Prehospital command hierarchy, fitting it in with the regular medical community

[ZootownMedic]

Which is, of course, what makes the educational standards and general mentality of EMS so sad and dangerous.

Meh....I suppose. But I would say that the vast majority of Parmedics would be open to more continuing educaton, MD facetime/training, and the like. On the flip side of that coin though Paramedicine needs to get the respect it deserves as advanced medical providers and CLINICIANS. This is way past the days of the show 'Emergency' and there are TONS of excellent medics. The bad ones need to be weeded out but thats every profession ESPECIALLY bad doctors. People love to point the finger at EMS but there are just as many bad nurses and docs as Paramedics....we just dont SEE their screw ups as often as they get to see ours.

 

[LondonMedic]

Meh....I suppose. But I would say that the vast majority of Parmedics would be open to more continuing educaton, MD facetime/training, and the like. On the flip side of that coin though Paramedicine needs to get the respect it deserves as advanced medical providers and CLINICIANS. This is way past the days of the show 'Emergency' and there are TONS of excellent medics. The bad ones need to be weeded out but thats every profession ESPECIALLY bad doctors. People love to point the finger at EMS but there are just as many bad nurses and docs as Paramedics....we just dont SEE their screw ups as often as they get to see ours.

Is that because you're gods only 96% of the time...

 

[ZootownMedic]

And to add to that last statement Paramedics are by far the LEAST compensated clinicians but still have incredible amounts of liability. Few people in EMS do it for the pay but its funny when people make comments about education and the like when Paramedicine is a 2 year degree in most parts just to scratch the surface. And EMS education standards vary across the board just as much as Nursing standards do..............

 

[ZootownMedic]

You must have misunderstood......what I meant is that most of the time medics make in field decisions regarding patient care without a higher level of care intervening. We have standing orders which allow us to do things BUT we still have to know WHEN to implement those orders just as doctors do in the hospital setting. You don't just do a lumbar puncture because you feel like it, you do it when you need CSF to test for meningitis.....just like we don't intubate when we feel like it, we do it because its in the best interest of the PT. In the end though the decision usually stops with us.......

 

[LondonMedic]

You must have misunderstood......what I meant is that most of the time medics make in field decisions regarding patient care without a higher level of care intervening. We have standing orders which allow us to do things BUT we still have to know WHEN to implement those orders just as doctors do in the hospital setting. You don't just do a lumbar puncture because you feel like it, you do it when you need CSF to test for meningitis.....just like we don't intubate when we feel like it, we do it because its in the best interest of the PT. In the end though the decision usually stops with us.......

You must have misspoke because you appear to have a poor understanding and appreciation of your own future profession as well as everyone else's.

 

[ZootownMedic]

You must have misspoke because you appear to have a poor understanding and appreciation of your own future profession as well as everyone else's.

Can you explain your insult? As I stated my opinion was my own and worth what you paid for it. If I offended you I apologize but you should get thicker skin. Not sure where in there I misspoke.........

 

[JPINFV]

And to add to that last statement Paramedics are by far the LEAST compensated clinicians but still have incredible amounts of liability.

They are also, by far, the least educated given what they are expected to do. Additionally, there are far too many paramedics who can't think past a protocol and advocate calling for any tough decision. One of the EMS (well, technically fire) legal blogs recently posted an open question regarding what if a patient wants to tape their own treatment. Someone actually answered that she would call medical control.

There are too many in EMS who want the cream of being a profession (title, power, and status) without the responsibility of being considered a professional. As long as it's considered OK and part and parcel of EMS to call medical control as a form of liability control, EMS will never be a profession.

Profession, it's a description, not an award.

Few people in EMS do it for the pay but its funny when people make comments about education and the like when Paramedicine is a 2 year degree in most parts just to scratch the surface. And EMS education standards vary across the board just as much as Nursing standards do..............

Yet how many EMS providers are actually involved in their profession besides manning an ambulance?

 

[LondonMedic]

Can you explain your insult?

If you're insulted by that, maybe you should have thought more carefully before expressing your overinflated sense of self-worth. You clearly lack the maturity and experience to recognise both the limitations of your knowledge and the limitations of your competence as well as the wider state of pre-hospital care in your country. :censored::censored::censored::censored: me, you think you know everything you need about the practice of hospital nursing in 12 hours.

 

[ZootownMedic]

If you're insulted by that, maybe you should have thought more carefully before expressing your overinflated sense of self-worth. You clearly lack the maturity and experience to recognise both the limitations of your knowledge and the limitations of your competence as well as the wider state of pre-hospital care in your country. :censored::censored::censored::censored: me, you think you know everything you need about the practice of hospital nursing in 12 hours.

I never said I knew everything about the practice of hospital nursing and was just giving my opinion and I have spent far more than 12 hours in the hospital setting I was just using that rotation as an example. I will end this conversation now before it goes too far. I would have loved to hear your opinions on the matter and we could have had a discussion. [Removed inappropriate language.] I'd rather be inexperienced and know I have a lot to learn than be pompous and arrogant like you. Cheers, doc.

 

[ZootownMedic]

As long as it's considered OK and part and parcel of EMS to call medical control as a form of liability control, EMS will never be a profession.

Unless you want to pay for doctors to ride on ambulances you will have to have lower levels of care riding. Nursing isn't a profession? They have doctor supervision almost always in the hospital setting as liability control.....and EMS isn't a profession, Paramedicine is.




Yet how many EMS providers are actually involved in their profession besides manning an ambulance?

I agree with you on this. Many do, many don't. It should be more.

 

[LondonMedic]

[Removed inappropriate language.]

I'd rather be inexperienced and know I have a lot to learn than be pompous and arrogant like you.

Maybe prehospital gods should make sure that they're not the ones being 'pompous and arrogant' first... :rofl:

 

[Katy]

This so-called "medical chain of command" is relatively diminished in the real world, and it sickens me that people are so caught up in their own certification and knowledge that we can't focus that certification and knowledge into helping our patient.

 

[firetender]

London and Smoke, you can do better with each other.

Thanks

 

[ZootownMedic]

London and Smoke, you can do better with each other.

Thanks

Agreed

 

[Tigger]

LPN's scope of practice varies greatly by state and additional training but for the most part they cannot do much more than a IV certified EMT can and a EMT-B here in the great state of Colorado can do quite a bit. Here a EMT-B can push any drug on the rig as long as the Paramedic TELLS them to do so. Kinda like how a LPN or RN needs a doc to tell them what to do. So I would put EMT-B's on the same level as LPN's but I think EMT-B's have alot more freedom.

Citation please, the Rule 500 that I read from states that basics can push frontline cardiac meds during an arrest only, and nothing else.

Now the hard part...the classic RN vs Medic argument...haha....its funny because on one of my third rides last week for P school we did a transfer of a patient from this hospital up north to the central one with a RN. The protocols had just changed where Medics are allowed to transfer patients with chest tubes WITHOUT a RN on board...one of the RN's made a comment about this and how medics are 'growing up'. We just laughed at her overweight worthless self and let her think that she was a real healthcare provider(she just sits at a desk in a slow, deadpan ER). So we then got the REAL ER RN(who was quite good BTW) and took the patient. A friendly argument started in the back between my preceptor medic, the RN, and myself. Her argument was that she can push ANY drug and that we can push only the ones on our 'short' list of like 40-50. We retorted that we can give drugs on standing orders at our discretion and that she had to have verbal ordered permission. The argument also arose about abandonment. Since technically Paramedics often take critical patients from one ER to another without a RN on board she tried to argue that it wasn't the same and that we aren't the same level of provider. The bottom line is RN's are in there own little world in the hospital and report directly to a Physician. While Paramedics report to a physician as well it is much less DIRECTLY(some go weeks without talking to their MD) and have WAY more freedom to perform both good and bad medicine.

Are there any reasons in favor of EMS not interacting with a physician more? I mean honestly it can only lead to the betterment of EMS given that we need the MD's help to advance. In order for MDs to really trust their EMS providers (and I know it does happen, just not where I am), we are going to have you know, actually talk to the doctor now and then.

Also think twice about RNs only being able to implement procedures and interventions or asses a patient without an MDs orders. I've seen and been a part of codes worked at Penrose in C Springs where the ED physician was not present for any length of time. Everything went smoothly with only a few RNs, Techs, and RRT. A

 

[Katy]

So I would put EMT-B's on the same level as LPN's

This is where the problem is Are you seriously comparing a 120 hour training course for a 12 month rigorous education?

 

[JPINFV]

Unless you want to pay for doctors to ride on ambulances you will have to have lower levels of care riding. Nursing isn't a profession? They have doctor supervision almost always in the hospital setting as liability control.....and EMS isn't a profession, Paramedicine is.

If the nurse has an issue with nursing care, in contrast to medical care, they aren't going to call the physician for orders. Additionally, they aren't going to call just because they're scared about liability. Personally, I think the "I'm not sure if the patient who's A/Ox4 and has capacity can sign AMA, so I'm going to call medical control just in case, and that way the liability is on them" type of call is nothing more than a -false- sense of security.

I don't want to have physicians riding on every ambulance. I want the people who are providing care on an ambulance to be able to have the foundation to make decisions and justify those decisions without using medical control as a "I'm scared of the dark, and medical control is my blanky."

Furthermore, it's not even appropraite to compare a nurse calling for orders to a paramedic. The ward nurse more often than not is calling the patient's personal physician, who personally knows the patient, has examined the patient, and knows what the patient's current treatment plan is and why, where the medical control physician only knows what the paramedic thinks is important to tell him.

Oh, and if EMTs aren't professionals, then they need not be on an ambulance without direct supervision. If paramedics are a profession, then they, as a whole, need to start acting like it, including demanding a proper education.

 

[ZootownMedic]

This is where the problem is Are you seriously comparing a 120 hour training course for a 12 month rigorous education?

Not in medical knowledge....just in freedom of skills allowed

 

[Katy]

Not in medical knowledge....just in freedom of skills allowed

I'm not sure they surpass the LPN's in that area either.

 

[ZootownMedic]

If the nurse has an issue with nursing care, in contrast to medical care, they aren't going to call the physician for orders. Additionally, they aren't going to call just because they're scared about liability. Personally, I think the "I'm not sure if the patient who's A/Ox4 and has capacity can sign AMA, so I'm going to call medical control just in case, and that way the liability is on them" type of call is nothing more than a -false- sense of security.

I don't want to have physicians riding on every ambulance. I want the people who are providing care on an ambulance to be able to have the foundation to make decisions and justify those decisions without using medical control as a "I'm scared of the dark, and medical control is my blanky."

Furthermore, it's not even appropraite to compare a nurse calling for orders to a paramedic. The ward nurse more often than not is calling the patient's personal physician, who personally knows the patient, has examined the patient, and knows what the patient's current treatment plan is and why, where the medical control physician only knows what the paramedic thinks is important to tell him.

Oh, and if EMTs aren't professionals, then they need not be on an ambulance without direct supervision. If paramedics are a profession, then they, as a whole, need to start acting like it, including demanding a proper education.

Well, I don't know where you work but I'm sorry you have such a low opinion of EMS. Half of the students in my class have bachelors and 75% have associates. Some of them have degrees in biology and other medical related sciences. EVERYONE in my class has taken college level A&P I & II, Psychology, and Microbiology. Plus almost everyone has been on the street as EMT's for a minimum of 1 year most have several years of experience. I'm not sure how you are equating all of this school and experience as undereducated.....Don't take one apple out a barrel and call the whole barrel bad