scope expansion in Washington state?

[Handsome Robb]

Can this please not turn into a KCMO/SMO/COPAS bashing thread? We don't need any "my mom's brother's sister's cousin's roommate told me..." stories. Sorry not trying to single you out but that's how these threads turn bad quickly. There are plenty of times patients that should've been "ALS" don't get it because there's only one medic unit in the county and it's about as far away as you can get from the call and still be within the county. If I remember correctly they run 8 medic units to cover the entire county.

I don't like it anymore than anyone else but it's been beaten to death. I think the KCMO model would work fantastically with the first tier of the system being ILS rather than BLS. I'd bet there are some of the most competent EMTs in the nation for the simple fact that unless you're having immense circulatory or respiratory collapse you're not getting a medic. Add analgesia and antiemetics to the ILS scope with appropriate education and the quality of care and symptom relief would skyrocket.

Sorry, pet peeve of mine but "pregnant with 10/10 abdominal pain, SVT and 80/p" after an assault isn't SVT, it's ST (at the barebones definition of SVT you are correct since it's a tachycardia originating above the ventricles). You know what it is and where it's coming from, above 150 =/= SVT.

 

[chaz90]

Sorry, pet peeve of mine but "pregnant with 10/10 abdominal pain, SVT and 80/p" after an assault isn't SVT, it's ST (at the barebones definition of SVT you are correct since it's a tachycardia originating above the ventricles). You know what it is and where it's coming from, above 150 =/= SVT.

Thanks for this. I was getting ready to post something similar. Now I can go back to my nap. I agree with the rest of the post too FWIW. The more I see of tiered systems, the more I start to think I'll never want to be back in an "ALS truck to every call" system again.

 

[MonkeyArrow]

I'd have to respectfully disagree with tiered systems as I have seen the merits of ALS on every truck in my neck of the woods down here in GA and I like it. I think with a tiered system at the current level of certs (EMT-B, EMT-I, EMT-P) at least in GA, there stands too large of a standard of care continuity. With dispatching BLS and ALS based off of 911 calls, the level of care one receives may be lacking as lay people do not always provide the best info. Additionally, sending an ALS unit to a BLS call does not have any adverse effects for a patient, per say, but does tie up an extra ALS unit in a system where they are low in number because of the tiered system. Also, BLS units will presumably be unable to administer analgesics which significantly decreases the quality of care for some of our patients that could benefit from it (not going to go into it further as this has been discussed in other threads here). The use of a tiered system can also create logistical nightmares for certain cities (like Detroit) who are already understaffed and can't get their ambo's out the door already aside from having to classify and rezone calls. Also, in areas with private/public or fire department based EMS where fire apparatus rolls out on medical calls, this new idea could quickly become unfeasible for certain systems out there. Namely, this video is what I am referring to: http://www.youtube.com/watch?v=Yp0O0Za73QM

The use of an all ALS system will allow the quality of care to remain high specifically high for those needing pain medications. You can only send out one unit with ALS capabilities and handle the call instead of tying up two of your units and/or refusing to provide pain meds. The all ALS unit ensures that you will always have the right unit out the door while being able to call out an extra unit if needed (coding pt.). You can continue to dispatch as you were and provide a high quality of care.

 

[waaaemt]

Can this please not turn into a KCMO/SMO/COPAS bashing thread? We don't need any "my mom's brother's sister's cousin's roommate told me..." stories. Sorry not trying to single you out but that's how these threads turn bad quickly. There are plenty of times patients that should've been "ALS" don't get it because there's only one medic unit in the county and it's about as far away as you can get from the call and still be within the county. If I remember correctly they run 8 medic units to cover the entire county.

I don't like it anymore than anyone else but it's been beaten to death. I think the KCMO model would work fantastically with the first tier of the system being ILS rather than BLS. I'd bet there are some of the most competent EMTs in the nation for the simple fact that unless you're having immense circulatory or respiratory collapse you're not getting a medic. Add analgesia and antiemetics to the ILS scope with appropriate education and the quality of care and symptom relief would skyrocket.

Sorry, pet peeve of mine but "pregnant with 10/10 abdominal pain, SVT and 80/p" after an assault isn't SVT, it's ST (at the barebones definition of SVT you are correct since it's a tachycardia originating above the ventricles). You know what it is and where it's coming from, above 150 =/= SVT.

Chill your buns mister! No one is bashing kcmo. I don't even work in that county, this was a different county with more medics available. you dont seem to know what a medic dump is, it's when a medic is on scene but too lazy to assess/treat the pt so BLS trucks have no choice but to take an ALS pt. On the other hand taking an ALS criteria pt when a medic is too far out is just good pt care.

And no she had confirmed SVT, I ain't making this up! on a side note south king has about 8 medic units, they cover more rural areas. Seattle itself has about 8 medic units. And for the most part they get the job done, no complaints about the tier system.

I was just pointing out how AEMT as a base level would be beneficial in even medic saturated areas.

ANYWAY....back to my main question .... Anyone have more insider info on timetables of when this stuff will happen??

 

[NomadicMedic]

Respectfully disagree. If you want to give drugs and do "medic stuff" go to medic school. If you are in an area served by paramedics and they are too busy or burnt out to respond to ALS calls or they turf ALS calls to basics, that's a system issue and they need more medics. Not partial medics.

 

[8jimi8]

Because having every EMS provider be a medic is totally unnecessary... Also your illustration of EMTs compared to medics and medics compared to MDs is totally contradictory. You're saying every medic should just go for the whole thing and become an MD? But then you're saying that's wrong? What?

2 years in comparison to 8-14 is not contradictory

as far as expanded scope, i'd really like to see a masters level education for that. talk about not having the education... Paramedic textbook does not go into what medications should be prescribed and why.

 

[unleashedfury]

Respectfully disagree. If you want to give drugs and do "medic stuff" go to medic school. If you are in an area served by paramedics and they are too busy or burnt out to respond to ALS calls or they turf ALS calls to basics, that's a system issue and they need more medics. Not partial medics.

This..

BLS and ALS tiered systems can be a nightmare if not managed correctly. But are overall useful. No need to tie up a ALS unit for a BLS discharge to a SNF. or dialysis runs.

However the "bean counters" will see one thing. If we put out more ILS units. We can allow for lower paid personel to supplement the short supplied ALS units. So instead of adding needed ALS units to compensate more ILS units will pop up.

I can't speak for national numbers, but In my area theres not a shortage of paramedics, and the 4 big companies around here that have at least 5 units on the road daily rarely have a truck available They would rather work short staffed and have calls handled by their BLS crew vs. adding another ALS unit. The good thing is EMT's do learn how to properly manage patient.

 

[MonkeyArrow]

This..

BLS and ALS tiered systems can be a nightmare if not managed correctly. But are overall useful. No need to tie up a ALS unit for a BLS discharge to a SNF. or dialysis runs.

However the "bean counters" will see one thing. If we put out more ILS units. We can allow for lower paid personel to supplement the short supplied ALS units. So instead of adding needed ALS units to compensate more ILS units will pop up.

I can't speak for national numbers, but In my area theres not a shortage of paramedics, and the 4 big companies around here that have at least 5 units on the road daily rarely have a truck available They would rather work short staffed and have calls handled by their BLS crew vs. adding another ALS unit. The good thing is EMT's do learn how to properly manage patient.

And this was my point exactly. If properly managed, sure, a tiered system could work and be perfectly efficient. However, the reality is that companies only care about their bottom lines and will look to cut costs wherever possible. If they can slip under the radar with 5 ALS units instead of the 7 that the area needs, why would they spend the extra money since they are "getting by perfectly fine" without them. Thus, certain calls get turfed. With an all ALS system, there is no chance to cut standard of care or turf since there is no lower level of care to turf to.

 

[NomadicMedic]

This thread is about WASHINGTON state. Please remain on topic. If you'd like discuss other systems, please start a new thread.

I've moved the Canadian/BC discussion to it's own thread.

 

[RMPNW]

The state can add whatever skills or components it wants to the curriculum for each level of care but each county MPD will still have the ultimate say in what skills may be used in his respective county. For example EMTs in Washington State (by curriculum) can do CPAP and 12-lead acquisition but many county's (like King & Snohomish County) do not allow them by protocol, whereas some (like Pierce County) do allow them. To my knowledge there are no changes in regards to changing the base level in Washington State from EMT-B to AEMT.

 

[Handsome Robb]

Chill your buns mister! No one is bashing kcmo. I don't even work in that county, this was a different county with more medics available. you dont seem to know what a medic dump is, it's when a medic is on scene but too lazy to assess/treat the pt so BLS trucks have no choice but to take an ALS pt. On the other hand taking an ALS criteria pt when a medic is too far out is just good pt care.



And no she had confirmed SVT, I ain't making this up! on a side note south king has about 8 medic units, they cover more rural areas. Seattle itself has about 8 medic units. And for the most part they get the job done, no complaints about the tier system.



I was just pointing out how AEMT as a base level would be beneficial in even medic saturated areas.



ANYWAY....back to my main question .... Anyone have more insider info on timetables of when this stuff will happen??

I wasn't excited...

I know plenty well what a medic dump is thank you very much.

Any tachycardia that originates above the ventricles is "SVT" by definition...hence "supraventricular tachycardia."

Your system does not work in its current state. Hate to break it to you.

 

[Drax]

How about an epi pen where you can just remove and replace expired epi doses? Who wants to go in on that with me?

anyway, I totally disagree with AEMT being unnecessary in sno, king and pierce counties. Especially for the private amb guys who get ridiculous medic dumps all the time. I always hear of medics dumping what looks like a drunk bum who actually has 20 stab wounds and bp of 60/p and stuff like that. I even talked to an AMR guy who had Seattle medics dump a STEMI on him. And personally I've taken in a girl who was pregnant, was punched in the belly, had 10/10 abdominal pain, SVT and 80 something/p bp.

And I'm not saying all medics around here dump patients, 90% are amazing but a few are just lazy

I'm down on the removable epi dose pen.

I'm not quite sure I understand, what does having incompetent (not saying that I agree) paramedics have to do with pushing for AEMTs? Just another set of eyes on? I'm willing to bet AEMTs can be "not so on point" as well.

 

[Handsome Robb]

It's not that their paramedics are incompetent up there, far from it.

It's the culture the system has created.

 

[waaaemt]

It's not that their paramedics are incompetent up there, far from it.

It's the culture the system has created.

Yes exactly! Thank you.


And I'm not saying AEMT will or should fix the culture problem. But it's just a practical application in our current systems.

Also I don't get why all these people are so against a higher baseline scope.
I remember on other threads a lot of these same people bashing EMTB scope, wage and professionalism. Now WA state is moving towards increasing education and wage and these guys are whining about how every body should be medics instead, ignoring the part where medics scope will also be expanded.

Speaking of which, that will be awesome and will reduce tons of unnecessary ER visits.

 

[unleashedfury]

Yes exactly! Thank you.


And I'm not saying AEMT will or should fix the culture problem. But it's just a practical application in our current systems.

Also I don't get why all these people are so against a higher baseline scope.
I remember on other threads a lot of these same people bashing EMTB scope, wage and professionalism. Now WA state is moving towards increasing education and wage and these guys are whining about how every body should be medics instead, ignoring the part where medics scope will also be expanded.

Speaking of which, that will be awesome and will reduce tons of unnecessary ER visits.

How will that reduce unnecessary ED visits? There will still be people who insist on going to the hospital. While I agree that the community paramedicine program may reduce ED visits There is still going to be the select few that will want to go to the ER even if it means faking idiopathic pain.