Replacing EMS with nursing revisited

[Veneficus]

I missed this in all of the excitement.

And how, on the off chance that it was scurvy, is it a true emergency that a Paramedic should have dealt with, let alone taking to the ED, when the patient was going to the dentist, with much more education on the matter than the average ED MD, in mere minutes?

For the benefit of those still reading I would like to just off topic a little and discuss this.

Vitamin C deficency is caused from malnutrition. Which means other malnutrition states are possible. But the life threatening sequele for the benefit of clinical education. (malnutrition can be a sign of neglect, which is serious enough to require mandatory reporting)

Defect in type I collagen. (which your blood vessles have) can cause your blood vessles to be unstable and rupture. (trouble there)

In addition you can lose your teeth. Which is not only an asthetic problem that can lead to psychosocial problems but can also lead to further malnurishment.

Furthermore the potential hemarthrosis can be mistaken for hemophilia A. Which could lead to a misdiagnosis and inappropriate treatment in the hospital.

And how would a nurse on an ambulance been any better in said situation than a Paramedic? Do nurses have the ability to test for scurvy in the field any more than a Paramedic?

I was under the impression that nurses are responsible for assessing the nutritional status of patients as part of their nursing assessment. But that is just what I have been told by nurses I know. I have no reason to doubt them, so I consider it true.

Ok, clinical time over, back to the topic at hand.

 

[Aidey]

What is the major difference between the systems in the UK/OZ/NZ/etc that have been touted as so much better, and evolved so much fast.

Universal healthcare with EMS run by a central agency.

We don't have either of those, and aren't going to anytime soon. It is a lot easier for change to be made when it is done from the top down than the bottom up. Comparing the evolution of EMS in those countries to the evolution of EMS in the US isn't a fair comparison because the way we get from Point A to Point B is totally different than those places.

 

[Veneficus]

What is the major difference between the systems in the UK/OZ/NZ/etc that have been touted as so much better, and evolved so much fast.

Universal healthcare with EMS run by a central agency.

We don't have either of those, and aren't going to anytime soon. It is a lot easier for change to be made when it is done from the top down than the bottom up. Comparing the evolution of EMS in those countries to the evolution of EMS in the US isn't a fair comparison because the way we get from Point A to Point B is totally different than those places.

I think it is a very fair comparison.

In those countries, cost containment is a serious issue. In the US, cost containment has become a serious issue.

Yes our system is different, it is failing. But public or private, industries still need to meet the needs of the consumer. EMS is no different.

There is a lot of talk about what is reimbursed and what isn't. But that is subject to change. Additionally as was pointed out earlier, there is reimbursement for home healthcare.

Similarly, a business (fire department, county service, etc) which opens up new revenue streams or provides additional value while reducing costs is a successful enterprise.

In any industry it is rare for the techs to be given a voice at the discussion when professionals and power players are discussing where cuts are going to be made.

If it potentially means your job, is it not worth what it takes to make sure your interests are represented?

 

[Aidey]

I was under the impression that nurses are responsible for assessing the nutritional status of patients as part of their nursing assessment. But that is just what I have been told by nurses I know. I have no reason to doubt them, so I consider it true.

Ok, clinical time over, back to the topic at hand.

As someone who has had the unfortunate opportunity to have multiple ER visits this year, I've never had my overall nutritional status assessed. Even after a documented 100+ lb weight loss between my ER visits this year and my previous ER visits. The closest thing I had to a discussion about nutrition was when my gallbladder went bad and the MD asked me about fatty foods and alcohol.

Even my GP doesn't go much past are you getting enough of the good stuff, and are you going easy on the caffeine? And she is an awesome GP, who leans towards the holistic side of things.

Now, I do remember when I did the geriatric clinicals during Paramedic school when the RNs did intake assessments on patients being admitted to the SNF (that was literally attached to the hospital) they assessed nutrition status. I also often notice information on the patients diet and eating habits in charts sent out from SNFs.


Soooooooooooooooo, my end point is that I suspect that things like a nutritional assessment are done on an as needed basis depending on the situation, complaint, setting etc. I don't think it is something done on every patient, all the time, especially in the ER.

 

[TransportJockey]

As someone who has had the unfortunate opportunity to have multiple ER visits this year, I've never had my overall nutritional status assessed. Even after a documented 100+ lb weight loss between my ER visits this year and my previous ER visits. The closest thing I had to a discussion about nutrition was when my gallbladder went bad and the MD asked me about fatty foods and alcohol.

Even my GP doesn't go much past are you getting enough of the good stuff, and are you going easy on the caffeine? And she is an awesome GP, who leans towards the holistic side of things.

Now, I do remember when I did the geriatric clinicals during Paramedic school when the RNs did intake assessments on patients being admitted to the SNF (that was literally attached to the hospital) they assessed nutrition status. I also often notice information on the patients diet and eating habits in charts sent out from SNFs.


Soooooooooooooooo, my end point is that I suspect that things like a nutritional assessment are done on an as needed basis depending on the situation, complaint, setting etc. I don't think it is something done on every patient, all the time, especially in the ER.

Nutritional assessments are done on pretty much every patient that is admitted to the hospital. But they are done by (at my old hospital system) dieticians and nutritionists.

 

[Veneficus]

As someone who has had the unfortunate opportunity to have multiple ER visits this year, I've never had my overall nutritional status assessed. Even after a documented 100+ lb weight loss between my ER visits this year and my previous ER visits. The closest thing I had to a discussion about nutrition was when my gallbladder went bad and the MD asked me about fatty foods and alcohol.

Even my GP doesn't go much past are you getting enough of the good stuff, and are you going easy on the caffeine? And she is an awesome GP, who leans towards the holistic side of things.

Now, I do remember when I did the geriatric clinicals during Paramedic school when the RNs did intake assessments on patients being admitted to the SNF (that was literally attached to the hospital) they assessed nutrition status. I also often notice information on the patients diet and eating habits in charts sent out from SNFs.


Soooooooooooooooo, my end point is that I suspect that things like a nutritional assessment are done on an as needed basis depending on the situation, complaint, setting etc. I don't think it is something done on every patient, all the time, especially in the ER.

Just because something isn't done, doesn't mean it shouldn't be done.

I know that it is not routine in the ED, which is one of the reasons there can be misdiagnosis, but lack of treatment because with the exception of thiamine and perhaps b12, the ED really isn't the best place to attempt to treat malnurishment.

I have no doubt to your experience though.

 

[Aidey]

I think it is a very fair comparison.

In those countries, cost containment is a serious issue. In the US, cost containment has become a serious issue.

Yes our system is different, it is failing. But public or private, industries still need to meet the needs of the consumer. EMS is no different.

There is a lot of talk about what is reimbursed and what isn't. But that is subject to change. Additionally as was pointed out earlier, there is reimbursement for home healthcare.

Similarly, a business (fire department, county service, etc) which opens up new revenue streams or provides additional value while reducing costs is a successful enterprise.

In any industry it is rare for the techs to be given a voice at the discussion when professionals and power players are discussing where cuts are going to be made.

If it potentially means your job, is it not worth what it takes to make sure your interests are represented?

There are definitely similar problems, I don't disagree with that. My observation is on the management side of things. If the NHS wants to change something about how the ambulances work, they can, and it affects all of the ambulances equally.* Who exactly in the US has the power to do that? No one, the DOT sets educational minimums, but they have no enforcement ability. Individual states, cities, counties and services within those entities have a lot of freedom of what they want to allow EMS to do. There is no way to make a national change easily like exists in the countries that have more advanced EMS.


* I'm assuming equally, I don't know if the zip code lottery affects ambulance care the same way it affects hospital care.

 

[Shishkabob]

Just because something isn't done, doesn't mean it shouldn't be done.

I know that it is not routine in the ED, which is one of the reasons there can be misdiagnosis, but lack of treatment because with the exception of thiamine and perhaps b12, the ED really isn't the best place to attempt to treat malnurishment.

I have no doubt to your experience though.

It's also neither routine to be checked in the field, and we have thiamine as well... so I'm confused as to why you even brought it up as a point against Paramedics in the first place?

 

[Veneficus]

It's also neither routine to be checked in the field, and we have thiamine as well... so I'm confused as to why you even brought it up as a point against Paramedics in the first place?

Because if an agency is doing or has a home healthcare component it should be part of the regular assessment. Especially in the children or elderly.

Despite some of the back and forth, this was never meant to be a paramedic vs. nurse thread, it was supposed to focus mainly on how nursing could be the solution to the dilemas facing EMS.

Physicians are taught and tested on nutrition, and as was pointed out, they may not be assessing it properly either. It still doesn't mean it shouldn't be done.

It is not that I don't want EMS to succeed, they are simply their own worst enemy. I am trying to move on from the problem and discuss solution.

 

[Aidey]

I should have added that my case may not be the best example, since all the ER docs who treated me know me, so they were probably much more trusting than they would be of some random person.

 

[ffemt8978]

Rather than waste time going through the 200 posts in this thread to remove the off topic posts this thread is closed.