Problems in EMS

[Canoeman]

Wow -- just read this thread -- looks like the problems in EMS are right here.

There are many problems in our system(s). From care and treatment techniques to how managers can get enough money to pay salaries or get the vols new ambulances. No system can be right or wrong at times. It often is because of the geography we choose live in or the base of our subsities, or progressiveness that are the issues at heart.
May I suggest, for example, that the EMT with the 110 hour course who has the glucometer and pulse oxymeter near the summit of Mt. Washington can be a very valuable asset to me before I send four of my best Paramedics in lifethreatening harms way to a person with a bit of hypoglycemia that can be easily corrected by the 110 hour guy. I can use that guy from time to time.

Often issues also need to be looked at wearing another persons shoes.


Canoeman

 

[JPINFV]

Save it guys, this is not a thread about why EMTs should not carry glucometers or oximeters. This is a thread about the problems in EMS. We have discussed the use of these tools many times before. Maybe if EMTs wish to be allowed to use these devices everywhere and have absolutely no controversy over it, we should lobby for better education. I can virtually swear to you all that if EMT was a year program and Paramedic was two years, the whackers, volunteer departments, and idiots will all but disappear. Im not saying any smack on vollies other than, usually, professionals do not offer their services for free, and if EMT took a year, and not a two week camp, many would reconsider getting into EMS. And consider the rise in professionalism...

I recently met a co-worker who went through a two week camp. When a nurse gave him report and told him the Pt was given some ought units of insulin, my coworker said to the nurse: "you mean how milligrams of insulin, right?"

Hmm.....

I agree that education is key. The problem is that a lot of EMT-Bs feel entitled to use what ever shiny, beeping toy (e.g. pulse ox, glucometer, advanced airways, drugs, IVs) they can get their hands on regardless of their (lack of) education. Hence the "I don't get why we can't use [insert toy here] at the EMT-B level" posts that crop up from time to time.

Also, to note about the 2-week camp, EMT-B is a 2 week camp. It's just because some courses drag out the 2 week camp to 3 months by holding classes one day a week doesn't mean that the program is any longer. If EMT-B was academically rigorous, then the course hour time argument would hold less water, but as it stands now it's simply not that rigorous.

 

[JPINFV]

May I suggest, for example, that the EMT with the 110 hour course who has the glucometer and pulse oxymeter near the summit of Mt. Washington can be a very valuable asset to me before I send four of my best Paramedics in lifethreatening harms way to a person with a bit of hypoglycemia that can be easily corrected by the 110 hour guy. I can use that guy from time to time.

Often issues also need to be looked at wearing another persons shoes.


Canoeman

Harms way for a medical patient? Being a bit dramatic or do your emergency vehicle drivers need a bit of valium to counteract the adrenalin rush? Why, may I also ask, are EMT-Bs being sent to ALOC calls in the first place? Also, what are the EMT-Bs going to do for the hypoglycemic ALOC patient? Oral glucose is a stop gap, one that can't be used in severely hypoglycemic patients to begin with. Start a line and give D50? Glucagon? Nutritional counseling to prevent more bouts of hypoglycemia from a provider who isn't even required to have taken biochem?

 

[daedalus]

Absolutely correct. It was stated here before by someone, but EMTs are just not educated to view the bigger pictur. I know that EMTs are supposed to be trained to use limited measures to keep the patient alive (AED, O2, CPR, C-Spine) but this is a role that should be left to a non-transporting first responder. Some one in charge of patient care should have a greater understanding of the human body and how medicine works from the nutritional advice given to a diabetic to the complete process of the treatment for AMI right down to discharge.

I learned something in EMT school, I learned that I know nothing. Kinda sucks :sad:

 

[AlaskaEMT]

Interesting USA Today article on this subject:

http://www.usatoday.com/news/nation/ems-day1-cover.htm

Do you think the 3 problems it pinpoints are accurate?

 

[Meursault]

It's USA Today. Therefore, no. The story has some questionable assumptions, and they've dumbed down their coverage of the study so much that I can't really tell how useful it is.

Aside from that, it's heavily focused on DC. Anyone in that area who has an opinion on the story's accuracy?

I have heard good things about Seattle for out-of-hospital arrests: they've been aggressive about bystander CPR and PADs, and from the story, they're apparently doing well with EMS, too. That's great, but completely irrelevant.

I don't think they've identified any of the major problems.
-Turf wars: The author does love to blame firefighters.
-Performance measurement: There are lots of different ways to go about that, some of which are counterproductive.
-Strong leadership: As essentially everyone else has mentioned, the problems in EMS are not regional. Besides, I think the "strong mayor" they're talking about is Tom "Mumbles" Menino. That's made me lose the little sliver of respect I had left.