Say goodbye to your career

[daedalus]

http://forums.studentdoctor.net/showthread.php?t=564434

The kind doctors at SDN are discussing our elimination and execution.

 

[daedalus]

dramatically decrease the time and effort we spend training pre-hospital providers; like I said, you can train a corpsmen in basic assessment and procedures in a few months, there's no reason you need 2 years to train a paramedic

-Emergency Medicine Resident (MD)

While we argue actively to INCREASE our education length and content, this doctor wants to CUT our most basic EMT education down even further!

 

[Code 3]

Kind of hard to really understand what's going on. The original post is blocked by a large Google Ad box (at least for me), which makes the quoted text difficult to decipher. In addition, by reply #2 they seem to already be bickering at each other and going OT.

 

[41 Duck]

Some doctor doesn't like EMS. Yeah, well... some EMS providers don't like docs, either. Big whoop.


Later!

--Coop

 

[VentMedic]

Remember this is also an anonymous forum with a variety of different members including EMT(P)s. A few are wannabes trying to get into med school but have yet to get through the local community college prerequisites. You may even recognize a few if you frequent some of the other EMS forums. There are also a couple from this forum. Some are often disgruntled on whatever forum they appear.

However, there are posts that do make a few good points. The spending is misappropriated for services in many areas. Focus has been on bigger and more for equating to better instead of improving the systems to provide better medicine.

The concepts are not new and much of the mentality for "ALS" still stems from a mentality that was first presented in the 1960s and then pushed again in the 1990s when Fire saw the opportunity to provide EMS services with their own agenda. ALS was down played to a few skills. Since EMS has not proven itself as a whole and is notoriously fragmented with different self-serving agendas, it is an easy mark for criticism.

Interesting read from the 1990s
http://www.fd-doc.com/2000Hours.htm

 

[Meursault]

Oh, this thread. It's not all that new, but Tired makes some good points.

We've been doing large portions of prehospital medicine very wrong, sometimes dangerously wrong, for a long time. This includes the original rationale for EMS, the treatment of out-of-hospital cardiac arrest (just wrote a policy brief and I'm entirely too eager to talk about it). Without improvements, EMS is a money pit with questionable impact on outcomes.
"Improvements", in this case, does not mean "more money", at least not for agencies. More money for comparative effectiveness studies would be nice; I think the last full study on cost-per-QALY for EMS improvements was done in '95, although there have been meta-analyses since then.

 

[Epi-do]

As I skimmed over the responses of some of the posters there, the following caught my attention (emphasis added by me):

What would I like to see done with EMS? Pretty much this (think "glorified taxi service"):
- eliminate all ALS paramedics and EMTs, use only BLS (yes, use BVM only)
- strip EMT "assessments" down to the bare minimum; nobody cares if the EMT thinks it's GERD instead of an MI
- dramatically decrease the time and effort we spend training pre-hospital providers; like I said, you can train a corpsmen in basic assessment and procedures in a few months, there's no reason you need 2 years to train a paramedic
- expand the system of alorithm-based prehospital care that already exists based on the presenting complaint to standardize care
- minimize interventions they are permitted initiate outside the hospital; require physician verbal orders before doing most anything
- along the same lines, start using dedicated physicians to guide EMTs in the prehospital setting; stop pulling ER physicians away from their work to answer calls from the field

Talk about undoing what little bit of progress we have made. Let's just go back to the days of Mother, Jugs, and Speed and simply drive people to the hospital. Granted, we still have a long way to go, IMO, starting with improving/increasing education. Fortunately, not everyone on that board agreed with this guy, but WOW! Not really sure what to say about the above post.

 

[MedicMeJJB]

A lot of doctors have that "God complex" ... they need to get over themselves. Why can't everyone just appreciate team work?! We should be a team.. we stablize and transport, if we don't - they have bodies for the basement or patients that are in even more of a hot mess when they eventually get to the ER for treatment.

 

[Meursault]

As I skimmed over the responses of some of the posters there, the following caught my attention (emphasis added by me):



Talk about undoing what little bit of progress we have made. Let's just go back to the days of Mother, Jugs, and Speed and simply drive people to the hospital. Granted, we still have a long way to go, IMO, starting with improving/increasing education. Fortunately, not everyone on that board agreed with this guy, but WOW! Not really sure what to say about the above post.

Hey, in some cases (trauma?) if EMS would just get them packaged and drive them to the hospital, they might do better. Likewise, bagging patients instead of multiple intubation attempts might be a better strategy.

Reducing assessment ability and requiring physician verbal orders is classic EM prejudice. Rightly or wrongly, a lot of providers feel that they can't rely on EMS assessments. What they're missing is that making EMS providers better means that you can use their assessments.

I'd actually like to see a shift in the opposite direction, towards doing more in the field and transporting less. We'd need more advanced care providers, like prehospital PAs or actual physicians (like SOS Médecins in France). I haven't done the research to justify it, but it's intuitively appealing.

 

[daedalus]

Not PAs or doctors, but paramedics with a better scope and the ability to treat and release. AND the ability to refuse certain transports like toothache or needs-a-script-for-methadone

 

[LucidResq]

Hey, in some cases (trauma?) if EMS would just get them packaged and drive them to the hospital, they might do better. Likewise, bagging patients instead of multiple intubation attempts might be a better strategy.

Hopefully more education will lead to better clinical judgment, so that an EMT or medic will be able to get their priorities straight and recognize when the best tx is diesel.

 

[VentMedic]

Not PAs or doctors, but paramedics with a better scope and the ability to treat and release. AND the ability to refuse certain transports like toothache or needs-a-script-for-methadone

At this time EMS has not fostered that way of thinking. EMS has made it a point of justifying its worth solely on emergencies and down playing anything else involved in patient care. It has gone further to make the differentiation of ALS and BLS (or BS as many refer it) as worthiness of the provider with BLS associated with the lower level provider being EMT. Instead, it would be some BLS patients that would most benefit from an advanced practitioner.

The PA and the NP have already seen these opportunities in this country. Nurses and some Paramedics are already providing this service in other countries. However, the minimum entry education level for both professions is much higher and it is not a far stretch to extend their education and skills to be an asset in this field.

I just do not see this happening for quite some time. Even if it was possible to provide the education and the additional skills, providing medicine in this aspect would include changing the way some perceive prehospital or out-of-hospital medicine as well as a different patient care concept.

 

[marineman]

Quite frankly I see this as a good thing. Lets face it, there is no way that modern America will allow prehospital treatment to revert 40 years. On the other side these future Docs realize that something must be changed within the EMS system as the way it currently sits is inadequate. I think with this generation of M.D.'s at the helm they will realize that the only direction the American public will accept from here is up (meaning more education, training and treatment options).

Yes a very small group of EMS "professionals" have been fighting that battle for years but for some reason your opinion always seems to carry more weight when your signature is followed by M.D.


Hopefully that made a little sense, that margarita was fantastic.

 

[daedalus]

Does this mean the paramedic is worthless?

Do you think the samples for the studies that conclude ALS prehospital care is useless are tainted by the fact that 60+ % of calls in some systems are "BS taxi rides" where no amount of prehospital care could make a difference?

Do these studies mean you want a BLS truck for your mother while she chokes on a piece of meat firmly stuck in her larynx where only direct visualization will save her? A BLS truck to the soccer field when your kid forgets his inhaler and has an asthma attack? A BLS truck when your daughter develops severe anaphalytic shock at school? What about when your wife has chest pain where the medic could have done a 12 lead and determined STEMI and brought her to the cath lab when instead she is brought to the local doc in the box ER and dies from cardiac arrest?

I always thought it was PAINFULLY obvious that paramedics make a huge difference.

 

[MedicMeJJB]

Does this mean the paramedic is worthless?

Do you think the samples for the studies that conclude ALS prehospital care is useless are tainted by the fact that 60+ % of calls in some systems are "BS taxi rides" where no amount of prehospital care could make a difference?

Do these studies mean you want a BLS truck for your mother while she chokes on a piece of meat firmly stuck in her larynx where only direct visualization will save her? A BLS truck to the soccer field when your kid forgets his inhaler and has an asthma attack? A BLS truck when your daughter develops severe anaphalytic shock at school? What about when your wife has chest pain where the medic could have done a 12 lead and determined STEMI and brought her to the cath lab when instead she is brought to the local doc in the box ER and dies from cardiac arrest?

I always thought it was PAINFULLY obvious that paramedics make a huge difference.

Totally agreed.

 

[Sasha]

Also consider the data could come from places where the hospitals are 2 minutes out, not 30.

Still, even so. That 2 minutes with out an advanced airway could mean certain death.

And I have issue with the "stop wasting so much time training". As if they do the training directly themselves?

 

[mycrofft]

I'm enjoying the smorgasbord of input here.

Sasha hit a nail dead on: transport time. We, including me, (er,I), generally think "urban or suburban EMS" . Think Cherry County, NEB., or Whidbey Island in a winter storm. "Triage of time" steps in, and even Johnny and Roy can't save as many pts if their limited skills and protocols demanding radio contact are tested in hour long reponses.

The primary concept of the EMT-A and the EMT-P was a sound one, especially when considered with the nearly-concurrent creation of the FNP and PA, creating means to extend care beyond first aid and CPR alone, closer to the patient and off the grounds of the hospital. Then employers and willing employees started making all sorts of mutant spinoff "EMT-lings" (I was there, don't kid yourself, we were party to it also) who could each use a different set of tools and protocols.

This system has gotten crumpled up and needs a good ironing-out. Monetary cutbacks may do some of this, but more likely will hurt the higher-cost and the private responders before fire-EMS.

Yes, you can train military medics quickly (or basic EMT's, or maybe even paramedics if you cut back the academic undergrowth), but the longer the transprt and the trickier the case, the greater the likelihood for negative outcome. How about concentrating funding for higher-end responders to areas with longer response times (as well as more PA's FNP's, etc), and expand non-ER resources in short response areas to stop wasting your time on non-emergency calls and trying to find an ER with an open bay?

 

[Sjames]

I know for a fact that MO is increasing EMT-B training. Its going from 2 days a week to 3. Also I believe clinical times are going to double. This will be happening in August per MODOT.

It seems like training is increasing over here.

The following is stuff I am not sure about...

I have heard that the EMT B will be phased out in MO and only EMT-I and paramedic will be on ambulances.Also I heard they are getting rid of first responders and you will have to have a minimum of an EMT B to be a first responder.

 

[Arkymedic]

The point is a lot of us here (myself included) feel that the EMT should be a 1 or 2 year program including A and P, microbiology, medical terminology, and some basic courses like English. We also feel that the EMT-P level should go to a 4 year or more style program to encourage higher professional standards. Going from 2 to 3 days and increasing anywhere from 8-48 hours of clinicals is great, but it is not nearly enough. In some places the extra hours would mean you were done sooner, not that you learned more.

I know for a fact that MO is increasing EMT-B training. Its going from 2 days a week to 3. Also I believe clinical times are going to double. This will be happening in August per MODOT.

It seems like training is increasing over here.

The following is stuff I am not sure about...

I have heard that the EMT B will be phased out in MO and only EMT-I and paramedic will be on ambulances.Also I heard they are getting rid of first responders and you will have to have a minimum of an EMT B to be a first responder.

 

[Sjames]

I agree with you.
There are a lot of problems though. Around here EMT B usually only get paid a little over minimum wage and medics not much better. Pay varies greatly by company and area.
With more education people will expect and need to be paid more. There will be education loans to pay back and so forth. EMS just needs a major reworking.

More education would be great. It would be nice to see paramedics with at least a AAS. I don't think they would need a 4 year degree.
Students don't get near enough training. A few hours on an ambulance and your ready to go! HAHA