medics with attitudes

[Bieber]

We run dual paramedic trucks, and in the system I'm in, I prefer that. If it were paramedic-EMT, I'd end up running all the calls; we're just too busy, and most of all calls are code yellows (intermediate triage).

Fire is dispatched to all calls and they serve as BLS backup. Really, aside from CPR, ventilation, vitals and patient movement, there's really nothing else they provide. The extra set of hands is helpful, but outside of lifting assistance and CPR, I could do without them just fine. And I try not to think in terms of BLS versus ALS, I think in terms of "what medical care does this patient need?"

Sorry if that offends you.

 

[CAOX3]

What's humorous is I know far more crappy medics who spent a significant amount of time as a basic than those who didn't. The ones who were long-term basics learned bad habits by the bucketful.

You hit the nail on the head there. Education at all levels is pathetic. I'm not going to get into what my EMT class consisted of but you needed college level anatomy and physiology just to get a seat and the patient assessment segment was about 120 hours. We gave multiple medications, intubated amongst other things. Today I have to take an in-service to use an epi-pen. Then EMT class then along with experience was an educational foundation to be built upon. There was two levels EMT and medic educated to work autonomously but able to compliment one another when the need arose.

Back then if you were a paramedic you had at least three years of education, autonomous providers who rarely if ever picked up a phone for a doctors opinion.

Those classes don't exist anymore, why would they. They have been replaced by three week and six moths zero to hero classes taught in someones garage.

Today you have a three week super hero punting to a six month know it all who is attempting to diagnose and treat CHF without a college level physiology class, its a joke.

We had it right, we dropped the ball, now its time to clean up the mess.

 

[Veneficus]

If you are so anti-EMS Dr. Parasite, why do you stick around this site? If EMS was not useful, you'd think that they would have done away with it years ago. We must make a difference, otherwise why pay us to do this job?

I would be careful about using this argument.

The question on whether ALS care is worth the price is being raised not only by doctors but politicians as well.

Unless you can present some evidence beyond anecdotes and dogma, this is not a spectre you want to raise in defense of ALS EMS.

 

[Bieber]

I would be careful about using this argument.

The question on whether ALS care is worth the price is being raised not only by doctors but politicians as well.

Unless you can present some evidence beyond anecdotes and dogma, this is not a spectre you want to raise in defense of ALS EMS.

What specific parts of ALS are being questioned? Also, do you have any links that you might like to share regarding the issue?

I agree that in this era of evidence-based medicine, we have to very strongly reevaluate our practices all across the board and determine which ones are actually worth their cost and have been shown to be effective, and which ones just simply aren't meeting the cut, however I also think that while many of us can agree that we need to increase educational standards, that it may come into conflict with the same push to eliminate wasteful spending. The political answer will always be train to the minimum standards and cut out those skills found to be ineffective to reduce the cost; effectively minimizing education and turning EMS providers into skill monkeys while at the same time cutting out those skills that haven't proven their worth.

How pervasive is this movement towards cost effectiveness? A quick google search turned up some mention about the cost effectiveness of physician-based anesthesia, but what about other areas of medicine? Are physicians themselves being evaluated for their cost effectiveness versus other care delivery models (PA or NP led, for example)?

 

[Zodiac]

But is anything in health care really worth the price? Not agreeing or disagreeing with what anyone has said so far, just curious. Having been without any kind of health insurance since I was 16, it's been something I've thought about for a while.

 

[Veneficus]

What specific parts of ALS are being questioned? Also, do you have any links that you might like to share regarding the issue?

I agree that in this era of evidence-based medicine, we have to very strongly reevaluate our practices all across the board and determine which ones are actually worth their cost and have been shown to be effective, and which ones just simply aren't meeting the cut, however I also think that while many of us can agree that we need to increase educational standards, that it may come into conflict with the same push to eliminate wasteful spending. The political answer will always be train to the minimum standards and cut out those skills found to be ineffective to reduce the cost; effectively minimizing education and turning EMS providers into skill monkeys while at the same time cutting out those skills that haven't proven their worth.

How pervasive is this movement towards cost effectiveness? A quick google search turned up some mention about the cost effectiveness of physician-based anesthesia, but what about other areas of medicine? Are physicians themselves being evaluated for their cost effectiveness versus other care delivery models (PA or NP led, for example)?

I think you are missing my point.

All aspects of US medical care are now under a microscope in order to reduce medical spending. That microscope includes cost/benefit ratios.

EMS has not created any hard numbers, even if flawed, to compete with the hard numbers, even if flawed, against them.

Without these numbers, there will not be a leg to stand on when it comes to demonstrating effectivenss. EMS providers must start quantifying their positions, not simply state them. That is not good enough anymore.

As to the last part, physicans constantly demonstrate their benefits quantitatively. With multiple measures. Even where NPs and PAs operate, the question is not whether a physician is superior, it is a question of whether the consumer base can afford or recruit the necessary physicians.

My point to the what I was quoting is that EMS particularly paramedic level providers in the US, have to start quantifying their positions. Their value is comming under question from multiple avenues and all they have to refute it with is self serving speeches. That is a losing strategy.

Providers argue against education, even though that is a measurable value throught all societies in the world. They now argue against questions of their effectiveness with the exact same tactics.

It isn't going to work any longer. There are too many people who have to protect their slice of the pie in the inevitable cuts.

Pointing out this information doesn't protect my job.

 

[Bieber]

I think you are missing my point.

All aspects of US medical care are now under a microscope in order to reduce medical spending. That microscope includes cost/benefit ratios.

EMS has not created any hard numbers, even if flawed, to compete with the hard numbers, even if flawed, against them.

Exactly what numbers are you talking about? There's numerous studies across the board regarding treatments commonly used in EMS. If you're talking about a comprehensive study of the efficacy of EMS as a whole, I agree there's none that I've yet found and somebody ought to do one, but that would be quite an undertaking.

Without these numbers, there will not be a leg to stand on when it comes to demonstrating effectivenss. EMS providers must start quantifying their positions, not simply state them. That is not good enough anymore.

I agree.

As to the last part, physicans constantly demonstrate their benefits quantitatively. With multiple measures. Even where NPs and PAs operate, the question is not whether a physician is superior, it is a question of whether the consumer base can afford or recruit the necessary physicians.

To be honest, I don't think anyone is safe anymore. I briefly noticed a study comparing nurse-led clinics to traditional ones the other day. Without reading real deep into it, I believe the results weren't grossly different. I'm not trying to make a big debate over the efficacy of physicians or their cost-benefit, I'm just saying that I don't think any medical profession is inherently "safe" in the political and economic environment we're in right now. People want more for less, which is exactly why PAs and NPs are becoming more prominent in all fields of medicine at the moment.

My point to the what I was quoting is that EMS particularly paramedic level providers in the US, have to start quantifying their positions. Their value is comming under question from multiple avenues and all they have to refute it with is self serving speeches. That is a losing strategy.

I don't disagree with you that we have to quantify our positions, but can you send some links for the rest of us? I haven't really heard about certain agencies questioning the value of paramedics in se, and I'd be interested in learning more about this issue.

Providers argue against education, even though that is a measurable value throught all societies in the world. They now argue against questions of their effectiveness with the exact same tactics.

It isn't going to work any longer. There are too many people who have to protect their slice of the pie in the inevitable cuts.

Pointing out this information doesn't protect my job.

Increasing our education is one of several solutions we need to implement in order to improve our care and ability to competently treat patients. It's not the end-all, but it's the crux upon which all other solutions to the EMS system rests. We're finding out more and more that we are prehospital providers are not as able as we once thought to handle the most critical patients (or that medicine simply isn't advanced enough to treat them), and that the most successful treatments we CAN provide are those administered to non-critical patients (pain control, for example).

 

[clibb]

Why do some agencies make their Paramedics wear badges? It looks retarded.

 

[Sasha]

To intimidate their patients into thinking theyre the cops.

 

[medic417]

Why do some agencies make their Paramedics wear badges? It looks retarded.

Yes it does just as bad as the badges the basics wear at the same company. My theory is the badges are for the mad patients to have a place to aim at. :unsure:

As to research. The hard part is how to conduct a study. There was a study that concluded that Paramedics should not decide who rides in the ambulance. The way they came to that conclusion was if a Paramedic decided that a patient did not need an ambulance yet the patient was admitted to the hospital the Paramedic was wrong. That is very flawed. If we are honest most patients could travel with a family member safely to the hospital. There has to be a way to determine true immediate life threats rather than just using admission as the criteria. Sorry can not find that study right now but seems like it even made it into JEMS or one of the other toilet paper mags EMS has, sometime in the past 2 years.

And then as any study data gathered can be interpreted multiple ways depending on what you are hoping to prove/disprove.

 

[MontanaEMT]

Ah the ParaGod syndrome. I work with a few of them, and the best advice is to just wow them with your abilities. Everything starts with BLS and when ALS fails, they should fall back to BLS. I have noticed the medics that don't like BLS are the ones who did not have strong skills before going into ALS!

 

[medic417]

Ah the ParaGod syndrome. I work with a few of them, and the best advice is to just wow them with your abilities. Everything starts with BLS and when ALS fails, they should fall back to BLS. I have noticed the medics that don't like BLS are the ones who did not have strong skills before going into ALS!

Nope it all starts and ends with patient care. No more no less.

 

[jgmedic]

I wonder how this thread would go if posted the other way "How do medics deal with EMT's who have "EMT's save medics" syndrome?"

 

[Veneficus]

I wonder how this thread would go if posted the other way "How do medics deal with EMT's who have "EMT's save medics" syndrome?"

look at them as if to say:

"The poor creatures, they don't know any better."

It does no good to argue with people who think everyone else is less informed than they are.

 

[usafmedic45]

I wonder how this thread would go if posted the other way "How do medics deal with EMT's who have "EMT's save medics" syndrome?"

Despite Venie's sage advice, I think we should give that thread a shot.

 

[mcdonl]

Who cares about the title anyway? *IF* the person is a know-it-all jerk, they would be that way if they were any profession.

MEDIC's care about EMS enough, and care about their careers enough to go for the highest level you can achieve in this field. Good for them. I am not in the position to do so, but I am not jelous. I am happy to have them. Sure, I have worked with MEDIC's who were jerks... but I have worked with BASIC's, FF's, Drivers and chief's who were jerks too.

And, with 15 years of Hospital Administration under my belt don't even get me started on MD's and RN's....

 

[Shishkabob]

I wonder how this thread would go if posted the other way "How do medics deal with EMT's who have "EMT's save medics" syndrome?"

Or the "My decade of experience at the lowest level overshadows your education at the highest level and less years of experience"

 

[firetender]

Barf!

All this Level This and Level That talk makes me sick to my stomach.

In the moments you have at the scene with your patient you have the situation and your training and skills. Logic says that if you're going to respond to emergencies for your living or as an aspiration you'd want to know as much as you could about every aspect of emergency medical care and management of a traumatized person.

...and anyone who has been in the field a while knows that such things as Scene Management, although supposedly a "Basic" skill is something you are ALWAYS learning more about and finding different ways to do.

Everything -- all the Levels -- are going on at the same time.

The medics with attitudes on either side of the BLS/ALS fence all share one thing in common; they think they know but they don't.

The ones who really DO know either keep their mouths shut or share that knowledge with their colleagues in such a way that it is useful rather than antagonistic. If they get resistance, they just go elsewhere rather than wasting their energy on people who really DON'T want to learn more and become better at what they do..