Interesting comments

[CAOX3]

http://www.ems1.com/columnists/bryan-bledsoe/articles/429787-Evidence-based-EMS

#1 The EMS Mess

As a so-called necessary health care expenditure, I think EMS is the largest hoax ever foisted on the American People. There is no data, not one study, which shows that anything beyond the intermediate level — basic EMT with defibrillator capabilities — does anything in the long run to change the health care of the United States. The problem is this: it is a hidden cost. Do you realize what it costs for a fire department to simply keep everyone current with their ACLS cards? This is what Casey Stengel would call a long run for a short slide. This has become a local government power base and the numbers are not even figured in to the overall health care costs in the United States.


Wow, now we are a hoax foisted on the American public.

 

[CAOX3]

Sorry I'm having some technical difficulties, they could be attributed to operator error. Anyway.

My opinion is I have been in the EMS field for a long time as an EMT, I see on a daily basis the benefit of ALS on patients. I do believe not every 911 ambulance should be, or needs to be staffed at the ALS level, Those are my opinions based on my experience.

Now this comment, by this MD which I find a highly uneducated opinion of the EMS system. Is this the general opinion held by ER doctors towards EMS providers?

 

[akflightmedic]

Redacted....

 

[remote_medic]

Ok, assuming that ALS providers make no difference in saving lives (for the sake of this argument)...does he make any comment on pain relief that we can provide in the field after...say a knee dislocation. Is that not another important part of our job as ALS providers?

 

[reaper]

Well, we could say that the ER's across america are a hoax. A GP could do just as much for their pt's, no need for Emergency Dr's!

We in EMS know that is not true, but it is saying the same thing that this nimwad is saying!

 

[JonTullos]

That doc's probably never seen the inside of the ambulance, let alone done ride time. It shows how uneducated and misinformed he is. I pray that the docs around here don't share that attitude.

 

[CAOX3]

I would like to clarify I have the utmost respect for DR Bledsoe. He is a true asset to EMS and as a physician.

My comment were directed at this DR Henry. What bothers me most is the fact is he held a position as president of the American College of Emergency Physicians.

 

[VFFforpeople]

I find the problem steming from Egos. (as told to me by rid). It is true, I mean look around the forums, we have EMRs, EMTs,Medics. eachone thinks they are better than the level below them. RNs,have a complex above Medics, and so on, **(keep in mind this is a generalzation, and not true for all)** DRs. to me always seemed to of had that complex, in some way or another. Just the way it goes, it is to bad to see people calling EMS a waste. Lol, I wonder if he trained the Dr. that was taking care of my aunt in the STICU..me: "How is my aunt." Dr. "Well she could get better, do worse, or stay the same." me: "You went to medical school to tell me what my 4yr old could tell me?" Dr. "Stern pissed grunt, and walked away." lol. It is like anyother job, always will have people like that.

 

[CAOX3]

Ok, assuming that ALS providers make no difference in saving lives (for the sake of this argument)...does he make any comment on pain relief that we can provide in the field after...say a knee dislocation. Is that not another important part of our job as ALS providers?

I would say yes.

I also agree with the rest of the comments by Bledsoe. When scientific evidence proves something ineffective we (EMS) still practice those treatments for twenty years after the fact, and when something is proving beneficial it takes most of the country twenty years to institute it.

Why should anyone take us seriously especially the medical field.

 

[BLSBoy]

STEMI.
CPAP.

Thats more then enough, right there.

Shove it Doc.

 

[DV_EMT]

wow... this guy is shallow.

I'll say this much....

If EMS wasn't around... then who in their right mind could/would be saving them? and what about 9/11. Im pretty sure that EMS was a VERY INTEGRAL part of that mess.

 

[Mountain Res-Q]

I would tell this smart boy that NOBODY in medicine really saves live... all we do is prolonge them so that they can die at a latter date. Of course, by that logic we should close all hospitals and ban the practice of medicine. We will save truck loads of money... of course we will have a life expectancy of 25 years... but hey...

Save lives or not, EMS in the field makes a difference in someones lived... even if it is just a hand to hold.

 

[daedalus]

This doctor is not wrong. In fact, he is telling it like it is. If we do not get out act together, we will be our own demise. I have read this and seen it discussed at other websites, and I can tell you the general consensus is that EMS should be equipped with a BVM and a van, thats it. This is because we have refused to embrace evidence based medicine and outcome based research, and have fooled ourselves into thinking we are only needed for "real emergencies". If a EM doc spends 12 years of his life getting his education, and is hundreds of thousands in debt, and still has to see hoards of non emergency patients, why shouldn't we? The cool thing is that what I hear from rid/ryder, the new curriculum includes more public health and pathophysiology, and this is a small but decisive step forward.

This is an incredible opportunity for you newbies to see what the real medical establishment thinks of us. Use it as one, and prove that you can become an educated provider that embraces modern medical science.

 

[VentMedic]

The OPALS is interesting in that for the basic-life-support phase, the "primary care" paramedic is BLS. These paramedics had previously graduated from a 10-month program at a community college and were trained to provide all basic-life-support measures, including oxygen, bag–valve–mask ventilation, and automated external defibrillation.


In the U.S., BLS is an EMT-B with 110 hours of training.

The Canadians' idea of BLS education is more along the lines of what the U.S. training should look llike. The "BLS" Canadians spend more hours being educated and trained than many of the U.S. Paramedics.

 

[HotelCo]

And what is the scope of practice of a Canadian EMT, compared to an EMT from the USA?

 

[VentMedic]

And what is the scope of practice of a Canadian EMT, compared to an EMT from the USA?

In skills it may not be that much more than some of the U.S. expanded EMT scopes. It is the education that makes the difference.

 

[BLSBoy]

This doctor is not wrong. In fact, he is telling it like it is. If we do not get out act together, we will be our own demise.

Respectfully, I both disagree, and disagree.
How many lives have been saved by field activation, and recognition of STEMIs, by use of bronchdilators, CPAP?

Are we going to make the difference in a cardiac arrest? Not unless it happens in front of us, or the Big Man upstairs is looking over them.

Are we going to make a difference for the STEMI whos closest facility is a Trauma Center with no cath lab? Damn straight. We will be saving at least 2 hours, if not more from their balloon time, in addition to providing interventions en route.

How bout the severe asthmatic? Or the CHFer that is struggling to breathe? How bout the anaphalixis?

Now, am I claiming to be an all knowing, all wonderful life saver?
Hell no. But THESE are the circumstances where we have the chance to make the biggest difference, the biggest impact.

I have had an ER Doc tell me once "congrats, you saved her life" once, and there have been a few calls where I KNEW I made a difference, I KNEW I saved a life because I was ALS.

They are rare, but you know em when you get em.

I am not going to argue that we need to get our stuff together. Forthwith.

 

[daedalus]

Respectfully, I both disagree, and disagree.
How many lives have been saved by field activation, and recognition of STEMIs, by use of bronchdilators, CPAP?

Are we going to make the difference in a cardiac arrest? Not unless it happens in front of us, or the Big Man upstairs is looking over them.

Are we going to make a difference for the STEMI whos closest facility is a Trauma Center with no cath lab? Damn straight. We will be saving at least 2 hours, if not more from their balloon time, in addition to providing interventions en route.

How bout the severe asthmatic? Or the CHFer that is struggling to breathe? How bout the anaphalixis?

Now, am I claiming to be an all knowing, all wonderful life saver?
Hell no. But THESE are the circumstances where we have the chance to make the biggest difference, the biggest impact.

I have had an ER Doc tell me once "congrats, you saved her life" once, and there have been a few calls where I KNEW I made a difference, I KNEW I saved a life because I was ALS.

They are rare, but you know em when you get em.

I am not going to argue that we need to get our stuff together. Forthwith.

I know what you mean. The problem with the OPALS study or any study trying to figure out the value of ALS cannot be applied to all areas. We now have the CPAP and 12 lead in the field, and our citizens are really benefiting from ALS here. Still, anecdotal stories and a fragmented EMS are not going to be enough to convince the professional community that we can do good. Like I said, this is a good lesson for the newbies to see that EMS in the US are not fairy tale perfect at this time.

 

[BLSBoy]

I know what you mean. The problem with the OPALS study or any study trying to figure out the value of ALS cannot be applied to all areas. We now have the CPAP and 12 lead in the field, and our citizens are really benefiting from ALS here. Still, anecdotal stories and a fragmented EMS are not going to be enough to convince the professional community that we can do good. Like I said, this is a good lesson for the newbies to see that EMS in the US are not fairy tale perfect at this time.

I hear ya. I work in an urban area, where ALS is supposed to be the "worst". Well the closest facility ain't a cath lab. There alone, we prove our worth, and our STEMI times are phenonimal.

Perfect? No such thing. However, there IS the best thing that we can deliver. We all should strive for perfect, but we will land among the best we can deliver.