National EMS Scope of Practice Model Revision

taxidriver

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But at the end of the day, basics will not get dispatched to that call alone. Instead, an ALS unit that's twenty minutes will get it while the patient will still be on scene bleeding out. I just used that specific example because it's something that I have actually seen happen. Along with their greater set of skills Medics are also more educaeted and more experienced. When a mother throws her baby down the stairs out of rage of course what that baby is a trauma center and fast. I still don't want basics like myself with 3 months of schooling and a couple clinicles going on those calls.
 

VentMonkey

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Maybe if you were working the road when there was no ALS to respond to a pedestrian hit by a car because they were dealing with a "sick" patient your opinion would change.
Oh, I have. Perhaps re-read my replies to your posts and maybe you'll realize just how foolish your approach sounds. Better yet, read the entire thread from the beginning if you haven't done so already; it was chocked full of posts by some rather articulate folks on this site.
They also need fluid which as a basic I can't provide. I'm not preaching that this needs to be revised on a national level.
Nor should a basic be able to, because their knowledge is, well, basic. Again, you do not know what you do not know.
I'm simply stating that are places in the US that need it.
Need what? Fluids? Trauma patients need cold, hard, sterile steel; nothing relatively new there. Definitive care is...defining.

The places you speak of (i.e., rural "middle of nowhere" America) often utilize air resources for this very reason. A faster mode of transportation...to get said trauma patient to the place that has cold, hard, sterile steel.
 

taxidriver

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Those statistics also don't change the fact that protocols are protocols. If a patient is bleeding out they need fluids according to my protocols and basics will not be getting that call for that reason. Now the scene to OR time is increased dramatically.
 

Flying

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Those statistics also don't change the fact that protocols are protocols. If a patient is bleeding out they need fluids according to my protocols and basics will not be getting that call for that reason. Now the scene to OR time is increased dramatically.
That's a problem with medical direction and resource management, not EMTs not being able to do more.
 

taxidriver

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That's exactly right. The problem is within the 911 system and the reality of it is that some of them are really messed up. I'll run on people that took their insulin and forgot to eat all day and be happy. But when ALS is busy with all of that and a call comes up where they are actually needed, that patients gonna be waiting a ridiculous amount of time for a unit posted elsewhere to show up. Right now the standard is if you dial 911 you're getting ALS. When there are only two rigs covering an entire city this can be disasterous. I'm advocating that the emt-b class be extended and cover more just so the system can be more efficient. Imagine the mess Detroit would be in if they were an all ALS system. Luckily they aren't, they put their basics through an academy and give them the training they need to make the system more efficient. They're still a mess but they needed something like that and they aren't the only city where that would help.
 

VentMonkey

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That's exactly right. The problem is within the 911 system and the reality of it is that some of them are really messed up. I'll run on people that took their insulin and forgot to eat all day and be happy. But when ALS is busy with all of that and a call comes up where they are actually needed, that patients gonna be waiting a ridiculous amount of time for a unit posted elsewhere to show up. Right now the standard is if you dial 911 you're getting ALS. When there are only two rigs covering an entire city this can be disasterous. I'm advocating that the emt-b class be extended and cover more just so the system can be more efficient. Imagine the mess Detroit would be in if they were an all ALS system. Luckily they aren't, they put their basics through an academy and give them the training they need to make the system more efficient. They're still a mess but they needed something like that and they aren't the only city where that would help.
Detroit isn't exactly the best example to utilize given their history. With that, if they're rebuilding for the better- good for them. Maybe your system expects this, but every system is unique in that it's separate from the next.

For all the jokes about California that are made almost daily on here, my system doesn't expect it's basics to sit and twiddle their thumbs eternally waiting for the "heroics" that its medics possess in their bag-o-tricks, but instead supports logical thinking in the best interest of the patients health and well-being. Maybe you need to find a different system.
 

taxidriver

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Detroit isn't exactly the best example to utilize given their history. With that, if they're rebuilding for the better- good for them. Maybe your system expects this, but every system is unique in that it's separate from the next.

For all the jokes about California that are made almost daily on here, my system doesn't expect it's basics to sit and twiddle their thumbs eternally waiting for the "heroics" that its medics possess in their bag-o-tricks, but instead supports logical thinking in the best interest of the patients health and well-being. Maybe you need to find a different system.
Maybe, but if I worked anywhere else around me I'd be doing IFT's all day so I'm happy hehe. It's really just a sticky situation and I think someday someone is going die waiting for ALS instead of getting raced to the hospital. Maybe we disagree on how to fix that problem but I think we can all agree it's a problem that needs fixing.
 

Flying

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Right now the standard is if you dial 911 you're getting ALS. When there are only two rigs covering an entire city this can be disasterous.
From what I've seen New Jersey is doing relatively fine with just basics and medics in their two-tier system. Many other states are also doing fine with just basics and medics in their respective systems. I've been told by a PHTLS educator that AEMTs were phased out of the state because adding a couple of extra skills to EMTs had no net positive effect on patient outcomes.

I think your county needs to hire additional medics, modernize their dispatch practices and introduce ALS intercepts and a number of other things, instead of having "911" level calls continue to wait on ALS and/or sort-of ALS.
 

DesertMedic66

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They also need blood which as a basic I can't provide. I'm not preaching that this needs to be revised on a national level. I'm simply stating that are places in the US that need it.
Fixed it for you
 

taxidriver

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From what I've seen New Jersey is doing relatively fine with just basics and medics in their two-tier system. Many other states are also doing fine with just basics and medics in their respective systems. I've been told by a PHTLS educator that AEMTs were phased out of the state because adding a couple of extra skills to EMTs had no net positive effect on patient outcomes.

I think your county needs to hire additional medics, modernize their dispatch practices and introduce ALS intercepts and a number of other things, instead of having "911" level calls continue to wait on ALS and/or sort-of ALS.
I agree completely. The reason I was saying basics should have to go through a more rigourous education program is so that the system would have more confidence in us and realize that not all calls need ALS. If the 911 dispatching system can simply modernize on its own then great, but I don't see it happening. That just might be the way she goes.
 

DesertMedic66

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The facts don't change protocols. This patient will still be bleeding out waiting for ALS that's half an hour away.
Of bleeding can not be controlled by BLS means there is very little I am going to be able to do as ALS. If it’s internal bleeding I am not going to be cutting them open to stop the bleed. If I give this patient a ton of fluid all I am doing is thinning the blood out and making it so that they can not clot as well and flooding their body with a volume replacement that has zero oxygen carrying capacity. Also I will be unintentionally cooling the patient down. A cold trauma patient who’s blood can not clot and can not carry oxygen = a dead patient.
 

VentMonkey

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The facts don't change protocols. This patient will still be bleeding out waiting for ALS that's half an hour away.
Yikes. You are in no way A) making a valid case and argument for why basics in your area need to be able to start IV's, and are B) postulating with a grandiose amount of caution to the wind.

When I think of articulate, and trustworthy basics on here @DrParasite, @EpiEMS, and @NysEms2117 come to mind. I highly doubt any of them would advocate for such rubbish at their respective provider level. But hey? I could be flat out wrong; it's happened before, and it will happen again, and again.
 

taxidriver

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I'm not saying I disagree with you. I understand it would be much better to Just slap some o2 on the patient and boogie. But if protocols state they need fluid then they are going to get fluid, basics will not be getting that call. So while all the cities medics are out giving sugar to diabetics and checking up on people who called because of hypotension that patient that needs to get to the hospital will be waiting and waiting and waiting.
 

VentMonkey

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@taxidriver, ya lost me. But citing "if protocols say..." doesn't work with the more astute paramedic providers. You're making reference to the notoriously dubious "cookie-cutter" paramedic; you don't want to be that medic...ever.
 

gonefishing

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The facts don't change protocols. This patient will still be bleeding out waiting for ALS that's half an hour away.
I've had some serious GSW victims in the past and managed at a BLS provider level with no issues. I managed the bleeding, transported the pt and they made it. They got an IV after the fact and they in fact lived. Time is something that matters. ALS providers are not gods nor are they witch doctors. With my GSW patients ive had in the past it was package load and go. You can do everything in the back you would do on that street corner while your partner hauls butt and be able to take them to a facility with all the hands, care providers, tools that they would require. I had a pt shot up like swiss cheese. Patched and controlled bleeding, my als was 5 minutes away. IV or not he died right there on the street with us working on him. Nothing als could do.

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Flying

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I really don't see why the system needs to adopt a hodge podge solution because you don't think a certain type of policy change can be affected.

What I'm seeing is this: "The protocols won't change, therefore an inefficient solution [that is more likely to be rejected than a change in protocol] is needed to circumvent that."
 

taxidriver

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Exactly, but basics aren't getting those calls in my system. I really do agree with what everyone is saying but basics will not get any sort of trauma or time sensitive calls alone. My idea is only an attempt to make ALS more available so response times are increased for the patients that need to go.
 

gonefishing

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Exactly, but basics aren't getting those calls in my system. I really do agree with what everyone is saying but basics will not get any sort of trauma or time sensitive calls alone. My idea is only an attempt to make ALS more available so response times are increased for the patients that need to go.
Some of my gsw calls were still alarms. I've had em where they get blasted and stumble to your ambulance as your taking cover.

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VentMonkey

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Exactly, but basics aren't getting those calls in my system. I really do agree with what everyone is saying but basics will not get any sort of trauma or time sensitive calls alone.
:confused:how unfamiliar are you with the New York City EMS system, and its overwhelming amount of call volume?
 

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