What is EMS???

[DrParasite]

A simple question, one that I think gets lost in certain debates.

At it's most basic level, what is EMS? What is Emergency Medical Services?

In a couple other threads, EMS was defined as having an ambulance responding to a medical emergencies staffed by two highly skilled (relatively) lowly educated people operating under a doctor's orders, then transporting the patient to the hospital.

So in a nutshell, EMS can be defined as responding to an emergency, stabilizing as best you can, and transporting to definitive medical care.

However, based on some posting on these boards, they are either unhappy with this basic job description of EMS, wish they could do more, or think they know better than those who have M.D. an D.O. after their name, despite having significantly less training.

Items such as suturing, prehospital TPa, and non-emergency physicals probably can be done by EMS personnel, but how much has that deviated from the concept of EMS? EMS deciding a patient doesn't need to go to the hospital and refusing to transport the patient, or Paramedics not having protocols, but rather guidelines that they can change in any way they want (without prior approval of the med director) are all interesting concepts, but how much have they gotten away from the whole medical director/medical directee relationship that used to be a crucial part of EMS?

There are paramedics here that say that oxygen via NRB is bad (despite MD written protocols saying otherwise), C-spine and backboarding are over rated, and how every person should be treated by a paramedic, and while they are all very interesting concepts, those with higher levels of training (MD, DO, and PhD) seem to disagree. Yet those paramedics think they know more the the docs. And that's not including the EMTs who think they don't need a paramedic on every call (maybe ignorance really is bliss?).

I also thought that the job of an EMT was to stabilize a person as best they could, prevent whatever was happening from getting worse, and transport to definitive medical care (which is a hospital emergency room). Add a paramedic to the mix, and the job is pretty much the same; throw in some more tools to stabilize the patient, package as best you can, and transport to definitive medical care. But the basics are still the same.

So my question becomes, with all the talk about making a paramedic a master/doctorate degree, with paramedics being asked to do more, as well as asking for more tools in their box and drugs in their box, has EMS moved away from it's basic core principle, of stabilizing a patient as best they can, and transporting to definitive medical care?

 

[SanDiegoEmt7]

It's not that paramedics feel more knowledgeable on the subject than MD/DOs, there are certain protocols that are outdated or do not have evidential proof of patient benefit shown in clinical study.

High flow O2, and low flow for that matter, aren't always indicated even though the protocol book says so, ask any MD/DO in EM. Backboards are truly only required for a small percentage of patients that end up getting put on one.

The advancement of Paramedicine, and the elimination of the EMT-B, are important, in that when they have the knowledge of a 4 year plus degree along with 2+ years of supervised clinicals, the MD/DOs can have more faith in the prehospital providers and "blanket/lowest common denominator" protocols can go away, to the benefit of our patients might I add.

Unfortunately, I know many paramedics who wouldn't be in the field if they actually had to undergo a full education to get their job. The other point of education is to justify increased earnings for paramedics, single role not dual role, so that people are inclined to stay in their profession. This allows for the existence of more EMS providers with a great deal of experience that can train the next generation, because there's motivation for them. many paramedics change to other health profession for the monetary advancement.

At home physicals and suturing? Probably not going to happen as that is a huge jump in scope and education. We should be focused on producing quality providers, as is done in many different parts of the international community (australia, canada, etc.) that can better understand the rationale and decision making process in the treatments we already have available. Only once we prove ourselves can we ask for more.

EDIT: I don't think anyone here is a proponent of moving away from our core responsibilities as an EMS provider, and to be honest there are so many issues to fix with what we already do that anyone who is a proponent of that is insane or has never worked in the industry.

 

[lampnyter]

My simple thought of what EMS is is helping people in the time of an emergency. Whether we just transport or give medicine, you never know how many lives you could end up saving.

 

[CAOX3]

Its a job.

 

[Melclin]

So in a nutshell, EMS can be defined as responding to an emergency, stabilizing as best you can, and transporting to definitive medical care.

You must see an amazing amount of sick patients. Lucky you.

Most patients don't need "stabilisation" and many patients don't even need an ED. Traditionally EMS wasn't about making those decisions. Doesn't mean we can't change for the better.

Items such as suturing, prehospital TPa, and non-emergency physicals probably can be done by EMS personnel, but how much has that deviated from the concept of EMS? EMS deciding a patient doesn't need to go to the hospital and refusing to transport the patient, or Paramedics not having protocols, but rather guidelines...

There are paramedics here that say that oxygen via NRB is bad (despite MD written protocols saying otherwise), C-spine and backboarding are over rated, and how every person should be treated by a paramedic, and while they are all very interesting concepts, those with higher levels of training (MD, DO, and PhD) seem to disagree.
...
Yet those paramedics think they know more the the docs.

You really don't get it. Its not that paramedics think these things are good ideas while everybody else disagrees. Its that doctors, and anyone who's been to school for more than 15 minutes, knowthese things are good ideas, but can't trust poorly educated providers to make the decisions.

They make simple blanket protocols that they know are detrimental to many patients in the knowledge that it will be less detrimental than someone with a few months of training making those decisions.

Wouldn't it be nice if they had well educated paramedics for whom they could write flexible guidelines that allowed some room for adjusting clinical decisions to suit each patient. Where the the medical director's decision to institute a new treatment modality was based on whether or not it will work and not on whether or not the paramedics are too stupid to apply it safely.

When I call an ambulance, I don't want a high school drop out with a glorified first aid certificate turning up. I'd rather call a taxi. It'd be quicker.

 

[emt_irl]

Alot of your comments seem to be u.s based though, in alot of other countries ems doesnt refer to an m.d, they use there education, guidelines and common sense to make informed decisions based on there clinical findings.

 

[mcdonl]

Just my opinion....

To me, EMS is about getting the patient to definitive care. And, performing as GOOD and assessment and DETAILED history as possible and as little interventions as needed. By needed, I mean provide interventions needed to relieve pain or stabilize the patient.

The less we do, before bringing in a patient the less the ED needs to factor into their definitive care. <-- I think it is more to this point than the notion that we are not skilled enough to do more.

 

[jrm818]

There are paramedics here that say that oxygen via NRB is bad (despite MD written protocols saying otherwise),

With the new ECC guidelines it looks like those silly MD's are finally starting to see the light and catch up with the medics

C-spine and backboarding are over rated, and how every person should be treated by a paramedic, and while they are all very interesting concepts, those with higher levels of training (MD, DO, and PhD) seem to disagree. Yet those paramedics think they know more the the docs.

I don't know where you're getting the idea that there is a huge rift between paramedics and doctors on these issues.

I don't think too many medics "think they know more than the docs" as a rule.

From what I've seen, the general outline of the arguments put forth by medics (or basics) criticizing current protocols runs something like this:

A) current practice is X
B) preponderence of new evidence says doing Y is more beneficial to our patients than doing X
C) if we're serious about EBM we should modify our treatments based on evidence
D) It is practical to do Y
E) We should do Y instead of X

I think the essential point to make is that there are few debates where a medic says "I think we should start shocking asystole because my knowledge of cardiac pathophysiology is better than that of a cardiologist, and I just say so."

Instead the arguments are nearly always based on development of new evidence This evidence is generated by peer-review scientific examination. Generally the authors and peer reviewers of such research are PhD's or MD's (for now EMS researchers are the exception not the rule). Really, when you hear medics criticize current practice, they're almost always picking up the banner of an MD or PhD who has published evidence that suggests a change might be necessary.

I also do think that for specific issues, its very possible that certian medics do know more than certain physicians. C-spine precautions are probably a decent example - I'm willing to bet that most doctors don't give two hoots how immobilization is accomplished, haven't read any of the literature, and don't care to.

Compare the judgment of that sort of MD with an educated involved medic who has practical knowledge of techniques of immobilization, understanding of the relevant physiology, and who has kept up with the literature on immobilization. I think it's reasonable to say that our hypothetical medic will be more knowledgeable than our hypothetical physician about this issue.

The physician is almost certianly more knowledgeable about many many other topics, but if you want to know about c-spine precautions, who are you going to rely on?

So my question becomes, with all the talk about making a paramedic a master/doctorate degree, with paramedics being asked to do more, as well as asking for more tools in their box and drugs in their box, has EMS moved away from it's basic core principle, of stabilizing a patient as best they can, and transporting to definitive medical care?

I think for some emergencies rapid transport will remain the primary role of EMS for the foreseeable future. I'd say such emergencies are primarily surgical problems like major trauma. Those emergencies are such a tiny portion of the actual EMS requests for service, however, that it's doesn't strike me as the most effective/efficient/logical/smart place to focus our concern.

definitive medical care (which is a hospital emergency room

This definition is patently false in many patients. Definitive care for many sick patients may be the ICU. For an MI, definitive care is really a cath lab. For trauma, its surgery not the ED. Etc. Etc.

Definitive care may not even be in a hospital. For a drug/etoh abuser, an addiction facility is really "definitive" care. For a suicidal pt. it may be an inpatient psych facility. For grandma who calls at 2AM because she forgot how to work her chair electric, "definitive care" may be a PCA, a nursing home, or some other non-hospital service. And (someday, or today in some places) for Timmy who cut his arm, definitive care may be the back of an ambulance where he can be flushed and sutured without the expense, wasted time, and hassle of going to the ED to wait for hours to be seen in a small room with a bunch of people with the swine flu, all the while further burdening an already overburdened system. I think this sort of development would be a good thing, and I bet Timmy would agree.


Summary:

1. Tradition is a miserable argument for perpetuating the status quo. It is always good re-examine why we do things the way we do and try to improve our efforts. In the EMS world "improve" means "improve care for our patients."

It's fine to debate the best way to provide care, and certianly not all "advancements" do actually improve care, but simply saying "we've always done things this way" is not an argument, and should be dismissed out of hand, as I dismiss it now.

2. Doctors are human and make mistakes like anyone else. some have poor judgment and some just don't care. Some are fantastic. Either way doctors are not god and to blindly assume that anything said by a physician is truth simply because they have "MD" after their name is foolish and uneducated. More importantly, doctors disagree with each other all the time.

3. Regardless of the definition of EMS, as providers we should be interested in doing what is best for our patients. "Patient advocacy" is not something that is only practice on scene. Advocacy means informing yourself about options and advocating for the option that best supports the real goal of EMS: Help as best we are able to improve the quality of life and alleviate the suffering of those in need.

 

[mcdonl]

This definition is patently false in many patients. Definitive care for many sick patients may be the ICU. For an MI, definitive care is really a cath lab. For trauma, its surgery not the ED. Etc. Etc.

Not sure how it works in your neck of the woods, but for our municipal 911 service we bring the sick and injured to the ED unless they are signed off.

As far as stitching little Timmy up, well... I guess your ambulance service is so NOT over burdened you do not need to worry about who is going to handle the call when little Timmy's grandfather codes and your in the middle of suturing little Timmy's arm in the back of your traveling clinic.

Whatever, point I am making is my definition of definitive is based on my experiences and the way our EMS service runs.

 

[MrBrown]

EMS is the front-line emergent pathway via which people enter the health system, simple as that.

They may go up further into the system if deemend clinically necessary otherwise be discharged from it and treated/not transported or assessed and left at home.

 

[JJR512]

EMS is the front-line emergent pathway via which people enter the health system, simple as that.

I agree with this and really think it's just that simple. What I like about this definition is that it doesn't have anything to do with the people acting as EMS providers or their training. EMS can be provided by First Responders. It can also be provided by Doctors. What is actually done in the field will obviously vary based on the level of training and education possessed by those performing the emergency care, but regardless of that, MrBrown's definition remains accurate.

 

[JPINFV]

A simple question, one that I think gets lost in certain debates.

At it's most basic level, what is EMS? What is Emergency Medical Services?

In a couple other threads, EMS was defined as having an ambulance responding to a medical emergencies staffed by two highly skilled (relatively) lowly educated people operating under a doctor's orders, then transporting the patient to the hospital.

Is that what EMS is for eternity, or just what EMS currently is, which means it can evolve to take on additional roles?

However, based on some posting on these boards, they are either unhappy with this basic job description of EMS, wish they could do more, or think they know better than those who have M.D. an D.O. after their name, despite having significantly less training.

What's wrong with wanting to do more provided an appropriate level of education is required?

Some of us are working towards having an MD or DO behind our names.

An MD or DO doesn't suddenly grant amazing and untold secret powers except the ability to call a spade a spade for those afraid of the "D" word.

Items such as suturing, prehospital TPa, and non-emergency physicals probably can be done by EMS personnel, but how much has that deviated from the concept of EMS? EMS deciding a patient doesn't need to go to the hospital and refusing to transport the patient, or Paramedics not having protocols, but rather guidelines that they can change in any way they want (without prior approval of the med director) are all interesting concepts, but how much have they gotten away from the whole medical director/medical directee relationship that used to be a crucial part of EMS?

Guidelines doesn't eliminate the director/directee role. The medical director should be involved to make sure that the providers operating under his/her oversight are able to display an appropriate level of critical thinking and diagnostic capabilities instead of following a cookbook. You don't need much training to follow a cookbook, however I'd hate to be one of the patients that doesn't neatly fit into the cookbook sequence of treatments.

Given an appropriate level of diagnostic ability, what's wrong with treat and release? Contrary to popular belief, not everyone needs to have labs run. I saw a 9 y/o girl in clinic on Monday who had a really bad case of athlete's foot become infected. My supervising resident didn't run a culture, he prescribed Bactrim and told her mother to call back if it didn't clear up in a few days.

There are paramedics here that say that oxygen via NRB is bad (despite MD written protocols saying otherwise), C-spine and backboarding are over rated, and how every person should be treated by a paramedic, and while they are all very interesting concepts, those with higher levels of training (MD, DO, and PhD) seem to disagree. Yet those paramedics think they know more the the docs. And that's not including the EMTs who think they don't need a paramedic on every call (maybe ignorance really is bliss?).

Oxygen: See 2010 AHA guidelines. See Harrison's Internal Medicine. Look up radical oxygen species. Contemplate what's wrong with the patient and what you're hoping to accomplish. Alternatively, accept that the prevailing wisdom is that EMS providers are too stupid to be taught to titrate a basic medication.

C-Spine: See research regarding efficacy. Contemplate the question about why this is one of the few interventions that we have to justify not doing instead of justifying doing. Why doesn't every patient with ALOC get narcan?

I also thought that the job of an EMT was to stabilize a person as best they could, prevent whatever was happening from getting worse, and transport to definitive medical care (which is a hospital emergency room). Add a paramedic to the mix, and the job is pretty much the same; throw in some more tools to stabilize the patient, package as best you can, and transport to definitive medical care. But the basics are still the same.

Not making the patient worse by misusing treatments is an important part of stabilizing a patient.

So my question becomes, with all the talk about making a paramedic a master/doctorate degree, with paramedics being asked to do more, as well as asking for more tools in their box and drugs in their box, has EMS moved away from it's basic core principle, of stabilizing a patient as best they can, and transporting to definitive medical care?

Unless EMS only wants to be seen as a medical taxi ride where the only two major career choices for the majority of providers is the front of the ambulance or the back of the ambulance, the yes. In fact, I'd argue that it has to move beyond just providing transport. Should fire departments stop doing everything that isn't involved with extinguishing fires, including rescue services and prevention services?

 

[firetender]

That's the Theory, anyway!

At it's most basic level, what is EMS? What is Emergency Medical Services?

I also thought that the job of an EMT was to stabilize a person as best they could, prevent whatever was happening from getting worse, and transport to definitive medical care (which is a hospital emergency room). Add a paramedic to the mix, and the job is pretty much the same; throw in some more tools to stabilize the patient, package as best you can, and transport to definitive medical care. But the basics are still the same.

EMS has always been about the care and transport of the sick and injured and dead. Period. The dead don't usually start that way, but you get the picture. Okay, sometimes we haul the healthy, too, but we get reimbursed so it's okay!

EMS has never been limited to the transport of true emergencies to definitive care.

It is a service whereby people are moved away from the site of their immediate traumatic experience to a more sophisticated or appropriate destination for a continuation of care.

At the scene and en-route, a moveable feast of therapies and interventions can occur, but bottom line, it's about the wheels.

SOME services limit themselves to ER's and the like, but what's the truth? Often times it's about getting someone to intermediate care, maintenance facilities, or disposal centers like morgues.

It has never been about success, or particular interventions or therapy, it has always been about moving people in need from here to there. Remember, it was formed and regulated by the Department of what? TRANSPORTATION.

The words say EMERGENCY Medical Services

Perhaps it should be S.E.M.S.

Sometimes Emergency Medical Services

 

[Veneficus]

Many smart things have already been said, some I agree with, some I am not sure about.

A simple question, one that I think gets lost in certain debates.

At it's most basic level, what is EMS? What is Emergency Medical Services?

I'd like to break this down to "what is an emergency?" By itself it means different things to different people.

"What is emergency medical service?"

I think at one point in time it meant performing basic interventions of the day performed while transporting a patient with an acute life threatening pathology to more capable providers.

The reason I chose to use the word pathology is because it changes over time. (hense the study of paleopathology) When US EMS was first formed, acute traumatic pathology was the major defining purpose of EMS. (see the white paper on accidental death and disability)

In a relatively short period of time, the notion that if a pathology was acute, acute intervention could somehow change the outcome. Which is sometimes true and sometimes not. Through our collective experience, knowledge, and failures, we have found that what we thought was time sensitive is often not as sensitive as we once thought.

Performing timely interventions in order to deliver a pt. to the hospital started to be measured not by the patients taken to the hospital, but the patients leaving it. Having seen and been in the trench on that major shift, I would like to offer that it was probably the most defining moment of what EMS is/was to become.

In a couple other threads, EMS was defined as having an ambulance responding to a medical emergencies staffed by two highly skilled (relatively) lowly educated people operating under a doctor's orders, then transporting the patient to the hospital.

I think this was and in some places still is the definition. Like with any advance in mankind, there are some who are quicker than others to embrace the change.

It is also important to understand the context of that definition as well. When EMS first came into being, aside from doctors and nurses, there weren't any other healthcare providers playing a major role outside of the military. (that is a thread unto itself)

However, with the exponential advances in medical science (not to be confused with medicine as a whole as some very important parts are being lost in its industrialization) it has spawned an entire cadre of hyperspecialized healthcare experts. Each of these experts has dedicated themsleves to advancing their area and providing tangible value.

While the physician is still the medically most well rounded, and seen as the ultimate medical expert by not only society, but also a large number of providers, the physician is not the only expert anymore.

So in a nutshell, EMS can be defined as responding to an emergency, stabilizing as best you can, and transporting to definitive medical care.

I think that that was true at some point, but I think it is no longer applicable because the needs of those who fund and use EMS have changed.

In the modern countries, accidents are no longer the main public health concern, in less developed nations, it is not the primary concern either. Which puts it square in the column of developing nations. If you look at many current EMS initiatives outside of the most developed countries, you will see they are basically where the US was in the 60's and 70's.

However, based on some posting on these boards, they are either unhappy with this basic job description of EMS, wish they could do more, or think they know better than those who have M.D. an D.O. after their name, despite having significantly less training.

I wouldn't say I had significantly less But having climbed the EMS ladder to get here from the bottom, I do think I have a perspective similar to that of a prior enlisted military person that becomes an officer. I know first hand the concerns of the people in the trench, but I am also a junior member of the more strategic thinkers.

It is not that I disagree with what EMS was, or in some parts is still, but what it needs to be has changed.

In today's modern world, there is a need for a medical/social provider who can rapidly respond to the patient, as opposed to the patient coming to the healthcare provider, who can assess the needs of the patient and either solve the problem or as a gatekeeper to the medical machinery direct the patient to the resource that would best help the patient. In many cases it is a social problem or a chronic medical issue. Very seldom an "emergency." The ED itself, has morphed from a place of care of the acute pathology to a place of primary entrance into the medical system. If EMS is an extension of the ED, or of the emergency physician, it is only logical the role of EMS would also evolve.

Items such as suturing, prehospital TPa, and non-emergency physicals probably can be done by EMS personnel, but how much has that deviated from the concept of EMS?

Actually? None of it. If you trace the roots of EMS to military medics, the enlisted persons in the field have been performing many of these "advanced skills" since WWI. (that it 1914 for the youngins)

Some of those skills were deemed to not be needed in the civilian world due to the proximity of the hospital or doctor who still made house calls. (I would add the IO was originally established for these medics for ease of placement and field conditions during this time, however it was deemed inappropriate until its popular resurgence in the 1980s.) Based on the fractured industrial healthcare of today, some of the other skills that were not previously needed are also finding a place in prehospital care today.

 

[Veneficus]

EMS deciding a patient doesn't need to go to the hospital and refusing to transport the patient, or Paramedics not having protocols, but rather guidelines that they can change in any way they want (without prior approval of the med director) are all interesting concepts, but how much have they gotten away from the whole medical director/medical directee relationship that used to be a crucial part of EMS?

I think they haven't gotten away from it at all. Even physicians have medical directors. (senior physicians) who set policy or practice procedures. That role is crucial at any healthcare level. THe only thing that really changes among the various levels is how much direct oversight or deviance from the policy is permitted. However, EMS is the only healthcare unit that is still trying to make these definitions black and white. Which of course in medicine is an absolutely foolish excercise. Medicine has never been "if: then" if the goal is to treat a patient it is at best "maybe:sometimes:depends."

To use a military analogy again, the deviation a recruit is permitted is basically nothing. The deviation of a petty officer more. A senior petty officer even more, and the Chief and above are all but autonomous units and in some instances actually are. (substitute the appropriate rank structure of your favorite branch)

There are paramedics here that say that oxygen via NRB is bad (despite MD written protocols saying otherwise), C-spine and backboarding are over rated, and how every person should be treated by a paramedic, and while they are all very interesting concepts, those with higher levels of training (MD, DO, and PhD) seem to disagree.

I think this is a misperception. It is not that the Docs don't know better. It is doctors who taught me these things we not helping and in many cases harming. It is a question of who will be the first to change and how quickly the rest will follow suit.

If you notice, once a patient gets to the hospital all of these EMS interventions are changed in a large number if cases. The standard of care became such not because of what was best practice, bt because of what was common practice. Blood letting was once a standard of care for trauma. In today's litigous society, there is safety in numbers, nobody wants to be out there all alone when they make a change. Medically, since so many past interventions proved to be fruitless, much more and much stronger evidence is needed to effect the change of new practices. Disproportionate compared to the level of evidence reqired before. A side effect of an increase of collective knowledge. Consider when many of these standards were put into effect, molecular biology wasn't even a recognized branch of science.

Yet those paramedics think they know more the the docs. And that's not including the EMTs who think they don't need a paramedic on every call (maybe ignorance really is bliss?).

Actually it seems like a very natural progression. There are relatively few docs who spend considerable time in the prehospital setting in the US. The mechanicwrenching on your brakes may have insights that the engineer who designed your car didn't.

I also thought that the job of an EMT was to stabilize a person as best they could, prevent whatever was happening from getting worse, and transport to definitive medical care (which is a hospital emergency room). Add a paramedic to the mix, and the job is pretty much the same; throw in some more tools to stabilize the patient, package as best you can, and transport to definitive medical care. But the basics are still the same.

Bolded part was always absolutely false. At best it was oversimplified. Definitive care was a doctor. The ER was where the doctor could reliably be found. Emergency Medicine was not a recognized specialty. In fact many (not all) ED docs were physician rejects of some sort when EMS was founded. The ones who were not rejects went on to found the EM specialty, and a hard faught battle it was.

As for stabilizing, it was stabilizing to the best of what was known of the day. It still is, only what is known has increased.

So my question becomes, with all the talk about making a paramedic a master/doctorate degree, with paramedics being asked to do more, as well as asking for more tools in their box and drugs in their box, has EMS moved away from it's basic core principle, of stabilizing a patient as best they can, and transporting to definitive medical care?

Without a doubt it has. It will continue to because of what society at large will/does require of it as well as what medical science of the age dictates as an acceptable level of care.

Some desperately try to hold on to yesterday, but tomorrow always comes.

 

[Melclin]

I'd like to break this down to "what is an emergency?" By itself it means different things to different people.

"What is emergency medical service?"

I think at one point in time it meant performing basic interventions of the day performed while transporting a patient with an acute life threatening pathology to more capable providers.

Its interesting to note that the term EMS is not used here. The term Ambulance is used in the same sense as EMS, "What is Ambulance". Refering to the actual vehicle requires the use of a definite or indefinite article: the ambulance, an ambulance.

We don't seem to be quite as caught up in the idea of the 'emergency' as you blokes over there. Also, our roots are in community based first aiders and the gentleman resuscitationist obsession of the 19th century. I'd like to speculate on the origins of our different approaches from a historical point of view one day when I'm more book learned. Like why its always been a given that providers need to understand what they're doing.

One of our first EMS PhDs went to a woman who did a lot of work figuring out why people call ambulances and on the idea of what constitutes an emergency. She found, as I have said before, that people don't tend to put much thought into the criteria of a medical emergency, they simply call when the lose the ability to cope with a situation of a vaguely healthcare nature.

Its an interesting conclusion to consider when people talk about educating the public about when call an ambulance. Abstract knowledge of when and when not to call doesn't equal coping capacity. It has relevance when talking about people who call for non-emergent reasons, in that educating them may be a dead end. Perhaps to a certain degree we should stop whining about them while taking them all to hospital on 15L of oxygen (only to be discharged before we finish our paper work) and go out and get better primary care education so we can recommend more appropriate treatment pathways and our journey isn't wasted.

 

[MrBrown]

Brown agrees with Oz. By virtue of British tradition and that orginisation that is better left unnamed we have grown up in the Commonwealth nations with a more "health-care" orentaited view of Ambulance whereas in the US it seems that the growth of the emergency medical service post Accidental Death and Disability and Pantridge n such sees a heavy slant towards "emergency".

We also do not use the term EMS here although it is used informally when formally referring to what would be called EMS we use the term Ambulance.

Now come Oz, its a go, an RTA, persons trapped .... there is just enough light left in the day for us.

Ambulance, Medivac airborne ....

 

[Melclin]

Sorry, Dorris has tripped over her rug and needs picking up off the floor and the local nare do wells have been indulging in the spray paint and need to be assessed before the jacks take them home, so I'll be busy for the next couple.

Give me a yell on the telephone machine if you can't find you ketamine.