Question to the experienced

[Tigger]

Boy, where to begin.

One of the hardest lessons to learn in EMS is, “not everyone is nice”.

This is probably the most important takeaway. Ideally, quality care is delivered in a personable manner. Not everyone can do that. Working with those people can be a drag.

Actually your comparison is accurate, yet proven to be of benefit. I was reading an article the other day where I think it is Pittsburgh police often transport before EMS even arrives. It is part of their Scope of Work, they train for it and are expected to do it...throw them in and transport. I think this also has to do with a trauma center being on every corner, however they have been doing this practice for well over a decade. Other police departments follow similar protocols...so there is tremendous merit in the police just throwing them in and transporting and not waiting.

I think this is a bit apples and oranges to the OP's situation. The reason this "method" works (and by god I hope they issue tourniquets now), is that there are so many hospitals available. If the cops just through some mangled dude in the back of the squad car and had to drive an hour, I don't think the outcomes would be very good...

it's insulting because the information is wrong. Show me an EMT class that is only 120 hours. I mean, a paramedic class is only 800 hours, so while it's more because they can do so much more, but it's still no where near enough.

Show me a paramedic that is 800 hours... My clinical and internship time was longer than that.

so we agree, whether you have an EMT or medic, what the patient really needs is a surgeon.what they really need is a chest tube. but we will agree that a needle decompression is better than nothing. I've read about helicopters that were carrying blood, but very very few ground units.... how common is it for ground paramedics to be carrying and administering blood to trauma patients?

Things that keep from dying from tension pneumos: needle decompressions. Things that BLS does: not needle decompressions. If the helicopter is not flying, I can slide into the local critical access hospital and get a chest tube placed, and then continue on my way. Can grab some blood too. On the way I might give some TXA. Probably some pain medications. Maybe even RSI him. Could this patient go BLS? I suppose. But having these patients for more than say 15 minutes ? Time to bring some tools to the table. I am not disputing that rapid access to surgical care is what will best improve outcomes for this patients. But to discredit all the other things that could be done on a long transport is short sighted at best.

Also, let's just call a spade a spade here. The delivery of your commentary is totally off-putting and does nothing to strengthen your points or overall quality of discussion. There is no reason to deliver your message in such an aggressive way and it's disheartening to watch an "experienced provider" talk to providers in such a way.

 

[johnrsemt]

Back to the patient and transport; right now it would be 85 miles to our level I's, and about 80 miles to Level II; and that would be ground. and probably 3 plus hours if we were lucky. No chance of getting a helicopter. Snowing like crazy all over the area.
My PT job is 120-130 miles to the same hospitals. A few years ago they transported an active MI to a Level I via ground 128 miles, took them 5hrs 25 minutes due to heavy snow and ice, they got the flight crew and their gear delivered by a State Trooper. Helped the patient, he survived. But it wasn't fun for the patient or the crews.
Sometimes the response time at both FT and PT job can be over 2 hours from station to the scene then back past station, then to the hospital
Sometimes the Golden hour can be up to 6 hours.

 

[gotbeerz001]

One of the hardest lessons to learn in EMS is, “not everyone is nice”.

Sounds like you got a pretty good example of that today.

My “pep talk” when I work with a new partner usually starts with:
“Our job is to solve problems and be nice; if you find yourself doing things that are not moving toward these ends, you’re probably wrong.”

 

[DrParasite]

Show me a paramedic that is 800 hours... My clinical and internship time was longer than that.

Since you asked: http://www.mpcc.edu/health-and-medical-occupations/accelerated-paramedic-training-(emt) This one was 1,000 hours, but the didactic is only 480 hours, while the EMT basic didactic (outside of California) is around 200. I do wish the EMT curriculum had a longer and better clinical time, but that's above my pay grade.

Things that keep from dying from tension pneumos: needle decompressions. Things that BLS does: not needle decompressions. If the helicopter is not flying, I can slide into the local critical access hospital and get a chest tube placed, and then continue on my way. Can grab some blood too. On the way I might give some TXA. Probably some pain medications. Maybe even RSI him. Could this patient go BLS? I suppose. But having these patients for more than say 15 minutes ? Time to bring some tools to the table. I am not disputing that rapid access to surgical care is what will best improve outcomes for this patients. But to discredit all the other things that could be done on a long transport is short sighted at best.

I'll give you credit for the needle decomp (esp since I already said it). the other stuff you are taking credit for by having the ER perform, so it's not like you are doing it. And I am waiting for more places to give TXA, I've heard its a wonder drug in trauma, just not around here. pain meds are great, and RSI has it's place. But at least we agree that this patient needs a doctor and a surgeon.

Also, let's just call a spade a spade here. The delivery of your commentary is totally off-putting and does nothing to strengthen your points or overall quality of discussion. There is no reason to deliver your message in such an aggressive way and it's disheartening to watch an "experienced provider" talk to providers in such a way.

So you're offended that I called paramedics out on what they can't do? Or that I attempted to correct old information, only to be told that California is running classes that are stuck in the 90s? I think you should review that post I was referring to. No one disputes that paramedics can do more than EMTs, but to completely disregard them as being anything is insulting at best; It's kinda like how paramedics feel when they are talked down to by doctors and nurses.

Would you feel better if I showed you the studies that showed that paramedics don't affect mortality in traumas? Maybe they are too old, so I'd even ask you to provide studies that show that paramedics do impact mortality in a good way.

Listen, I'm sorry you are so offended.... please provide some studies based on evidence based medicine that shows the contrary.

 

[Tigger]

Since you asked: http://www.mpcc.edu/health-and-medical-occupations/accelerated-paramedic-training-(emt) This one was 1,000 hours, but the didactic is only 480 hours, while the EMT basic didactic (outside of California) is around 200. I do wish the EMT curriculum had a longer and better clinical time, but that's above my pay grade.I'll give you credit for the needle decomp (esp since I already said it). the other stuff you are taking credit for by having the ER perform, so it's not like you are doing it. And I am waiting for more places to give TXA, I've heard its a wonder drug in trauma, just not around here. pain meds are great, and RSI has it's place. But at least we agree that this patient needs a doctor and a surgeon.

We don't have trauma surgery available. The hospital gives us the blood and we continue on our way. Which is something BLS crews cannot do. Same with transporting a patient with a chest tube in, although honestly our hospital is not going to do that and just tell us to keep needle decompressing the patient (awesome).

So you're offended that I called paramedics out on what they can't do? Or that I attempted to correct old information, only to be told that California is running classes that are stuck in the 90s? I think you should review that post I was referring to. No one disputes that paramedics can do more than EMTs, but to completely disregard them as being anything is insulting at best; It's kinda like how paramedics feel when they are talked down to by doctors and nurses.

Would you feel better if I showed you the studies that showed that paramedics don't affect mortality in traumas? Maybe they are too old, so I'd even ask you to provide studies that show that paramedics do impact mortality in a good way.

Listen, I'm sorry you are so offended.... please provide some studies based on evidence based medicine that shows the contrary.

Far from offended. It just be nice to see professionals discuss things like...professionals.
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