National EMS Scope of Practice Model Revision

taxidriver

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:confused:how unfamiliar are you with the New York City EMS system, and its overwhelming amount of call volume?
I know they're a busy department and if there was any way to make sure that were enough units capable of getting the job done I'd be all for it.
 

taxidriver

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I feel many of you misunderstand what I'm trying to say. To summarize, give basics the ability to run more of the easy BS calls so that ALS is available and doesn't have to come from 20-30 minutes away. All I'm saying.
 

NysEms2117

ex-Parole officer/EMT
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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.
I'd guarantee that as a basic working 24 hrs a month, I see more "trauma or time sensitive calls" then most medics would I'm also a nys emt-b. Nothing more, nothing less. The point before about als being forever away, my pal @EpiEMS has said this countless times on various different threads there's a wonderful thing called ALS intercept. Or if your hours from a hospital, call HEMS, then you get outstanding providers like ventmonkey, chase, and summit, who know more about healthcare then I do if I'm allowed to use google... I sit on both sides of reform, if people want to make paramedic the minimum, I see the logic and im not offended. I haven't used my EMT-B knowledge more then 10 times working, I say this all the time... it is COMMON SENSE, they're bleeding, try to stop that. If they aren't breathing try to assist them in breathing. If you can't, call somebody that can.
I think a major problem is when people graduate emt-b class and get there certificate they think it's a giant accomplishment, which it is, however it's an accomplishment that needs to be put in perspective.


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NysEms2117

ex-Parole officer/EMT
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I feel many of you misunderstand what I'm trying to say. To summarize, give basics the ability to run more of the easy BS calls so that ALS is available and doesn't have to come from 20-30 minutes away. All I'm saying.
Have you ever been able to watch a paramedic work a trauma case?? If not, I want to to go observe a paramedic and I think any good paramedic (like most of the ones on this site) would say they bls before als. Starting an iv on a person that's been dead for 10 minutes doesn't do a damn thing. Trying to start an iv on a person that's been shot 4 times before controlling breathing doesn't do a damn thing.

Where I work my medic partner does his assessment, then either tells me what to do if it's a bls maneuver OR tells me what to get. The fact of the matter is, chances are you can always do something...


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NomadicMedic

EMS Edumacator
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I went on a GSW Wednesday night that was BLS all the way. My system sent TWO paramedic units. :/

We'll get it figured out eventually.
 

DesertMedic66

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I feel many of you misunderstand what I'm trying to say. To summarize, give basics the ability to run more of the easy BS calls so that ALS is available and doesn't have to come from 20-30 minutes away. All I'm saying.
A good place to start would be to utilize an EMD system that can serve several functions such as: sending the appropriate resources (ALS or BLS) with an appropriate response/priority (lights and sirens or normal driving), and also have the ability to tell people over the phone that no ambulance will be sent out for your stubbed toe.

We just starting doing a somewhat EMD system and it’s working out ok. However all 911 calls are still ALS.

I have never worked in a system that uses paramedic fly cars/SUVs but from reading a lot of posts from people who are in that system it seems to be a good option.
 

GMCmedic

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A good place to start would be to utilize an EMD system that can serve several functions such as: sending the appropriate resources (ALS or BLS) with an appropriate response/priority (lights and sirens or normal driving), and also have the ability to tell people over the phone that no ambulance will be sent out for your stubbed toe.

We just starting doing a somewhat EMD system and it’s working out ok. However all 911 calls are still ALS.

I have never worked in a system that uses paramedic fly cars/SUVs but from reading a lot of posts from people who are in that system it seems to be a good option.
Ive said it before. EMD would be great, if the entire system werent designed around leading questions.

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NomadicMedic

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PMDS (priority medical dispatch) doesn't ask leading questions, but does have some questions that can change a call determinant from BLS to ALS. For example, a stable nursing home patient that needs to be seen at the ED would code as as a 33 Bravo, but as soon as the dispatcher asks, "has this patient been evaluated by a medical professional?" and the CNA calling says "Yes", its upgraded to a 33 Charlie, which puts ALS on it. Does it need ALS? Probably not. But that's a glitch in the system.

Medical directors have the option to adjust responses and call determinants, but it's an involved process and many departments just install the EMD protocol set as it comes off the shelf and consider it "good enough". If you have issues or questions with your EMD Protocols, you should get involved with the committee that oversees EMD QI. It'll be an eye opening experience
 
OP
EpiEMS

EpiEMS

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In an urban setting, there is evidence (also see here and here) to suggest that penetrating trauma benefits more from rapid transport by police than waiting for EMS. Heck, I'd argue that BLS care is likely as good as ALS (if not better, because it's cheaper) for most trauma in the urban setting.

I went on a GSW Wednesday night that was BLS all the way.
I'm almost getting to the point where I think that penetrating trauma without airway & breathing complications should only get a BLS unit dispatched.
 

Summit

Critical Crazy
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I feel many of you misunderstand what I'm trying to say. To summarize, give basics the ability to run more of the easy BS calls so that ALS is available and doesn't have to come from 20-30 minutes away. All I'm saying.
Reading the convoluted logic you used to to support these points, why people didn't focus on your primary points in discussion is obvious. In trying to support your points, you made arguments that seemed reveal large deficiencies in your understanding of evidenced based practice and philosophy of care, the types of deficiencies that reveal the pitfalls of giving EMTs more.

You have a resource utilization and system philosophy issue. Fix the underlying problem.
 

taxidriver

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Sounds like many of you are looking at the problem as if it's a perfect world. I was hardly even making a medicine related argument, I'm arguing for efficiency and getting people the help they need when they call. Basics running any 911's is still very taboo in my area. Even when we bring in patients from nursing homes for low hemoglobin levels you can hear the doctors chatting with eachother "Why are there so many basics in the ER?" If you understood how hospitals and our dispatch system viewed basics then you would understand why i thought that the logical thing to do was to make basics more educated and give them a higher skill set. I still think this would help considering the only other opposing arguments were that trauma patients don't need fluid.
 

taxidriver

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Reading the convoluted logic you used to to support these points, why people didn't focus on your primary points in discussion is obvious. In trying to support your points, you made arguments that seemed reveal large deficiencies in your understanding of evidenced based practice and philosophy of care, the types of deficiencies that reveal the pitfalls of giving EMTs more.

You have a resource utilization and system philosophy issue. Fix the underlying problem.
That's weird considering I'm not arguing to change the kind of treatment people get. Just to make sure they get the care they need and quickly. We run ALS trucks medic-medic. Most nights theres only two of them covering a city of 60,000. Basics will not get any sort of Emergencies if ALS won't be making it on scene first. ALS intercept is not a thing since for the most part there's usually a hospital 5-10 minutes away but nevertheless, BLS will not have anything to do with that call. Instead a unit covering a dif city will be pulled in. Seriously, if anyone has a better solution I'm all ears. I'm not trying to be ignorant or act as if I know more than the more experiences folks here but no one presented a different solution.
 

VentMonkey

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@taxidriver without being too much more of a Richard, you're lacking one of the most fundamental things one can when debating on this forum- experience; both in the field and out of it.

You're misreading others replies as well, and telling me (us) that I (we) view things with a perfectionists perspective. Most of us are fairly well experienced in life, and in the field; I'm pretty sure we realize things will never be perfect. How else would we have survived this industry long enough to see another starry-eyed, young naive EMT suggest what's already been suggested?

There isn't anything wrong with being new, and full of ideas; aren't we all at some point? It's what makes every profession grow. But we are telling you--from experience--you're way off base, and have no clue what you are talking about.

Also, maybe learn how to clarify your point a little better. You're confusing me, and I don't even possess half the knowledge, grammatically (or other), that some of these folks with bachelors and masters degrees do.
 

GMCmedic

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That's weird considering I'm not arguing to change the kind of treatment people get. Just to make sure they get the care they need and quickly. We run ALS trucks medic-medic. Most nights theres only two of them covering a city of 60,000. Basics will not get any sort of Emergencies if ALS won't be making it on scene first. ALS intercept is not a thing since for the most part there's usually a hospital 5-10 minutes away but nevertheless, BLS will not have anything to do with that call. Instead a unit covering a dif city will be pulled in. Seriously, if anyone has a better solution I'm all ears. I'm not trying to be ignorant or act as if I know more than the more experiences folks here but no one presented a different solution.
Run medic/basic trucks instead.

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taxidriver

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Although Detroit has a messed up EMS system and they aren't the best example they fixed themselves a lot lately and I'm sugg w
Run medic/basic trucks instead.

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That's probably more likely to happen than anything I've suggested. Still, it's a grey area. A lot of the medics don't think of basics as competent enough and don't want to do all the work in the back for a whole shift so it's still rare to see.
 

NysEms2117

ex-Parole officer/EMT
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A lot of the medics don't think of basics as competent enough
why should they? Basics took a 200 hour express worst case scenario class. as previously mentioned, people like @VentMonkey and @Summit should be primary providers in the field. I (as an emt basic) do not know nearly enough. Your 19, you have a lot to learn, and room to grow, just take advice these folks are giving you. They have been doing it for YEARS. If you don't want my advice fine, i've only been doing it for a year and a half, but do know this... I listen first, especially if its something i don't know much of anything about.

Edit: It's all about knowing where you fit into the system, and acting accordingly with said role. I work on a critical care rig, so most of what i do is getting what my medic partner needs... thats my job.
 

Summit

Critical Crazy
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@taxidriver The point here is that EMTs should NOT be sitting on scene 30 minutes waiting for ALS. They should load and proceed to definitive care or an ALS intercept. That is a very basic and easy to solve systems problem.

Resource utilization issues you have described are complex to solve, but the above quick solution will help address the extreme cases you provide as examples.

The philosophy of care that you should understand, and was hit on by Vent was, practicing EMS as if protocols were the gospel to the detriment of the patient is the worst kind of healthcare philosophy you can embrace.

There is plenty of philosophy to discuss regarding additional skills vs additional education. How is time best spent? Where was time spent for AEMT? The market has not been fond of AEMT. I think there is a thread discussing the merits of IV access as an addon skill for EMTs somewhere...
 
OP
EpiEMS

EpiEMS

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Basics will not get any sort of Emergencies if ALS won't be making it on scene first.
This is pretty confusing - so if there is a free BLS unit, but no free ALS units, the BLS unit will not be dispatched?
 

taxidriver

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This is pretty confusing - so if there is a free BLS unit, but no free ALS units, the BLS unit will not be dispatched?
Yep. They will instead pull an ALS unit that's further out. They won't let us start doing our job without ALS over our shoulder.
 

MonkeyArrow

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Yep. They will instead pull an ALS unit that's further out. They won't let us start doing our job without ALS over our shoulder.
So, uh, what do you when you get on scene first? Sit in the truck waiting for ALS?
 

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