Staff Systems with More EMTs and Fewer Paramedics

I was unaware of this. I just know of the one I talked about and the practices of LA Fire hijacking and dominating all ALS with their medics.
 
There's a whole big world of EMS, everyone does it a little differently. Keep looking til you find the one that fits you best. :)

I still believe DE's paramedic system is one of the best.
 
Yep everyone dose it a bit different and some to a new level of crazy like Komifornia. I am very pleased with Arizona protocals as it more broad scoped and I don't feel like a chauffeur as much.
 
DEmedic said:
See: the entire state of Delaware.
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See: almost the entire state of New Jersey, except they have two medics in every SUV instead of just one.
 
How about capes? Yea, it'll be annoying in bad weather, but it'll allow for a show of heroism and a much faster response time than helicopter or jet pack. Also not prone to traffic jams, unless you count air traffic.
 
Remi said:
Why what do AEMT's do (that basics don't) that impacts outcomes?
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Let's see....

Laryngoscopy
Orotracheal Intubation
Cardiac Monitor Strip Interpretation
Manual Defibrilation
Peripheral IVs
Intraosseous initiation w/ lidocaine administration for pain relief
Peripheral IV blood samples
Sub-Q/IM Epi
Non-patient assist nitroglycerin
IN medications
Needle chest decompression
Administer Benadryl, Benzos, Glucagon, Narcotics

I imagine the list changes from state to state, but I'd say that's a fairly representative sample.
 
MrJones said:
Let's see....

Laryngoscopy
Orotracheal Intubation
Cardiac Monitor Strip Interpretation
Manual Defibrilation
Peripheral IVs
Intraosseous initiation w/ lidocaine administration for pain relief
Peripheral IV blood samples
Sub-Q/IM Epi
Non-patient assist nitroglycerin
IN medications
Needle chest decompression
Administer Benadryl, Benzos, Glucagon, Narcotics

I imagine the list changes from state to state, but I'd say that's a fairly representative sample.
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Arizona is kinda different protocals depending on how rural and access to care. In the rural areas protocals for basics are way more broad then say the Phoenix Valley area.
 
MrJones said:
Let's see....

Laryngoscopy
Orotracheal Intubation
Cardiac Monitor Strip Interpretation
Manual Defibrilation
Peripheral IVs
Intraosseous initiation w/ lidocaine administration for pain relief
Peripheral IV blood samples
Sub-Q/IM Epi
Non-patient assist nitroglycerin
IN medications
Needle chest decompression
Administer Benadryl, Benzos, Glucagon, Narcotics

I imagine the list changes from state to state, but I'd say that's a fairly representative sample.
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I wasn't looking for a list of ILS skills; I asked what do they do that actually positively impacts outcomes.
 
MrJones said:
Let's see....

Laryngoscopy nope
Orotracheal Intubation nope
Cardiac Monitor Strip Interpretation maybe
Manual Defibrilation nope
Peripheral IVs yes
Intraosseous initiation w/ lidocaine administration for pain relief nope (unless it's a kid, and then still no lidocaine)
Peripheral IV blood samples who cares?
Sub-Q/IM Epi yes (of course so can EMT's in many, many states)
Non-patient assist nitroglycerin whoopee?
IN medications double whoope?
Needle chest decompression nope
Administer Benadryl, Benzos, Glucagon, Narcotics nope

I imagine the list changes from state to state, but I'd say that's a fairly representative sample.
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Granted, there are exceptions to the above, but most of the things you listed are not a "standard" part of what an intermediate EMT (by one name or another) would do. And if you are talking about the actual AEMT level...hell no.
 
triemal04 said:
Granted, there are exceptions to the above, but most of the things you listed are not a "standard" part of what an intermediate EMT (by one name or another) would do. And if you are talking about the actual AEMT level...hell no.
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Really? That list came directly from an AEMT Scope of Practice document.
 
Remi said:
I wasn't looking for a list of ILS skills; I asked what do they do that actually positively impacts outcomes.
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And you don't think that the performance of those skills can actually positively impact outcomes?

Fascinating.
 
MrJones said:
And you don't think that the performance of those skills can actually positively impact outcomes?

Fascinating.
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For someone who refers to themselves as an iconoclast, I'm surprised you are not more critical of the benefit or necessity of many of the things we do in EMS.

Rather, you seem to assume that just because some regulatory agency decides to allow a skill to be placed on a list of "things we are allowed to do", that said skill is important enough to dictate system design?

I'm not saying that every individual skill needs to have been validated as necessary by numerous RCT's in order to be worth including in protocols. But we are talking about giving authority for the performance of invasive skills to very minimally trained clinicians.......in that case, I think the protocols we give them ought to adhere to what we know is important and works.

All sorts of ALS interventions are unproven as beneficial, so we should not assume that just because the EMT-I can "do more", that the care they provide is necessarily better for patients than that provided by an EMT.
 
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Remi said:
For someone who refers to themselves as an iconoclast, I'm surprised you are not more critical of the benefit or necessity of many of the things we do in EMS....
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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.

Just sayin'.... ;)

Every skill I listed - from an approved State scope of practice document - is a skill that an AEMT can perform and an EMT cannot, and each impacts outcomes in one way or another. Whether that impact is positive or negative depends on any number of factors, and a Paramedic can just as easily muck it up as can an AEMT.

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.
 
MrJones said:
Really? That list came directly from an AEMT Scope of Practice document.
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....no...no it didn't. (except for glucagon and narcan, those are in there) Your particular state might have added certain things onto the AEMT level, but you might want to peruse what the "stock" AEMT can do, as put out and tested by the national registry. It's just another name for the old I-85; IV's, couple meds (mostly IM) and an EGD.

As far as what is beneficial; the ability the give IM narcan, glucagon, epi and nebulized albuterol will, or could if used appropriately, pay off. If a portable delivery system for nitrous every becomes available again that also has benefits.

The rest...meh.
 
MrJones said:
Let's see....

Laryngoscopy
Orotracheal Intubation
Cardiac Monitor Strip Interpretation
Manual Defibrilation
Peripheral IVs
Intraosseous initiation w/ lidocaine administration for pain relief
Peripheral IV blood samples
Sub-Q/IM Epi
Non-patient assist nitroglycerin
IN medications
Needle chest decompression
Administer Benadryl, Benzos, Glucagon, Narcotics

I imagine the list changes from state to state, but I'd say that's a fairly representative sample.
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What state(s) allow 'advanced EMT's' to give narcotics? Not calling you out, I'm just genuinely curious...
 
46Young said:
I forgot to mention that a tiered system is most appropriate in a dense urban area, and that becomes more undesirable the more you move towards a rural system. The same goes for FD ALS first response... invaluable out in the sticks where the ambo is 30-45 minutes away, and the fire station is 5-10 minutes away.
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CentralCalEMT said:
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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Part of the argument that many (like me) have for tiered systems is as much about providing the best experience for the paramedic in to maximize outcomes as it is for targeting the right resources to the right patient. This doesn't change just because the setting is "rural". If a population is so spread out that you're 30-45 minutes from the nearest ambulance, what makes you think you'll have an engine ready to respond? In those circumstance we're talking about such a low call volume for that department and any paramedic assigned to an engine is going to be horribly under-experienced, thus should probably NOT be providing "ALS" level care beyond what may be in the AEMT scope of practice.

Just because the area is rural does not mean you are entitled to the same standards of care as a more populated area because it just isn't possible. That's a sacrifice one makes when they choose to live in a rural setting. Even rural critical-access hospitals are not at all expected to provide the same advanced care one might expect of a small community hospital in a more populated setting. Rural EDs are frequently not staffed with EM-trained physicians. The ICUs (if there is any) are often not staffed by intensivists. Specialists may only come to the hospital to work a few weeks a year. The surgeons likely only perform the most basic of surgical procedures. Again, these are things one must accept if you want to live away from other people.
 
triemal04 said:
....no...no it didn't. (except for glucagon and narcan, those are in there) Your particular state might have added certain things onto the AEMT level, but you might want to peruse what the "stock" AEMT can do, as put out and tested by the national registry. It's just another name for the old I-85; IV's, couple meds (mostly IM) and an EGD.

As far as what is beneficial; the ability the give IM narcan, glucagon, epi and nebulized albuterol will, or could if used appropriately, pay off. If a portable delivery system for nitrous every becomes available again that also has benefits.

The rest...meh.
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....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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