Things we can do nothing about?

[usalsfyre]

I wasn't trying to say that there's an equivalence when each level of EMT certification has very different training and skills. Like a cardiologist, dermatologist and neurosurgeon are all physicians, Basics, Intermediates and Paramedics are all EMTs.

But to Linuss' point, that's all changing, so it'll be a moot point in the near future.

But they all have the same initial education and background, then specialize from there. That can't be said of EMT vs Paramedic. Other than "ambulance" there's not much that's the same other than the increasingly ridiculous requirement that paramedics pass an EMT course first.

 

[WuLabsWuTecH]

What do you think you are, a physigod or something?! Psh, you'll probably put "Dr." in front too, huh?

I prefer Doctogod thank you very much!

An aside: apparently it's incorrect to use a title AND post-nominal letters.

Just remember, you can't spell "doctor" without "DO."

Why do I feel so incredibly dirty for using that line all of a sudden?

if M.D. stands for Medical Doctor, or more correctly, Medicinae Doctor, is D.O. latin for "Other Doctor?"

 

[WuLabsWuTecH]

For NREMT, however some states, such as California, have already removed the "EMT" part from the paramedic title. So in California, there are no more EMT-Paramedics regardless of NREMT status. On a side note, I can't claim to be an EMT-I anymore either...

No more funnier than the EMTs who conveniently forget that there's a "basic" in their title.

Yeah, i wish we'd get rid of the EMT-B, -I, -P system sooner rather than later.

For patients that don't know what's going on: Basic? Where's the guy who knows more than you? Or, B? Where's the A EMT?

None of my departments use titles on shirts anymore, but in the privates it certainly did get confusing for some patents who thought they were getting inferior care...

 

[MrBrown]

We have national clinical guidelines, nothing wrong with them and we are better for having such consistency.

Oh, and WTF is Brown going to have to endure being an MBChB in the US? People already look at Brown like Brown has two heads whenever Brown speaks :unsure:

 

[WuLabsWuTecH]

We have national clinical guidelines, nothing wrong with them and we are better for having such consistency.

Oh, and WTF is Brown going to have to endure being an MBChB in the US? People already look at Brown like Brown has two heads whenever Brown speaks :unsure:

:unsure:

Sure does look like two heads to me!

My latin is not very good but I'm going to take a stab at this:
Medicinae Baccalaureus, Churguriuae Baccalaureus?

I know it's the 6 year degree (or 7 years in some countries) of the old England and Scotland system (yes I said it, old because it's not used in the new world anymore ) that is used in the commonwealth states with some notable exceptions (canada) and other counties still (Japan comes to mind?) and is similar to the NEOUCOM BSMD degree.

I think a long, long time ago Columbia University used to give out MBBS degrees...

 

[Shishkabob]

We have national clinical guidelines, nothing wrong with them and we are better for having such consistency.

Oh, and WTF is Brown going to have to endure being an MBChB in the US? People already look at Brown like Brown has two heads whenever Brown speaks :unsure:

FYI Brown... your country is about the size of most US states. 25 US states (50%) also have a greater population than your entire country. In fact, the metropolitan area I live in has a greater population than your entire country in 10% of the area. Being "national" is no more impressive than being state-wide.

 

[WuLabsWuTecH]

FYI Brown... your country is about the size of most US states. 25 US states (50%) also have a greater population than your entire country. In fact, the metropolitan area I live in has a greater population than your entire country in 10% of the area. Being "national" is no more impressive than being state-wide.

Uh Oh... Uh...Brown? I think he just called your country small...

 

[Anjel]

We have national clinical guidelines, nothing wrong with them and we are better for having such consistency.

Oh, and WTF is Brown going to have to endure being an MBChB in the US? People already look at Brown like Brown has two heads whenever Brown speaks :unsure:

Idk why all of a sudden you think you are better than all of us.

You are coming to america. Marrying an awesome american. So you cant think you are that much better.

 

[Tigger]

I see no issues with statewide protocols, assuming (as already mentioned) that they are used as minimums.

The idea that the protocols could be different region to region is a bit baffling to me, wouldn't it be useful to have universal expectations of care statewide? Wouldn't this also eliminate much of the confusion associated with moving from area to area instate (i.e. California)? If anything, EMS needs less governing bodies if any sort of efficient increase in standards is going to occur.

I guess I am kind of partial to the way things are done in MA, where we have a statewide protocol for each level of provider. If a procedure is not listed in the protocol but a service's medical director feels that his providers are educated in its use and that said procedure will be of a benefit to patient care, he and the agency can request a waiver from OEMS. If the medical director isn't comfortable with his providers performing a certain procedure, I can't imagine he would be strong armed into obtaining a waiver, it is his license/reputation on the line as well.

 

[JPINFV]

Idk why all of a sudden you think you are better than all of us.

You are coming to america. Marrying an awesome american. So you cant think you are that much better.

I take the tone of a lot of what Brown says with a grain of salt.

 

[abckidsmom]

I take the tone of a lot of what Brown says with a grain of salt.

Just a small grain of salt.

 

[exodus]

Yummy Crystaloids.

 

[JPINFV]

Just a small grain of salt.

Perspective. Is that a large grain of salt, or a small grain zoomed in on?

 

[WuLabsWuTecH]

Oh man, this is getting deep...

 

[DrParasite]

If you get called for something like a stubbed toe, what would you do and say to the patient? Would you just tell them that there is nothing you can do for it and still offer a ride to the hospital/make them sign an AMA if they don't want to? I was just wondering because my teacher said something about how if they call you then you should always offer a ride to the hospital.

yep, pretty much. sometimes walk the patient to the ambulance, sit on the bench, and we will leave you in the triage area of the ER. it's actually acceptable and written in policy for ambulatory patients.

Idk why all of a sudden you think you are better than all of us.

all of a sudden????? he has been that way since he first popped up on emtlife, what makes you think this is a sudden change?

 

[MrBrown]

FYI Brown... your country is about the size of most US states. 25 US states (50%) also have a greater population than your entire country.

And yet that has no bearing on anything whatsoever, Brown notices the US always uses the line of "oh but we are so big" as an excuse. Sure, 50 autonomous states who are guaranteed the right to self govern when it comes to matters outside Federal jurisdiction and the Constitution makes things more complex ... but lots of other sectors have done it including the Fire Service (NFPA) and nursing. Ambulance Service New South Wales is one of the largest geographic areas of the world for Ambulance cover and it has consistent clinical guidelines, as does British Columbia so sorry mate, being big ain't a good reason.

Uh Oh... Uh...Brown? I think he just called your country small...

Eh, Brown can live with it

all of a sudden????? he has been that way since he first popped up on emtlife, what makes you think this is a sudden change?

Wrong .... Brown is one of the most humble people you could ever meet, just ask Mrs Brown

My latin is not very good but I'm going to take a stab at this:
Medicinae Baccalaureus, Churguriuae Baccalaureus?
.

Good job mate, and its five years.

Idk why all of a sudden you think you are better than all of us.

We are not better than you, but does it not make logical sense that any jurisdiction who can offer one standard of patient care has an advantage over another who cannot?

Some states like Pennsylvania and Massachusetts have state-wide standing orders, some places like Los Angeles, Miami-Dade and Lee (FL) have County wide standing orders, others like Dallas-Ft Worth (BioTel) and Houston have system wide standing orders unique to that particular area independant of City or County boundaries (ironically Dallas Fire and Houston Fire are two of the absolute worst examples of Paramedic education in the world) while there are hundreds of other services who have standing orders unique to that particular service independent of what anybody else is doing.

A Paramedic in Los Angeles is different than a Paramedic in Reno who is different from a Paramedic in Dallas, who is different from a Paramedic in New York City who is different from a Paramedic in Hot Springs, Arkansas; some are tied to medical control to take a piss and others are not.

Hmm .... could this perhaps be less effective and efficient than a system say like oh Brown doesn't know ... the UK, Australia, various provinces in Canada and down here where we have one set of standing orders?

 

[RealMedic]

In addition to all the medico/legal issues, sadley, the bottom line in the ambulance transport business, is money. If you get a call whether it's emergent or not, you will transport. That's how ambulance transport companies make money. Especially the tranfers, thats where the $ are at. Even 911 calls for BS will get billed to Pt, state, federal, entities for collection. Like the two-tier systems used mostly out west, where when 911 is called, ya get a county/city fire rescue paramedic unit plus AMR or designated ambulance company that contracts with that city/county. They all charge you, your insurance co., state, federal etc...
If you ever even think about a pt. refusal, there is a huge hassle procedure that discourages that in most places for the very reasons I just listed not withstanding that it could be a serious pt. issue as well better evaluated at a definitive care facility. Whew!
Plus another thing, your going to have to do paper work anyway right? Might as well take em in and cover all the bases. Everyone's happy/wins.

 

[WuLabsWuTecH]

Brown, It's only 5 years where you are? How does that work? 3 Basic Sciences and 2 Clinical? (Or equivalents thereof since hardly anyone in the states does 2+2 anymore).

Realmedic:

Most of the departments where I am either don't bill, or soft bill only. The discussion here was not about money (though a valid concern) but about patient safety. I seriously doubt that toe you stubbed will kill you between here and the hospital, nor will it get any worse between here and the ER such that you need a crew.

On the other hand, there are some seemingly minor injuries that can preclude transportation sitting up in a car from being comfortable or could make it outright painful. If that is the case, I will offer these patients transportation and try to convince them that transport by our squad will be more comfortable/less painful for them.

 

[Shishkabob]

And yet that has no bearing on anything whatsoever, Brown notices the US always uses the line of "oh but we are so big" as an excuse.

Sorry, it does when you try to go "Oh we can do it nation-wide!" when your nation is smaller in size and population than many US states.

That's like Vatican City going "Hey, we have a 30 second response to ANY call for emergency in our tiny 0.2 sq mi country, why can't YOU do it?!"

Ambulance Service New South Wales is one of the largest geographic areas of the world for Ambulance cover and it has consistent clinical guidelines, as does British Columbia so sorry mate, being big ain't a good reason.

And each of those are consistent with states, not countries.

 

[WuLabsWuTecH]

Sorry, it does when you try to go "Oh we can do it nation-wide!" when your nation is smaller in size and population than many US states.

That's like Vatican City going "Hey, we have a 30 second response to ANY call for emergency in our tiny 0.2 sq mi country, why can't YOU do it?!"

And it only takes them 30 seconds because they stop to pray first!

And each of those are consistent with states, not countries.

I think what Brown is trying to say is that interoperability would be easier with a nationwide protocol. The districts he mentions are large yet they have a standard protocol. Yet we have now come full circle. If we use a cookie cutter protocol, doesn't that just mean we can't micromanage to let certain people use their own judgment in whether or not to advise for going to the ER POV?