First responders

[jafo]

OK TTLWHKR,
Just to be clear, I never said anything in my post about working outside the scope of practice for whatever level you are certified in. If you read the CFR maunal, then read the Basic manual, you will see that the major difference is the amount of anatomy, medical, pulminary, and circulatory information and explaiantion given. My goal is to UNDERSTAND as much as possible to make good decisions WITHIN my scope of practice. Right now I review every call I go on with the lead EMT to learn how he/she made their decisions, what they observed, how they made determinations, etc. It is a constant learning experience. It teaches me how to think and what to look for in the patients best interest.
The beef you present can happen at any level, but the example you provide happens to deal with first responders in your State. I hope PA can get it's act togehter for the sake of the public it serves. In New York, it is very clear where the lines lie, and I have no intention of crossing that line. As you have clearly shown, when you cross the line, everyone loses.
As for the National Scope of practice, that is a different argument. Your state may gain from it, (and that is good), but many states that have kept up with the times will take a step back if they sign on to it.
Just my 2 cents.

 

[Jon]

Originally posted by TTLWHKR@May 3 2005, 09:28 AM
I forgot to mention...

The main reason for loss of licensure was that they had an airway bag set up w/ BVM's, assorted airway equipment including some odds & ends of ET Tubes, Laryngscope and Combi-Tubes. The Combi-Tube is not approved for EMT's in the Comm. of PA. The FR's stated in their testimony that EMT's were allowed to because they read about it in JEMS. The articles was from another state.

I think prior to our arrival, they had attemped to intubate the patient, who taught them to do that I have no idea. But it was a very bad situation. When we checked the equipment on our trucks, they had gotten rid of most of the stuff we had on there and replaced it with a slew of stuff they weren't trained to use. Which is how I found out what eBay was. They had sold our equipment on eBay to buy their "Paramedic gear".

Who ever taught them to be Jr. Paramedics did a good job, but sometimes I wish they has stuck to the basic stuff b/c their help is missed on many calls.

OK.

You originally said something about Epi... could they give Epi for a code?

Jon

 

[Jon]

Originally posted by jafo@May 3 2005, 09:38 AM
OK TTLWHKR,
Just to be clear, I never said anything in my post about working outside the scope of practice for whatever level you are certified in. If you read the CFR maunal, then read the Basic manual, you will see that the major difference is the amount of anatomy, medical, pulminary, and circulatory information and explaiantion given. My goal is to UNDERSTAND as much as possible to make good decisions WITHIN my scope of practice. Right now I review every call I go on with the lead EMT to learn how he/she made their decisions, what they observed, how they made determinations, etc. It is a constant learning experience. It teaches me how to think and what to look for in the patients best interest.
The beef you present can happen at any level, but the example you provide happens to deal with first responders in your State. I hope PA can get it's act togehter for the sake of the public it serves. In New York, it is very clear where the lines lie, and I have no intention of crossing that line. As you have clearly shown, when you cross the line, everyone loses.
As for the National Scope of practice, that is a different argument. Your state may gain from it, (and that is good), but many states that have kept up with the times will take a step back if they sign on to it.
Just my 2 cents.

Very well put

 

[jafo]

Whkr,
I just saw your additional post. Sounds to me like whoever was leading this crew was not doing his/her job very well. There is just no excuse for this type of situation. I say this mostly because it was not someone making an on scene decisiion to exceed their Scope in order to save a life, but it was clearly premeditated by the purchase of gear they could not use legally.

And there is no clicical time for EMT's in PA?! Wow, I thought that was a no-brainer. I'll be driving a lot more carefully in that State from now on.

To close this out, we all need to be the best we can be if we expect to be treated and respected as care givers. Every profession has it's clowns, and we have ours to be sure. But it behooves all of us to do what we can to weed those clowns out, no matter how well meaning they may be.

 

[TTLWHKR]

Originally posted by MedicStudentJon+May 3 2005, 09:41 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (MedicStudentJon @ May 3 2005, 09:41 AM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-TTLWHKR@May 3 2005, 09:28 AM
I forgot to mention...

The main reason for loss of licensure was that they had an airway bag set up w/ BVM's, assorted airway equipment including some odds & ends of ET Tubes, Laryngscope and Combi-Tubes. The Combi-Tube is not approved for EMT's in the Comm. of PA. The FR's stated in their testimony that EMT's were allowed to because they read about it in JEMS. The articles was from another state.

I think prior to our arrival, they had attemped to intubate the patient, who taught them to do that I have no idea. But it was a very bad situation. When we checked the equipment on our trucks, they had gotten rid of most of the stuff we had on there and replaced it with a slew of stuff they weren't trained to use. Which is how I found out what eBay was. They had sold our equipment on eBay to buy their "Paramedic gear". 

Who ever taught them to be Jr. Paramedics did a good job, but sometimes I wish they has stuck to the basic stuff b/c their help is missed on many calls.

OK.

You originally said something about Epi... could they give Epi for a code?

Jon [/b][/quote]
It wasn't a code; it was a bee sting. The patient was unconsious. They were following the Basic EMT Protocols, as instructed by the DOH. So I guess I blame them too, they tend to explain things, but not get the point across. Like me.

I didn't say you did work out of your scope, I meant that I would rather have them not know what to do because in a bad situation they may feel the need to do more. Which they did.

And I found these. http://www.smemsc.org/Scope%20of%20Practice%207-04.htm


If they did all of that now, except for the combi-tube part and the EPI-they probably would have gotten away w/ it and just one guy put on probation.

In Pennsylvania; it is *NOW* legal for FR's to use oro/Nas airways, oxygen, BVM; the mention of combi-tude is application of the BVM to the tube and venting. I guess that would be covered by the new ALS Assist class. In fact, looking at it now, I think the only skills they do not have are Pt/Ast/Meds, Rapid Ext; and Helmet Removal. I think the Ambulance Attendant has the skills a FR used to have.

Thank gawd for google.

And they were led by a FR. It was a FR Squad... We just bought First Aid Bags and the Truck.. A 120,000.00 truck gone to waste. Made a good brush truck after that though.

 

[Lisa]

Our small county has just recently (within the last year) Started utilizing MFR's./ We only run one county owned ambulance and it helps cut down response times. We have response times up to 20 minutes depending on which end of the county you live in. I personally like FR as long as they know what they are doing and they are reliable. We have some that always get a crazy BP and pulse, but for the most part it has helped our community out. Some patients like just knowng someone is there. I am in a Vollie Fire Dept. so we run all our FR's out of it. However, I also have my EMT-IV license but am not currently working due to my pregnancy. Responding as a FR helps me keep my skills fresh and gives me good practice.

 

[rescuecpt]

Originally posted by Lisa@May 3 2005, 10:31 AM
Our small county has just recently (within the last year) Started utilizing MFR's./ We only run one county owned ambulance and it helps cut down response times. We have response times up to 20 minutes depending on which end of the county you live in. I personally like FR as long as they know what they are doing and they are reliable. We have some that always get a crazy BP and pulse, but for the most part it has helped our community out. Some patients like just knowng someone is there. I am in a Vollie Fire Dept. so we run all our FR's out of it. However, I also have my EMT-IV license but am not currently working due to my pregnancy. Responding as a FR helps me keep my skills fresh and gives me good practice.

Does your FD have EMTs? I'm confused as to why you could FR while pregnant but not EMT?

 

[Luno]

Hmmm, I don't really have experience working with FRs, however, OECs are another matter, and I think kind of on the same page as FRs. Hey, JAFO, welcome, ex-mil?

 

[jafo]

Intersting comment Luno. (No I'm not ex-mil, but I am sympathetic to them and some of my best firends are.) OEC's do get similiar training to CFR's, but I only spent 2 nights reading the OEC book, so I coudn't really make a comparison. My opinion (here's where I get in trouble) is that much like LEOS, OECs have a 'higher calling' if you will in that they serve the public on the mountain and the medical side is sometimes secondary. However, I know several OECs well that are also EMTs, and are very good at what they do. WFRs can also be the same way, but most WFR's that I know are very dedicated to their skills and their patients. They usuually are search and rescue types. Now I know, based on your location (Long Island, Right?) that you don't have any WFRs down that a way (I lived there for 30 years). WFRs and WEMTs work to a VERY different set of protocols and do things as a rule that a street EMT would never do unless he absolutely had to (such as reducing fractures before splinting.) The Wilderness types generally have their patients for much longer periods and have to handle issues like ongoing care, infection control, much better patient packaging, etc.
Even so, your milage varies with every skill set and every individual. Thats why we have protocols, isn't it?
Be safe.

 

[jafo]

Sorry Luno, I just checked your location and see that I was off by a mere 3,000 miles. I guess you very well might know some WFRs after all. I had you confused with someone else. Sorry.

 

[Jon]

What is an OEC? I'm lost.


Jon

 

[TTLWHKR]

Originally posted by MedicStudentJon@May 3 2005, 07:12 PM
What is an OEC? I'm lost.


Jon

Outdoor Emergency Care?

 

[TTLWHKR]

Originally posted by TTLWHKR+May 3 2005, 08:38 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>QUOTE (TTLWHKR @ May 3 2005, 08:38 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MedicStudentJon@May 3 2005, 07:12 PM
What is an OEC? I'm lost.


Jon

Outdoor Emergency Care? [/b][/quote]
Yes, I think that's right. The text I use to instruct Wilderness First Aid is called "Outdoor Emergency Care Instructor's Guide".

Sounds about right, eh?

 

[emt/fr]

I started out as a first responder a few years ago and i still do it. I deal with all of the responders in our fire district, some are great and some do very little. As far as training goes there isn't much difference here between fr and emt-b. I am pretty sure there still is a fr liscence in the state of wisconsin, because you still have to take the refresher course every two years.
You have to remember that some of these people have very few calls and could use some more frequent refreshing on thier skills which should be up to thier coordinator. If you have a problem maybe you should contact them and offer your time to help refresh them and tell them what you expect from them when they are on scene.

 

[Luno]

JAFO, I asked because of your name, it is a mil joke, an old one... Anyway, back to OEC, I'm not sure that I understand the "higher calling" of the OEC, I've worked Pro Ski Patrol (NSP) and medical was alway in the forefront. Granted there are additional things, but medical was primary. OEC was probably my only exposure to FRs, other than some other Pros were WFRs.

 

[jafo]

Yeah Luno, I know the acronym, and thats why I chose it. It fits, for the most part.

My comment about the higher calling was probably poorly worded. What I meant was that many OEC (Outdoor Emergency Care) patrollers started out as straight Ski patrollers, and added the medical later.I do know that the OEC focuses strictly on what happens at Ski areas and sports activity. We have a squad about 3 towns from us that services a Ski area. One of the EMTs there is ex-mil with a lot of experience. Every once in a while I hear him mumbling about how patients are treated and packaged before he gets them. Maybe I'm taking it out of context, I dunno. The point was that no matter what level, you can always have some who are not at the top of their game. I'm not trying to single anyone out, because I am bound to have a bad day too sometime.
I wish that the WEMT course were more available in our area, and not quite so expensive. The only way to get it here is to travel somewhere else, lay out a lot of bucks and stay at the course site for extended periods. The bridge from EMT to WEMT is a 6 day course I think. I also wish that the state recognized it at the same level as the EMT. Our State EMS system does not even mention it as far as I can find. The State DOH does recognize it for Wilderness Guides and Camp Staffs, etc. There currently are no state protocols for WEMT in New York, and as TTLWHKR has shown us, not having protocols is a very bad thing.
Be Safe

 

[TTLWHKR]

If a state does not have thier own W-EMS Protocols, there are national protocols

Wilderness First Aid: 16 Hours
3 Year Cert Period

Wilderness Advanced First Aid: 14 Hours
3 Year Cert Period

Wilderness First Responder: 34 Hours
3 Year Cert Period

Wilderness Emergency Medical Technician: 64 Hours (6 Days)
3 Year Cert Period

Wilderness Emergency Medical Services Institute
http://www.wemsi.org/index.html

CDS Outdoor Schools Inc.
http://www.cdsoutdoor.org/

 

[jafo]

I was refering to treatment protocols, which for Wilderness situations is very different from what a street EMT would do.

 

[Lisa]

Rescuecpt......
Our Fire Dept does not have EMT's...I think there are only maybe 3 or 4 of us that are EMT's. I am not currently working due to my pregnancy ( I am 8 weeks away from my due date) The county in which I live can not take the laibility...which i can understand. I do however respond as a first reponder if it is close to my house or they need an extra set of hands. My husband is also in the Fire Dept so alot of the times I just ride in with him. It has helped me keep my skills up as well as getting to know all the crews very well. OUr Dept is strictly Vollie, so they don't really say much as far as me responding as a first responder. I have also had some complications so I haven't been responding as much in the past month or so.

 

[Chimpie]

Lisa, are you saying that even though you are an EMT, when you respond for the fire department you only serving as a First Responder? As in the fire dept doesn't allow EMT care to be provided?