Street EMS vs. Transport

[tony1]

I love it. Maybe your aunt will finance this and be our silent partner. We won't even need to transport. We can just park the mobile ER outside the NH and treat and release.

 

[bstone]

I imagine it'd be more fun if we had semi-trucks with jacuzzis and MRIs built into them. I'll ask my aunt if/when we get to that point.

 

[looker]

I love it. Maybe your aunt will finance this and be our silent partner. We won't even need to transport. We can just park the mobile ER outside the NH and treat and release.

I am curious what is the start up cost in Chicago?

 

[tony1]

I myself really have no idea but bstone can probably find out since his aunt owns a company.

 

[bstone]

I myself really have no idea but bstone can probably find out since his aunt owns a company.

Hey! That's supposed to be our dirty secret.

I'll ask her about it sometime.

 

[Millerblade]

Transport vs 911 ( very opiniated, watch out)

My real question is how does street ems compare to transport. I have heard from a few people but I would like some more opinions. If I go the transport route, I want to be useful and do the job I was trained for. I just want to know from people who have done it, if they felt more like an emt or a glorified taxi driver.

First, I have been a transport medic and a 911 medic, and the two are very different in nature, but in my opinion have a very important role in the EMS provider that wants to learn what they are doing, why they are doing it, and makes you a better EMT. ( In this case, I will be using the term MEDIC, but this goes for basics and medics.)

I have seen people go from basic to medic in a very short time period, and I see clearly ( What's in it for me? attitude) This is going to produce terrible medics in the long run. Now that I have your attention, please read on.

I am a firm believer that basics that learn how to do transports properly are better groomed, have better mental skills ( come on, is it that hard to start an IV or intubate someone?) It's more important to understand WHY you need the IV, or intubate vs just doing the skill. When your doing transports, you have a choice of how you treat your position.
1. Are you going in with the attitude of, I don't want to do anything? ( Yeah, that will win hearts and minds with your future employers!)
2. Go in with the attitude that MOST people go through this process, although repeatitive, I can learn something new with each patient you come accross. THIS is the experience that people that move way to fast from EMT to Medic loose. THIS IS HUGE.

If you take the time to master your patch ( all medics perform as EMTs first) know what you can do, when to do it, and most importantly, WHY your doing it. This will set you up for a sucessful future.
How do you know that your transfer won't go south?
When I do transfers, ( yes, I still do them too) I may have to share that the patient is NOT ready to go, and might need more care before tranfering them to a nursing home/rehab.

Honestly, I wish in the state of Texas, we had a clause that EMT must work at that level for 6 months before moving to Paramedic. I DON'T LIKE THE SCHOOLS THAT PROMOTE "QUICKLY GETTING YOUR MEDIC." See, it's a money thing, they don't care about what they turn out.

Unfourntually, If I get one a new member of our department, or a new paramedic student, I don't change my mind set. YOU chose to move from one patch to the other one without mastery, however, that was your choice. I expect and demand that you know everything about being an EMT on top of your newest training as a paramedic.

I get a lot of slack about this, but if you were hurt on the street and you had breathing problems, and the new medic is having starting a IV, do you see this as a problem?

Bottom line, I have way more respect for the new medic that spent some time in the ditches and teach them new things, vs, someone trying to waste my time to skate through, have no clue how to do basic things like: bandaging/splinting, the correct direction of a nasal cannulla. Some actually hope and pray that I pencil whip them through training. NOPE!

THINK.....doctors take the time to be a medical student then a resident. After that they become a doctor.
Learn your craft.


Peace! Off Soap box....Please be safe out there!

 

[firecoins]

THINK.....doctors take the time to be a medical student then a resident. After that they become a doctor.
Learn your craft.

Technically they are a doctor once they graduate medical school and are allowed to call themselves doctor if they do no further medical studies. They become licensed after a 1 year internship which is usually included in the residency. Some people who complete medical school go into research and never actually practise medicine.

 

[Millerblade]

see.....old people need to be corrected sometimes....Thanks fire coins!

 

[Sasha]

My real question is how does street ems compare to transport.

Both have their unique challenges, perks, and learning experiences. I prefer IFT to 911, but I know many who couldn't hack it. It takes a dedicated person to do IFT and not get lazy and complacent and to deal with critically sick and injured for more than five minutes at a time, interrupted with moments of extreme bordeom of nursing home discharges and dialysis transfers.

 

[Sasha]

THINK.....doctors take the time to be a medical student then a resident. After that they become a doctor.
Learn your craft.

Medical Student is to Doctor as Paramedic student is to Paramedic. Medical student is not the "Big dog" version of an EMT. Nurses aren't CNAs before they become nurses, PAs aren't PCTs before they move on to their future goal.

Not to brag, but I had very little time between emt school and medic school, and I'm generally respected as a "good medic"

 

[Aidey]

That argument works for requiring paramedics to have a longer education, not for longer time between EMT school and Paramedic school. The entire time a medical student is in their education and residency they are learning. There is nothing guaranteeing an EMT isn't working in a coffee stand in the time between EMT school and Paramedic school

 

[jjesusfreak01]

Technically they are a doctor once they graduate medical school and are allowed to call themselves doctor if they do no further medical studies. They become licensed after a 1 year internship which is usually included in the residency. Some people who complete medical school go into research and never actually practise medicine.

Right, they are an MD, but not a physician. I learned this from the show "Trauma", from which I get all my medical and EMS knowledge.

 

[JPINFV]

Right, they are an MD, but not a physician.

No, they are a resident physician, not an attending physician. They are still, though, a physician with an unrestricted license to practice medicine.

 

[himynameismj]

I am a newly certified EMT-B in NJ and I am looking to find a career position. I know that many rescue squads and street ems do not hire a lot of new EMTs due to lack of experience, and I was told that volunteer and transport is the best way to get the experience. Now don't get me wrong, because I am willing to start at the bottom if need be, but not really what I was interested in.

My real question is how does street ems compare to transport. I have heard from a few people but I would like some more opinions. If I go the transport route, I want to be useful and do the job I was trained for. I just want to know from people who have done it, if they felt more like an emt or a glorified taxi driver.

Oh damn, here comes the soap box. "Street EMS" is literally a figment of some lazy crap EMT's imagination. The reason we have "Street EMS" is because most of today's EMS students think they're doctors post-initial training and refuse to actually learn the book right. That book was written by doctors. People who after all is said and done, have endured thousands of more hours than us in training. You should be appreciative that doctor's even took the time to recognize our importance back in the mid-60's which allowed us to grow. If you learn that book right (Especially Pt Assessment), you will be way ahead of your peers. If you are doing EMS in general, you need to be the best you can be. Learning that book is just a starting point in being the best that you can be. Follow up training involves CEU's on what you identify as your weak points, and continually practicing skills. "Street EMS" is literally a way of saying "I could be held accountable if something goes wrong here, but it makes my life easier". Examples include letting patients walk down the steps, walk long distances, doing rapid extrications for non-critical pt's (not using the KED), "forgetting" you have something called a scoop stretcher, "forgetting" you have a backboard for elder fall victims, taking the nursing home's vitals instead of your own and calling it a base, sitting behind the pt during transport, avoiding the splint of a fx, etc. This is stupid stuff. Practicing "Street EMS" makes you crap, so my answer is.. do things the way the book says so. Your partner may look at you like you're WASTING HIS / HER TIME, but the truth is you're saving his *** from liability. LEARN PT ASSESSMENT.

 

[firecoins]

Right, they are an MD, but not a physician. I learned this from the show "Trauma", from which I get all my medical and EMS knowledge.

I get mine from "House"

 

[JPINFV]

Oh damn, here comes the soap box. "Street EMS" is literally a figment of some lazy crap EMT's imagination.

Actually, I will argue that there's a difference between the actual practice of medicine and what is actually taught. Simply put, patients and situations don't read textbooks. Ideally, for most patients, that difference should be null, however health care providers, regardless of the level, need to be able to know when to improvise and make changes from the ideal treatment plan. Variation isn't bad, but "street EMS" doesn't give carte blanche to do anything and everything, but deviating from the cookbook isn't necessarily a bad thing.

On an additional note, there's a significant amount of utter bull excrement included in EMT training. The most significant of such is the elevation of supplemental oxygen as some sort of cure all to only be administered via NRB at a flow rate of 15 liters per minute. As a comparison, Harrison's Internal Medicine (essentially the bible of general medicine) addresses the use of oxygen in STEMI patients as the follow, "In patients whose arterial O2 saturation is normal, supplemental O2 is of limited if any clinical benefit and therefore is not cost-effective. However, when hypoxemia is present, O2 should be administered by nasal prongs or face mask (2–4 L/min) for the first 6–12 h after infarction; the patient should then be reassessed to determine if there is a continued need for such treatment."

Tintinalli's Emergency Medicine (one of the major emergency medicine text books, the other being Rosens) addresses oxygen in ACS with " Supplemental oxygen may reduce ST-segment elevation in patients with acute myocardial infarction (AMI). It is therefore reasonable to provide 2 to 4 L of oxygen routinely by nasal cannula, even to patients with normal oxygen saturation. In patients with unstable angina or NSTEMI, O2 should be provided in patients with signs of hypoxia." Notice no mention of a NRB, no suggesting for NSTEMI/UA patients, and even the recommendation of oxygen for STEMI patients is very weak.

So maybe if EMT training was so poor, I'd be able to argue against going against the text book treatment, but there is simply too much "thou shalt do ___ regardless of assessment."

Edit: Just checked Rosen's Emergency Medicine (I have access to a bunch of textbooks through insitutional subscriptions online via Access Medicine and MD Consult), and Rosens doesn't address the use of oxygen at all. Those terrible emergency physicians, denying life saving oxygen to their patients.

The reason we have "Street EMS" is because most of today's EMS students think they're doctors post-initial training and refuse to actually learn the book right. That book was written by doctors. People who after all is said and done, have endured thousands of more hours than us in training.

h34r:

Learning that book is just a starting point in being the best that you can be. Follow up training involves CEU's on what you identify as your weak points, and continually practicing skills. "Street EMS" is literally a way of saying "I could be held accountable if something goes wrong here, but it makes my life easier".

What's the purpose of CMEs if you can't implement what is learned because that means moving away from the textbook. That's a conundrum that I've realized exists in EMS. CMEs are supposed to expand a provider's knowledge base, which means that different providers are going to approach a given situation differently based on education and experience. However deviation from the cookbook protocol or textbook is treated as being bad, which is completely counter to the point of CMEs.

Examples include letting patients walk down the steps, walk long distances,

Depends on the situation

"forgetting" you have a backboard for elder fall victims

Should depend on the providers assessment taking age into consideration, and not a "well, the patient fell and is over ___ age."

sitting behind the pt during transport

Except it is perfectly possible to monitor a patient from the jump seat and the jump seat is the safest location to be in in the back of an ambulance.

do things the way the book says so.

As discussed above, the EMT textbook is often blatantly wrong and bad medicine. Unfortunately, too many in EMS prefer emotional based medicine over evidence based medicine.

 

[DrParasite]

As discussed above, the EMT textbook is often blatantly wrong and bad medicine. Unfortunately, too many in EMS prefer emotional based medicine over evidence based medicine.

and yet.....

That book was written by doctors. People who after all is said and done, have endured thousands of more hours than us in training. You should be appreciative that doctor's even took the time to recognize our importance back in the mid-60's which allowed us to grow. If you learn that book right (Especially Pt Assessment), you will be way ahead of your peers.

 

[JPINFV]

Actually, while most books have a medical director, they aren't written by physicians. None of the 3 authors for Mosby's EMT-B are physicians. Additionally, the curriculum for EMS providers isn't exactly written like the providers being trained have, or need, a good grasp of actual medicine and the science underpinning it. Basically, it says that the physicians writing it don't think you can identify a hypoxic patient if the hypoxia slapped your head and stole your significant other.

 

[jjesusfreak01]

No, they are a resident physician, not an attending physician. They are still, though, a physician with an unrestricted license to practice medicine.

Ahh, but what if you are not in a residency, as is the case with the girl in "Trauma"? I assume without the residency, you are not a resident physician, are not licensed by the state, and cannot practice medicine.

 

[JPINFV]

Ahh, but what if you are not in a residency, as is the case with the girl in "Trauma"? I assume without the residency, you are not a resident physician, are not licensed by the state, and cannot practice medicine.

However she wasn't practicing as a physician. In most states, first year residents work under a limited license to practice where they are limited to practicing only in their training program. During the first year of residency, physicians take Step 3 of the licensing exam (COMLEX or USMLE depending on DO or MD respectively) and following completion of post graduate year 1 (PGY 1, AKA internship), the resident becomes a fully licensed physician. Since essentially all physicians complete a residency, they are still residents learning a specialty. This is essentially what makes it lunacy that she would complete medical school, but decide to go into another health care provider field other than complete a 3-4 year residency (for emergency medicine), or even 1 year and become a fully licensed physician.

Now there are some physicians who never do residency or internship and instead do research or something else. I'd argue that they are still physicians due to their education. Does one become not a paramedic when their license lapses, or do they just become an unlicensed or retired paramedic?