Finally ! Someone who cares about BLS and EMT's

[JPINFV]

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.

Clinical experience, while preferred, is not required

http://prospective.westernu.edu/physician-assistant/requirements

Applicants must demonstrate health care experience sufficient to develop an understanding of the PA profession, the health care environment, and their own aptitude for the PA profession. Experiences should include shadowing a PA and work and/or volunteering in which responsibilities involve fairly extensive direct patient contact. Direct patient interaction is valued most highly by the admissions committee. Recent successful candidates have had hundreds of hours of work and/or volunteer experience. The program does not set a minimum number of hours of health care experience. Volunteer work is valued as highly as paid work.

emphasis added.
http://www.physicianassistant.wisc.edu/admissions.htm#criteria

Bayor University does not mention HCA at all.
http://www.bcm.edu/pap/?PMID=6194

Prior patient contact experience is considered desirable and applicants with such experience will be given priority consideration but not to the exclusion of applicants without such experience.

http://shrp.umdnj.edu/programs/paweb/admissions/AdmisReqCASPA.html

Hyperbole much? Sorry, not all PAs need prior HCA before applying. Saying that is like saying that all medical students need HCA and research prior to applying just because the vast majority of them do.

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...

Are you really going to compare paramedicine to surgery? Heck, I wouldn't even compare medicine to surgery in terms of the amount of training needed. Similarly, as far as residency goes, it's not like residents go from 100% supervision to 0% supervision overnight when they graduate. Plenty of residents moonlight in double or triple coverage ERs where they are operating with less oversight than they do when working in their residency.

 

[daedalus]

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.

Actually, only around about 20% of charts done by most PA-Cs are signed off by physicians in most states. The number of charts needed to review are getting smaller, and in some states the only supervision requirement is meeting once a month with the supervising physician. I know of a PA who accomplishes this by a round a golf with is supervising physician.

Of course, there are levels of competency. A new grad PA who lands a EM job will present most cases to his/her attending, where as a residency trained PA with a few years of additional work experience may only have to ask a few questions a month.

 

[JPINFV]

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.

So you were to go to the hospital, you would be OK with the ER tech being the sole person in charge of your care, including assessment, treatment interventions, and disposition?

 

[JPINFV]

Actually, only around about 20% of charts done by most PA-Cs are signed off by physicians in most states. The number of charts needed to review are getting smaller, and in some states the only supervision requirement is meeting once a month with the supervising physician. I know of a PA who accomplishes this by a round a golf with is supervising physician.

Of course, there are levels of competency. A new grad PA who lands a EM job will present most cases to his/her attending, where as a residency trained PA with a few years of additional work experience may only have to ask a few questions a month.

I stand corrected, how ever, 20% review and feedback is much more review than I've ever gotten on any of my EMS charts.

 

[daedalus]

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?

With the EMT's very limited ability to take a history, preform a effective physical examination, and synthesize the information, how will an EMT know if a patient has a AAA? Does an EMT understand the predisposing factors for AAA, and the exam and history findings?

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).

You are not wrong about some of this, but it does not mean that trauma patients do not deserve paramedic response and care. Paramedics should have better refined BLS skills and a better understanding of trauma patients so that serious situations are recognized and evidence based care is initiated. I spent more hours in the trauma lectures for my class then total amount of hours in the entire EMT program.

10 characters. See above, my responses in bold.

 

[zmedic]

The argument that a medic can provide a better assessment than an EMT isn't the question. The question is "can we figure out using dispatch protocols which patients can be handled by EMTs, who can then call in ALS if needed." Sure it would be great to just have paramedics on every ambulance and fire truck. Better yet, why don't we have doctors instead? It cost more to train a medic, and a heck of a lot more to pay them. Look at the difference between yearly salary for medic and an EMT.

What we really need is more research. There has been some evidence that trauma patients do better with BLS rather than ALS. Now it isn't conclusive but the evidence suggests medics tend to do more on scene (airways, IVs) rather than rapid transport. But we need to look at a lot of different scenarios. If the evidence comes out that with appropriate EMD there is no difference in survival or morbidity having some patients cared for by BLS v an all ALS system, then we'll move that way.

With healthcare reform things are going to change. There are already places where the ambulance services or FDs are saying "we can't pay two medics each $45K a year to run a double medic ALS truck, we need to figure out something else that works."

 

[piranah]

RI explanation to the question above is the EMT-Cardiac....a porely trained protocol junkie...that has a 6 month education and can give 90% of medic drugs....trust me..look at RI and see you dont want that..I just recently became a medic from Basic and i have to say..during my training...I had no idea as a Basic..truly...Basics have a vital role but when it comes down to it a paramedic has the training,critical thought process, and the clinical experience(the actual "clinicals") that a Basic just does not have....the reason I became a medic was because i wanted to be the best in EMS, go to the top and bust my ***..be the "best i could be"..(i know im sorry).....and that entailed me getting my medic license....and that "simple temp" has a lot more going on than you think....

 

[Sasha]

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.

Hello sepsis! So nice to meet you!

Obviously you've never responded to a nursing home to find a patient who'se had a fever "for three days" ready to code on you! Sepsis has an abysmal survival rate, the earlier you can start treatment, the better. How do you know from dispatch it's JUST a fever and they're not septic? Do you know how to assess someone for sepsis? Sepsis is a serious life threatning emergency that DOES require ALS.

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).

No patient should be needlessly left in pain just because you have an inflated sense of self importance and think "you can handle it". Pain in itself can have adverse effects on the body and raise their anxiety level worsening their problem.

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.

You think that, at the BLS level, with your BLS assesments, without knowing the ALS scope and capabilities and how to do an ALS assesment. You want to be able to handle medical problems? Go to paramedic school.

I can't imagine how anyone would be satisfied with years and years as an EMT. Even at the paramedic level, I get frustrated with how little I can do to help the patient and how little I actually know. I couldn't imagine dealing with the patients I deal with at the basic level ever again.

 

[MrBrown]

The whole "BLS vs ALS" argument is really an American thing, why, because America in its infinate wisdom is the only first world nation on earth that I know of which still subscribes to the long outdated, purist "basic life support" notion of the 1970s!

If we compare "BLS: American style" to the rest of the world, it's probably left in about 1990.

If you think a "BLS" response is appropriate because 'all the patient needs is ride to the hospital" than you are sadly mistaken. Sub acute patients are much more intellectually demanding to diagnose, require a much higher level of knowledge and skill and are 100x more challenging than something like a cardiac arrest.

Now let's be honest with ourselves, you can write down what you need to do for a cardiac arrest on one side of A4; ask the Resuscitation Council and American Heart Assocation, they've done it. You try writing down on one side of A4 what you need to do for a patient who presents with "my tummy hurts" - can't be done.

I am not talking "skills" here, sure this really could turn into a pissing match where we hold up all the other systems in the world and look at thier long lists of skills and Degree and Masters and Post Graduate qualifications then hold up the American system of an oxygen tank and a toaster.

But that's a symptom of the disease.

Far be it from me to say what you guys need because I am not up on the intracacies of your totally discombobulated system but here's a few notions that would fix up this "BLS vs ALS" argument once and for-all

- Proper, federal level oversight; so long NHTSA!
- Proper funding
- One, national professional body
- At most, a handful of national industrial bodies, like the IAFF

 

[CAOX3]

Interesting discussion, how many times can we discuss the same topic?

Everybody for the most part in the US is under educated including the triage nurse with an associates degree.

If you haven't sat in a traditional university such as in Canada for four years then you have no business even arguing the point.

Only in America would a person with 6 months of training argue with someone with 9 months about who is more prepared to handle a life threatening emergency.

 

[piranah]

excuse me but i spent the last 2 1/2 yrs....to get my medic and it was more credit hrs a week than a full time student at university...ooo and the whole idea of being under educated. Well, no comment. It is all what you put into it because i know at university all the first 2 yrs is learning how to drink lol......

 

[BLSBoy]

It's not just the time spent in the traditional facility spent learning.

Learning from the school of hard knocks is a helluva teacher.
Learning from the crusty ol medics who are make a helluva teacher.
Not just being a rock, showing up, and going home.

More to it then just formal education, but that DOES make up a large part of it.

 

[Lifeguards For Life]

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.

Hey Doc, where do fevers come from?
(and only dr parasite...)

 

[JPINFV]

Hey Doc, where do fevers come from?
(and only dr parasite...)

Mother nature when not delivering her XX monthly special!

 

[Lifeguards For Life]

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.

Speaking from a medical standpoint (not a humanitarian standpoint) you're views expressed here tonight, have been some of the more ignorant opinions I have read on this forum.

Researchers have provided information that can improve the ways in which pain is assessed and treated. At the same time, they have described the previously unknown and negative long-term effects of pain. As a result, pain issues are taken much more seriously today than in the past. Acute pain causes a release of "fight or flight" stress hormones. These stress hormones cause a breakdown of body tissues, as well as an increase in heart rate and blood pressure. The end result is a strain on the immune system which can complicate the effects of injury and slow down recovery.

There has been an enduring belief that pain does not have long-term consequences. It is also falsely believed that babies and young children cannot remember painful events. These beliefs have resulted in the notion that pain in a young child is not important in their immediate or future development. However, researchers are accumulating information that indicates that these claims are false.

Some research now suggests that there are long-term consequences of pain in infants. This is especially the case for babies who spend a long time in hospital early in life and undergo many painful procedures without the benefit of any pain relief medication. However, researchers are also showing that the young child’s brain is very adaptable, or "plastic", in the way it deals with painful events. As a consequence, the brain is often able to find ways to compensate for these early pain events. Other research shows that babies who suffer a lot of pain from procedures early on without effective pain relief may go on to develop further pain as they grow older. They may also respond differently to pain during future pain events.

Acute pain in adults left untreated, can potentially turn chronic.

Now speaking from a humanitarian's view point, why would you want to deny a patient, who is in obvious pain, pain management? If you felt you were having any form of an emergency, and were in a substantial amount of pain, you would want measures taken to relieve your pain would you not?

 

[Foxbat]

At the same time, they have described the previously unknown and negative long-term effects of pain. As a result, pain issues are taken much more seriously today than in the past.

It is interesting that in Soviet/Russian medical literature it is widely recognized that pain is a major contributing factor of shock and one of the most important things in preventing and treating shock after trauma is pain management. In American literature I couldn't find much info about this. Can anybody explain what are the effects of pain on development of shock in case of major trauma?

 

[rescue99]

The "ALS/BLS" (where else in medicine is there ALS and BLS? Is there such a thing as a BLS physician?) divide is simple. Is this patient going to see a physician in an emergency room? Then the patient deserves at least an assessment by a paramedic due to the extreme difference in education, training, diagnostic tools and interventions between basics and paramedics.

Hip fracture patients and adults with high fevers can not be accomodated properly at the Basic level. The hip fracture patient may be best suited with meds for pain managment, the adult with a high fever may benefit from intravenous fluids and/ or medications.

Ahhh...spoken like a true rookie ALS is not needed most of the time but, it is handy to have when more intervention is necessary. IFT definately benefits from a higher skill level too.

I prefer teaching MFR, Basic EMT's and Specs hoping as they become Medics, they will not forget their roots. A great beginning generally makes a good Medic.

 

[ffemt8978]

It's been a while since I've had to to post this...


Play nice

 

[JPINFV]

Ahhh...spoken like a true rookie ALS is not needed most of the time but, it is handy to have when more intervention is necessary.

[I know... I used this line earlier, but no one likes answering this]

Would you accept going to the emergency room and having an ER tech examine, treat, and discharge you regardless of what your complaint was?

 

[rescue99]

[I know... I used this line earlier, but no one likes answering this]

Would you accept going to the emergency room and having an ER tech examine, treat, and discharge you regardless of what your complaint was?

Well, we often receive treatment from a practitioner other than a pahysician so I'd have to say the situation can dictate the course.