Nationalization or federalization of EMS

[VentMedic]

jrm818,

Anti-doctor? A doctor, or any other medical professional, can not use the same excuses made by some in EMS that "we live too far away" to get a higher education.

How do you think other medical professionals keep up their skills and knowledge which may be more complex than the few hours required for even the Paramedic in some parts of the country?

Why should the people in rural regions go without ALS care while EMS fights its "BLS vs ALS" battles?

Maybe it is time the soft gloves come off in this profession for a dose of reality. The people in the UNITED STATES deserve to have quality medical care and that includes EMS. This goal is what started the profession in the 1960s and it is a shame that some have not even gotten to the level it started at in the 1960s.

 

[jrm818]

Where I started in EMS we had a bunch of volly Paramedics. They did not work elsewhere and we did fewer than 20 calls a month many times with multiple Paramedics on the ambulance. They maintained skills and education by doing clinicals and attending classes though most of that required days away from home and paid work. Yes now they are doing as I described slowly going paid.

While I admire their dedication, I'd be uneasy with a medic treating me with that little clinical exposure, depending on how many clinical hours they did on thier own time. That said, this is still specific to your region - there are any number of reasons this could be impossible somewhere else.

 

[VentMedic]

While I admire their dedication, I'd be uneasy with a medic treating me with that little clinical exposure, depending on how many clinical hours they did on thier own time. That said, this is still specific to your region - there are any number of reasons this could be impossible somewhere else.

What's with all the excuses for not providing quality medical care?

If we ran with your other thoughts of having only Paramedics on a truck instead of doctors is sacrificing care, having only EMT-Bs is definitely a sacrifice.

If that is your thought, having at least a Paramedic would be a benefit.

 

[lightsandsirens5]

You are right there is no excuse for remote areas not to have ALS. Honestly you could argue they have greater need for it than do citys.

Maybe we do. But it is the age old "do more with less" thing! Look at the revenue that a city has. Now compare that to an area 30 times the size with one quarter the money! It is just as wrong for agencys that have the capability of ALS to force their way on agencys that don't have enough money, people or time as it is for us small rural guys and gals to force our way on the rest of you! EMS is NOT a one size fits all thing!

.....basics can basically only sit and hold a dieing persons hand.

This is not true and you know it. If you think it is, then God help you.

But a medic might be able to convert that bad rythym and the person live.

Who says a basic or intermediate can't? At my agency basically all we can't do is pace.

In this day and age Paramedic can even be attained with much of the class work by distance learning.

It still take the same amount of time and money that lots of people don't have.

 

[Aidey]

I don't think nationalization has to mean "everyone, everywhere is ALS".

 

[lightsandsirens5]

^

AMEN!

ten char.

 

[jrm818]

jrm818,

Anti-doctor? A doctor, or any other medical professional, can not use the same excuses made by some in EMS that "we live too far away" to get a higher education.

How do you think other medical professionals keep up their skills and knowledge which may be more complex than the few hours required for even the Paramedic in some parts of the country?

Why should the people in rural regions go without ALS care while EMS fights its "BLS vs ALS" battles?

Maybe it is time the soft gloves come off in this profession for a dose of reality. The people in the UNITED STATES deserve to have quality medical care and that includes EMS. This goal is what started the profession in the 1960s and it is a shame that some have not even gotten to the level it started at in the 1960s.

I meant "anti-doctor" in that you don't think there should be doctors on ambulances, that paramedics are "good enough." A MD is a higher education level than paramedic. Are you suggesting that those who do not go from paramedic to MD/DO are "making excuses"?

As for the living too far away -that's because MD's are not volunteers. Doctors do not go to school for many many years to give their service away for free - they could not sustain such a sytem. Volunteers have to balance their other life functions with EMS, which prohibits long periods of time not working away from home.

In general I'd say that doctors keep their skills by seeing patients (in addition to classes, training, etc) for which they are compensated. I doubt there are many (any) doctors who see less than 20 patients a month. If there were such a doctor, I'd question if he was really needed, or if I wanted him treating me...

"why should people go without ALS?" I'd say lack of money is a pretty good reason. This rhetorical argument of "why not ALS" is infinitely regressive. I can make the exact same argument with the exact same reasoning for having fully MD ambulance response...yet no one is calling for that. MD ambulances in general aren't thought to be cost effective or feasible, and in some places paramedics may not be either.

Medical reality is that cost matters - a lot. Availability of medical care is not free, and is not guaranteed in a lot of places. Heck plenty of people can't get a Primary Care Physician, never mind good ALS emergency care. I'd argue that the former is a lot more important overall. Just because ALS is "better" than BLS does not mean it is an appropriate option for everywhere.

Heck in places where the medics may have borderline clinical exposure, i'd say ALS may be worse. more treatment is not always better.

 

[Sasha]

But a medic might be able to convert that bad rythym and the person live.

In order to do that the medic must have the equipment capable of displaying the rhythm and defibbing, cardioverting, or pacing! The cheapest used lifepak 12 I found was in the 6,000 dollar range and it is only guarenteed for a year! Granted I didn't spend a lot of time looking, but man! That's a LOT of money for one month for an area that's living below the poverty line.

 

[Aidey]

This conversation is moving too fast for me.

I came from a service that felt that I-85 was the highest level of care they were required to provide, because after all, and IV is an ALS procedure. Anything beyond that was a bonus, even if it meant that cardiac patients were transported by someone who didn't even know how to turn the EKG monitor on.

I was never confortable with it then, and I'm not comfortable with it anywhere else. There are more than 2 levels of EMS. People don't need to become paramedics, but there are other intermediate certifications they can obtain.

While ALS may not be available everywhere, I don't like dressing up BLS to look like ALS. Be one or the other. If the people don't want to pay for ALS, fine, educate them on the consequences and be BLS. You can still work torwards becoming ALS, but don't do it 1/2 way.






P.S. I also want to add that this isn't about BossyCow's situation, but more generalized because I know there are other areas that have the same issues. (I come from one).

 

[jrm818]

What's with all the excuses for not providing quality medical care?

If we ran with your other thoughts of having only Paramedics on a truck instead of doctors is sacrificing care, having only EMT-Bs is definitely a sacrifice.

If that is your thought, having at least a Paramedic would be a benefit.

missed this one in my last reply. I don't think there need to be doctors on all ambulances, nor do I think all ambulances NEED paramedics. Sure it's better, but sometimes you do sacrifice care for other priorities. Yes ALS is probably generally better than BLS, but MD is better still.

The point is everyone here who is not an MD is working for a system which is "sacrificing" some degree of care in the interest of cost/availability of providers by employing paramedics instead of higher trained doctors. How can you cast stones at a system in a different area who does the same sort of cost/benefit analysis but finds that only EMT-basics are affordable/cost effective in their particular area.

so, more bluntly - what's your systems' excuse for not providing quality medical care by becoming a doctor? I'm sure the answer is good, and I'm sure it resembles Bossy Cows systems reasons for not having paramedics.

 

[BossyCow]

These islands are not heavily populated, nor are the incomes particularly high with many being retirees. Property value and income are disportionate and if you looked at the volunteer service link, a special district was created. Assistance is still needed from the state.

We are a special district, which is much of our problem. The local citizenry is very heavily invested in their independence over the need for service. Our state only provides assistance in the form of fire education, timber tax and an under $2000 grant for 'misc. supplies' all other funding must come from our tax district alone. We are on a renewed attempt to pass a levy but each failed levy further depletes our budget.

You've been fighting a fight but what fight? You don't seem to be pro-Paramedic in many of your posts and still argue that your BLS service provides good compassionate and professional care just like the big city ALS companies.

Yeah, I don't know where you got this. My husband is a paramedic and I'm extremely pro ALS. I've been tearing my hair out over the reduced ALS coverage from the agency I've been using for my ALS support. I have not said that my BLS is as good as ALS but have said we do what we can because we can't afford anything else.

If you were a Paramedic, do you not think you might be able to present some arguements more effectively from a different point of view? We have read all the EMT vs Paramedic arguements on the forums with each having their passionate stances for their title. Maybe it is time to lead by example and get your own Paramedic certificate if you are passionate about epresenting your service to provide a higher level of medical care

I have a day job for which I am very well paid. I am not going to leave that at 50+ years old and go to school for a career change that is not going to pay me what I make now. I have, however found scholarships and written grants to pay tuition for 3 different paramedic students. All three of them are currently working outside of my district.

 

[lightsandsirens5]

In order to do that the medic must have the equipment capable of displaying the rhythm and defibbing, cardioverting, or pacing! The cheapest used lifepak 12 I found was in the 6,000 dollar range and it is only guarenteed for a year! Granted I didn't spend a lot of time looking, but man! That's a LOT of money for one month for an area that's living below the poverty line.

Hey Sasha, are you fightin' for us now?

Gag! I didn't realize the 12 costed that much!!

 

[VentMedic]

I meant "anti-doctor" in that you don't think there should be doctors on ambulances, that paramedics are "good enough." A MD is a higher education level than paramedic. Are you suggesting that those who do not go from paramedic to MD/DO are "making excuses"?

As for the living too far away -that's because MD's are not volunteers. Doctors do not go to school for many many years to give their service away for free - they could not sustain such a sytem. Volunteers have to balance their other life functions with EMS, which prohibits long periods of time not working away from home.

In general I'd say that doctors keep their skills by seeing patients (in addition to classes, training, etc) for which they are compensated. I doubt there are many (any) doctors who see less than 20 patients a month. If there were such a doctor, I'd question if he was really needed, or if I wanted him treating me...

"why should people go without ALS?" I'd say lack of money is a pretty good reason. This rhetorical argument of "why not ALS" is infinitely regressive. I can make the exact same argument with the exact same reasoning for having fully MD ambulance response...yet no one is calling for that. MD ambulances in general aren't thought to be cost effective or feasible, and in some places paramedics may not be either.

Medical reality is that cost matters - a lot. Availability of medical care is not free, and is not guaranteed in a lot of places. Heck plenty of people can't get a Primary Care Physician, never mind good ALS emergency care. I'd argue that the former is a lot more important overall. Just because ALS is "better" than BLS does not mean it is an appropriate option for everywhere.

Heck in places where the medics may have borderline clinical exposure, i'd say ALS may be worse. more treatment is not always better.

Your arguments for doctors vs Paramedics are not valid in that many services did (and do) HAVE physicians on the ambulances at one time but with proper education and training, Paramedics were allow to perform just as well. Physicians ARE STILL used on some transports if the patient warrants a higher level. They are also on the ambulances that provide EM residencies.

We are talking about services that have not been ALS and some do not want to be ALS, not just because of money, but because of the additional responsibiliies of what a higher education and certification might bring in terms of liability and accountibility.

The money thing should not be used as an excuse for not providing medical services. Poor people are just as entitled to medical care as the rich and can use that card to make a play for additional grants and adjustment in their state's tax distribution funding.

So your arguement that because healthcare sucks in the U.S. in general, EMS should remain at a lower standard also? What about all the areas that have managed to provide quality EMS? Maybe they should lower their standards so those that make all the excuses will feel justified in their lower level of care?

BTW, most doctors and many other healthcare professionals do pay for their training and CEs out of their own pocket in addition to what their facilites provide. The average professional from RNs to MDs will spend easily 300 hours of additional time on education and training each year.

 

[Sasha]

Hey Sasha, are you fightin' for us now?

Gag! I didn't realize the 12 costed that much!!

I would love to see the entire country as ALS. I think every patient deserves an ALS assesment, but if there's no money, there's no money. Calling someone uncreative or telling them they just have to try harder doesn't make it happen.

 

[VentMedic]

so, more bluntly - what's your systems' excuse for not providing quality medical care by becoming a doctor?

Again, doctors were common at one time on our 911 Fire Rescue ambulances. Doctors in their EM residency still ride on the ambulances. If we are transporting a patient, by flight or ground, that warrants a doctor, there will be a doctor on board.

 

[VentMedic]

I would love to see the entire country as ALS. I think every patient deserves an ALS assesment, but if there's no money, there's no money. Calling someone uncreative or telling them they just have to try harder doesn't make it happen.

But, Florida, with all of its problems, was able to become all ALS for 911.

 

[lightsandsirens5]

Again, doctors were common at one time on our 911 Fire Rescue ambulances. Doctors in their EM residency still ride on the ambulances. If we are transporting a patient, by flight or ground, that warrants a doctor, there will be a doctor on board.

And when we need ALS, we call up an air-med crew and they fly up and either take the pt or ride with us.

 

[VentMedic]

And when we need ALS, we call up an air-med crew and they fly up and either take the pt or ride with us.

Wow! Fly a helicopter to a scene and take it out of service for a ground transport? If you had a Paramedic already on board, you would save your district a lot of money by not putting the helicopter into flight and also endangering the crew with a patient that could go by ground.

This is probably the best argument I have heard so far on this thread as to why ALS is needed in some areas.

 

[jrm818]

Your arguments for doctors vs Paramedics are not valid in that many services did (and do) HAVE physicians on the ambulances at one time but with proper education and training, Paramedics were allow to perform just as well.

I'm pretty sure there are still treatments that MD's perform that Paramedics cannot. The educational requirement aren't even close, and to suggest otherwise is laughable. A more accurate statement would be "paramedics were able to provide care that was more cost effective and was a good enough analogue of MD care." BLS is another iteration of that, simply at a lower level on the "sliding scale" of care.

Physicians ARE STILL used on some transports if the patient warrants a higher level. How about 911 calls? Those exist, but are few and far between. for example, Pittsburgh has "doc in a box"s, but they are a tiered response anywyas, like many BLS services are with tiered ALS

They are also on the ambulances that provide EM residencies.
That is for the benefit of the residents, not generally because the ambulances feel the need to have doctors

We are talking about services that have not been ALS and some do not want to be ALS, not just because of money, but because of the additional responsibiliies of what a higher education and certification might bring in terms of liability and accountibility.

I've seen no evidence of this "fear of liabillity." Where are you getting this? Especially using Bossy Cow's system as a case study, it is pretty clear that money and availablity of ALS providers is the problem

The money thing should not be used as an excuse for not providing medical services. Sure it should. We aren't commies, you have to pay for things in this country. The sad fact is that some area's can't. I think capatilism is a pretty good system, despite its flaws. One of those flaws is that sometimes there is uneven allocation of goods (or care). Cost-effectiveness is extremely important in the provision of medicine, especially as technology exponentially increases the treatment and assessment options but at extreme financial cost. ALS is simply not cost effective in some areas

Poor people are just as entitled to medical care as the rich and can use that card to make a play for additional grants and adjustment in their state's tax distribution funding. HA! What "Card?" Poor places generaly have less effective representation in state governments. They'd be very lucky to get additional funds. And really, why should some people be forced to pay for other's medical care?

So your arguement that because healthcare sucks in the U.S. in general, EMS should remain at a lower standard also? I'd call that a misrepresentation. My argument is : Many areas suffer from a limited amount of money and access to medical providers. Those areas should determine on their own the best way to allocate their limited resources, be that in providing ALS care or in trying to keep a local clinic open, or simply to put food on their table. While it would be nice to live in a utopia where there was good free medical care available to everyone who needs it, that is a fantasy, and while it may be a good goal, it is silly to pretend that is how things work now What about all the areas that have managed to provide quality EMS? Maybe they should lower their standards so those that make all the excuses will feel justified in their lower level of care?They should do whatever they think best. They should also restrain themselves from telling everyone else to do things as they have. Circumstances are different in differnet places...that should be obvious

10 characters, i guess my bold above doesn't count. I'll be leaving this thread for a while now, back later tonight.

everyone carry on.

 

[jrm818]

Wow! Fly a helicopter to a scene and take it out of service for a ground transport? If you had a Paramedic already on board, you would save your district a lot of money by not putting the helicopter into flight and also endangering the crew with a patient that could go by ground.

This is probably the best argument I have heard so far on this thread as to why ALS is needed in some areas.

OK i lied...after this I am leaving

that is not an argument for the "need" of ALS, but a benefit of ALS. "need" would be proven by demonstrating that ALS care makes demonstrable positive changes in overall population health in a cost effective manner.

E.G. if the money for ALS could also be spent increasing primary care access, and it was shown (as i bet it would be if this could ever be acutally quantified) that every dollar spent on PCP access has more of an effect on overal population health than every dollar spent on ALS, than I'd say ALS is not "needed" at all.