Most Advanced Procedure

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zman

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I was just intersted to see what the most advanced procedure you can perform in your area is? I know there are some pretty progressive EMS systems out there and then there are some not so progressive, like mine. So lets hear it, what the most advanced procedure that can be performed in your locality!

-zman
 
Triple by pass.;)

Sorry EMS is not about the skills, so why try and one up each other?
 
medic417 said:
Triple by pass.;)

Sorry EMS is not about the skills, so why try and one up each other?
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I agree. There are systems where more advanced procedures would be justified than in others. Part of the systems responsibilities though is to ensure that there is good formal education associated and linked to those skills.

R/r 911
 
"Skills" can be taught to almost any human and some animals, even the "advanced" ones. What should be the appropriate question is what type of patient is your agency educated for and capable of transporting? Many ALS trucks double as CCTs and transport critical patients with an LVAD, IABP, ECMO (adult), various ventilator modes, on a variety of gases, a wide assortment of lines and tubes as well as a drugstore of drips.
 
VentMedic said:
"Skills" can be taught to almost any human and some animals, even the "advanced" ones. What should be the appropriate question is what type of patient is your agency educated for and capable of transporting? Many ALS trucks double as CCTs and transport critical patients with an LVAD, IABP, ECMO (adult), various ventilator modes, on a variety of gases, a wide assortment of lines and tubes as well as a drugstore of drips.
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That gets me all sorts of excited. :P

But to the OP who cares about skills. In Santa Barbara, we can do needle crics while in ventura we cannot. Both counties have the same primary provider (AMR) and the same medical director. It is all about transport times in both counties.
 
Here you go daedalus:

http://www.emtlife.com/showthread.php?t=8948&highlight=flight+scenarios

In the past, some of us on this forum have done procedures such as intracardiac epi, subclavian central lines, chest tubes and pericardial centesis. The first fell out of favor due to risk and alternative delivery methods which can also be said of the second. Chest tubes and pericardial centesis are still done by some CCPs on Flight and Specialty as well as a few ALS agencies where distance to the nearest facility or helicopter might make a difference.

However, it is knowing how to stabilize a patient to get them from point A to point B that really counts. One should NOT depend on the speed of the ambulance. When some EMTs make the comments about what difference can a Paramedic make in certain situations, the answer is in the stabilization. Sometimes it just takes the ability to maintain an adequate MAP for perfusion that makes the difference whether the patient has a decent chance of regaining a normal life.
 
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Ridryder911 said:
I agree. There are systems where more advanced procedures would be justified than in others. Part of the systems responsibilities though is to ensure that there is good formal education associated and linked to those skills.

R/r 911
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Quoted for agreement.

Recently ground ACP's had needle cric removed from the trucks. The Ontario Base Hospital Group reviewed it's use province wide, found it had been used three times in as many years and after some discussion among the medical advisory group it was pulled. So now on a skill checklist Ontario probably looks like it's lagging behind and yet Advanced Care Paramedics still have three years of formal education.

Skills, as has been said are a poor indication of a system's quality and in fact when I see some of the extended lists of toys, to me it begs the question, when was the last time it was used? How competent are the providers? We only need to look at some abysmal ETT stats to see the dangers of including items in a skill set without ensuring mastery of the skill and ensuring adequate practice on human patients under supervision before hitting the road and as part of CME.
 
Why don't we just play along with the thread and answer the question without being so damn proper, politically correct, and exerting your own educational agenda for once. Just have fun with it.

I think by now everyone on here knows the importance of education as a foundation to skills. Its mentioned I think in every single thread about 20 times.
 
"Advanced"

Talking about "Advanced" procedures sounds like a way to have pissing contest if I can put it in such crude terms (and all due respect to the original poster). Ventmedics point about "stabilisation" is the best direction to take such a conversation.

"Stay and play" or "Load and go" was the old catchcry of general ambulance thinking for decades. In the past the idea was in fact pretty ludicrous when you think about it because there were so few "procedures" (read management options) that we had to stabilise pts with and hence alter outcomes favourably.

Today the situation is vastly different and changing further with each new addition to our kitbag of tricks.

There is enough evidence now from the many pre-hospital studies to demonstrate that pt outcomes have benefitted from pre-hospital practices that result in achieving haemo or homeostasis. Venty mentioned perfusion mangament as one example. I know for a fact that our rapidly improving post arrest stats here in Melbourne has resulted from aggressive ROSC interventions, arrhthymia Rx, RSI implmentation and cooling management.

So if we're going to talk about "advanced procedures" I would certainly frame the proposition in terms of a gammet of advanced procedures producing haemo or homeostasis.

MM
 
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VentMedic said:
"Skills" can be taught to almost any human and some animals, even the "advanced" ones. What should be the appropriate question is what type of patient is your agency educated for and capable of transporting? Many ALS trucks double as CCTs and transport critical patients with an LVAD, IABP, ECMO (adult), various ventilator modes, on a variety of gases, a wide assortment of lines and tubes as well as a drugstore of drips.
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I've often said, "It's not in knowing what to do and being able to do it. That's simple. Any moron can be taught that. The trick of this job, ladies and gentlemen, is in being able to do something and know when and when not to do it".

I've been caring for the critically sick and injured for over a quarter of a century. And anyone who has mastered this "trick" in that time is a better provider than I am.
 
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You do realize that these procedures are not for the fun of it but are meant to save a life. However, just as easily, they can cause death.
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My point exactly! I was not referring to having fun with the procedures.. I was referring to having fun with the thread and forum in general... no need for ppl to take things so literal and be so proper. This isn't a college classroom.

Someone asked a question to get an idea how invasive some EMS systems are. Simple question... simple answer.
 
The trick of this job, ladies and gentlemen, is in being able to do something and know when and when not to do it".
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So true...
 
ResTech said:
Someone asked a question to get an idea how invasive some EMS systems are. Simple question... simple answer.
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No it is not as simple as that. There are a few procedures that Paramedics are permitted to do but few will ever do because they are not "cool" such as foley catheters and NG/OG tubes.

As well, there are agencies that now no longer do ETI for Peds. Several other agencies are now looking at eliminating ETI for adults. IO is still not wide spread and some agencies will not believe an EJ is considered peripheral. RSI is still controversial and with the wide variety for the mix of certs on crews, it is easy to see where safety could be an issue and I don't even have to mention education there. You have agencies that don't carry med pumps. Some agencies are very limited on the meds and may not be able to do medicated drips. Even some ALS trucks that claim to do CCT must have the RN set them up with everything they need and then all the medic has to do is stare at the pump or maybe just shut it off if the beeping annoys them.

So with so many inconsistencies in EMS with the different certs and education, it is difficult to get very excited about someone doing any advanced skill or protocol unless you hear they have accomplished the education to go with it for the entire agency. Now that is exciting.
 
I am probably not that much older than most of the members of here. When I was working in EMS, I was actually younger than most of those I had under my purview. In fact, the age difference was sufficient that many of them were old enough to be my parents (I actually dated the daughter of one of my EMTs for a while).

That doesn't mean you automatically deserve any more respect or that others deserve any less respect. You guys are great, I love reading your posts, but you do not rule the forum and your word is not law or to be taken as such.
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That is not what I meant. I do not think I deserve any more respect than the next person. What I was trying to imply was that as professionals- whether it is you or I coming with the stance- we base our decisions (or rather we should) base them on evidence and when getting into a debate one is well advised to have that evidence at hand when beginning. If Rid said something I disagreed with and which he could not defend, I assure you I would tear his stance apart the same as I would one proffered by a junior member here. It has everything to do with treating the topic with proper respect and acting as professionals when acting within the profession. Nothing more, nothing less. Sorry for the confusion.
 
VentMedic said:
You do realize that these procedures are not for the fun of it but are meant to save a life. However, just as easily, they can cause death.
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Ugh. Really? Procedures are fun. Should be taken seriously, but, hell, our jobs are fun. The most fun I've ever had on a call was doing a crich and then a chest tube...Sorry, I have neither documentation nor studies for procedures being "fun." Just ask old medics who *aren't* jaded. We do some cool and fun stuff. Sometimes patients live, too!
 
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