The practicality of EMT Basics as an emergecy responder

[Medic Tim]

Whats the ALS fix for Stroke? Cadiac Arrest? Bleeding?

I wouldn't call them a "fix" but.
Some areas have prehospital fibrinolytics they can also check and treat hypoglycemia as needed.

medics have access to acls drugs though the benefit of them has and is questionable.

Some places have topical hemostatic agents and I know of one area that has tranexamic acid for traumatic hemorrhage.

 

[Bob67]

I think the level of care has to match the need. Yes it is much easier said then done. It also depends on your location and how quickly you can get the next level of care.

Do you think the insurance companies want to pay medics for a lift assist?

 

[Veneficus]

Do you think the insurance companies want to pay medics for a lift assist?

Do you think insurance companies want to pay for anything at all?

 

[VFlutter]

Do you think the insurance companies want to pay medics for a lift assist?

Call the fire department. You do not need medical training for a lift assist.

 

[abckidsmom]

Call the fire department. You do not need medical training for a lift assist.

In our area, those are high-risk calls. Old people who "don't want to bother" us call for help getting up after their syncopal episode, hip fx, etc. At least half of them are actually sick, and need to go to the hospital.

 

[Bob67]

Call the fire department. You do not need medical training for a lift assist.

But, you don't know what they will turn into. Some turn into ALS calls and some require several assists and a bariatric truck.

I am looking at it from a resource allocation perspective. The first responders may also be overwhelmed or feel under utilized if they feel the calls are above or below them.

 

[NYMedic828]

In our area, those are high-risk calls. Old people who "don't want to bother" us call for help getting up after their syncopal episode, hip fx, etc. At least half of them are actually sick, and need to go to the hospital.

I think chase meant for a lift assist, not actual care.

FDNY dispatchs an engine for lift assists to ambulance crews who request it. They are usually onscene within 3-4 minutes.

 

[abckidsmom]

I think chase meant for a lift assist, not actual care.

FDNY dispatchs an engine for lift assists to ambulance crews who request it. They are usually onscene within 3-4 minutes.

Our area dispatches an engine for "I've fallen and can't get up." I don't like it.

 

[RocketMedic]

The ALS fly car is a legitimate option in many areas.

 

[JPINFV]

Whats the ALS fix for Stroke?

What's the BLS fix that can't be provided by a taxi driver?

...oh, and rule out hypoglycemia.

 

[Handsome Robb]

ive had many discussions about this and i dont care what people say emt-b's are very helpful and DO save lives.ive saved many and helped many people.Most calls are BLS anyways and it only becomes ALS because they put ekg's on people and give iv's.it's all how u use it and how good u are.Basics are just as good.

So helpful we don't even use them in the 911 system here. All AEMT/EMT-I and medics, every truck is ALS.

Example, I ran a syncope today with a BLS special events crew. Drunk guy fell down went boom and it came out as a syncope. Needless to say the BLS crew was a bit on the freaked side moving way to fast but making no meaningful progress. But hey, they looked damn good doing it!!

 

[medicman14]

So helpful we don't even use them in the 911 system here. All AEMT/EMT-I and medics, every truck is ALS.

Example, I ran a syncope today with a BLS special events crew. Drunk guy fell down went boom and it came out as a syncope. Needless to say the BLS crew was a bit on the freaked side moving way to fast but making no meaningful progress. But hey, they looked damn good doing it!!

Out of curiosity, using your logic... Since our entire State doesn't use aemt or emt-I, what does that say about them?

 

[Brandon O]

What's the BLS fix that can't be provided by a taxi driver?

...oh, and rule out hypoglycemia.

Good information gathering and delivery to the best destination with appropriate resources mobilized. Y'know... same as every call.

Although I think I've started to believe that tPA is hardly worth doing, so it may be a bit academic. Stroke calls are like practice run: all the elements of an acute patient with none of the actual potential to help them!

 

[NYMedic828]

Good information gathering and delivery to the best destination with appropriate resources mobilized. Y'know... same as every call.

Although I think I've started to believe that tPA is hardly worth doing, so it may be a bit academic. Stroke calls are like practice run: all the elements of an acute patient with none of the actual potential to help them!

Hospital is going to re-acquire every bit of information you provided. It doesn't serve as much purpose as you think.

I'm glad you've decided thrombolytic therapy isn't worth doing. Maybe the doctors will take your opinion into account the next time you bring in stroke. Research and studies found on the Internet are great for self education but until you devote 11 years of your life to studying medicine it isn't your decision to decide which route of definitive treatment is and is not appropriate. Your job is to take them to a stroke center, just incase. (Every hospital here is a stroke center)

I'm willing to bet that if you work in a busy area you have brought more than one patient in as a CVA and they were really hypoglycemic. So while it isn't actually a stroke, you presumed it to be. If you did rule in favor of hypoglycemia you still don't have the tools to fix it. Atleast not beyond what anyone else has in their kitchen.

As a paramedic, I am undereducated as can be. But, it's a good start. EMT is less than 200 hours in a lot of places and 100 of that is learning how to use carrying devices and scene safety. It's hardly more than basic first aid.

This isn't an attack but people are just being realistic here. Anyone with half a brain can figure out that if something is bleeding, you should cover it. CPR training has become very common among society. Almost every BLS protocol has the words "call for ALS" in it. It is what it is.

 

[Veneficus]

Although I think I've started to believe that tPA is hardly worth doing, so it may be a bit academic

Just my opinion, but I don't think the problem is the tPA, I think it is how it is used that is the problem.

Just as PCI for revascularization of the heart, I think tPA as an adjunct to direct revascularization of the brain is where the benefit is realized.

As I have discussed many times, the seperation of surgery and medicine is entirely artificial.

The use of IV systemic tPA is simply an attempt of medical treatment of a surgical disease. Why would anyone be shocked when it doesn't work nor produce studies demonstrating benefit?

Anytime you try to treat a surgical disease with medication all you do is delay the needed treatment.

Clotting agents, IV tPA, you name it, the dream of nonsurgeons using medicine to treat surgical diseases is alive and well. It is folly. But people fund research for it and pay lots of money to try.

Edit: think of it this way:

When your sink clogs, you pour the drano right into the pipe that is clogged right?

You do not pour the drano into the water connection to your house and hope it unclogs your sink.

 

[Brandon O]

Hospital is going to re-acquire every bit of information you provided. It doesn't serve as much purpose as you think.

Well, yes. Same as how we don't skip our assessment just because we took a report from a sending facility. But the relevant information can be found and assembled into a single, coherent block, so that the only thing which needs to occur is a quick confirmation. And appropriate resources can be prepared so that they're ready to go once that confirmation occurs. This is the same reason why our crashing trauma patients get more timely care when EMS brings them in than when they're dumped at the door by a taxi.

I podcasted about this recently with Dr. Walsh (I think I'm not allowed to post links here? it's in my profile if anyone's interested). He made a suggestion that I found insightful, which is that EMS making an effort to ensure that Joe or Jane family member who can verify time-of-onset -- and provide consent, when relevant -- is actually transported with the patient (not languishing in a personal vehicle or wherever) can be quite helpful. This is the sort of thing I mean. Yes, it'll eventually happen on its own, but not as quickly, and time is a factor.

I'm glad you've decided thrombolytic therapy isn't worth doing. Maybe the doctors will take your opinion into account the next time you bring in stroke. Research and studies found on the Internet are great for self education but until you devote 11 years of your life to studying medicine it isn't your decision to decide which route of definitive treatment is and is not appropriate.

Er... I agree. Hence we're managing these patients as if they'll receive timely thrombolysis. I think we're all in agreement on that.

I'm willing to bet that if you work in a busy area you have brought more than one patient in as a CVA and they were really hypoglycemic. So while it isn't actually a stroke, you presumed it to be and if you did rule out stroke in favor of hypoglycemia you still don't have the tools to fix it. Atleast not beyond what anyone else has in their kitchen.

We perform BLS glucometry, so no, but even barring that, I'm not certain that I understand what you're saying here.

 

[Brandon O]

When your sink clogs, you pour the drano right into the pipe that is clogged right?

You do not pour the drano into the water connection to your house and hope it unclogs your sink.

I agree that more targeted lytic therapy may prove to push the risk/benefit balance in the right direction -- in the future. I even think that systemic tPA as it's used now is probably overall beneficial in certain selected patient groups, which unfortunately I don't think we've adequately elucidated. But I also think that at this point in the research, "the dream is dead" and there's such a thing as accepting the evidence instead of wondering if maybe the dice will roll different with yet another trial... and also that eventually (and we're probably there) if you do find a benefit, it's clear that it won't be very large.

We get attached to therapies, especially when there aren't many other options. But they're not puppies.

 

[Veneficus]

I agree that more targeted lytic therapy may prove to push the risk/benefit balance in the right direction -- in the future. .

There are hospitals all over the world doing it now.

The problem is it requires resources that not every hospital can commit to.

I am also familiar with multiple locations in the world that have multiple stroke centers in the same city, but only 1 of those centers in the given city actually perform direct arterial tPA by vascular surgeons or interventional radiologists.

I am really not sure why neurosurgeons on not also training in the procedures on a larger scale.

After all, cadiology found it very beneficial to both their income and prestige to adopt an interventional role.

 

[JPINFV]

Hospital is going to re-acquire every bit of information you provided. It doesn't serve as much purpose as you think.

If EMS did and documented a decent neuro exam (strength besides just feet pushes and hand squeezes, cranial nerves, sensation, DTRs, cerebellar tests. Most of this can be done in an ambulance, except maybe DTRs due to movement artifact), it would be very helpful in determining whether the stroke/TIA is recovering, progressing, or stable. The problem is that it has to be done and documented. EMS charts are actually reviewed in the ED, as well as by the inpatient team.

 

[JPINFV]

Good information gathering and delivery to the best destination with appropriate resources mobilized. Y'know... same as every call.

Most areas that I've seen require that BLS transport to the closest available receiving center, regardless of any specialty considerations. Also, good information gathering? So... how's your neuro exam?