Definitely agree. That is why I am in the field setting instead of the ED as a full time, it by my choice and yes, I can say I have been called crazy more than once for returning back to the field setting.
The way I look at it is that health care is like a jig saw puzzle. Each division is piece or part of that puzzle. Some pieces may be larger than others, but still without that single piece it is not a whole picture.
That is why I laugh, when EMT's, medics, describe themselves as being the EMS. In reality, we are only a part of EMS, albeit an important part, just a part. Surgery, trauma and ICU services, even rehab is just as an important part.
Again, it is not the EMT that is the problem rather the role that is expected with the current training/education or lack of. Medicine has increased and with it expectations and understanding of general medical care. Unfortunately, the EMT curriculum did not follow the same path and upkeep and progression. I am not being critical on the Basic alone, the Paramedic level as well is far behind the same expectation level. The difference is though, the Paramedic is required to obtain additional educational courses such as ACLS, PHTLS/ITLS to at least expose and upkeep current trends.
As I noted after reviewing the new curriculum, I was one of the first to criticize the Paramedic's portion as well. Yes, additional notations was made, but still lacking. The old philosophy of .."you don't need to know that"... has always been stated by those that did not know "that". I have as of yet, seen any thing and describing, .. Wow! I wish I was more ignorant on this or I wasted my time learning that!... Field medicine, really should be considered a speciality. Instead of making excuses of "not knowing", in reality, we need to know prehospital and in-hospital as well. Since medical patients are now routinely premature discharged, and more in-home treatments are now being routinely performed, the old adage of "field medicine only" is no longer valid. EMS personnel has to be abreast not only in out of hospital but in-hospital treatments as well.( i.e chemotherapy treatments, at home vents, IV antibiotic therapy infused through central lines.) We are the only health care professional that perform broad care that do not have a "general medical knowledge" before specializing. That is why, others in medical care do not understand EMS role. Yes, you might be able to run a code, but cannot read a thermometer or describe the importance of BUN, which is basic medicine.
I agree the ED maybe more a controlled environment, (although that can be debatable at times
) one needs to remember, There are stressors everywhere. True, in different forms, but still stressors. Instead of the "yapping dog, the ill lit room, or possible assailant; one may have a surgeon that is yelling and screaming about .... "lab's being late!"..or the "wrong size trochanter or wrong scalpel blade!".. and at teh same time the three other patients that want to go to the bathroom, t.v. channel needs to be changed or the IV pump is going off. Now, you are still stuck with that critical patient (after EMS has left) and there are no ICU beeds to receive that patient. Each person that provides care, has some level of stressors in their work environment.
Personally, I rather enjoy the stressors of the field. Maybe, because it is like home to me, but the more the better. This is what I was educated to do and perform, as well the challenge of the job.
Again, most of the time I have read my interpretation as "slamming EMT's": rather quite the opposite is true. I much rather see the role be defined for the current level of training that they receive. That is as a first responder role; to initially stabilize and assess the patient. Then after arriving EMS (ALS) unit arrives, to assist as directed.
It is foolish to expect someone to be comfortable or perform transport on a patient on ventilator with a trach tube, with a triple lumen at home, that is septic has now developed pericarditis and having chest pain. It is not fair for the patient nor the EMT.
Many may claim, that it would be too "radical" to change. I ask those from Canada to describe how it changed within their system and did so in a very short time. So yes, it can be done and be done successfully.
Something to think about...
R/r 911
