thegreypilgrim
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Yes I know but I'm talking more about the idea of defending your decision to step outside protocol or exploit its ambiguities in general.
is "ALS" a lie?
- Thread starter Veneficus
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Yes I know but I'm talking more about the idea of defending your decision to step outside protocol or exploit its ambiguities in general.
Once again this seems to be a uniquely American phenomonia.
Our Ambulance Officers do not have "protocol" or "medical control" and we seem to get on just fine. There is a set of clinical guidelines which cover the major etiologies of what is likely to be seen in practice (eg cardiac arrest, seizures, asthma, hypoglycaemia) however much is left to the knowledge and experience of the crew, presentation of the individual patient and larger clinical context. We also have unlimited drug doses inline with good clinical practice and prudent professional judgement.
This is not to say we are rogue practitioners left unchecked to dangerous devices to practice cowboy medicine out in the wild frontiers of the street but rather are appropriately equipped to use our education and experience in the best interests of the patient. In other words we do not box everybody into a standardised protocol pathway in order to treat them because thats all we know how to do and see everything black and white.
An example Brown can think of is a patient picked up from an urgent care centre who had shortness of breath and chest pain. We couldnt figure out of he had asthma or some sort of cardiac event so went down the road of a little from column A and a little from column B.
Maybe all American ambos are as colour blind as Brown is regular blind and see everything black and white?
Our Ambulance Officers do not have "protocol" or "medical control" and we seem to get on just fine. There is a set of clinical guidelines which cover the major etiologies of what is likely to be seen in practice (eg cardiac arrest, seizures, asthma, hypoglycaemia) however much is left to the knowledge and experience of the crew, presentation of the individual patient and larger clinical context. We also have unlimited drug doses inline with good clinical practice and prudent professional judgement.
This is not to say we are rogue practitioners left unchecked to dangerous devices to practice cowboy medicine out in the wild frontiers of the street but rather are appropriately equipped to use our education and experience in the best interests of the patient. In other words we do not box everybody into a standardised protocol pathway in order to treat them because thats all we know how to do and see everything black and white.
An example Brown can think of is a patient picked up from an urgent care centre who had shortness of breath and chest pain. We couldnt figure out of he had asthma or some sort of cardiac event so went down the road of a little from column A and a little from column B.
Maybe all American ambos are as colour blind as Brown is regular blind and see everything black and white?
DrParasite
The fire extinguisher is not just for show
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Question: how many paramedics want to have no oversight? not "I want to do what I feel is best," but rather "I have no safety net, I can do what I want and if I'm wrong, it's going to all come down on me?"
think of it this way: what are the medical malpractice insurance costs for an ER physician? now, compare that to a paramedic's malpractice insurance (if they even have it).... which do you think is greater? and if a paramedic or an MD screws up, and is found civilly liable, which do you think will be a higher judgement?
Before someone jumps all over me for being anti-education, that is not the case. I think education is a good thing, and I think some systems are waaaaaay too medical control dependant (like NJ's that has you call the doc on EVERY ALS patient). But there are definitely some benefits to not being as independent as doctors, despite what some think
think of it this way: what are the medical malpractice insurance costs for an ER physician? now, compare that to a paramedic's malpractice insurance (if they even have it).... which do you think is greater? and if a paramedic or an MD screws up, and is found civilly liable, which do you think will be a higher judgement?
Before someone jumps all over me for being anti-education, that is not the case. I think education is a good thing, and I think some systems are waaaaaay too medical control dependant (like NJ's that has you call the doc on EVERY ALS patient). But there are definitely some benefits to not being as independent as doctors, despite what some think
AnthonyM83
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That one's easy. At least around here, prehosptial providers are rarely allowed to go outside the variability that protocols allow. Many times, it's not that a provider doesn't have a better idea, rather it's not an option at all, even if we pass it by online medical control. So, the best many providers can offer a conversation is sharing facts (rather than their own synthesis) of how things are done based on their experiences.
It should be mentioned that greater education allows people to push the boundaries of problem solving. It's important to be aware of one's own ignorances. I'm sure some talks with medical directors will yield plenty of examples in which the providers thought they had thought out a solution, but due to lack of deeper knowledge, arrived at an incorrect solution where the situation was made worse than if protocol had been followed.
So, really, I believe one needs both. One needs the desire to push the boundaries FIRST, but needs the further education BEFORE they actually do it.
Melclin
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Exactly. I very much like the idea of IV benzos, titrated IV narcan, IN narcan, even nebulised opiates if pushed. Our service is pretty strict about routes. We have IN fent and IV morph...why not IV fent as well? Its simply an oddity of the introduction process and an attempt at reducing the amount of new information, but if we were to push some IV fent, or IN some benzos...clinical breach...unless you lie on the paperwork, which many do. We have more flexibility than many in our system but some strangely restrictive things as well.
Something like O2 for example. If I wanna use a nasal cannula and titrate my O2 to an SpO2 of 94-98 like various forward thinking UK NICE guidelines like in strokes and MI, I would run into trouble. Firstly, its unlikely I'd have pulse oximetry. Secondly, the stroke experts and cardiologist from here still want 8LPM by mask in the first 6 hours full stop. How can I question them? Not only are they physicians, but they are experts in those fields.
I had to have a university entrance score above the 85th percentile (nursing was somewhere in the low 70s
), write a short essay explaining why you wanted to start a paramedic degree and have a resume, of sorts, showing various activities proving your interest in studying being a paramedic (volunteering, previous healthcare studies, etc).You then have to put up with a a great deal of uni that has nothing to do with all the "sexy" stuff.
This is nothing to do with the 1.5-2.5 year long employment/qualification process of panel interviews, tests, mentoring and training that will follow.
However, it hasn't really succeeded in attracting people with a superior work ethic or commitment. You just get high achieving slackers rather than complete idiots. People who are perfectly capable of working out what Substance A, when given formulas of B and C is a series of chemical equations, but completely uninterested in a true commitment to improving themselves as providers. It also has to be said that to a certain extent, free thinking is drummed out of people because of a certain adherence to the old ways, but its not anywhere near solely responsible for our problems.
Don't get me wrong, our position is far more enviable than yours and it would be a great improvement for American EMS. I'm just saying, its not perfect, and in fact, comes with its own set of problems.
18G
Paramedic
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The EMS system in play today was set into motion long before most of us were prob alive. I personally think protocols are very necessary for EMS.... some providers do fall heavy onto protocol reliance and refer to the protocols often, but why blame them? It is the trickle down effect. Physicians and people with many more years of school then Paramedics have set up this system to their liking. Why does the field provider always get the blame? Why not start blaming whoever was responsible for instilling this protocol driven care and mindset and education requirements? I don't agree with protocol excuses or over reliance but it is what it is.
Until there is a vastly improved education base.... your not gonna see "free thinking" EMS care and not because current Medics are not capable but because the system does not allow for it. And even if tomorrow Paramedics were required to have 4yr degrees, how about the hundreds of thousands of Medics who don't? It's not something that can be transitioned that easily. The field is its own beast with its own unique dynamics.
If you need to prepare for a procedure or prepare a med or infusion or whatever, you cant walk away from your patient and the chaos and go to the nice clean nurses station to do all of that. Simplicity is necessary in the field for efficiency and safety.
Critical thinking is a must but we simply do not have the leeway to deviate from system standards and protocols. It's nice for everyone to convene on a message forum and tout this and that, but ultimately your future as a provider hangs on your abiding by established protocol and system standards.
Until there is a vastly improved education base.... your not gonna see "free thinking" EMS care and not because current Medics are not capable but because the system does not allow for it. And even if tomorrow Paramedics were required to have 4yr degrees, how about the hundreds of thousands of Medics who don't? It's not something that can be transitioned that easily. The field is its own beast with its own unique dynamics.
If you need to prepare for a procedure or prepare a med or infusion or whatever, you cant walk away from your patient and the chaos and go to the nice clean nurses station to do all of that. Simplicity is necessary in the field for efficiency and safety.
Critical thinking is a must but we simply do not have the leeway to deviate from system standards and protocols. It's nice for everyone to convene on a message forum and tout this and that, but ultimately your future as a provider hangs on your abiding by established protocol and system standards.
JPINFV
Gadfly
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Why is the back of your ambulance constantly in a state of chaos?
While stabilizing critical patients (since, if it isn't a critical "has to be done this second" intervention, than you have time to breath regardless of where you are), is not the emergency department also a bit of controlled chaos.
18G
Paramedic
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I didnt say that it was "constantly" a chaotic environment but is something that is known to happen from time to time. Regardless, the field requires a different approach then the ED. Nurses have as much time as they need with their patient's where EMS does not. And not to mention when EMS is called we are there from the very start of the illness or injury and get things moving when no assessment or interventions have been done.
Nor does the ED usually have all the environmental factors to contend with that are present in the field.
Nor does the ED usually have all the environmental factors to contend with that are present in the field.
JPINFV
Gadfly
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Are assessments not repeated in the ED? Shouldn't physicians and nurses be conducting a complete exam instead of saying, "well, I don't need to ask about this because someone else already did?" If you're at a doctors office or SNF, do you ask confirm what the transfer report covered when performing an assessment on your patient, or do you not question what you were told?
Do patients not present critical, but sans EMS in the ED?
Why does EMS have such significantly less time? Who's panties get in a bunch if you take a few extra minutes? Is a 'diesel bolus' always the best thing for a critical patient?
What environmental factors are present inside the ambulance? Do your doors not close? Is the HVAC system broken? Do you not have lights?
On the other hand, it's not all rainbows in the ED anyways. How many patients do you care for at any one time? How much do the RNs in your area care for? The physicians? How often do you start drips or pumps? The RNs? How many different drugs do you have that require an infusion instead of a bolus? How many are available in the ED?
While I won't argue that there aren't differences between the ED and the field, I question how significant they are, and how many of them are the fault of EMS culture instead of tangible differences. The "Critical patient, starting transport is more important than stabilizing the patient" rush is an example of EMS culture instead of a tangible difference. Fast is slow, slow is smooth, smooth is fast. So, just because there may be time to go fiddle at the nurses station doesn't mean that it's all rainbows and puppies and the like.
Do patients not present critical, but sans EMS in the ED?
Why does EMS have such significantly less time? Who's panties get in a bunch if you take a few extra minutes? Is a 'diesel bolus' always the best thing for a critical patient?
What environmental factors are present inside the ambulance? Do your doors not close? Is the HVAC system broken? Do you not have lights?
On the other hand, it's not all rainbows in the ED anyways. How many patients do you care for at any one time? How much do the RNs in your area care for? The physicians? How often do you start drips or pumps? The RNs? How many different drugs do you have that require an infusion instead of a bolus? How many are available in the ED?
While I won't argue that there aren't differences between the ED and the field, I question how significant they are, and how many of them are the fault of EMS culture instead of tangible differences. The "Critical patient, starting transport is more important than stabilizing the patient" rush is an example of EMS culture instead of a tangible difference. Fast is slow, slow is smooth, smooth is fast. So, just because there may be time to go fiddle at the nurses station doesn't mean that it's all rainbows and puppies and the like.
18G
Paramedic
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I think my minor point was taken outside of its intention.
point is... ppl need to stop blaming the field provider for the flawed system. They didn't create it. The so-called higher educated people did which is a perfect example of education isn't everything.
It's like lets create a brand new system for doing something and hire ppl to implement the system. These people do their job exactly the way they are supposed to within the system... but for some reason the system design isn't the best and the the results are crappy even though the people working are doing the job exactly the way they are supposed to. The workers can't improve because of the way the system was designed but yet the superiors want to blame the workers for their own messed up processes and mistakes. This is where we are in EMS. Someone else created this monster but yet lets make the people in the street look like the bad guy all the time.... BS.
Field care is field care... it's not meant to be nor was it ever intended to be definitive. EMS does what it can to provide comfort, reduce pain and suffering, and sometimes actually save someone from dying all within the very immediate onset of illness or injury. Sometimes I see people getting confused with the purpose of EMS. If you want to do more then become a PA or doctor or a nurse in a hospital. If I can reduce someones pain from a nasty fx or give someone relief from all night N&V and being dehydrated then I feel good about that. That is my job as a Paramedic.
I think there is a threshold for what should be done in the field and what should be left to being done in a hospital.
point is... ppl need to stop blaming the field provider for the flawed system. They didn't create it. The so-called higher educated people did which is a perfect example of education isn't everything.
It's like lets create a brand new system for doing something and hire ppl to implement the system. These people do their job exactly the way they are supposed to within the system... but for some reason the system design isn't the best and the the results are crappy even though the people working are doing the job exactly the way they are supposed to. The workers can't improve because of the way the system was designed but yet the superiors want to blame the workers for their own messed up processes and mistakes. This is where we are in EMS. Someone else created this monster but yet lets make the people in the street look like the bad guy all the time.... BS.
Field care is field care... it's not meant to be nor was it ever intended to be definitive. EMS does what it can to provide comfort, reduce pain and suffering, and sometimes actually save someone from dying all within the very immediate onset of illness or injury. Sometimes I see people getting confused with the purpose of EMS. If you want to do more then become a PA or doctor or a nurse in a hospital. If I can reduce someones pain from a nasty fx or give someone relief from all night N&V and being dehydrated then I feel good about that. That is my job as a Paramedic.
I think there is a threshold for what should be done in the field and what should be left to being done in a hospital.
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Shishkabob
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Dispatch...
While I don't want to turn this in to yet ANOTHER Medic vs Nurse:
Me? Often, one. It's the nature of the beast, though. How many patients does a triage nurse have to deal with at any one time? One.
But how many "Critical" patients does a nurse handle at any one time as well? Often one, sometimes 2 ... but with a lot of help if needed, as opposed to just me, with an EMT-B, maybe some first responders, an hour from a doctor.
When was the last time a nurse had to handle 9 patients with varying acuteness in sub-freezing temperatures in the middle of the road, dealing with extrication, triage, treatment and transport in the dark with limited resources? Hey, I had to do that last week!
Fairly often, actually. Mmm.. Tridil! I love thee.
Luckily my medical director views EMS as an extension of the ED, and states as such "We bring the ED to the patient, not the other way around", so we actually GET to do some interventions and stabilizations in the field.
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Ridryder911
EMS Guru
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Whoa! Sorry, but there is NO such thing as "field medicine" or "hospital medicine".. etc. Medicine is medicine! It is exactly that ignorant mentality and poor insight of understanding what medicine is all about! I can inform you it was not... " The so-called higher educated people did which is a perfect example of education isn't everything".... that caused the mess! It was those in charge bending down and watering curriculum and curtailing to volunteer and poor EMS services not to adhere to traditional medical standards! Look around, what other medical profession does not require a degree entry level or to be accredited?... That's right.. no one else!
Sorry, want to slap a bad-aid and run fast back to hospital, chose the wrong business.. that went out 40 years ago. Seriously, I work all sides of the counter and truthfully; there is little difference in the first few minutes of interventional therapy (if EMS is properly educated and have strong medical protocols).
If we continue to restrict ourselves only to "emergencies" and those supposed "life threatening events", we will soon be finding ourselves hunting for a job or no need to be there; as we should be! Only about 10% of patients in the prehospital environment really require intravenous therapy and less require medications. We need to remove restricting ourselves in a box and only focusing upon tidbits of healthcare. Either be part of it or get out! There are so many avenues of medicine that EMS that needs to explore before ever trying to justify the "mythical" field medicine BS.
Is there adaption within areas of medicine? You bet.. but; trying to differentiate care and treatment specifically is nonsense. I heard the entire rhetorical BS when they told us twelve lead, intubation, thrombolytics and chest decompression was "hospital care". Let's quit making excuses and get on with the profession, shall we?
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Practicing medicine with a certification
I saw a lot of posts so far detailing the legalities of practicing medicine without a license.
I thought we should look a little closer at this phrase.
Nurses have a license to practice nursing.
PAs have a license to practice...
RTs have a license to practice...
OT/PT have a license to practice...
Chiropracters...
Podiatrists...
A physician holds an "unlimited license" to practice medicine. So logically I would conclude there is a "limited" license as well. Otherwise why would anyone need to qualify it?
If we consider what the practice of medicine is, it is the application of scientific priniciple for the purpose of diagnosing and or treating diseases.
We already know that despite the best attempts of some so called "medics" to pretend not to diagnose, they do. I don't think anyone would argue that ALS providers "treat" patients. Otherwise you wouldn't need all that expensive gear.
So why does EMS have a certification and not a license if they are in fact practicing medicine?
Well, I don't really have the answer. But of course I have a theory. A certification simply states you have met the minimum training requirements. It does not govern practice. It also means that somebody with a license (which is governed) must be responsible. That means being certified instead of licensed absolves individual responsibility.
But this is where it gets a little hazy. Since an EMS certification can be revoked, it is either being used practically as a license, or the minimum training to maintain it is constantly evolving past the initial educational course.
So why would providers want to be certified and not licensed? Well, it is an old point.
If you a minimally trained, you have a skill. Similar to say fire suppression or water rescue.
You as an individual can only be held accountable to your rules and standards and not intents.
Any groups of people we know who would value those things?
Volunteers and fire departments. As a skill set, it precludes the need for advanced education to make decisions. As a limited liability, it means the volunteer has the least responsibility. After all, if you were the only one personally liable for your decisions, you really would have a lot to lose for your hobby.
But word analysis aside, EMS does in fact practice medicine. You can't help but do it. Otherwise you would never be able to choose the protocol for the signs and symptoms. You would never be able to offer treatment other than a ride.
Now I will be the first to point out that a skill set was the initial EMS education. But somewhere along the way, medicine even in the prehospital environment became too complex to be effectively performed as a skill.
It is the attitude of providers that stops education moving forward.
It begs the question; "Since EMS does practice medicine, what kind is it practicing?"
I have a modest suggestion.
http://www.youtube.com/watch?v=4sJxDUxrlqE
I saw a lot of posts so far detailing the legalities of practicing medicine without a license.
I thought we should look a little closer at this phrase.
Nurses have a license to practice nursing.
PAs have a license to practice...
RTs have a license to practice...
OT/PT have a license to practice...
Chiropracters...
Podiatrists...
A physician holds an "unlimited license" to practice medicine. So logically I would conclude there is a "limited" license as well. Otherwise why would anyone need to qualify it?
If we consider what the practice of medicine is, it is the application of scientific priniciple for the purpose of diagnosing and or treating diseases.
We already know that despite the best attempts of some so called "medics" to pretend not to diagnose, they do. I don't think anyone would argue that ALS providers "treat" patients. Otherwise you wouldn't need all that expensive gear.
So why does EMS have a certification and not a license if they are in fact practicing medicine?
Well, I don't really have the answer. But of course I have a theory. A certification simply states you have met the minimum training requirements. It does not govern practice. It also means that somebody with a license (which is governed) must be responsible. That means being certified instead of licensed absolves individual responsibility.
But this is where it gets a little hazy. Since an EMS certification can be revoked, it is either being used practically as a license, or the minimum training to maintain it is constantly evolving past the initial educational course.
So why would providers want to be certified and not licensed? Well, it is an old point.
If you a minimally trained, you have a skill. Similar to say fire suppression or water rescue.
You as an individual can only be held accountable to your rules and standards and not intents.
Any groups of people we know who would value those things?
Volunteers and fire departments. As a skill set, it precludes the need for advanced education to make decisions. As a limited liability, it means the volunteer has the least responsibility. After all, if you were the only one personally liable for your decisions, you really would have a lot to lose for your hobby.
But word analysis aside, EMS does in fact practice medicine. You can't help but do it. Otherwise you would never be able to choose the protocol for the signs and symptoms. You would never be able to offer treatment other than a ride.
Now I will be the first to point out that a skill set was the initial EMS education. But somewhere along the way, medicine even in the prehospital environment became too complex to be effectively performed as a skill.
It is the attitude of providers that stops education moving forward.
It begs the question; "Since EMS does practice medicine, what kind is it practicing?"
I have a modest suggestion.
http://www.youtube.com/watch?v=4sJxDUxrlqE
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18G
Paramedic
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Rid I have to respectfully disagree with most of your post. Those who make the changes to the curriculum aren't those working 3 jobs as a field provider! And yes there is most certainly a uniqueness to field care... how can u say it is the same as hospital delivery?
The majority of what we do is not what is glorified on Rescue911, Third Watch, Trauma, etc... agreed. But these cases will ALWAYS be imminent so no, EMS providers will not need to be looking for a new job no matter how infrequent these cases are. Communities will demand EMS 24/7.
I'm all for expanded EMS services in the community. I took this job to help in anyway I can. But do not try to say that the everyday EMS provider created the system we have today. If so, where was I over the past 20 years?
The majority of what we do is not what is glorified on Rescue911, Third Watch, Trauma, etc... agreed. But these cases will ALWAYS be imminent so no, EMS providers will not need to be looking for a new job no matter how infrequent these cases are. Communities will demand EMS 24/7.
I'm all for expanded EMS services in the community. I took this job to help in anyway I can. But do not try to say that the everyday EMS provider created the system we have today. If so, where was I over the past 20 years?
AnthonyM83
Forum Asst. Chief
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I don't know if that's really an issue as far as the current discussion. Certification and licensure is mainly semantics. Some states give licenses. Some give certifications. In California, EMTs get state certifications and paramedics get licenses. It doesn't seem to change much as far as LEGAL ABILITY to synthesize a solution rather staying within the protocols.
It's a chicken and egg problem, and which comes first depends on the provider, but also the agency. I'd like to come up with more advanced problem solving on-scene, but I know it can be dangerous because of the limits of my education. The thing is, people who are really too lazy or scared to can also use this excuse.
If everyone's educational minimum was increased, though, there wouldn't be that excuse as now everyone would have better base knowledge to work from. And then think of the converse, it would be inappropriate to start requiring more of the "making up ALS" on the go from people on scene without adequate education.
It's a chicken and egg problem, and which comes first depends on the provider, but also the agency. I'd like to come up with more advanced problem solving on-scene, but I know it can be dangerous because of the limits of my education. The thing is, people who are really too lazy or scared to can also use this excuse.
If everyone's educational minimum was increased, though, there wouldn't be that excuse as now everyone would have better base knowledge to work from. And then think of the converse, it would be inappropriate to start requiring more of the "making up ALS" on the go from people on scene without adequate education.
Medications don't act differently under a hospitals roof. There may be some differences in DELIVERY of care (which you seem to allude to) but not in the practice of medicine itself.
Maybe 30 years ago we weren't in control, but the time has come to take back control of the profession.
Melclin
Forum Deputy Chief
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On the topic of the differences between "the field" or "the street" (two unabashedly American terms, it must be said), I think it is fair to say there are considerable differences.
This is not at all to say that medicines work differently or that you don't need none o' that book learnin on the street. I understand that some idiots essentially do say that, which, along with nurses having a hissy fit in reply to any suggestion that they are not god's perfect gift to medicine, makes this topic fraught with danger.
Part of being a new prehospital provider is about learning to manipulate your environment. One of the most noticeable differences I've found in working with our top tier providers (MICA/ALS) as opposed to our 2nd tier (Paramedics), is that they seem to have a supreme ability to turn a scene of considerable chaos into something comparable to the controlled environment of a resus cubicle.
To a rookie like me, its amazing how much clearer a pts condition is in a hospital cubicle. Lots of light. Plenty of time. Plenty of space. Plenty of help. A nice clear set of vitals and hx laid out in front of you on screens and charts. But then I think I can actually have all of those things.None of it is exclusive to the ED. But I have to make it happen.
I think it should be a part of our skill set as prehospital providers to be able to mannipulate our environments to optimize a situation and negate the differences between the field and the hospital. In any case, our response to those differences certainly shouldn't be 1), to ignore them, or 2), to use them as a justification for substandard care.
Its not as bad as being rick rolled, but I'm still not happy with you.
This is not at all to say that medicines work differently or that you don't need none o' that book learnin on the street. I understand that some idiots essentially do say that, which, along with nurses having a hissy fit in reply to any suggestion that they are not god's perfect gift to medicine, makes this topic fraught with danger.
Part of being a new prehospital provider is about learning to manipulate your environment. One of the most noticeable differences I've found in working with our top tier providers (MICA/ALS) as opposed to our 2nd tier (Paramedics), is that they seem to have a supreme ability to turn a scene of considerable chaos into something comparable to the controlled environment of a resus cubicle.
To a rookie like me, its amazing how much clearer a pts condition is in a hospital cubicle. Lots of light. Plenty of time. Plenty of space. Plenty of help. A nice clear set of vitals and hx laid out in front of you on screens and charts. But then I think I can actually have all of those things.None of it is exclusive to the ED. But I have to make it happen.
I think it should be a part of our skill set as prehospital providers to be able to mannipulate our environments to optimize a situation and negate the differences between the field and the hospital. In any case, our response to those differences certainly shouldn't be 1), to ignore them, or 2), to use them as a justification for substandard care.
Its not as bad as being rick rolled, but I'm still not happy with you.
18G
Paramedic
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Yes, I am referring mainly to care delivery and with that comes certain limitations. Should all modalities suitable for the ED be ideal for the field? I don't think so. Some tout pre-hospital ultrasound as the next big thing. Is it cool to do?... of course. How will it really change the game? Will the patient be treated any differently? I only see it as a triage tool but since we already over triage as a safety net I don't see any real difference between having ultrasound or not having it in the field. If you suspect internal bleeds, tamponade, pneumo, or whatever, transport to the trauma center and treat based on PE findings which in those cases should be very obvious. Trauma centers and most other hospitals have bedside ultrasound that is on the patient within moments of arriving anyway.
There is already the argument that ALS care delays definitive care and is worse for some patients. Adding to the scene time and trying to do 100 things in 15mins instead of 10 isn't registering with me yet. Like I said previously, when do we reach the threshold of what we should be doing pre-hospital?
And I agree very much that it's time to take the reigns of our profession and make Paramedic a minimum 2yr degree and have more 4yr EMS programs developed. I think we need more refinement on what we currently do and not look to adding tons more.
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