Trama and BLS

I have worked for private ambulance companies for a little over a year now (full time). I have yet to see a single trauma. It's all been hospital discharges to nursing homes (occasionally to a residence), dialysis runs like you mentioned, etc...you know what it is because you do it. I have yet to hear of any actual trauma patients handled by any level (BLS or ALS) in either company I've worked for. Occasionally a BLS crew will be with a patient that needs to go Priority 1, either from the get-go (nursing home underestimated the condition of the patient) or en route (patient's condition deteriorated in transit).

Actually, the only traumas I've known either company I've worked for to be involved with were the MVCs (still known to many as MVAs) between their own ambulances and other vehicles. :D
 
BLS Trauma Calls

I work for a semi rural county ambulance service, 3200 runs this year, and have worked here since I got my EMT #. If you want trauma really bad you could try and find somewhere in the country that just has one paramedic per shift. There are drawbacks to rural EMS however, commuting has become a major issue for a lot of people, getting lost is very easy and quite likely at times in a new response area, being the rookie all over again, and of course pay. I am going out on a limb here and guessing you make at least $10 an hour doing transfers. I started out making $7.50 an hour as a new EMT here.

I like the randomness of small town EMS though. You may do nothing for 8 hours or you may have a day like we had today, you start out with just enough crews to cover your Dr's appts and keep ALS back to cover 911 and you get a BLS transfer, a scheduled dialysis run send your 2 BLS crews out and then two 911 calls for resp. distress and a 3 car MVC with 4 patients, 1 entrapment who is critical. Thank goodness for our mutual aid from 2 neighboring counties. Did I mention that we are at least 25-30 minutes from either of the 2 small ER's that we transport to, an hour away from the regional hospitals and an hour and 30 minutes by ground to the trauma center, burn center, and the childrens hospital. After you see a few dozen trauma patients you will find that medical patients are usually a lot more interesting.
 
In all actuality, there is little treatment per say in trauma patients, especially at basic level. Other than immobilization and splinting, very little else. Even advanced level has its limitations of treatment(s), as I just came off a traumatic arrest, (which is very rare I would work). Other than intubating and performing a chest decompression, not much difference was done than a usual cardiac arrest.

We sometimes loose site, that all calls can be mundane if one really breaks it down. Performing to the best of our abilities, and utilizing all calls as experience...

R/r 911
 
Part of it is just luck of the draw anyway. My first year in the field, if I was called to an MVA, the pt was either self extricated and refusing treatment or DRT (Dead right there). Not a lot of trauma practice there! However, I saw cardiac, cerebral bleeds, respiratory distress, kidney failure, sepsis, strokes, psych, rectal bleeds, appendicitis and you name the medical call. But very little trauma.

By contrast, a friend who graduated in the EMT class ahead of me saw nothing but trauma while working in the same system. She saw falls, MVA's, ATV accidents, GSW, accidents with machinery, incidents with livestock, logging accidents, stabbings..... She couldn't take a drive in her car without a MVA with multi-system trauma happening in front of her on the road. She even had trauma literally drop into her lap at a Stones Concert (head injury, drunk concert goer). We started accusing her of causing it for the practice.

With time, we both levelled out.
 
Looking for Trauma practice. Consider volunteering or working for pay in the first aid room at a ski resort. In addition to a volunteer EMT-B, I ski patrol. Once we had 16 major accidents within 60 minutes. Any PT that was treated is considered a major.

To volunteer your EMT-B skills at a ski resort, usually you want to talk to the patrol director at the ski area. To find the patrol director at a ski area see -->
http://www.nsp.org/nsp2002/whos_who_template.asp
 
catskills said:
Once we had 16 major accidents within 60 minutes. Any PT that was treated is considered a major.
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Jeezy Yikes!!! I can think of a VERY short list of patrols that have the capacity to deal with 16 simultaneous major traumas....
 
Summit said:
Jeezy Yikes!!! I can think of a VERY short list of patrols that have the capacity to deal with 16 simultaneous major traumas....
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The real pressure was on our Radio Dispatcher. She has to keep track of all the equipment toboggans, spineboards, O2 Trauma packs that are stored in caches and buildings all over the mountain. She is the best of the best when we have a large number of patients being treated at the same time. We filled up the first aid rooms and had to put patients in the administration office and a conference room in another lodge. Of course everything flows down hill. The local EMS ambulance also hit the breaking point transporting that many patients to area hospitals. Fortunately not all the 16 patients needed to be transported to area hospitals.
 
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Aileana said:
hahaha, so true...ALS skills are very important, and do help out the patient immensely sometimes, but if the BLS skills aren't in place first, there'd be no (live) patient left for the ALS crew to work on :P.
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Why does it seem that the ALS/BLS distinction is only in EMS and everyone else just calls it "patient care" or "treatment?"
 
JPINFV said:
Why does it seem that the ALS/BLS distinction is only in EMS and everyone else just calls it "patient care" or "treatment?"
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Because, unfortunately in EMS we half arse everything. Some reason or another;(in comparison to other medical professions) we always attempt to take the easiest, pathetic, poorest method available ... the old band-aid on a arterial bleed analogy.

Who in their right mind, would believe a person could call themselves a medical professional with less than a year training or minimal of an associate degree? Heck, even manicurist course is longer than the Basic EMT, and the beautician is usually longer than a Paramedic course... what do we expect?

So we come up with levels... to separate those that pursued patient care and those that entered enough to help. Sorry, it is true..Where other professions have continued.. EMS has chickened out. Instead of doing the right way, we much rather have "substitutes". Again, any level above Basic and lower than a Paramedic is always compared against the "gold standard" of Paramedic. No matter, what letter is behind the EMT.

Personally, scrap everything and start over. Paramedics in EMS and Basics on first response type systems. Each performing their role...and closing the puzzle on patient care.

R/r 911
 
Ridryder911 said:
Because, unfortunately in EMS we half arse everything. Some reason or another;(in comparison to other medical professions) we always attempt to take the easiest, pathetic, poorest method available ... the old band-aid on a arterial bleed analogy.
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Do you seriously mean to tell me that a 120 hour course and a bottle of oxygen doesn't make me a Medical Hero First Class?

/me sits down and cries in the corner.
/me removes his tongue from his cheek.
 
Ridryder911 said:
Some reason or another;(in comparison to other medical professions) we always attempt to take the easiest, pathetic, poorest method available ... the old band-aid on a arterial bleed analogy.

Who in their right mind, would believe a person could call themselves a medical professional with less than a year training or minimal of an associate degree?
...
Instead of doing the right way, we much rather have "substitutes".

R/r 911
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Cough cough CNAs cough cough.

I agree, though. I'm just lashing out because you've progressively crushed my dreams of Rescue 911, Saving Lives, and Making A Difference.
 
Only t.v. commercials advertising CNA courses designates them as health care professional, the same way I would designate the kid at Taco Bell as a Chef.

Of course most public is still impressed if you are able to take a blood pressure..

R/r 911
 
the medic school i attended required us to go through an exit interview with the medical director (who is also medical director for the private ambulance co that runs the school and med director for the largest level 1 hospital in the area). during my interview with him he talked about how he reviews every emergency call and paramedics often times spend 20 minutes on scene with trauma patients that are only 5 minutes from a trauma center, whereas basics load and go and many times will have the patient in the er before the medic units even leave the scene. so as a medic i try to be very conscious of my scene time for any type of call.
 
Hmmm...

I'm confused, the original poster works for a private company that does IFT work and they complain that there isn't enough trauma?

What did you think you were getting into when you went to work for a company that does transports?

There seems to be a major disconnect between what's being taught in EMT classes and the reality on the ground.

Here in Los Angeles county we have private companies that transport pts. and that work along with the county fire dept doing "911 service". Even those EMT's don't run ALS calls. The primary role for an EMT-B or EMT-1 as we're referred to out here is to work with the FD paramedics and then transport the pt. to the ER. Very rarely will an EMT be doing any actual trauma work, other than assisting a paramedic. There are a few exceptions in some counties but very few.

If the original poster wants more trauma, you're gonna have to find a place to work where that's going on, seems pretty simple really. That might entail going to work for a fire dept. or continuing your education to the paramedic or the RN level.

If you were told while in school that you were going to be out on the street working trauma calls while working for a private company, you were simply misinformed.

As for the other issues that have been brought up in this thread. No doubt that there are major problems in the whole EMS system, but denigrating the efforts of those starting at the bottom isn't going to fix any of those problems. I'd rather try to instill the notion that even a lowly EMT-B is starting a career in the medical profession rather than make cheap comments about how bad the training is. EMT-B's exist for the same reason medical students exist, to learn their way into the medical system. Why put down the people who are making an effort instead of questioning the system that they're trying to work within?

John E.
 
I enjoyed and agreed with your comment until .."EMT-B's exist for the same reason medical students exist, to learn their way into the medical system"..

Which is totally incorrect. Medical students do not have multiple license or cert.'s to work their way into the medical system. They complete their medical training and while doing so are interns as they perform their "clinicals" and are not on their own. As well, it is after they have completed their license (M.D./D.O.) they are in the medical system they now work upon their own and still maybe under guidance as in residency programs.

The Basic EMT curriculum sucks..period. It is just little more than ARC advanced first aid.. again, those that compare the two can validate it. One definitely, does not call themselves a health professional after completion of an first aid class. Thus why EMT's should be at first response levels.

Again if there were no "bottom" to start at and everyone started at one level of no BLS or ALS rather "patient care" there were only be one level., Then we would not have EMS providers in confusion and patients would receive ALS care if needed. Again to use the analogy; one does not have to be a PA before medical school, nor RN has to be a prior CNA or LPN, so why would require such for EMS?

R/r 911
 
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Personally, I'd rather have a good medical call over a trauma anyways. At least medical calls make you think about what is actually going on with the patient past, "Wow, duuuuude, that car is like totally crushed."
 
I wasn't clear...

when I made the comparison between EMT-B's and medical students. My point was that one has to start somewhere, in EMS that seems to be EMT training. In the more general medical field, it's med school.

Obviously there are major differences, the med student is already a 4 year college grad. etc. But there are definitely similarities between them as well. Particularly if the EMT is planning on continuing with their education.

My main point was that a person who goes thru EMT training shouldn't expect to be dealing with "trauma" on any sort of a regular basis. I'm sure that there are areas of the country where an EMT-B is doing that sort of thing but I have no doubt that it's few and far between.

As far as the curriculum itself, I took an ARC first aid class a few years ago and it was far less difficult and less demanding than my EMT training. I can well remember thinking at the time, "is this it?". While I wasn't trained to be running ALS trauma calls during my EMT class, I did learn far more about physiology, anatomy, pharmacology, etc. than I ever learned from any first aid class.

This is not to excuse the low level of training that some EMT classes consist of. I personally think that the training should be at a higher level but that's a topic for another thread.

By the way, this is the sort of thread and the level of discourse I was hoping to find on this forum. Far better than others I've been reading. If nothing else, the mere fact that there are people here who talk about things like raising the bar on EMT education gives me hope that things can be improved upon.

And as far as the medical vs trauma call, well yeah. Car crashes and other injuries are exciting and all that but the opportunity to help improve a pt.s life, at even a minimum level is to my mind far more rewarding than having another war story to tell. But I was the oldest guy in my EMT class and have seem enough trauma in my lifetime so what do I know...


John E.
 
John E said:
when I made the comparison between EMT-B's and medical students. My point was that one has to start somewhere, in EMS that seems to be EMT training. In the more general medical field, it's med school.
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The problem is that there is a great difference between being solely responsible for a patient's care (EMT-Basic on a "BLS" ambulance) and a medical student's involvement with a patient prior to rotations (some medical schools have their students talking to patients from their first semester, but an interview class involving real patients is far different than deciding medical care and providing treatments on your own accord). Even medical school clinical rotations can't really be compared to an EMT-B because of both the shear amount of education (normally 2 years medical school plus 4 years of undergrad) prior to them and the controlled environment.

The only way to even remotely compare a basic to a medical student in terms of an "educational experience" is by requiring a basic to always be accompanied by a paramedic. I guess you can argue that an EMT-B exam could be integrated into a paramedic education in the same sense that medical students have 4 exams (steps 1, 2, 2 clinical skills, step 3) before they are granted a medical license. These exams are given throughout their education and are more than a simple pass/no pass licensing exam (scores are used for residency placement).
 
I work for a private ambulance company in Massachusetts as a basic and ive gotten a few traumas.Its a BLS skill also you never know when you might get a trauma.
 
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