Urgent care on wheels

[VFlutter]

It seems you don't like RNs from this and just reading a few of your recent posts. An EMT also must turn their patients over to MDs. Your ego as an EMT might get you into trouble if you believe you can do it all without referring to a doctor. The original discussion concerns NPs and PAs. NPs are RNs who continue their education to a BSN and then a Masters level. Unless you have an understanding of the education and scope of practice for other professionals, it is really not appropriate for you to make such comments just in an attempt to make RNs look stupid.

It is really not appropriate for you to make such an assumption about him or his "ego as an EMT'. You are new to this forum so I understand you are no familiar with many of our regular posters but I will let you in on a little secret.... He was an RN.

 

[MediMike]

Hahaha...that's happened a couple times. Was confused about Vene and JP as well...it'll come to him eventually.

 

[medichopeful]

It is really not appropriate for you to make such an assumption about him or his "ego as an EMT'. You are new to this forum so I understand you are no familiar with many of our regular posters but I will let you in on a little secret.... He was an RN.

Which he mentioned in his post that Clipper didn't particularly like :wacko::

I worked as a primary care nurse conducting my own sick call using a 500 plus page standardized procedures manual. I was a former EMT and a baccalaureate prepared licensed RN with such experience in the field (military).

 

[Clipper1]

It is really not appropriate for you to make such an assumption about him or his "ego as an EMT'. You are new to this forum so I understand you are no familiar with many of our regular posters but I will let you in on a little secret.... He was an RN.

He talked more about his abilities as an EMT. He also demonstrated very little understanding about RNs and what they can or can not do. From reading his other posts he hates being an RN and wishes to be an EMT. He makes a point of showing RNs as inferior and poorly trained to make any decisions. That you can read for yourself in his posts.

 

[Clipper1]

...because an EMT transferring care to a physician and a mid-level transferring care to a physician is completely the same thing. At the current situation, one is expected to be competent at treating and releasing within a certain population of patients. The other isn't. Where's the efficiency if the mid-level is going to triage a significant number of patients to a physician anyways? So we get to pay for a trip to the mid-level AND a trip to the physician? After all, fiscal efficiency is the only reason mid-levels exist.

No. An EMT is not a mid level provider. They do not have anywhere near the same level of education. They do not have the same abilities when it comes to triage and ordering or prescribing. Do you really want EMTs to take the place of NPs in the health care system? What training do they have in diseases, labs, pediatrics or geriatrics?

I understand you are passionate about being an EMT but you must realize that there is alot more to medicine and the over all health care process which an EMT is limited by education and scope. EMT is an entry level provider.

There is really alot of hate for RNs, NPs and PAs on this forum. It seems that many EMTs do not get enough exposure to other professions. It also appears that know about CMS, insurances, budgets, health care costs and regulatory boards are not clearly understood either.

 

[Clipper1]

Which he mentioned in his post that Clipper didn't particularly like :wacko::

He might be an RN but his posts also say he is more of an EMT. His own personal preference with a known dislike of nursing should not be a cause to misrepresent what all RNs can and can not do. If he does not like being an RN then he shouldn't be one.

 

[JPINFV]

No. An EMT is not a mid level provider.

I never said they were the same. Do you want to try wacking that straw man again?

I understand you are passionate about being an EMT but you must realize that there is alot more to medicine and the over all health care process which an EMT is limited by education and scope. EMT is an entry level provider.

Actually, since I guess you missed my earlier post... I'm a 3rd year medical student. Want to try again?

 

[Clipper1]

I never said they were the same. Do you want to try wacking that straw man again?



Actually, since I guess you missed my earlier post... I'm a 3rd year medical student. Want to try again?

You post more in suport of EMT-Bs on an EMT forum. There is nothing to indicate your level of education is that of a 3rd year medical student. Have you been in any clinical situation yet where there is interaction with other health care professionals? I know in one reply to me you assumed a doctor was looking only at SpO2 on a child. A doctor or even a 3rd year MS should realize one might be analyzing all data rather than just taking one number into consideration. By not pointing out there is much more, you really are not doing EMTs a favor by leading them to believe medicine is so simple not further education is needed. If you are an MS3, don't be afraid to utilize or show what you have learned. At some point you will have to stop relying on being an EMT and move forward. Of course not all med schools are created equal but not knowing you or your school, I only have your posts to go by. Does your med school teach this dislike for midlevel practitioners or is this the EMT in you talking?

 

[JPINFV]

You post more in suport of EMT-Bs on an EMT forum.

Really? Where? You're not really too familiar with my posting history if you think I show some sort of unwavering support for EMTs and paramedics.

There is nothing to indicate your level of education is that of a 3rd year medical student.

Except the entire "OMS-III" part of my training. The "MS" stands for "master of science" since I graduated from a masters program prior to medical school. Of course we know nothing about your background.

Have you been in any clinical situation yet where there is interaction with other health care professionals?

Every single day.

I know in one reply to me you assumed a doctor was looking only at SpO2 on a child.

No. I said that supplemental oxygen in a patient diagnosed with lower airway inflammation (bronchiolitis) secondary to a viral infection (RSV) was being done based off of clinical exam and oxygen saturation. You were the one who was calling for blood gasses and a VQ scan. However I guess that doesn't work with your narritive, hence why you still haven't replied in that thread.

If you are an MS3, don't be afraid to utilize or show what you have learned. At some point you will have to stop relying on being an EMT and move forward.

Again.. you're not too familiar with my posting history apparently.

Of course not all med schools are created equal but not knowing you or your school, I only have your posts to go by. Does your med school teach this dislike for midlevel practitioners or is this the EMT in you talking?

Cute. You want to judge my medical school? On what merit do you plan on judging them.

Also, I love how apparently suggesting that mid-levels are gods of medical care with no limits to their ability means that, somehow, I have a "dislike" of midlevels. Just as much as you want EMTs to know their limitations, is there something wrong with wanting midlevels to know their limitations?

 

[Summit]

Clipper. Chill out. It is the internet. There are definitely some people on the forum who aren't kind to midlevels and RNs, but stop putting your crosshairs on anyone in your path including RNs. Let's get back to the topic at hand.

 

[ffemt8978]

Clipper. Chill out. It is the internet. There are definitely some people on the forum who aren't kind to midlevels and RNs, but stop putting your crosshairs on anyone in your path including RNs. Let's get back to the topic at hand.

Yeah, that.

 

[mycrofft]

Just woke up from my nap. Did I miss anything?

Clip, my thumbnail CV: First aid/lifeguard 1972; firefighter 1975-79; EMT 1977-84; Air Nat Guard med tech 1980-1987; RN 1983-present (BSN); Air Nat Guard nurse 1987-1997. Nurse sick call was in a County correctional setting, field medical support for Guard was 1985-1997. CERT vollunteer active 2007-2012.

I bake a mean sourdough bread and like cats AND dogs.

 

[Clipper1]

Really? Where? You're not really too familiar with my posting history if you think I show some sort of unwavering support for EMTs and paramedics.


Except the entire "OMS-III" part of my training. The "MS" stands for "master of science" since I graduated from a masters program prior to medical school. Of course we know nothing about your background. (Osteopathic Medical Student? Around here and in more teaching hospitals MS is med student. You will learn this if you get into clinical situations. )


Every single day.

No. I said that supplemental oxygen in a patient diagnosed with lower airway inflammation (bronchiolitis) secondary to a viral infection (RSV) was being done based off of clinical exam and oxygen saturation. You were the one who was calling for blood gasses and a VQ scan. However I guess that doesn't work with your narritive, hence why you still haven't replied in that thread.


Again.. you're not too familiar with my posting history apparently.




Cute. You want to judge my medical school? On what merit do you plan on judging them.

Also, I love how apparently suggesting that mid-levels are gods of medical care with no limits to their ability means that, somehow, I have a "dislike" of midlevels. Just as much as you want EMTs to know their limitations, is there something wrong with wanting midlevels to know their limitations?

Gods of medical care? I do prefer an NP or PA to be in charge of a clinic for medical care with involves non emergent treatment, long term care and preventative medicine over an EMT or Paramedic. To say there is not a place for NPs or PAs is just very short sighted on your part.

Bloods gases and V/Q Scan? Where did you get thAt from? I will repeat that a knowledge of the disease process will determine overall treatment and weaning protocols. A V/Q Scan is not necessary in this situation. You might want to review the indications for a V/Q Scan. ABGs may or may not be necessary also since it is likely a CXR (Chest X-Ray) was done. A CMP or CBC was probably done which would have indicated the type of infection or inflammatory response. You did state you did not know what type of workup was done.

My knowledge of your previous posts comes from here.

http://www.emtlife.com/search.php?searchid=3332948


I don't reply to every response nor do I look at this website very often. It seems this forum is a closed discussion to only a few. The VAP posts were brought to my attention by an EMT in the ED who gets a kick out of showing us what EMTs and Paramedics think of nurses and PAs. It definitely sets the tone around here when we know how we are viewed by EMTs and Paramedics in public.

#########################

For the person from King County, I invite you to join us on the discussion forums at SCCM. We welcome any professional who is interested in advancing patient care. I also suggest to those interested in a more informed discussion complete with references that they should join a professional group with a closed member access. Names and workplaces can be freely disclosed since they are a requirement for entrance. These are great places for networking. I have heard EMS has a few organizations like that which EMTs and Paramedics can join.

 

[Veneficus]

I also suggest to those interested in a more informed discussion complete with references that they should join a professional group with a closed member access.

Did that.

Drs. Only. Credentials verified. Doesn't work out so well though, like all internet forums, there seems to be a core group that dominates discussion and while everyone is invited to join, participation is somewhat more reserved.

I used to belong to a mixed professional forum when I was a medic. However, the constant berating I got from PAs "with much more medical education" got old fast.

They don't seem to like it too much now that I turned that table.

EMTs and Medics aren't actually welcomed many places. They are simply tolerated or given a seat at the childrens table.

Go to a trauma conference and see the difference in the breakout sessions for doctors and medics. It is like not even being in the same hotel.

Names and workplaces can be freely disclosed since they are a requirement for entrance.

People I trust know who I am. Just because a person discloses their name and workplace doesn't mean they are not psycho.

disingenious Jake.

 

[JPINFV]

...and since Clipper keeps lying out her teeth about my posts (hint: I did say I know the workup... I have access to the EMR) and making strawmen so large that it could be a wonder of the modern world, she's joined the very very small list (now 4) known as my ignore list.

 

[NomadicMedic]

Last warning to keep this thread on topic.

 

[Carlos Danger]

Echoing Clipper's last two posts, the provider role under discussion has long been the realm of the community health RN/NP.

In fact, it bears very little resemblance to EMS and paramedicine.

Community medicine really doesn't resemble emergency medicine AS EMS SEES IT (as opposed to how the ED is forced to deal with it). As Clipper points out, the role of a community health whatever is very far from the role EMS providers typically believe they fill (and train for).

This.

Community health has long been the purview of nursing.

I don't see any reason why EMS couldn't get involved, but I don't see it happening in the way and on the scale that many of it's advocates seem to want.

I wrote a long and detailed post about why in the last thread on the topic of community health paramedicine.

Mostly I think the challenges would come down to problems with licensure and the feasibility of getting universities to design the educational programs on a large scale.

 

[Carlos Danger]

Metro Medical

Unfortunately, I just don't see much role for paramedics in services such as this.

Not that they couldn't do it with the right education, but NP's and PA's already exist....

 

[Summit]

Metro Medical

Unfortunately, I just don't see much role for paramedics in services such as this.

Not that they couldn't do it with the right education, but NP's and PA's already exist....

Indeed, and why the push for the lateral move anyway? Push up before you spread out. I think it is as simple as the mindset of, "outside the hospital is prehospital medicine no matter what is actually happening and prehospital medicine is EMS. PA school is too much, so lets make a some super-duper medics, and call it good." This isn't logical, especially when matched against what frequently is said in threads with non-turf-war themes: that non-acute patients are a waste of EMS resources.

 

[JPINFV]

Indeed, and why the push for the lateral move anyway? Push up before you spread out. I think it is as simple as the mindset of, "outside the hospital is prehospital medicine no matter what is actually happening and prehospital medicine is EMS. PA school is too much, so lets make a some super-duper medics, and call it good." This isn't logical, especially when matched against what frequently is said in threads with non-turf-war themes: that non-acute patients are a waste of EMS resources.

The problem, as I see it, is the large number of people who are calling 911 for chronic health needs. As such, it's not necessarily that EMS is best suited or the best enterprise to provide home health. It's that it's being accessed in that manner regardless and at expense to the system as a whole. The option is to either adapt to the current demands being placed on the system, or be run over by an out of control system.

Emergency departments aren't the best suited for patients with chronic primary care diseases either. However, imagine if emergency physicians suddenly said "screw this, we aren't PCPs. That new onset HTN that isn't up to urgency/emergency standards? Go away. Med refill? Go away." The healthcare system would collapse overnight. It's not that they want to do it... it's that the system demands that they do it.