National Standards

[vc85]

I've noticed in some past threads that people have said that one way to make EMS better/more professional then now is to have some sort of national standard/training.

Is this really the best option though? Some might even say a statewide standard is too broad. For example, the way you would handle a call in an urban environment when you have 6 level 1 trauma/stroke/cardiac/peds/chest pain etc centers in a 10 minute radius is totally different then you would handle a call in a rural environment where it is a 45 minute ride to a bandaid stand hospital and 2+ hours to anything more than that

 

[SeeNoMore]

I think it is reasonable to develop a national standard that ensures that Paramedics obtain an appropriate level of education, experience and competency before they practice independently.

As you point out, the type of system you operate in will certainly offer different challenges and influence the way in which you operate. That being said, every Paramedic should be able to appreciate the clinical situation they find a patient in and initiate appropriate treatment including transport to an appropriate facility. For those in an urban enviroment that may well mean they will not have a reasonable need to initiate certain therapies due to close proximity to the necessary care found at a hospital.

But I don't think that is an argument against national standards.

Instead I think it would be appropriate to continue to have sub specialities of Paramedicine akin to different types of Nursing. Some examples might be Critical Care, Community Medicine, ED work , etc.

I think a more unified standard might advance our field as a whole.

 

[Handsome Robb]

The first thing we need to do is a national standard for education. These programs with less than 1000 hours in them are ridiculous.

There's a reason nursing went to an ADN and now BSN. Why hasn't EMS followed suit? Nursing is a very well respected profession. EMS is a trade and the red headed stepchild of healthcare and public safety.

Even with short transport times the best solution isn't always put them in the rig and take them to the hospital, very rarely is that the proper treatment. I hate it when people say "we're close to the ER, they'll give them pain meds there." Yea they will after the patient sits there waiting for us to give our handoff, then the nurse to do their assessment, then report to the physician who then comes in and does their own assessment, then leaves and places orders which the nurse has to see have been placed, read them, go get what they need and then carry them out. That process often takes 30 minutes or more.

That's just one example.

 

[Handsome Robb]

To expand on national/statewide protocols, I don't think they're the answer however I think a national scope of practice that provides a degree of uniformity is a good step. The NREMT tries to do this but the emphasis there is tries. There are plenty of states that don't even recognize a NREMT certification. You've got places like Texas that medics are doing a lot on standing orders and have very wide scopes of practice then you've got places like California that a medic can't scratch the patient's nose for them without calling OLMD first. Depending on where you are in the nation you might not receive the same level of care as you would in other places, which isn't fair to the patient.

 

[SeeNoMore]

The first thing we need to do is a national standard for education. These programs with less than 1000 hours in them are ridiculous.

There's a reason nursing went to an ADN and now BSN. Why hasn't EMS followed suit? Nursing is a very well respected profession. EMS is a trade and the red headed stepchild of healthcare and public safety.

Even with short transport times the best solution isn't always put them in the rig and take them to the hospital, very rarely is that the proper treatment. I hate it when people say "we're close to the ER, they'll give them pain meds there." Yea they will after the patient sits there waiting for us to give our handoff, then the nurse to do their assessment, then report to the physician who then comes in and does their own assessment, then leaves and places orders which the nurse has to see have been placed, read them, go get what they need and then carry them out. That process often takes 30 minutes or more.

That's just one example.

I generally agree with your post but certainly transporting patients somewhere is often a proper end goal, except in situations where a Community Paramedic might be a good resource to help manage chronic health issues without transport to an ED right that moment.

I absolutely think that treating pain or initiating many therapies that may continue as the patient arrives in the ED, ICU etc is an important part of Paramedic care. I think pain management in particular is one of the most important things we do.

That being said, I also think we need to be realistic about what is best for the patient. If you are in an urban system with Level 1 Trauma Centers minutes away it makes very little sense to place chest tubes or spend undue ammounts of time on scene. Transport in these cases is an important decision, and one made hopefully because of the providers appreciation of the patient's condition. In a more rural system it may be the best case scenario to have prehospital providers initiate therapies that may be rare in more urban systems.

 

[NPO]

I see no reason a basic responder (EMTB) cannot have a standard fairly broad scope (compared to LACo standards that is). Things like CPAP, Glucose testing, nitro, asprin, etc should be standard. I could come up with a good list if i sat down and thought about it but that's just an example. For advanced care practitioners I can understand having some variance in protocol by region.

 

[SeeNoMore]

I see no reason a basic responder (EMTB) cannot have a standard fairly broad scope (compared to LACo standards that is). Things like CPAP, Glucose testing, nitro, asprin, etc should be standard. I could come up with a good list if i sat down and thought about it but that's just an example. For advanced care practitioners I can understand having some variance in protocol by region.

I'll buy that. Health Systems generally don't all operate in the same way. But I would want to see EMS agencies operating differently because of the realities of resources/geography or honest differences in opinions on research and treatments. That's a lot different than having certain communities getting substandard care because of a lack of knowledge or a need to cling to old tired dead ideas that persist despite science, reason and countless models/leaders showing a better way.

 

[NPO]

Oh cmon. Just come out and say it. LACo EMS needs a wake up call. Another benefit to having standard BLS nationwide is mutual aid.

I am currently sitting in my ambulance, outside of my response area. I am legally not allowed to load a patient where my tires are resting because of stupid rules. A standard BLS protocol would provide presedence to allow EMTs to roam. Perhaps not pick up willy nilly where ever, but still treat. For example, my company cannot reapond outside of the area its licensed, however if a unit finds itself outside that area due to a transfer or wandering boundaries, that crew could pick up in an emergency such as an MVA or if they're flagged down. What if its a paramedic unit out of area you ask? Revert to the national BLS protocol. Natural disaster or mass casualty? No problem. Ship in first responders. They're all trained to the same level and, under this proposed national scope, can all legally treat and transport.

But I'm an optimist.

 

[SeeNoMore]

Sure. I don't know that much about LA EMS. I have no issues with a national BLS model and expanding BLS care to include interventions like CPAP, Albuterol , Epi pens etc.

 

[NPO]

Let me try and summarize it.

If you can do it, we can't..

Aspirin just got added to our list of meds we can give. Along side 02 and oral glucose. Also just got pulse ox. Trying for Blood Glucose in the next decade.

Oh, but we can take IV pumps BLS.

 

[SeeNoMore]

IV Pumps? That is interesting.

 

[NPO]

Yeah... It is. Only some solutions, but it is strange lol. Most EMTs don't know about that policy. I've even met supervisors that didn't know. Its not common. I've only done it once.

 

[RescueRider724]

Sounds like this is a bi-polar thread....it started out discussing education and training standards and then protocols and policy nosed in. In my view, at least, these are two different animals. I do feel that one core education and training standard be set for the entire nation, that gives a baseline for all providers to meet educationally and with respects to the hands on they need to have prior to getting in a truck and running calls. I do not however; see any way possible that there could be a standardization of protocols due to the factors discussed by other posters, this would also necessarily effect the ability to standardize policies.

If there is a general consensus in the nation that the base level of care should be higher than the BLS (EMT-Basic) level then it is a simple process of making this known and getting the support to make the change to EMT-A as the base level and giving everyone the time to make the necessary upgrades. Policy and protocols would still have to be a local level call made by the medical director though, to take into account the different realities of operations in the field.