Shishkabob
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Actually, yes. If just 1 life is saved in a year by a surgical cric or needle thoracostomy, then it is worth it.
medics with attitudes
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Actually, yes. If just 1 life is saved in a year by a surgical cric or needle thoracostomy, then it is worth it.
Hey wait didnt I just say that?
Hmmmm.... apparently you have to hit submit after you type your response. :wacko:
DrParasite
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well, I'd say lets basics give pain meds, but we all know that isn't allowed.
hmmm, and where did I say that? where did anyone say that? in fact, can you show any scientific data supporting your claim?
haha. "If EMS was not useful, you'd think that they would have done away with it years ago." sorta like how we done away with back boards? and prepackaged oxygen tubing? and books that advocate putting an NRB on everyone? after all, if they weren't useful, we would have done away with them years ago... right
and I am not anti-EMS. what I am anti is non-evidence based medicine. Concepts like "an all ALS system is the best way to go", "every patient needs to be assessed by a paramedic and a heart monitor, because their stubbed toe might be referred pain from a heart attack", and "lets use the FD as first responders to bandaid the understaffed EMS system." EMS could be better, but some levels need more training, but I am also smart enough to realize that the system isn't perfect, and educated enough (you know, bachelor's degree, upper level science courses, probably could qualify as premed if I wanted), to know that often the best thing to do for the patient is give them a comfy ride to the hospital and let the doctors examine them. not for everyone, just often. it also needs to be funded properly, not just as an afterthought, or as the :censored::censored::censored::censored::censored::censored::censored: stepchild of health care and emergency services. give EMS enough funding to do the job right, on it's own, without need the help of others.
I have worked in both NJ and NY, as an EMT. It is my career, and I only work in 911 systems. I must make a difference, otherwise why would my bosses pay me to do my job?
yep, that was me. The bottom line for a basic, is that you don't know what you don't know. Like others said earlier in the thread, if the EMT sees the medics react a certain way to certain pt presentations, they begin to think they know as much as the medic. [/quote]and if a medic sees how a doctor reacts to a certain pt presentations, they begin to think they know as much as the doctor. amazing isn't it?
Damn, you got me. that's what happens when I make generalizations. let me rephrase: every person who is EDUCATED as a paramedic in NJ, has a degree. If you are a medic elsewhere and want to work in NJ, you can provided you meet certain criteria set force by the Department of Health after you file for reciprocity. My fault for generalizing.
I see you support a paramedic on every fire truck, ambulance, garbage truck, because as you said, if 1 life is saved in a year by the providers, than it's worth it.
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JPINFV
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Ok, which pain medications do you wish to allow EMTs to utilize to treat acute pain and how much education are you going to require in addition to the current level?
Shishkabob
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You HAVE a pain med already.
DrParasite, you contradict yourself. If the best thing we can do for a patient is to give them a comfy ride then we're probably massively OVERfunded. I could easily pick out two beefy unemployed guys, give them a CPR class, put them in a Spartan N.E.A.T. with lots of pillows and blankets while paying them minimum wage. Hell with enough folks I could keep them part-time and not worry about benefits. This could be done MUCH cheaper than what we currently have.
I'm really, really unsure of the point your trying to make. What comes across is "I'm just as good as a medic, see I've got a degree". The holder of a degree that does not educate one in the clinical component is not useless per say, but certainly not as useful in clinical medicine as those who have education in the practice of medicine.
If you truly believe in EBM then you need to explain away narcotic pain meds, CPAP, ACE inhibitors and nitrates for CHF, early cath lab and stroke team activation (real activation systems, not a basic bullying someone into it), antihistamines in anaphylaxis, the entire Surviving Sepsis campaign, the list goes on and on. Each of these are care most paramedic can provide (or at least begin to) that most basics can not. Where studies of prehospital medicine tend to fail is they are in urban areas with poorly trained medics, because that's where academic medicine is.
I'm not sure what you want out of EMS, or what you want it to be.
I'm really, really unsure of the point your trying to make. What comes across is "I'm just as good as a medic, see I've got a degree". The holder of a degree that does not educate one in the clinical component is not useless per say, but certainly not as useful in clinical medicine as those who have education in the practice of medicine.
If you truly believe in EBM then you need to explain away narcotic pain meds, CPAP, ACE inhibitors and nitrates for CHF, early cath lab and stroke team activation (real activation systems, not a basic bullying someone into it), antihistamines in anaphylaxis, the entire Surviving Sepsis campaign, the list goes on and on. Each of these are care most paramedic can provide (or at least begin to) that most basics can not. Where studies of prehospital medicine tend to fail is they are in urban areas with poorly trained medics, because that's where academic medicine is.
I'm not sure what you want out of EMS, or what you want it to be.
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JPINFV
Gadfly
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Hell, I've got an undergraduate degree, graduate degree, and am almost halfway through medical school, and if I had to choose between a clone of myself and a paramedic that isn't an idiot taking care of my emergency, I'd take the paramedic that isn't an idiot at this point.
RiverpirateEMT
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No attitude here at all. I get along very well with every medic I work with. It seems that no one has bothered to read the previous post I have made. In my state there is no such thing as 2 medics on a rig period. Doesnt happen end of story. If it is a MICU there is a EMT_B and a medic, otherwise it is 2 EMT-B's on a rig with a medic is a chase truck. That is how it works. Yes 2 medics on a truck would be wonderful , but it doesnt happen so again the medic has a EMT-B partner. That partner is there to do the medics grunt work. There is no calling for another medic except in extreme situations they can be called from another area.
When it is a MICU the EMT-B sets up everything for the medic ( 12 lead , iv bag and iv kit, sets up meds if needed , sets up glucometer and the likes). The EMT-B also drives the rig , helps load the patient , puts them on O2 if needed and so on. The medics pretty much depend on the EMT-B to know what they are doing to work together.
Again this is not an attitude. If a medic wants to go it alone more power to them, they will have to just do a lot more themselves. I am well aware this is not how it is in all states, it is just how it works here.
Oh also on the MICU if it is not a class 1 call the medic drives and the EMT-b is in back with the patient. This system works well here and it causes the EMT-B to be on top of their skills or get left behind. We are required to take ALS assist classes before we can run on the MICU's so we know what the medic needs before they ask for it most times ( not all times ).
Im quiet older than most EMT-b's I run with and learned long ago that no one is better than anyone else even if they think they are. I go with the flow and go home at the end of my shift to my family.
Shishkabob
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So, uh... which state is this that there are absolutely NEVER 2 medics in a single ambulance?
RiverpirateEMT
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there is no such thing as a absolute. In fact your right , my 72 y/o boss is a medic ( she keeps her cert up but doesnt touch patients she only drives ) so when a medic steps onto our rig there is technically 2 medics of board although all she does is take patient info and drive the rig. I work for a private company, we have 127 EMT's and medics. Our company will not pay for 2 medics on one truck. I also work for the local hospital that employs medics. They are in chase trucks not on rigs. There is no "rule" saying you cant have 2 medics just it doesnt happen because no company will pay for 2 medics on the same truck. We work under a federation that covers 9 counties, in that area there are no 2 medic trucks. It is the largest federation in the state.
Brown knows of no ambulance in the nation where two Intensive Care Paramedics are crewed together
medicRob
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I would not want to ride with anything less than EMT-IV (i/85 trained). The ideal situation for me would be RN/RN, RN/Paramedic, or Paramedic/Paramedic depending on the type of transport unit and whether or not they utilize critical care transport nurses. Paramedic / EMT-B would just increase my work load.
firecoins
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I deally it would be Medic/Medic and EMT-B driver.
JPINFV
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I went on a ski trip to one of the local ski areas (Big Bear for the So Cal people) and one thing I noticed was that the fire department does staff 3 people to their ambulances. I'm not sure what the levels are except that at least one of them is a paramedic.
lightsandsirens5
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firecoins
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its always good to have 2 people in the back. Just my opinion. 2 medics or RN/medic. Let the EMT-B drive and help with lifting.
Aidey
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I'm not sure I would say "always". There are plenty of calls where one person is more than enough, namely the "I have this non-emergent issue and no ride to the ER" calls. Once the patients reach a certain level of acuity, I agree that having two or more people would be better.
EMS49393
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Since he won't answer it, I will. It's clearly Pennsylvania.
Parasite,
I've worked on a MICU and a squad out here and honestly, I don't NEED an EMT. I need a driver and a patient transport person, hell, an orderly would do. I'm not a wilting flower, I can carry my own equipment.
As for doing all the ALS assist stuff, you can keep it. I am just as capable of putting a patient on oxygen as you are and more likely to make the correct clinical judgment as to how much oxygen they actually require. I run my own EKGs because not one EMT I have met here knows how to place a 12 lead, so I'm sure no one could place a 15 or 18 lead for me. Worse then not knowing, they refuse to ask and learn! Bottom line, I can do the patient care on my own, and I have been doing it on my own since I left my double medic system.
Now, if an EMT cares to check their God-like saving paramedic butt attitude with the lovely blonde at the coat counter, I'll be more then happy to let them engage in patient care. If not, well, they can get up front and drive. I do most of my magic while I'm rolling anyway.
And that degree crap you're spewing... my Mom is a very well educated RN, you know with a degree and stuff. In fact she's brilliant, with geriatrics and psychiatric patients. She'll be the first to tell you that she is unable to handle emergency medicine. She's educated enough to know what she does not know. Now that is a brilliant health care provider.
There are plenty of instances where having a medic as a partner was better than having a basic. 18 minutes from pt contact to delivery at the ED for an asthmatic w/ silent chest and multiple intubation hx. We had nebs, solumedrol, and mag onboard, with orders for epi if needed. She turned out well, and we saved her from being on a vent. Any working arrest; one medic is interpreting the monitor and dropping a line, and the other is handling airway and directing CPR. Any situation where we need meds onboard right away; if I'm dropping a lock, who's drawing up the meds? It bears mentioning that in NYC and where I work in VA, you're either a B, or you're a medic. We don't use the enhanced EMT. Sometimes you get a real tricky presentation and need another medic to consult. With a critical pt, it's good to have another medic monitoring the pt closely while I'm preparing an intervention off to the side somewhere. If you're drawing meds, you should llook to minimize distractions. What about IFT's? One medic for a balloon pump job? Three or more drips? The vented, sedated pt?
Sure, 90-95% of our pts in an all ALS system are not time sensitive (maybe 80% in the NYC tiered system), but having two medics onscene is necessary from time to time.
Sure, 90-95% of our pts in an all ALS system are not time sensitive (maybe 80% in the NYC tiered system), but having two medics onscene is necessary from time to time.