Future of EMS

AshWredberg

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Already ladies and gents,

I have to write a paper for my medic class about the future of EMS. This is an extremely broad topic, but the paper needs to be 2-4 pages in length. Any who, I am wondering if any of you would be willing to either suggest some ideas or offer some advice. For the experienced EMT's and paramedics, are there any devices that could benefit patient care if they could be portable in an ambulance, like CT scan? Any suggestions would be greatly appreciated! Thank you!

Ashlee
 

StCEMT

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Community Paramedics, that's easily a page or two depending on how in depth you want to go.
 

Carlos Danger

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Community paramedicine
National standardization
Changes in education (mandatory two-year degree for paramedics?)
Delivery models (private vs. municipal single-role vs. FD-based, etc.)
The impact of federal healthcare insurance regulation, etc.
 
OP
AshWredberg

AshWredberg

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Community Paramedics, that's easily a page or two depending on how in depth you want to go.
I love that topic unfortunately that is taken:(
My paper is more focused on creative ideas that would benefit ems in the future. Whether it be technology for treating patients or some other type of benefit.
 

ExpatMedic0

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I would check this document and look at what was purposed versus what is reality. http://www.ems.gov/pdf/2010/EMSAgendaWeb_7-06-10.pdf
Aside from that, an increase in education standards and folding EMS more into the overall healthcare system, which is going to become more integrated as a whole.
 

SpecialK

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The future of the ambulance service is in moving away from focussing on "emergencies" in the true sense to more unscheduled primary care.

Twenty years ago it might have been the norm for an ambulance to always be dispatched, and for the patient to always be transported to ED but that is certainly no longer the case and it will become increasingly less common. Ambulance personnel (including control personnel) will, and are, increasingly expected to make treatment and referral decisions in the "broader" clinical context rather than just "send ambulance, then decide if patient should remain at scene or go to ED".

As for technology and such there is lots of potential out there some of which is already being used such as blood, ultrasound, mechanical ventilation for patients having had rapid sequence induction, lactate measuring, portable CT scanning, and tele-medicine.
 

mgr22

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To the OP, just going with your original idea about new, portable devices, you could write about ultrasound as a prehospital diagnostic tool.
 

redundantbassist

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In an ideal world there would be national education standards- paramedic education increased, possibly to the equivalent of a bachelors or masters degree, to the point where providers are knowledgable enough to be able to make their own decisions under guidelines instead of following stringent protocols. Accordingly, there would be a decreased role or even complete removal of the EMT-B and AEMT in prehospital EMS.
 

Gurby

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You could write a lot about intubation. Whether paramedics should be doing it at all, whether only certain services should have it, RSI vs no RSI, video laryngoscopes, possibility of needing to meet a quota or do annual OR time to get tubes, comparing supraglottics to ETT's in different ways, etc.
 

46Young

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The dangers/burnout of 24+ hr shifts, how some EMS systems such as Charleston County and Greenville in SC have gone to 12's with a cap of 16, how ATC-EMS was moving towards the same. Related health effects, how you perform similar to an intox after 16 consecutive work hrs.

Or go the other way and report on how some of the west coast FD's have gone to the 48/96 schedule.
 
OP
AshWredberg

AshWredberg

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You could write a lot about intubation. Whether paramedics should be doing it at all, whether only certain services should have it, RSI vs no RSI, video laryngoscopes, possibility of needing to meet a quota or do annual OR time to get tubes, comparing supraglottics to ETT's in different ways, etc.
What is your standpoint on the situation?
 

SeeNoMore

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What is your standpoint on the situation?
I know I'm not the original poster , but IMO prehospital intubation should be reserved for a small number of highly educated AND experienced Paramedics. The program should be subject to strict and ongoing evaluation. That being said, even systems with high first pass success rates should be able to show that the procedure is beneficial to the patients they select for it. It is my suspicion that prehospital RSI will improve outcomes for certain patients, especially with extended transport times.
 

Gurby

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I know I'm not the original poster , but IMO prehospital intubation should be reserved for a small number of highly educated AND experienced Paramedics. The program should be subject to strict and ongoing evaluation. That being said, even systems with high first pass success rates should be able to show that the procedure is beneficial to the patients they select for it. It is my suspicion that prehospital RSI will improve outcomes for certain patients, especially with extended transport times.
Pretty much my view as well. On one hand, some patients will die without an ET tube (ie airway burns / laryngeal edema, etc). On the other hand, those patients are pretty rare, a lot of people don't intubate very often, and there is a ton of potential harm that can come from intubation.
 

SeeNoMore

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I agree. I am often struck by the fact that many Paramedics seem ill equipped to deal with the many elements of Intubation and RSI in particular. Even if you gather providers who possess the technical ability to atraumatically intubate the majority of patients they encounter , you then need to evaluate whether they possess enough education to safely intubate. Do they understand the relevant anatomy including positioning? Are they comfortable with effective BVM ventilation? Are they comfortable with a variety of airway devices (DL, Video, Surgical, Bougie, Different blade styles/sizes, back up devices etc). Do they understand the effects of induction, sedation and positive pressure ventilation on hemodynamics? How many people do they intubate a year? If the number is low will they be sent to an OR? Are they calm professional providers who won't panic at the first sign of trouble? Will they jump the gun and intubate prior to effective medical management of hypoension and hypoxia? Are they willing to proceed in an orderly fashion while managing airways which may someday include surgical airway management?
 

NomadicMedic

EMS Edumacator
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^^^this. I don't intubate enough people anymore to consider myself competent. I'll stick with an SGA.
 

SeeNoMore

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I think most of us don't intubate that often. But I admit I'm not quite sure of the average number per provider in the USA. I average somewhere around 2 a month now - or if not I go the OR and do 2-4 in a few hours. We do cadaver labs as well. To me 2 a month still seems low, but I think understanding the anatomy and procedure helps a lot. When I was new I felt like I succeeeded half out of luck - put the blade in and look around till you see a landmark. Now I proceed in a planned manner and try and be realistic about my relative lack of intubations by using a bougie or VL. I think the real key is to admit you are not an expert , at least not compared to some ED docs and Anasthesia folks.
 

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