Replacing EMS with nursing revisited

[SerumK]

Truthfully, this isn't a problem of EMS and any supposed lack of education, but of the civilian population who utilize 911 for non-emergencies and primary healthcare. If EMS / 911 were utilized only for true emergencies, I'd venture to guess this thread would not exist aside from people WANTING us to get in to community Paramedicine.

If wishes were kisses we'd all have herpes.

And don't bring up that "The patient defines the emergency, not us" crap. No. A stubbed toe is not an emergency.

The patient defines the emergency. We define the urgency. Deal with it.

When people feel the situation is out of their control, they call for help: 911. No amount of attitude from you as an EMS provider will ever change that reality.

When the EMS provider has the educational breadth and depth to be entrusted with the power to treat and release or refer to a PCP rather than take the pt. to the ED, then we can truly define urgency beyond whether or not to turn on the blinkies and woowoos.

 

[Journey]

This thread is silly / pointless.



Just laying that out there.

This is also a strange comment for someone from Texas where RNs are already being trialled in the dispatch centers and have also had a long standing in Community and Public Health to make a difference in some parts of your state.

Agree, completely. We're just mentally pleasuring ourselves at this point. :unsure:

For some on this forum it might be just mental masturbation but if you look at the Association websites of other professionals, including RNs (community, public, ED nursing), Social Workers, Case Managers, Emergency Preparedness, OT, PT and RT, you will see what is being done to keep programs alive and to support preventative and long term care before EMS is needed for a real emergency. These professions have established themselves and now they can lobby for the patient. EMS is still focused on themselves and what is the best name to be called to represent a skill they can do.

You have to see the broader picture and recognize there are many very capable health care providers in medicine that can assume many responsibilities with their initial education, additional education and lack of adversion to education and change.

 

[Shishkabob]

The patient defines the emergency. We define the urgency. Deal with it.

No, seriosuly, that saying is just as stupid as "EMTs save Paramedics".

It holds no basis and just exists to make someone feel better.

When people feel the situation is out of their control, they call for help: 911.

Never disputed that. But having a stubbed toe is not beyond someones control, and is of no reason to call 911.

No amount of attitude from you as an EMS provider will ever change that reality.

Attitude? No.

Educating people on when and when not to call 911? Heck yeah, as it should be.

 

[usalsfyre]

This is also a strange comment for someone from Texas where RNs are already being trialled in the dispatch centers and have also had a long standing in Community and Public Health to make a difference in some parts of your state.

Trialed by a massively overburdened EMS system due to refusal by an FD administration to put the correct amount of trucks on the road.

For some on this forum it might be just mental masturbation but if you look at the Association websites of other professionals, including RNs (community, public, ED nursing), Social Workers, Case Managers, Emergency Preparedness, OT, PT and RT, you will see what is being done to keep programs alive and to support preventative and long term care before EMS is needed for a real emergency. These professions have established themselves and now they can lobby for the patient. EMS is still focused on themselves and what is the best name to be called to represent a skill they can do.

You have to see the broader picture and recognize there are many very capable health care providers in medicine that can assume many responsibilities with their initial education, additional education and lack of adversion to education and change.

If you really have that rosy of a view of the world that those organizations are "speaking for the patient" and not lobbying for their members in the form of "it's good for the patient" than you are truly naive.

I know at some point in your past EMS "wronged" you, but the vendetta is getting old. Isn't their a more constructive outlet than coming on here and bashing paramedics?

 

[Shishkabob]

Isn't their a more constructive outlet than coming on here and bashing paramedics?

Perhaps at an RT forum?

Just sayin'.

 

[Journey]

Educating people on when and when not to call 911? Heck yeah, as it should be.

How do you educate those with dementia although to EMS they might appear perfectly normal because they still know their name and can still sign it?

What about all of those with mental illnesses whose services have been drastically cut over the past 10 years?

How about all of those with substance abuse problems?

What about those who just have no close alternatives to health care?

What about the kids, taught about calling 911 by their parents, who now will get mixed messages from you that it is bad to call 911 and they can get into trouble?

The ones you do educate are those who can afford TVs in houses to see the public service messages. These may also be the ones who do take your message to heart and don't want to be a bother such as the elderly who truly do need your services. Or, it might give the businessman a reason for not calling EMS for his chest discomfort because he wouldn't want to be accused of abusing the system and embarrassed.

The patient defines the emergency. We define the urgency. Deal with it.

It holds no basis and just exists to make someone feel better.

You might not think something like an amputated finger or a broken leg is not a big deal but the patient might think otherwise and so might the person who you tell to drive that person to the hospital because it is not an emergency to you. People have different pain and blood threshholds and making blanket statements like that impairs you own judgement for what is and isn't an emergency. It is like when you already form an opinion about a patient just by how it is dispatched or the neighborhood especially if it is predominantly a different race or socioeconomic status than you. You might also form your own opinion, as you already have stated, about dialysis and nursing home patients before ever seeing them.

 

[usalsfyre]

The patient defines the emergency. We define the urgency. Deal with it.

There's the patients inability to deal with the situation, and then there's a true emergent/urgent complaint.

When people feel the situation is out of their control, they call for help: 911. No amount of attitude from you as an EMS provider will ever change that reality.

Who said anything about attitude? But there is definitely a difference between an honest to God emergency, an urgent complaint that still needs treatment and transport or referral and those who just don't need medical services. Which is not something the patient defines.

More education is needed, but arguing that the patient is the only one able to define an emergency is dumb.

Why is it when anyone mentions that the majority of patients we treat and transport are not true medical emergencies (many times however they do fit in the urgent category) they get accused of being an uncaring bigoted ogre who lets their patients die?

 

[uhbt420]

When you define yourself by a unique knowledge set, and not "skills" then you can puff your chest out at me about "standing up for your profession".

relax, we're on the same side

i would also like to point out that Journey is ventmedic and it's so obvious that it hurts

 

[Journey]

If you really have that rosy of a view of the world that those organizations are "speaking for the patient" and not lobbying for their members in the form of "it's good for the patient" than you are truly naive.

I know at some point in your past EMS "wronged" you, but the vendetta is getting old. Isn't their a more constructive outlet than coming on here and bashing paramedics?

I only got involved in this thread because it was linked on another forum. On that forum we do discuss major issues facing health care especially in the EDs and critical care. Believe it or not but all those patients brought to the hospital by EMS do end up someplace so it is our concern also. I will say we also have a strong political stance for our positions and have gotten several bills passed which have kept patients being provided for many long term services.

It isn't about being wronged in EMS or a vendetta that RNs and other health care professionals see and have done and do things differently. It is about knowing how vast medicine and the health care or social welfare systems are. It seems some in EMS would rather make personal accusations or attacks rather than do a little research on the many topics that just this thread has touched on.

This is not about being naive but about actually working in health care to make a difference. If you can make life a little better even for one patient each day, then your job is not a waste.

Please feel free to look up any of the other websites to see what bills they have introduced to keep services available for those who need them in the community and in home care. State and Federal insurers such as Medicare are a constant challenge. EMS should take that more seriously and figure out how they can improve their role in the system.

 

[Shishkabob]

How do you educate those with dementia although to EMS they might appear perfectly normal because they still know their name and can still sign it?

What about all of those with mental illnesses whose services have been drastically cut over the past 10 years?

How about all of those with substance abuse problems?

What about those who just have no close alternatives to health care?

So, we're too uneducated to do our job, but educated enough to be drug counselors, mental issue counselors, and primary care providers?

What about the kids, taught about calling 911 by their parents, who now will get mixed messages from you that it is bad to call 911 and they can get into trouble?

I've yet to see a kid told NOT to call 911.

However, I have told a mom that calling 911 because her daughter started bleeding (Bleeding as in less blood than losing a tooth) in the mouth after brushing her teeth real hard before going to the dentist is probably not the best use of emergency personnel.

You might not think something like an amputated finger or a broken leg is not a big deal but the patient might think otherwise and so might the person who you tell to drive that person to the hospital because it is not an emergency to you.

Where did I ever say actual physical injuries that needed intervention were no big deal?

You continue to make stuff up to suit your case.

i would also like to point out that Journey is ventmedic and it's so obvious that it hurts

A few of us have known this for weeks. Haven't you seen us alluding to it in our posts? ^_^

 

[usalsfyre]

relax, we're on the same side

i would also like to point out that Journey is ventmedic and it's so obvious that it hurts

Sorry to go nuclear on you, just had some very, very frustrating experiences here lately with people not being able to tell me "why" before they did (or for that matter, did not) do an intervention.

 

[Journey]

So, we're too uneducated to do our job, but educated enough to be drug counselors, mental issue counselors, and primary care providers?

In several of your posts you have referred to being too uneducated to do your job rather than providing an agrument as to why you feel the hours of training in Texas to be a Paramedic is enough and qualifies those who only do the minimum to have so many skills and drugs at their access.

Do you know what a drug or mental health care counselor does? If you did you would see you are not either. I don't believe there is any state that will allow a Paramedic to even declare a person mentally incompetent for an involuntary mental evaluation hold.

Primary Care Providers are usually physicians or physician extenders which the Paramedic is neither.

The other examples are things I've gathered from your previous posts since you seem to be my biggest fan, I thought I'd see what other points you are so adamant about.

 

[uhbt420]

Sorry to go nuclear on you, just had some very, very frustrating experiences here lately with people not being able to tell me "why" before they did (or for that matter, did not) do an intervention.

not a problem, that's life on the internet

didn't Brown go to college for 4 years to be a medic in New Zealand? wonder if he thinks RNs would be any better than a medic with a degree

 

[usalsfyre]

It seems some in EMS would rather make personal accusations or attacks rather than do a little research on the many topics that just this thread has touched on.

I guess everyone needs to vent.


And yes, many people refuse to be educated. But wholesale replacement with another profession does not necessarily fix the issue.

 

[Journey]

I guess everyone needs to vent


And yes, many people refuse to be educated. But wholesale replacement with another profession does not necessarily fix the issue. Especially when the other profession is more geared towards "observe and report" as well as the "unicorns and rainbows" approach to healthcare.

Your vent is acknowledged. But that does not mean you should not see what others are doing in health care and to see where EMS could fit in.

The Paramedic in San Francisco realized he could not tackle the problem by himself and that EMS alone was not the answer.

didn't Brown go to college for 4 years to be a medic in New Zealand? wonder if he thinks RNs would be any better than a medic with a degree

Their EMS system is not as broken as that in the U.S. so it probably is not an issue.

 

[Shishkabob]

In several of your posts you have referred to being too uneducated to do your job rather than providing an agrument as to why you feel the hours of training in Texas to be a Paramedic is enough and qualifies those who only do the minimum to have so many skills and drugs at their access.

Where did I ever state the Texas minimum was enough?

Do you know what a drug or mental health care counselor does? If you did you would see you are not either.

Uh, kind of the point that I was making to YOUR post.

I don't believe there is any state that will allow a Paramedic to even declare a person mentally incompetent for an involuntary mental evaluation hold.

Honestly, that's a moot point considering cops, with no medical education, can do an APOWW for psychiatric evaluation.

Primary Care Providers are usually physicians or physician extenders which the Paramedic is neither.

Again, you missed the point I was making of your very own post...

 

[usalsfyre]

Do you know what a drug or mental health care counselor does? If you did you would see you are not either. I don't believe there is any state that will allow a Paramedic to even declare a person mentally incompetent for an involuntary mental evaluation hold.

I think Linuss's point was we are wholly unqualified to do either.

 

[usalsfyre]

Your vent is acknowledged. But that does not mean you should not see what others are doing in health care and to see where EMS could fit in.

I have no problem with this, and encourage others to do the same.

 

[Journey]

Unfortunately there are more who think with a very narrow focus in EMS which drags down the whole profession and anyone who comes up with an innovative solution will be criticized by some who just can't see the broader picture.

I guess I have learned now to stay on forums where making a difference and providing quality health care is still a good discussion especially when there are so many issues to prepare for in the next year where patients can benefit from our support.

 

[Aidey]

This wasn't a good discussion from the moment it turned into a hostile "All paramedics are uneducated idiots who are hopeless and should just be eliminated" rant. There are people who are more than willing to discuss making a difference and providing quality health care but this thread has not been a productive discussion.