Spin off to the BLS care thread
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Ridryder911
EMS Guru
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Unfortunately, very little. Do to the poor to no educational system they are usually now cook book medics from shake & bake programs, that they are simply task performers. Even at the advanced level. So many have optioned out to get something fast and neglect taking the time to obtain the building blocks required to understand the basics of science & medicine.
The possibilities are endless, but at this time as I have described not much in direct patient care. Don't believe it? Read TQI of EMS services, read how knowledge base have decreased as well as skill deterioration too. Sounds like we are improving with age? ..
Okay... to the topic:
EMT- Medical First Responder. Some.. and I use that conservatively, can assist a Paramedic
EMT/I - Really no difference than a Basic other they have obtained on how to perform a few more skills. Usually can assist a Paramedic more and tend to have more experience.
Paramedic- this standard was lower when it was first started and improved, then suddenly alike other EMS and medical programs, it too started "dumbing down*". Most can perform what some consider Basic to Advanced level care.
Dumbing down is something that many medical (not just EMS, but Nursing & Medical Schools) alike have noticed in the last decade or so. The movement where "everybody should pass" has been pushed. In reality, medicine is not for everyone, not everyone should or can pass, or even deal with it. Many do not understand there is nothing wrong with that, just similar to other professions.
We are in serious dilemma concerning EMS Education or the lack of. The number, the type of patients that was taught about is not even similar what we now see in the field. Unfortunately, we have not kept up with the demand of medicine or our patients.
R/r 911
The possibilities are endless, but at this time as I have described not much in direct patient care. Don't believe it? Read TQI of EMS services, read how knowledge base have decreased as well as skill deterioration too. Sounds like we are improving with age? ..
Okay... to the topic:
EMT- Medical First Responder. Some.. and I use that conservatively, can assist a Paramedic
EMT/I - Really no difference than a Basic other they have obtained on how to perform a few more skills. Usually can assist a Paramedic more and tend to have more experience.
Paramedic- this standard was lower when it was first started and improved, then suddenly alike other EMS and medical programs, it too started "dumbing down*". Most can perform what some consider Basic to Advanced level care.
Dumbing down is something that many medical (not just EMS, but Nursing & Medical Schools) alike have noticed in the last decade or so. The movement where "everybody should pass" has been pushed. In reality, medicine is not for everyone, not everyone should or can pass, or even deal with it. Many do not understand there is nothing wrong with that, just similar to other professions.
We are in serious dilemma concerning EMS Education or the lack of. The number, the type of patients that was taught about is not even similar what we now see in the field. Unfortunately, we have not kept up with the demand of medicine or our patients.
R/r 911
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mikeylikesit
Candy Striper
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I hear that. when i was in medic school i went over the book with my dad and he kept asking me questins about things that we aren't even required to know anymore. thanks to my dad i learned far more than the new age medic books are willing to teach. not outside of my scope but there are some things that everyone should know in patient care.
KEVD18
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the perfect ems system has yet to be designed. i am certainly not capable of doing it and i venture to say the same about everybody here. that being said, my idea of a perfect system has a place for all mainstream levels of emt(basic, inter and medic). R/r's view certainly has some merit, but i feel its incomplete. an all college educated(associates level) paramedic(hereby referred to as supermedics) ems system has two things going for it. it certainly provides top level care for its constituency. however it does it at a monumental cost. while we don't do it for the money, we have to be compensated fairly. if i have to spends 20 grand or better to get a job, that job better pay me well enough to make it work.
the theory that every person deserves the highest level of care is without a doubt true. however, there a people that are willing to make sacrifices on that accord. case in point, townships that have voted down increases in taxes that would pay for increasing public services. they would are, as a whole, happy with the level of service they have relative to the amount of money they spend via taxes. requiring every ambulance to be staffed by supermedics would greatly increase the cost of providing service to that community which time and time again certain places have voted against. regardless of how any one person feels about their rights, that's what they want and we cant force them.
there's also the business of private ems to consider. now, i will be the first to say i didn't get into this business to make money. that being said, there is a business in the medical transportation of people. there are many instances where a patient need to be monitored by a medically trained person. however, that persons training doesn't have to be exceptionally high. its doesn't take much training to administer oxygen to a dialysis patient, heck most of them do it themselves. but there's also the transportation part. stairs might be involved, physical position required for transport etc. you don't need an associates in paramedicine to do that. a bls ticket does the trick. the average cost of a nonemergent medical transportation of a scheduled patient in massachusetts is 500 dollars each way. now, certain discounts are offered for frequent fliers(i.e. 3 round trips a week for dialysis). now take all the other variables out and focus on the costs of the techs. i have been paid anywhere from 11.50-13.50/hr base to do that job. were i a super medic, i would expect a minimum of 20/hr. therefore, the average cost of that trip would increase hugely. medicare has already decided that they wont pay what we're charging now, much less the increased cost to staff the trucks with supermedics. this means that the amount of money that has to be paid by the patient increases. most of them cant afford what they have to pay now, they certainly cant afford a huge increase.
there's arguments on both sides of the argument. i don't think there's a perfect solution. i don't think there ever will be.
I figured I would post this there because the other BLS post was locked.
Of course EMTs staffed on a emergency vehicle is a financial decision, what else would it be.
Do I think every response requires a paramedic? No, and I have 15 years and about 15,000 responses under my belt oto back it up.
However if your EMTs are trained only to the state minimum, then no they shouldnt be staffing emergency vehicles.
My EMT training was along with the medics 400 hours didactic time, we were trained together in the same class room, if you were an EMT then you did half the clinical hours and half the ride time.
Lets remember 120 hours of training is a state minimum. As all medics are not created equal nor are all EMTs.
When you staff sevent-five ambulances a day, and approx seventy percent of your call volume does not require an EMT never mind a medic.
I kind of chuckle when I hear "Do you no a tooth ache can be a sign of a cardiac episode", " Toe pain can be a pre-indicator of a disecting aortic anuerysm" Yes I am sure they can be but 99.99999% of them are what they are.
How often do you see a person stroll into an ER with elbow pain and recieve a cardiac work up, or an IV? But because they dialed 911 there must be some secret underlying cardiac disorder.
Level -one trama centers treat thousands of patients a day. Have you ever heard of major and minor, or fast track? Why because elbow pain is elbow pain and toe pain is toe pain 99.9999999 percent of the time.
Come on guys I am all for education and comptent providers, but if these are your arguments then you are reaching a little. Adequetly train your BLS providers and allow your ALS providers to tend to the patients that require there services.
As far as the cardiac arrest save percentages. ALS/BLS cardiac arrest pts have very similar survival percentages. The ones that were quoted as being near twenty-percent have nothing to do with EMS, and everything to do with community training and the immediate initiation of CPR and defib by laypeople. If you do not reach these people in a timely fashion, and if no-one has intervened before you arrive these people have no survival rate, and anyone that tells you different is blowing sunshine up your you no what.
Of course EMTs staffed on a emergency vehicle is a financial decision, what else would it be.
Do I think every response requires a paramedic? No, and I have 15 years and about 15,000 responses under my belt oto back it up.
However if your EMTs are trained only to the state minimum, then no they shouldnt be staffing emergency vehicles.
My EMT training was along with the medics 400 hours didactic time, we were trained together in the same class room, if you were an EMT then you did half the clinical hours and half the ride time.
Lets remember 120 hours of training is a state minimum. As all medics are not created equal nor are all EMTs.
When you staff sevent-five ambulances a day, and approx seventy percent of your call volume does not require an EMT never mind a medic.
I kind of chuckle when I hear "Do you no a tooth ache can be a sign of a cardiac episode", " Toe pain can be a pre-indicator of a disecting aortic anuerysm" Yes I am sure they can be but 99.99999% of them are what they are.
How often do you see a person stroll into an ER with elbow pain and recieve a cardiac work up, or an IV? But because they dialed 911 there must be some secret underlying cardiac disorder.
Level -one trama centers treat thousands of patients a day. Have you ever heard of major and minor, or fast track? Why because elbow pain is elbow pain and toe pain is toe pain 99.9999999 percent of the time.
Come on guys I am all for education and comptent providers, but if these are your arguments then you are reaching a little. Adequetly train your BLS providers and allow your ALS providers to tend to the patients that require there services.
As far as the cardiac arrest save percentages. ALS/BLS cardiac arrest pts have very similar survival percentages. The ones that were quoted as being near twenty-percent have nothing to do with EMS, and everything to do with community training and the immediate initiation of CPR and defib by laypeople. If you do not reach these people in a timely fashion, and if no-one has intervened before you arrive these people have no survival rate, and anyone that tells you different is blowing sunshine up your you no what.
On the topic of survival rates for cardiac arrest being the same in ALS and BLS, well, I want to ask a little scenario that happened today.
So, dispatched to a home for a cardiac arrest. You're at the patient within two minutes of them going down. Family states patient is dialysis patient, skipped dialysis recently because the machines were broken.
BLS: CPR, AED (Doesn't let you shock), Simple oral airway, transport.
Time before drug therapy: 45 minutes. Too long.
ALS: CPR, Asystole on monitor. IV, ET, Epi, Atropine, Sodium Bicarbonate, Calcium Chloride. Pt converts to PEA at 60. More epi, more CPR. Pt recovers pulse.
Time before drug therapy: 4 minutes. Underlying cause fixed, cardiac activity returns in time.
---
There are a lot of different reasons for cardiac arrest. And many of those causes are ones that, through drug therapy, can be reversed. Ones BLS simply cannot perform.
H's and Ts.
Hypovolemia - ALS, IV Fluids.
Hypoxia - Both, with advantage to ALS for ET.
Acidosis - ALS, drug therapy.
Hyperkalemia or Hypokalemia - ALS, drug therapy.
Hypothermia - Both, with advantage to ALS for warm IV fluids.
Hypoglycemia or Hyperglycemia - ALS, drug therapy.
Toxins - ALS, drug therapy.
Cardiac Tamponade - ALS, identification and pericardiocentesis.
Tension pneumothorax - ALS, needle decompression.
Thrombosis - Usually neither, thrombolytics.
Thromboembolism - Usually neither, thrombolytics.
Trauma - See hypovolemia.
Treating the cause is vital.
So, dispatched to a home for a cardiac arrest. You're at the patient within two minutes of them going down. Family states patient is dialysis patient, skipped dialysis recently because the machines were broken.
BLS: CPR, AED (Doesn't let you shock), Simple oral airway, transport.
Time before drug therapy: 45 minutes. Too long.
ALS: CPR, Asystole on monitor. IV, ET, Epi, Atropine, Sodium Bicarbonate, Calcium Chloride. Pt converts to PEA at 60. More epi, more CPR. Pt recovers pulse.
Time before drug therapy: 4 minutes. Underlying cause fixed, cardiac activity returns in time.
---
There are a lot of different reasons for cardiac arrest. And many of those causes are ones that, through drug therapy, can be reversed. Ones BLS simply cannot perform.
H's and Ts.
Hypovolemia - ALS, IV Fluids.
Hypoxia - Both, with advantage to ALS for ET.
Acidosis - ALS, drug therapy.
Hyperkalemia or Hypokalemia - ALS, drug therapy.
Hypothermia - Both, with advantage to ALS for warm IV fluids.
Hypoglycemia or Hyperglycemia - ALS, drug therapy.
Toxins - ALS, drug therapy.
Cardiac Tamponade - ALS, identification and pericardiocentesis.
Tension pneumothorax - ALS, needle decompression.
Thrombosis - Usually neither, thrombolytics.
Thromboembolism - Usually neither, thrombolytics.
Trauma - See hypovolemia.
Treating the cause is vital.
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There was a reason the other thread was locked, and do not attempt to continue that conversation here or this one will be locked also.
Might as well get your key for the lock ready. We all know how this will end, instead of education there shall be stupidity. Its no longer ignorance. Ignorance is when someone truly doesn't know. Stupidity is a repeat performance. Stupidity shall rear its ugly head, more than likely from an insecure EMT-B who comes in here puffing out his / her chest crying foul because they do not like TO HEAR THE TRUTH.
Out of respect for you FF, along with Jon, Chimpie, MMiz, and the other veteran posters who contribute in an educational and positive manner, I will quietly bow out of this conversation with my peace having been said.
Good night to all, keep it safe.................................
daedalus
Forum Deputy Chief
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Many of histories most important accomplishments were born out of intense infighting and arguing. I find that these heated debates reveal the truth, and are therefor useful. Until we are all on the same page, simply shutting down a debate won't shutdown the argument or the ignorance...arrogance...
It is not due to any educational system at all. It is due to the medical directors desire to protect his license. Since we are simply his eyes and ears in the field we are merely trained to recognize conditions and treat that condition as per his standing orders. Then, if the patient presents in some way that is not covered by the standing orders, we call him for additional orders.
If you want to be a doctor then go to medical school I always say. If you want to follow the doctors orders then you came to the right place.
Back on topic. There is a place in emergency response for every level of care. It is up to the individual licensed providers to decide what combination is right for their own response area.
Interesting thought process....Locking a thread. Surpressing opinions, to curtail the views of your members. Hope that works out well for you, traffic equals money, no traffic equal no money. Boring mindless discussions about your thoughts on eight pocket pants and which trauma shares you prefer equals boring discussions which equals lack of traffic which equals no revenue.
Its a thought process like this that gets nothing solved, we revel in obsecurity because we promote mindless conversation. Opinions turn in to heated discussions which force people to learn to cognitivley think, and consider other viewpoints.
“Every great movement must experience three stages: ridicule, discussion, adoption”
-John Stuart Mill
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In order to clarify something, I'm going to post a response to address a couple of points before I take the rest of this conversation to PM.
This site takes in no money, no matter how much traffic we have here. Do you see any ads anywhere on this site? Let me save you some effort, there are none. This site is privately funded by the site owner, and no one else so your argument about more traffic equals more revenue doesn't hold water.
We take our rules very seriously, especially the be polite one. These are the same rules that you agreed to abide by when you joined this site.
The rest of this conversation will be taken to PM and this thread needs to get back on topic, please.
CFRBryan347768
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What revenue are you talking about? I see no ads on this site other then the very few if any posted in advertising. This is a community site, there is no profit for the owner. It's simply a way to connect people in the Emergency Medicine field across the world and hold intellegent conversations, even if it is eight pocket pants and shears. If you don't like it leave. It seems like your here to spark a heated debate, leave.
Ridryder911
EMS Guru
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If we are to be drones, then there is no sense of even obtaining any medical education. The excuses of having to be a physician to understand medicine is way out dated. If one wants to be a trained performer so be it. Anyone can be an amulance driver.
As more and more physicians are finding out .. cookbook protocols are a open door to litigation. As well as shake & bake medics. Just because one can follow a recipe does not make them a chef...
R/r 911
What exactley is wrong with a heated debate? It is beneficial to everyone involved, it forces the participants to be prepared, to be knowledgable, What is wrong with that.
I am not here to spark anything, but if one strikes me, am I am not of my own free will to comment on it. Am I anot? Did I personally attack anyone, call anyone a name? No.
I raised a point, that someone had touched on already and didnt agree with it, so schall we all walk together hand and hand through our merry little worlds? People disagree, its natural. You have your opinion and I have mine. Does that mean I dont like you. I dont even know you, it means that I disagree with you thats all.
Lets loosen up a little here k.....its a discussion forum lets discuss.
I didnt kick your dog for craps sake
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Get back on the topic of this thread, please...I won't ask again.
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BTW... I've reopend the other thread. We sometimes just lock threads for "cooling off" periods.Get back on the topic of this thread, please...I won't ask again.
http://www.emtlife.com/showthread.php?t=8028