What do you think is the most important thing EMS does?

[EMTinNEPA]

Assess, treat life threats, begin definitive care in the field, and transport.

A paramedic or EMT is only as good as his assessment. The only difference between the physical exam of a paramedic and that of a really well-educated EMT is certain diagnostic tools (mainly glucometer and cardiac monitor).

 

[Melclin]

I haven't figured out why yet, but i am thinking the need for mental security. Anyone else have insight on this?

I have noticed this. I have often found that the more educated people are, the more they realise how hard it is to be "sure" or to "proove" something. Less educated people will often simply read something or hear something and take it to be gospel truth. My personal favourite is, "I've been doing this since you were in nappies/ I have a son your age" the inference being that I'm wrong. My reply usually being that repetition of an error does not constitute experience, and that the plural of anecdote is not data. Understanding concepts like the value of different levels of evidence and different kinds of studies is pretty damn important to anyone in any healthcare field. Critical thinking and understanding the nature of knowledge are perhaps good starting points for better prehospital types.

Did you know both the Mosby and Brady paramedic texts have pathology sections that are cut and pasted out of context from advanced pathology texts?

Those American EMS textbooks are widely considered to be wastes of perfectly good paper here. Other than the fact that they are poorly written and confusingly laid out, any time you have a question to ask of them the answer is "ask medical control". In some cases I can't think of a more confusing and long winded way to describe often simple clinical issues. Occasionally they are patently wrong, as you say. There are entire topics like pain relief that are barely covered. We barely use them and nobody likes them. Tintinalli's Emergency Medicine is our go to text book on most subjects as well as our mediocre A&P (Martini) text and our much better Pathophys text (McCance) (which also happen to be the same A&P/Patho books all the allied health and nursing students use), but the primary source material is always considered to be better.

More education for EMS providers doesn't benefit me any.

It could and probably would. Most people will benefit from the services of EMS at some stage in their lives. Could be something as 'little' as breaking your wrist and not having any pain relief for 2 hours while the basic can do nothing and the medic s**ts himself over whether or not 1 or 2mg of morphine is to much. People who are against more education should consider, as Rid says, how they would feel when some idiot with a shiny new EMT cert screams in with his turn out gear and an AED ready to save the world.

 

[MrBrown]

Really, anyone could put every medical pt (and stable traumas as well) on an ECG/12 lead, SpO2, ETCO2 (nasal), do a temp and a BGL, and give O2, memorize the regional protocols, and appear confident and thorough to the ignorant. You could fake a whole career like that in some places.

Right there my friend is the entire problem, well said!!! B)

... and how did you get the closely guarded secret of the Houston Fire Department?

 

[Melbourne MICA]

Forests and trees

I believe sometimes we cannot see the forest for the trees in EMS. What is the most important thing we do?

Short and simple we respond to a crisis that the average person cannot handle or know what to do at that time.

Now, with that we can explore what extent and how much education is needed for those responding to emergencies. Futile discussions on what and the extent of education and training will always be debatable. Again, if it was your emergency what extent would you feel be necessary?

R/r 911

I'm with you Ridders.

The most important thing we do is to be advocates for our patients.

Because even when it seems we have done virtually nothing for them that would be mentioned in some medical textbook, article, quoted by some famous author, taught in some education programme;

- say put them on the stretcher and take them to ED -

We have still advocated for them by delivering them from medical crisis to medical intervention.

What was that line in the movie?

"we did nothing wrong? - yeah we did - we're supposed to fight for people who can't fight for themselves - we were supposed to fight for Willy".

MM

 

[MrBrown]

All this talk of willy and forrests and trees which rhymes with birds and bees makes Brown wonder if we should all re-submit that working with children check

 

[Aidey]

I'm with you Ridders.

The most important thing we do is to be advocates for our patients.

Because even when it seems we have done virtually nothing for them that would be mentioned in some medical textbook, article, quoted by some famous author, taught in some education programme;

- say put them on the stretcher and take them to ED -

We have still advocated for them by delivering them from medical crisis to medical intervention.

What was that line in the movie?

"we did nothing wrong? - yeah we did - we're supposed to fight for people who can't fight for themselves - we were supposed to fight for Willy".

MM

Is it advocating for your patient they aren't in medical crisis and you still transport them to an ED when they would be better served by an alternative?

 

[Melbourne MICA]

Advocacy for patients

Is it advocating for your patient they aren't in medical crisis and you still transport them to an ED when they would be better served by an alternative?

Yes it is.

Despite the fact, (and we all know this happens) we are called to patients who don't need ambulance care (but may need something else) we nonetheless still advocate for the patient by providing access to a higher level facility/resource or area of access to health care that may be able to provide them with what they need (even if its not health care).

It may be the patients mistake (having called the ambulance in the first place) or may reflect problems within the health system eg lack of after hours GP services. But in serving the patient we have advocated on their behalf because hopefully somewhere down the line somebody questions why these patient were brought to the ED in the first instance.

We have input through our own systems (services) to bring such problems to light via our bosses and departments, often have auditing and other processes within the organisation to identify inefficiences and can use other means (even kicking up a stink in the media or through a labor union eg) to encourage change - change that must always be in patients' interests.

So our advocacy, whether by choice, because of an mandatory obligation under legislation or under a charter - a statement of philosophical position enshrined in the services contract of business operation (as happens here in Melbourne - "The Ambulance Charter") still services patient need even when a transport seems wasteful/unnecessary.

We don't have to like being obliged to transport or having no alternative but our first moral (ethical) and professional obligation (in my opinion) is to the patient as their representative. It's our higher purpose if you like and one that on occasion requires humility and self sacrifice.

It really is the most important thing we do for people and the reason ambos rate so highly in public opinion.

MM

 

[atropine]

I believe sometimes we cannot see the forest for the trees in EMS. What is the most important thing we do?

Short and simple we respond to a crisis that the average person cannot handle or know what to do at that time.

Now, with that we can explore what extent and how much education is needed for those responding to emergencies. Futile discussions on what and the extent of education and training will always be debatable. Again, if it was your emergency what extent would you feel be necessary?

R/r 911

I totally agree with you that we are indeed responding to someone's crises, however in todays economy and buisness/capital like mentality patients are now customers. good custermer service should be cheap and effective at least to the custermer paying the bill, wheather it be insurance, subsity, taxes, or private party. once the averge Joe (custermer) know what their paying for and what they want to pay for ems will always be different or adaptive to the demographics it serves.

 

[Melclin]

It may be the patients mistake (having called the ambulance in the first place) or may reflect problems within the health system eg lack of after hours GP services. But in serving the patient we have advocated on their behalf because hopefully somewhere down the line somebody questions why these patient were brought to the ED in the first instance.

...

So our advocacy, whether by choice, because of an mandatory obligation under legislation or under a charter - a statement of philosophical position enshrined in the services contract of business operation (as happens here in Melbourne - "The Ambulance Charter") still services patient need even when a transport seems wasteful/unnecessary.

We don't have to like being obliged to transport or having no alternative but our first moral (ethical) and professional obligation (in my opinion) is to the patient as their representative. It's our higher purpose if you like and one that on occasion requires humility and self sacrifice.

I don't think its enough to take them to the ED and hope. I wanna see more referral options. There is no reason why we can't get the ball rolling on falls referral for example. Why should we simply hope that the nurse will notice? Did they see the house with power cords strewn everywhere and notice the large print text all over the house? They tried a program out rurally and it fell through unfortunately but I understand the powers that be (Walker et al) are keen on some new stuff in the pipes on the same issue. The RAD teams* are also a good idea, but I'm not sure how far they've expanded.

Being obliged to transport patients even if its not in there best interests reminds me of certain debates about doctors doing harm (euthanasia or abortion) despite the Hippocratic oath. I don't think its in the interests of the patient, us or the health system in general to transport them to the ED unless they need to go.

I think the best piece of paramedic-ing I've seen on placement, despite lots of MICA jobs and chopper jobs, was a roadie who spend over an hour with a patient who had fallen but was perfectly okay, addressed the cause of the fall, wrote a letter to the GP and rang and had the appointment moved up, spoke with her council case worker and organised for a walking frame to be delivered from the council, and made a cup of tea. What good would a trip to ED have done? (Esp that particular ED :wacko

* http://www.peninsulahealth.org.au/s...e/response-assessment-and-discharge-rad-unit/

 

[Aidey]

Being obliged to transport patients even if its not in there best interests reminds me of certain debates about doctors doing harm (euthanasia or abortion) despite the Hippocratic oath. I don't think its in the interests of the patient, us or the health system in general to transport them to the ED unless they need to go.

This is pretty much what I think. Transporting patients to the ED who are better served by other services sets off a chain reaction that affects the whole system negatively.

The patient doesn't get the best care they could and other patients receive delays in care. Patients also don't learn about the alternatives. By transporting them we reinforce the idea that 911 and the ER fix everything.

 

[eynonqrs]

Assess, treat life threats, begin definitive care in the field, and transport.

A paramedic or EMT is only as good as his assessment. The only difference between the physical exam of a paramedic and that of a really well-educated EMT is certain diagnostic tools (mainly glucometer and cardiac monitor).

I agree. I have noticed a big difference in how the new EMT's are taught as vs the older EMT's. It amazes me how the new EMT's in PA can't think for themselves.

I don't know who made that remark about that BLS shouldn't get paid, it is offensive.

Prime example. In Wyoming County PA there is only one ALS unit that provides coverage for the entire county and it is a fly car. The other ambulances are all BLS volunteers. The county is a huge area, where it can be 30+ min before ALS can get there. I bet ya the EMT's have to be on top of the game. This ALS unit is hospital based and they are looking to dump the service because they are losing money. That tells you that the hospital doesn't care, it's all about the bottom line.

EMS is over abused system.

I can see this is leading to an ALS vs BLS argument again. I am not going to get into it. As I have my own point of view.

That is all.

 

[mycrofft]

Waiter, Czech please.

.........:deadhorse: