happens) the PA is working as coverage in a single coverage ER, the response time of an emergency physician if something goes bad is going to be measured in seconds, not minutes.

 

[JPINFV]

News flash-- I'm a basic and I'm 1 class day from my final. Daedulus is a basic. L4L is a basic.

Hell, JPINIV is a basic. Is he not knowledgeable?

Don't lump people together. Diss the education, don't diss the people receiving it.

Sure, there are plenty of knowledgable basics out there. On the other hand, you can design a scope of practice and protocol based on the cream of the crop.

 

[VentMedic]

It's one thing if you say a new grad with no further education, but QUIT combining all basics into one group and calling them uneducated.

News flash-- I'm a basic and I'm 1 class day from my final. Daedulus is a basic. L4L is a basic.

Hell, JPINIV is a basic. Is he not knowledgeable?

How many of the EMTs in your service are in med school?

How many have at least 2 semesters of real college level A&P?

Do at least 1/3 of the EMTs hold at the very least an Associates degree? If I remember correctly, there aren't that many Licensed Paramedics in TX with an Associates to where they can get the extra patch.

Let me say that again... Epi and nitro.

How many states allow at least nitro to be carried by the EMT to be given and NOT just assisting the patient to take theirs?

Yes. The difference is your "Basics" can start IVs. If ours, as a whole, could start IVs, they'd be able to give more drugs. (Don't make the assumption I'm saying give all basics ability to do IVs...)

Now that is a really frightening thought with the minimum hours for the EMT training. What meds to you want them to push IV if they do not have a cardiac monitor? Adenosine? Atropine?

You are also contradicting yourself. You talk about all the PO meds and IMs you want the patient to take but yet, they have no IV or any other med to counteract the adverse effects of a med.

Medications and IVs should be left to providers to can do more than just a "skill". Just giving a med takes very little skill. It is know when and when not to and what to do if you did when you shouldn't.

This half-arsed piece mill "skill" mentality is what has gotten EMS to this crappy mess with over 50 different certs and no consistency for Medical Directors and legislators to even determine what some can or should not do.

You should not just expand the EMT education with 2 hours of training at a time for each little skill they feel they are "entitled" to do.

 

[zmedic]

I think it is important to differentiate between skills that EMTs would be using on their own versus as part of an ALS ambulance. When I worked in CO I was the basic partnered with a medic. Because I had been certified to start IVs, I could do that while the medic was taking a history, drawing up meds etc. So we had the monitor, had the drugs, but if the EMT can't do the skills they basically just do vital signs while the medic has to do everything. If an EMT can start IVs and do the monitor you can run a code with a medic, an EMT and a FF to do compressions.

With the shortage of medics and the expense of training them it makes sense to have better trained EMTs with a medic rather then trying to fund double medic trucks.

 

[Shishkabob]

I'm on my iPhone and as such can't type out a whole reply till later tonight.


Vent, you and I are already in almost total agreement, you're just taking what I said to be a "give basics more skills" argument, which it's not.

Few months ago in he "Should basics get ivs" thread, we were on the Dane page. As a general rule you should not have a skill that you can't fix if you screw up, like fluid shift balances and the like.




Were on the same page with that, Vent. I'm just doing what I've been doing for the past year: Argue and correct anyone who lumps all providers into one catagory. Sorry, all basics aren't equal and aren't uneducated, and anyone who says the contrary is wrong and I'll argue with them.


As I said in the other reply: I'm all for more education.

 

[VentMedic]

With the shortage of medics and the expense of training them it makes sense to have better trained EMTs with a medic rather then trying to fund double medic trucks.

Shortage of medics? Expense of training?

If they went to a state community college, 40 cr/hours x $25 - $75 dollars is not that much. Of coures it they went to a medic mill, the cost is $12K - $20k for a few hundred hours of training.

We have more medics than we know what to do with. Every FF and every FF applicant is a Paramedic in some parts of the country. We have no less than 6 on every scene. If you go into almost any of our McDonalds or Burger Kings you may find 1 or 2 employees who have had their Paramedic cert for a few years while trying each year to get on at a FD along with a couple thousand others who may also be Paramedics.

The best partnership is 2 Paramedics or Paramedic/RN so you can discuss some different approaches to patient care.

 

[VentMedic]

As I said in the other reply: I'm all for more education.

Agree with you always Linuss.

 

[DrParasite]

this discussion (as it always does) pretty much falls long certain lines: those who are medics think that EMTs can't do anything right, and every patient needs a medic JUST IN CASE they are suffering from an asymptomatic potentially ALS emergency, and EMTs who understand that most 911 calls aren't life threatening emergencies, and even those that are, they can be handled with BLS treatments until ALS arrives.

I don't think that BLS should get drugs, nor should they get IVs.

There are stupid BLS providers. There are stupid ALS providers. both can screw up an assessment and both can kill a person.

Do dying people need ALS? YES! No one is arguing this fact.

however, your AAA abdominal pain, does he need ALS? well, if he hemodynamicly stable? so what is ALS going to do aside from take a ride to the hospital?

I was taught that ALS is for acute life-threatening emergencies, where they could actually do something to resolve the problem.

most trauma's don't need ALS (bright lights and cold steel save trauma injuries, not ALS), saline and ringers don't carry oxygen. Ensure the patient has an airway and transport to a trauma center (and if not, then call ALS or use an OPA and a BVM).

your old guy with a fever does not need ALS. if the guy has had a fever for the past 3 days, waiting another hour for an IV to reverse his dehydration won't kill him. your simple arm fracture doesn't need pain meds prehospitally. he won't die during the 30 minute transport time to the hospital (some would argue he doesn't even need an ambulance, just take him in the car to the ED). and for many of your dispatched BLS emergencies, all they need is a ride to the hospital (or to their doctors office), not anything do be done to the other them before they get there.

if EMS dealt with 80% of actual life threatening emergencies, then I would agree with you that everyone needs an ALS emergency. but when that number is closer to 20% (which is pretty close to most areas), then a BLS truck is just fine.

 

[DrParasite]

If you go into almost any of our McDonalds or Burger Kings you may find 1 or 2 employees who have had their Paramedic cert for a few years while trying each year to get on at a FD along with a couple thousand others who may also be Paramedics.

woooooow. after all that hard work getting your paramedic cert, you can be qualified to work at a McDonalds or Burger King? I know there is a joke there somewhere...

every PA in the US needs hundreds if not thousands of patient contact hours before they can even apply to PA school. most nursing programs require, or at least recommend patient contact hours.

as for doctors not needing any prior experience, that is correct. and how many first years residents are absolutely clueless? what about second year? how many nurses can run circles around a first year resident? By the third and forth year they tend to develop a good idea of what is going on, and many still go for a fellowship (another year in one specialty) before they are considered "experts." 4 years of undergrad over a broad spectrum of stuff, 4 years focused on med school solely on medicine, and they still need another 3 to 4 years before they are given the green light to operate on their own. hmmm, imagine that, it takes them 10+ years before a doc can go from knowing nothing to an expert, and some only require 2 years (or a few months at a medic mill) to become an expert at prehospital care. funny how that works out...

 

[medichopeful]

this discussion (as it always does) pretty much falls long certain lines: those who are medics think that EMTs can't do anything right, and every patient needs a medic JUST IN CASE they are suffering from an asymptomatic potentially ALS emergency, and EMTs who understand that most 911 calls aren't life threatening emergencies, and even those that are, they can be handled with BLS treatments until ALS arrives.

Why shouldn't everybody get ALS? A person with a seemingly minor injury or illness could potentially benefit more from having ALS than they could from having BLS. That's a hard fact to argue against. If the patient starts to go downhill from something the EMT/Paramedic missed, who will be able to do more? A basic? Or a paramedic? It's not a trick question. EMS should NOT be about doing the bare minimum; it should be about doing what is BEST for the patient. And ALS can do a LOT more good than BLS can. ALS personnel can do BLS skills. BLS personnel can NOT do ALS skills. Keep that in mind. A paramedic could start out treatment at a BLS level, and elevate from there if needed. A EMT-B can start out treatment at a BLS level, but after that the patient's in trouble.

I don't think that BLS should get drugs, nor should they get IVs.

I'll completely agree with you here, except for oxygen (it's a drug) and Epi-Pens.

There are stupid BLS providers. There are stupid ALS providers. both can screw up an assessment and both can kill a person.

The paramedic will have a lesser chance of screwing an assessment up, and a greater chance of fixing it if it happens.

Do dying people need ALS? YES! No one is arguing this fact.

Not everyone who calls 911 is dying. ALS can do more than just save a life. Think pain management.

however, your AAA abdominal pain, does he need ALS? well, if he hemodynamicly stable? so what is ALS going to do aside from take a ride to the hospital?

Remember, if a paramedic can't treat a certain illness or injury, they can provide WAY more supportive treatment than a basic can.

I was taught that ALS is for acute life-threatening emergencies, where they could actually do something to resolve the problem.

I was taught something similar, but things need to change. Just because we are taught something does NOT mean that it is correct.

most trauma's don't need ALS (bright lights and cold steel save trauma injuries, not ALS), saline and ringers don't carry oxygen. Ensure the patient has an airway and transport to a trauma center (and if not, then call ALS or use an OPA and a BVM).

Keep in mind what I said above. A paramedic can do an assessment much better than an EMT-B, and may find out that that trauma that didn't need ALS really did. Also, remember that a paramedic can start out at a basic level (OPAs and BVMs), but can elevate it when needed.

your old guy with a fever does not need ALS. if the guy has had a fever for the past 3 days, waiting another hour for an IV to reverse his dehydration won't kill him.

All fevers are caused by dehydration?

your simple arm fracture doesn't need pain meds prehospitally. he won't die during the 30 minute transport time to the hospital (some would argue he doesn't even need an ambulance, just take him in the car to the ED).

Part of patient care is patient comfort. Though I've been lucky and I've never broken anything, I imagine it's not too comfortable. If you're in pain, do you want to just ride to the hospital? Car rides and ambulance rides can be bumpy. Wouldn't you like relief of your pain ASAP?

and for many of your dispatched BLS emergencies, all they need is a ride to the hospital (or to their doctors office), not anything do be done to the other them before they get there.

if EMS dealt with 80% of actual life threatening emergencies, then I would agree with you that everyone needs an ALS emergency. but when that number is closer to 20% (which is pretty close to most areas), then a BLS truck is just fine.

Have a basic be the tech in the ambulance, and have the paramedic just be there if this is the case. But have the paramedic do an assessment as well, or expand upon the basics, before making this determination.

 

[medichopeful]

some only require 2 years (or a few months at a medic mill) to become an expert at prehospital care. funny how that works out...

2 years barely makes one an "expert" at medicine...

 

[VentMedic]

woooooow. after all that hard work getting your paramedic cert, you can be qualified to work at a McDonalds or Burger King? I know there is a joke there somewhere...

The Paramedic is not that difficult to get and doesn't require many "hours of training". This is why FDs have little doubt in getting all their FFs certified. The "joke is" that few want any part of medicine or want to be a Paramedic. Some would prefer to work at places that don't involve health care until they are hired on at the FD.

Guess where that puts the EMT?

however, your AAA abdominal pain, does he need ALS? well, if he hemodynamicly stable? so what is ALS going to do aside from take a ride to the hospital?

I was taught that ALS is for acute life-threatening emergencies, where they could actually do something to resolve the problem.

most trauma's don't need ALS (bright lights and cold steel save trauma injuries, not ALS), saline and ringers don't carry oxygen. Ensure the patient has an airway and transport to a trauma center (and if not, then call ALS or use an OPA and a BVM).

your old guy with a fever does not need ALS. if the guy has had a fever for the past 3 days, waiting another hour for an IV to reverse his dehydration won't kill him. your simple arm fracture doesn't need pain meds prehospitally. he won't die during the 30 minute transport time to the hospital (some would argue he doesn't even need an ambulance, just take him in the car to the ED). and for many of your dispatched BLS emergencies, all they need is a ride to the hospital (or to their doctors office), not anything do be done to the other them before they get there.

if EMS dealt with 80% of actual life threatening emergencies, then I would agree with you that everyone needs an ALS emergency. but when that number is closer to 20% (which is pretty close to most areas), then a BLS truck is just fine.

I was wondering how long it would take before you expressed you anti-ALS viewpoints.

As I and others have told you on another forum, your remarks just illustrate why an EMT is NOT qualified to care for medical patients. YOU have very little to NO understanding of medicine. YOU attempt to glorify the EMT into something it is not because YOU do not want the responsibilty that comes with being a Paramedic. If YOU were to actually advance your education you would see just how ridiculous your statements are. It is because of EMTs like YOU who make such uneducated assumptions about medicine that the other EMTs who might have a clue are viewed with the same low opinions by other professionals.

I would say YOU are totally clueless as to how sick some of the patients you have transported really are and have absolutely no clue as to what a difference getting fluids started a little sooner than the ED can make.