Protocol Changes

Brandon O

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Totally did not realize that was your blog JP.

No love for midlevel providers round here :p
 

Veneficus

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Totally did not realize that was your blog JP.

No love for midlevel providers round here :p

none at all and the sooner the US wakes up and figures out they are a complete waste of money, the better.
 

JPINFV

Gadfly
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Totally did not realize that was your blog JP.

No love for midlevel providers round here :p


Actually, the entire reason I started that blog was because I got sick of writing out the same arguments over and over again here. It's much easier to just post a link when someone complains about how paramedics don't diagnose or asks how to write a narrative.

I can accept a use for midlevels as a force multiplier. I cannot accept midlevels as an independent practitioner.
 

Brandon O

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You guys are going to hurt my feelings. (But it's okay, because PhDs and DOs aren't real doctors either :p neener neener)
 

Medic Tim

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My area will be getting ACP (EMT-P) protocols (hopefully). I am licensed but still working as a PCP(EMT-Intermediate), as they are still working on a scope of practice. I am told we are the last place in North america that doesn't have some form of ALS.
 

EMSLaw

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PA and NP run EDs are the EMS volunteers of emergency medicine. Is it appropriate? Generally no. Are there places where they're the best we can do? Unfortunately yes. Can they handle the vast majority of cases? Yes, but generally not the ones that really count.

Oh, c'mon now, JP, did you have to go there?
 

JPINFV

Gadfly
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Oh, c'mon now, JP, did you have to go there?


You go to the emergency room with a life threatening emergency. Do you want a board certified emergency physician treating you or a PA or NP treating you?

You call 911 with a life threatening emergency. Do you want someone who does EMS on the side and who has to respond from home to the ambulance before responding to your emergency, or do you want someone who has made EMS their profession who can respond immediately?

So, yes, I think that single coverage EDs covered by mid-levels is an apt comparison to EMS volunteers when looking clearly at the level of care provided. Would you like to provide a counter? I'm more than happy to hear how, in the sense of care provided, I'm missing the mark with this analogy.
 

Tigger

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Trauma Point of Entry Plans for Massachusetts are supposedly going in to effect for real come the new year. Technically it's been in place since September but apparently there is going to be a bigger push for it's use. this trauma flow chart is supposed to tell you if your patient needs a trauma center (ACS level III or better). Kinda sucks if you work on the southcoast or cape, where there aren't any accredited trauma centers, or in western mass where there are three for like two thirds of the state.
 

Tigger

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You go to the emergency room with a life threatening emergency. Do you want a board certified emergency physician treating you or a PA or NP treating you?

You call 911 with a life threatening emergency. Do you want someone who does EMS on the side and who has to respond from home to the ambulance before responding to your emergency, or do you want someone who has made EMS their profession who can respond immediately?

So, yes, I think that single coverage EDs covered by mid-levels is an apt comparison to EMS volunteers when looking clearly at the level of care provided. Would you like to provide a counter? I'm more than happy to hear how, in the sense of care provided, I'm missing the mark with this analogy.
The fact that someone is responding from home is not an indication of the quality of care you are going to receive, so I don't really see how these are similar. There are plenty of places where the staffed EMS department provides only BLS care.
 

Bullets

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For NJ EMTs

Ability to titrate via NC
Aspirin administration for non-traumatic chest pain
Move TKs up in the bleeding control
Clarify spinal immobilization algorithm
Adopt PHTLS as trauma treatment standard
 

Bullets

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The fact that someone is responding from home is not an indication of the quality of care you are going to receive, so I don't really see how these are similar. There are plenty of places where the staffed EMS department provides only BLS care.

If you called 911 in my town, you could get any of the following "volunteers": 3 paramedics, a trauma PA, 4 NPs, an orthopedist, an ER MD, all of which started as EMTs and still actively volunteer, so dont judge a persons skills based on where they come from
 
OP
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exodus

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If you called 911 in my town, you could get any of the following "volunteers": 3 paramedics, a trauma PA, 4 NPs, an orthopedist, an ER MD, all of which started as EMTs and still actively volunteer, so dont judge a persons skills based on where they come from

I would have to say that your town is a very small minority in the quality of unpaid providers.


---
I am here: http://maps.google.com/maps?ll=33.821368,-116.521211
 

Veneficus

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You guys are going to hurt my feelings. (But it's okay, because PhDs and DOs aren't real doctors either :p neener neener)

Sorry,

But the idea of a mid level provider serving where physicians are not available has since been perverted; now they are running around academic facilities providing no better care than a paramedic following protocols (and often with the same attitude).

Always with an ego that rivals any surgeon I have ever met. But when they are called upon to actually do something, they are not comfortable or have some other excuse.

I do not agree with anyone who promotes the philosophy, "better than nothing."

Physicians are medical providers, not medical managers overseeing a plethora of protocol monkies who just add extra layers and extra cost which is unsustainable.

If you want to practice medicine, go to medical school, spare me the excuses as to why a person cannot. It is not that they cannot, it is they are not dedicated enough to.
 
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Brandon O

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Fair enough.
 

EMSLaw

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You call 911 with a life threatening emergency. Do you want someone who does EMS on the side and who has to respond from home to the ambulance before responding to your emergency, or do you want someone who has made EMS their profession who can respond immediately?

So, yes, I think that single coverage EDs covered by mid-levels is an apt comparison to EMS volunteers when looking clearly at the level of care provided. Would you like to provide a counter? I'm more than happy to hear how, in the sense of care provided, I'm missing the mark with this analogy.

This is an old canard here, the whole volunteer vs. paid debate, and I'm sure that we're not going to cover any new territory. But, here we go...

A physician is a different level of care from a mid-level provider. A paid EMT and a volunteer EMT have exactly the same training. As it happens, when you call 9-1-1 in my community, the volunteer agency does respond immediately, because we stay at our station. So there is absolutely no difference in response time or level of care.

You're making sweeping generalizations about volunteer agencies that are not universally applicable. Sure, there are volunteer agencies that aren't up to snuff. There are also paid ambulance services that are fly-by-night operations that I wouldn't trust to care for my worst enemy.

And just because a provider is paid doesn't mean they've made EMS their full-time profession. Or is the newly-minted Per Diem EMT who rides one shift a week quantifiably better than a volunteer simply because he receives a paycheck? If paid EMS /is/ quantifiably better, show me the study, because I certainly haven't heard of it.
 

Veneficus

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I don't know what JP has in mind obviously, but the way I understood it is a matter of dedication and time spent.

For those who study medicine. (aka doctors) it is all consuming. It occupies just about every waking hour. (it occupies about 14 hours of every one of my days when I am not vacationing in an outpatient clinic here )

That is not likely to change in the next 10 years.

The abstract of volunteer vs. paid, compared to "mid level" providers and physicians has little to do with actual transfer of monies, but of dedication.

I don't particularly like the PA position, mostly from my overwhelmingly negative personal interactions with those providers. My opinion on NPs is much better, as I understand not only why they are needed but that they are not playing doctor.

I don't care if you are old, don't want to take on debt, spend more time with your family, don't see a pay/education benefit, etc.

If you want to practice medicine, you need to be a doctor, or you are lesser. How much lesser doesn't really matter. In a race, you either won, or you lost.

In this case, you either are dedicated or you are not.
 

EMSLaw

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I don't know what JP has in mind obviously, but the way I understood it is a matter of dedication and time spent.

I can understand that, I suppose, though I think, with all respect, that it's a bad argument in this case. A NP or PA may be completely devoted to their chosen career. What they lack is the long period of formal learning that a doctor has. In the case of the NP, they also lack the doctor's focus on medicine, as differentiated from nursing.

But that's the same reason that I think the comparison between paid and volunteer providers in this case is a false analogy. Do you really think that outside people like some of the ones who post here on this forum, the average EMT spends all his waking hours thinking about EMS? We've often decried the educational standards and the lack of motivation in higher learning from the average EMT on the street.

The argument JP is raising is a straw man. "Would you prefer to have a professional, trained, dedicated EMS practitioner, or a (slovenly, untrained, undedicated) volunteer." It ignores the possibility of the volunteer being just as dedicated, or the 'professional' being a sub-par anything but. In my experience, there are very professional, highly motivated, well-trained persons in both areas, just as there are people who are nothing more than mouth-breathers with a patch and a pulse.

I'm sorry, but JP's analogy to me reads as an unfair swipe at volunteers.
 

JPINFV

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But that's the same reason that I think the comparison between paid and volunteer providers in this case is a false analogy. Do you really think that outside people like some of the ones who post here on this forum, the average EMT spends all his waking hours thinking about EMS? We've often decried the educational standards and the lack of motivation in higher learning from the average EMT on the street.

Do I think that the average paid EMT spends every waking hour thinking about medicine? No. However the average full time EMT is going to be taking calls 40 hours a week on average and be in systems that, on average, take more calls than the average volunteer service. Is there overlap between the two? Sure. Are there outliers that makes the analogy less than perfect? Yes. However are you seriously going to tell me that you'd rather have a volunteer than a full time EMT treating you? Sure, the initial training may be the same, but how to you quantify and qualify the experience factor?

The argument JP is raising is a straw man. "Would you prefer to have a professional, trained, dedicated EMS practitioner, or a (slovenly, untrained, undedicated) volunteer." It ignores the possibility of the volunteer being just as dedicated, or the 'professional' being a sub-par anything but. In my experience, there are very professional, highly motivated, well-trained persons in both areas, just as there are people who are nothing more than mouth-breathers with a patch and a pulse.

It ignores outliers. It focuses a lot on experience. No where did I mention slovenly as being a factor, unless you're going to argue that the volunteer services, on average, has a volunteer crew manning an ambulance 24/7.
 

JPINFV

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I don't particularly like the PA position, mostly from my overwhelmingly negative personal interactions with those providers. My opinion on NPs is much better, as I understand not only why they are needed but that they are not playing doctor.

The DNP would like to have a word with you, as long as the cute language like substituting "collaboration" for "supervision."
 
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