National EMS Scope of Practice Model Revision

taxidriver said:
Right now the standard is if you dial 911 you're getting ALS.
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pretty sure that's not the standard... The standard is an ambulance will arrive. In Delaware it's a BLS ambulance. In New Jersey, it's a BLS ambulance. In Boston and NYC, it's a BLS ambulance. Unless the call meets the criteria for ALS, than ALS is sent too.
taxidriver said:
When there are only two rigs covering an entire city this can be disasterous.
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you think that's bad... I now live in a state that has counties that have only four ambulances county wide, including one if the worst small cities in the US (or so the web reports say). And others without a hospital in the county.

I'm sure you can imagine how the a bodies aren't lining up on the side of the road....
 
taxidriver said:
Basics running any 911's is still very taboo in my area.... I still think this would help considering the only other opposing arguments were that trauma patients don't need fluid.
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ok, what area are you referring to? SoCal?

And trauma patients don't need fluid: they need bright lights and cold steel, which a paramedic can't provide.
 
May not be the standard in your area but it is in mine. And I know trauma patients need an OR. protocol in my area states they need fluid, that means they are only going to send units capable of providing that to those scenes.
 
Again, you have a systems issue, not an "EMTs need more skills" issue.
 
taxidriver said:
May not be the standard in your area but it is in mine. And I know trauma patients need an OR. protocol in my area states they need fluid, that means they are only going to send units capable of providing that to those scenes.
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Sounds like your system has an issue..... If you have a patient who is bleeding out, and you pump them full of fluid, all you are going to do is have pink koolaid on the floor of your ambulance. Maybe your system should look at the studies that say that trauma patient don't need a paramedic? And scoop and run will save more lives than IV fluid or any paramedic.

Maybe once your system catches up with the rest of the world, you can join the table with the big boys?

Oh, and where is your system, that delays appropriate patient care in trauma patients because they want to make sure they get IV fluid? I mean, if that's your standard, I just want to know what areas of the country I should avoid getting shot or stabbed in....
 
Yes, your system needs to be updated. But, unless you can make that happen, why not step back and ask yourself what can I do?
You could become a medic, so your system would have one more available! You could research, learn and present a report to your director on changes that could help.

You also need to stop thinking in what ifs! There are going to be pts that die while waiting for a unit to be available. You live in a town of 60k people. So unless you have 60k units in the road, there is always a chance someone will have to wait. That is just life and you accept it.

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EpiEMS said:
I'm almost getting to the point where I think that penetrating trauma without airway & breathing complications should only get a BLS unit dispatched.
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As a BLS provider, 10 minutes is the maximum time i want to spend on scene with a patient who m taking to trauma. I can do 99% of my job in the back of the rig, so however long it takes to do my rapid assessment, control and massive hemorrhage and package is ideal. If ALS is there by then, great, get in and let boogie. If not, oh well. With the advent of better blind airways, i really dont see the need for ALS on most calls. Unless its some kind of neck injury that would require a tricky tube or a cric, all ALS is doing is giving TXA.

The issues that TaxiDriver is discussing are systemic issues, not national issues. I dont feel that there is anything i need in my BLS scope to better handle trauma patients. Maybe iGels. But i rarely have instances were i need a better airway than an NPA.
 
Bullets said:
I dont feel that there is anything i need in my BLS scope to better handle trauma patients.
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I'd agree with that. I think BLS providers could use a bit more in the way of medical skills (e.g. CPAP, albuterol) in national scope.
 
I am only an EMT not a paramedic, but I feel like it could be useful if EMR's (I'm not super familiar with their curriculum) could use a c-collar / very basic until EMS arrives. What about an OPA airway? I feel like it's basic enough an EMR could manage? Anyone agree, disagree? Why?
 
Medic27 said:
I am only an EMT not a paramedic, but I feel like it could be useful if EMR's (I'm not super familiar with their curriculum) could use a c-collar / very basic until EMS arrives. What about an OPA airway? I feel like it's basic enough an EMR could manage? Anyone agree, disagree? Why?
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Better yet, do away with EMR altogether. There's hardly a need for a basics basic.

If you want to learn first aid, take a first aid course. Otherwise, sit through the whopping couple of hundred hours, learn all of the above skills in proper fashion, and pass registry like everyone else.
 
VentMonkey said:
Better yet, do away with EMR altogether. There's hardly a need for a basics basic.

If you want to learn first aid, take a first aid course. Otherwise, sit through the whopping couple of hundred hours and pass registry like everyone else.
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I understand this but I think the EMR cirriculum is an important role in terms of police officers or other civilians that don't want to take the next step into diving deeper. I think of police officers and city officials when I think of EMR. Do you disagree?
 
VentMonkey said:
and pass registry like everyone else.
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But EMRs have a registry exam - in many states, it is an 80 hour course, which is pretty good for cops & firefighters that don't perform EMS as a primary duty. The EMR level captures takes the most important BLS skills that can be done prior to EMS arrival - CPR/AED, BVM, hemorrhage control, etc. & adds background above what a first aid class does. Yes, I'd rather have folks take the EMT class, but, again, for single-role cops, firefighters, lifeguards, etc., EMR is appropriate.
 
EpiEMS said:
But EMRs have a registry exam - in many states, it is an 80 hour course, which is pretty good for cops & firefighters that don't perform EMS as a primary duty. The EMR level captures takes the most important BLS skills that can be done prior to EMS arrival - CPR/AED, BVM, hemorrhage control, etc. & adds background above what a first aid class does. Yes, I'd rather have folks take the EMT class, but, again, for single-role cops, firefighters, lifeguards, etc., EMR is appropriate.
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I think all firefighters should be an EMT, but then again fire and ems respond as one in my area to medical calls. Majority of which EMT-A or Paramedics.
 
CPR, and basic first aid--moreover hemorrhage control--is all law enforcement in theory needs to know. AED use prior to EMS? Sure, but I can't see any of this taking 80 hours collectively.

Babies have been delivered for centuries prior to the advent of these courses. That's hardly a skill so much so as maternal, and paternal instincts.
 
I am still a fan of having EMR as a level of training especially for LEO, lifeguards, search and rescue, security guards, etc when obtaining an EMT cert or having a medical director is not an option.
 
VentMonkey said:
CPR, and basic first aid--moreover hemorrhage control--is all law enforcement in theory needs to know. AED use prior to EMS? Sure, but I can't see any of this taking 80 hours collectively.

Babies have been delivered for centuries prior to the advent of these courses. That's hardly a skill so much so as maternal, and paternal instincts.
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DesertMedic66 said:
I am still a fan of having EMR as a level of training especially for LEO, lifeguards, search and rescue, security guards, etc when obtaining an EMT cert or having a medical director is not an option.
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Absolutely, do you think basic air management can be taught in that span or would you disagree?
 
@VentMonkey Including practical skills time, I don't think 80 hours is so crazy - but maybe it's more like 40-60? The educational guidelines for EMR go beyond a basic first aid class, at least, based on my experience with the AHA & Red Cross.
 
Medic27 said:
Absolutely, do you think basic air management can be taught in that span or would you disagree?
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Normally basic airway management is included in the EMR class.
 
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