Staff Systems with More EMTs and Fewer Paramedics

MrJones said:
....yes...yes it did.

But, having no desire to see this thread turn into an argument over a peripheral issue I'll stop there. You may have the last word if you so desire.
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Thank, I'll take the last word. I know you're trying to be sarcastic and play the bigger man, but still...gracias.

And as this thread is about lowering the number of paramedics, what an EMT (or AEMT as the case may be) can or cannot do would seem to be pertinent. Don't you think?

Now, it is very possible that your particular state has a provider inbetween an EMT and paramedic that can do the things you listed, they may even be called an AEMT; it's certainly done in some states so it wouldn't be a shock. As far as what you listed being "a representative list", or part of the intended scope from the national registry...not so much. It only takes a casual look to determine that.
 
MrJones said:
My initial comment and subsequent responses had nothing to with the "...benefit or necessity of many of the things we do in EMS." You asked what AEMTs can do, and EMTs can't, that impacts outcomes. I answered. You added 'positively' as a qualifier after I responded with a rather specific list that directly addressed the question as posed.
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I am confident that your reading comprehension skills are better than that. That I was referring to how AEMT's affect positive outcomes as opposed to EMT's is quite clear, given the context.

MrJones said:
Now, had you asked the less argumentative and more pertinent question "why do you believe that EMT as we know it today has to go away...with what we currently call AEMT becoming the base level for EMT" I would have noted that, while AEMT is still a relatively minimal level of medical training, it still goes beyond the training and education that an EMT receives and results in a provider who can do much more to assist with patient care (and is theoretically capable of handling more complex calls without the necessity of paramedic intervention). Additionally, I see it as a step in the right direction towards raising the standard of training for all levels - from EMT to Paramedic.
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My question was not argumentative at all - it was a pertinent and reasonable question and very much on topic.

The reason I didn't ask why you think EMT training should go away is because I didn't care to know why you think that. I asked what I asked because it's what I wanted to know. If you didn't want to answer, you didn't have to.
 
CentralCalEMT said:
I highly agree that tiered systems are extremely beneficial in urban areas. I think in some cases, in urban areas, ALS can be detrimental if you get a medic who wants to play paragod for 30 minutes on scene when a hospital that is a level 1 trauma center/STEMI center/stroke center, etc is a block away.

I also agree that this system has very limited usefulness in a rural setting, unless the rural area was well staffed with adequate numbers and types. I think it would be easier to find a unicorn than a well staffed rural system. Because there are so few ambulances, and ALS fire is non existent in many areas, I think rural systems should be all ALS if possible. My area is all ALS. But then again we have 4 ambulances for 1,200 square miles.
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See the issue with all ALS ambulance in rural settings is if BLS Fire shows and determines ALS is needed odds are air medvac is needed and can deffiently provide expedited transport where an all ALS ambulance service might not provide the best level of patient care cause they will feel ground ambulance transport is warranted when air medvac is probably better for patient outcome. I have seen this first hand in rural settings. An all ALS ambulance company being short staffed cause they feel 1 hour plus time to a trauma center is acceptable. What happens if it's all ALS ambulance service and your short staffed cause your transport times are long and a MCI happens? Just makes sense to me that it's better to have a mix to avoid such situations as ambulance companies will always go after the high profits of long transports. Also I have seen the chopper beat ALS ambulances multiple times especially when the ambulance is coming from the other side of their AOR. It's better to have a BLS ambulance on scene instead of waiting for the magical ALS ambulance which is still 20 plus minutes out.
 
escapedcaliFF said:
See the issue with all ALS ambulance in rural settings is if BLS Fire shows and determines ALS is needed odds are air medvac is needed and can deffiently provide expedited transport where an all ALS ambulance service might not provide the best level of patient care cause they will feel ground ambulance transport is warranted when air medvac is probably better for patient outcome. I have seen this first hand in rural settings. An all ALS ambulance company being short staffed cause they feel 1 hour plus time to a trauma center is acceptable. What happens if it's all ALS ambulance service and your short staffed cause your transport times are long and a MCI happens? Just makes sense to me that it's better to have a mix to avoid such situations as ambulance companies will always go after the high profits of long transports. Also I have seen the chopper beat ALS ambulances multiple times especially when the ambulance is coming from the other side of their AOR. It's better to have a BLS ambulance on scene instead of waiting for the magical ALS ambulance which is still 20 plus minutes out.
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First of all your posts are nearly impossible to understand.

Secondly, what in the world are you talking about? If the patient needs a paramedic then they need a helicopter? No, absolutely not. Do not pass go, do not collect 200 dollars, just no.
 
Tigger said:
First of all your posts are nearly impossible to understand.

Secondly, what in the world are you talking about? If the patient needs a paramedic then they need a helicopter? No, absolutely not. Do not pass go, do not collect 200 dollars, just no.
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Obviously your missing the point of what I'm saying. I'm applying the above to rural settings with limited facility's.
 
No, I don't think so. I work in a rural system with very limited facilities. We fly an average of (I think) 50-60 patients a year out of our 1500 transports. There are many interventions that a paramedic can provide that do not need to be followed up by a helicopter. Expedited transport very, very rarely makes a difference.

Perhaps you should elaborate.
 
Tigger said:
No, I don't think so. I work in a rural system with very limited facilities. We fly an average of (I think) 50-60 patients a year out of our 1500 transports. There are many interventions that a paramedic can provide that do not need to be followed up by a helicopter. Expedited transport very, very rarely makes a difference.

Perhaps you should elaborate.
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Yes a medic can do a lot of interventions. Im not debating this. When I hear rural I think of where I grew up with a call volume about a quarter of that and the farm equipment taking of limbs is not uncommon.
 
Nonetheless, you need to defend the statement that:

see the issue with all ALS ambulance in rural settings is if BLS Fire shows and determines ALS is needed odds are air medvac is needed and can deffiently provide expedited transport where an all ALS ambulance service might not provide the best level of patient care cause they will feel ground ambulance transport is warranted when air medvac is probably better for patient outcome.]

What outcomes are improved?
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Im just pointing out that an all ALS is probably not the best choice for rural America. It's better to have something than nothing. Say for example your company covers 2,000 square miles and ALS is 30 mins out but BLS is close by and can get them loaded on a chopper in 10 mins. The nearest hospital that can handle a major trama is 2 hours away. Would you honestly think driving 2 hours ALS is a better idea than a 30 minute chopper ride? I just think that there are way to many outside influence on an all ALS service and money being a big one.
 
Why do you have to have all ALS? We provide ALS service to our 600 square miles with BLS first response from volunteers. The super rural areas have transporting BLS ambulances that will rendezvous with us. Works just fine and does not place an excessive burden on air medical. Even most ALS calls are not time sensitive in the ways that EMS seems to think they are.
 
In this corner - hypothetical situations specifically formatted to support the contention that all ALS and airmed are the answer for rural EMS.

And, in this corner - actual rural EMS experience and data.

Ladies and gentlemen, place your bets at the window.
 
So a hypoglycemic coma needs a helicopter?
 
HEMS AMA FTW!
 
tigger, idk why, but i like it when you get all riled up... :p;)
 
I want EMS to become a respected part of healthcare so that I can have a career that I love for a long time. Comments like the above seek to take that away from me. Therefore they must be destroyed.
 
and here i was thinking that was subtle...bahaha
for real though, i have a lot (more) respect for you after that weird, sexual harassment justification post by escapedcaliff
 
I think using HEMS as the primary ALS to a given area is feasible and even makes good sense......IF certain conditions are met. Those conditions primarily being low ALS utilization (you can't be calling a helicopter every other day for diabetic wake ups), cost control of some sort (helos are very expensive, but I don't think it's right to be sending out $20,000 bills for an ALS rendezvous that normally would cost a few hundred dollars), and that the BLS services have some sort of backup plan for when HEMS isn't available, such as some way to manage severe pain, for instance.

Might be doable and cost-effective in really sparsely populated areas with few EMS responses. I think it's relatively common in other parts of the world.

A few posts back, medicsb made the point that you can't live out in the middle of nowhere and expect the same availability of service that you would have in the suburbs. I think that's worth keeping in mind when thinking about system design in really rural areas.
 
Remi said:
I think using HEMS as the primary ALS to a given area is feasible and even makes good sense......IF certain conditions are met. Those conditions primarily being low ALS utilization (you can't be calling a helicopter every other day for diabetic wake ups), cost control of some sort (helos are very expensive, but I don't think it's right to be sending out $20,000 bills for an ALS rendezvous that normally would cost a few hundred dollars), and that the BLS services have some sort of backup plan for when HEMS isn't available, such as some way to manage severe pain, for instance.

Might be doable and cost-effective in really sparsely populated areas with few EMS responses. I think it's relatively common in other parts of the world.

A few posts back, medicsb made the point that you can't live out in the middle of nowhere and expect the same availability of service that you would have in the suburbs. I think that's worth keeping in mind when thinking about system design in really rural areas.
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I would imagine that in the rest of the world that the costs associated with air medical are much lower given every other developed country's funding mechanisms for healthcare.
 
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