What is it a paramedic does?

firetender

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(This was part of another thread, was probably a bit off-topic, so I figured it'd be a good thing to put it at the center of its own bulls-eye!)

Depending on the call area, the paramedic has different percentages of emergency, non-emergency, evaluation of medical status, routine transport, critical calls, trauma, basic intervention, triage and on and on. Every area is different, but only in the proportions.

In some areas, it appears all about serious medical cases. In others, mostly about the horizontal taxi game. But regardless, in MOST areas a disproportionate amount of calls involve providing the kinds of reassurance or medical guidance that the people once had available to them through connections with relatives, the family doctor, or extended families who provided folk wisdom and intervention.

It's not their fault; medical care has been institutionalized and human beings are dispensed drugs when what their humanness calls out for is connection. Our society has relegated the burden of care for the sick and injured to a cadre of professionals where once the burdens were more evenly spread out amongst the citizenry as a whole.

Ambulance personnel are at the bottom of the food chain, getting eaten up by the assault of desperate people seeking help for what ails them, NOT by those needing emergency treatment.

What is not being acknowledged is that more and more, the ambulance delivers the hope of human compassion and technical skill to someone's scene of unbearable stress.

In reality, rather than being a Specialist, the paramedic is called on to be a Generalist who sometimes uses his/her specialist skills. The bottom line is paramedics deal with people in distress who do not have access to, cannot afford, or are not aware of other options in meeting their (perceived) immediate health care needs. As a sideline, sometimes medics intervene in serious medical emergencies.

The educational, technical, emotional, spiritual, interpersonal, moral and philosophical territory a medic must traverse is far more broad than is covered in manuals of emergency care.

It is my position that if the field is going to develop as a profession, it is going to have to broaden its perspective of itself and base it on reality. It is not and never has been strictly about the delivery of emergency medical care in much the same way as Nursing was never about bedpans.

In the real world it involves mastery of multiple modes of communication; extensive observation; multi-level discernments (where does this person best belong?), tact, diplomacy, and, if the job is to be done right, extensive knowledge of available local resources.

In an ideal world, the ambulance would be a triage unit, arriving at the scene and handling any immediate emergencies while mobilizing back-up services to follow, like EMT transport, social services evaluation teams, or psychiatric referral. As the EMS system stands, there are few services supporting IT; paramedics are flying without a net and then end up feeling guilty and somewhat ineffectual because most of the time, there are few whom they can really help.

WHY NOT TRAIN PARAMEDICS TO ACTUALLY HELP THE PEOPLE THEY SERVE?

So in looking over what I just wrote I'd have to conclude paramedics need to broaden their perspectives of themselves and the role they play in this society. They need to design a curricula for themselves that honestly prepares them for the reality, not the fantasy, of the job.

That means legitimization through a degree program (Read it and weep!) and that means a longer commitment to the profession. EMS is predominately a relatively young, transient's profession because it prepares its practitioners for only one-tenth of what they do.

Any hiring authority will tell you it is accepted that burnout is the major cause of medics leaving the field. It is a numbers game designed to keep fresh meat coming in.

Of course it is accepted as such, it's designed that way. If there will be change it's got to come from the personnel that can actually understand the role they really play in our society.
 
I have been trying to champion that idea for years, nobody in the US wants to hear it except Skip Kirkwood. (who probably came up with the idea long before me)

I would like to discuss ideas on how to realistically make this happen.
 
Does anyone else feel a lot of the time its almost like your an actor? I feel like the mere presence of someone in a uniform with any medical training reassures people and often times the presence and right choice of words is all thats needed.

I do a lot of event stand by at sporting events. When I run out onto the field when someone does not get back up, I do what I am suppose to and check pulse, motor, sensation, pupils, get a GCS ect ect Most of the time I feel like its just a show for everyone .I often just have the athlete give a thumbs up so everyone knows there ok.

But that little presence and just going threw the motions turns people FROM screaming "MEDIC!", crying, and the whole crowd freaking out, into everything is ok... but nothing was really ever wrong.
 
Does anyone else feel a lot of the time its almost like your an actor? I feel like the mere presence of someone in a uniform with any medical training reassures people and often times the presence and right choice of words is all thats needed.

Taking it to its most basic level, we represent to people that, even though death will overcome us all, somebody's trying to do something! We preside over many more deaths than we prevent.
 
after several years of training in sense memory, i do feel like an actor.
 
I feel that we are moving towards that sort of model here. Small steps, but at least we're taking them.

Probably 60% of our degree doesn't have anything to with emergency medical education. Relative to some of our American counterparts, we learn a great deal about chronic social issues, mental health and ways we can be of help to our pts when they don't need anything from our bags (referral to GP, advice etc), although I'm not sure how much of it sticks in the minds of the students. Everyone still wants to get out an see "wicked road trauma".

I've spoken at length with Mr Brown about 'extended' roles for paramedics related to this issue. I think we should have some officially recognized and supported ability to refer pts to specialists, not necessarily of the strictly medical variety, but to social workers, psychologists, OT. This does however need to be significantly supported by our education, which at present it is not.

One of my areas of interest is the management of mental health crisis, which is shamefully inadequate here. The attitude that many paramedics take to the mentally ill is equally deplorable. With any luck (if the money gods smile upon us) I will have the privilege of being involved in the development of an inter-professional education program for all health care providers in the hopes of smoothing out the cracks (differences in knowledge and attitudes to other HCPs) between different providers in regards to mental health crisis management. I think this is a good first step to providing the education necessary to allow paramedics to interact with and activate the services of many health and social care providers with respect to mental health issues.

Largely, I think the issue of extended roles will largely depend on the politics of the state services and the universities. If the dilution of the curriculum to raise pass rates in response to dwindling paramedic numbers, and other such changes continue, we will end up taking a significant backward step.
 
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I have been trying to champion that idea for years, nobody in the US wants to hear it except Skip Kirkwood. (who probably came up with the idea long before me)

I would like to discuss ideas on how to realistically make this happen.

Chief Kirkwood is one of the more active posters on EMS Connect. To be honest, if I lived near or went to undergrad near Wake County, it would be a hard choice between medicine and EMS. It's one of the few areas where it looks like they do EMS correctly. However, making career choices based off of working at only one place is extremely dangerous.
 
great post and made some good points but as i have herd in many of my classes a lot of people don't consider our profession as a necessity such as fire and police which any body who works in ems knows that's not true we . EMS has made a lot of progress from the old days where ambulance were actually ran by furnal homes and really did no treatment you either went to the hospital or the furnal home but now we have mobile icu's and flight teams which always has a paramedic on board. and even some special paramedics on like off shore drilling rigs are being thought to suture until more help arrives but in most places were paid bad and work long hours and that's not going to change until somebody realizes how much we really do and how much care is really given in the field
 
great post and made some good points but as i have herd in many of my classes a lot of people don't consider our profession as a necessity

Maybe because the service US provides is not what the public needs? You don't go to the fuel station to fill up on diesel and simply accept gasoline when the place doesn't have what you needed.

The idea the US needs EMS in its current form is not true. Consequently they are not willing to pay for what it is now.

EMS has made a lot of progress from the old days where ambulance were actually ran by furnal homes and really did no treatment you either went to the hospital or the furnal home but now we have mobile icu's and flight teams which always has a paramedic on board.

Many places have not changed treatment despite evidence, advances in science and medicine. Yes we have improved since funeral homes but not since the 1980s. Our major steps forward are actually more like a jump than a climb. I could type for ages on the ineffective or harmful treatments still mainstream in EMS. Who needs an ineffective or harmful medical treatment?


and even some special paramedics on like off shore drilling rigs are being thought to suture until more help arrives but in most places were paid bad and work long hours and that's not going to change until somebody realizes how much we really do and how much care is really given in the field

How much is that exactly?

Without trying to be overly critical, measuring EMS value based on a set of skills and beating our chests with how important we are is why EMS fails.

A surgeon is not better than a primary care doc because he cuts people. A cardiologist not better than a neurologist because of the amount of caridac medications available. All of these people are equally needed that is why they are paid what they are.

In the 21st century it is education and knowledge that defines anyone's value to society. The days of earning a middle class living with a tech cert. are over. The job markets for "public safety" forces are on the chopping blocks. The US doesn't need somebody to drive people to the hospital. They need somebody to address the peoples needs.

Anyone who cannot demonstrate their value everyday is not worth paying for. The public knws this, even if they don't know exactly what EMS does.

Anyone who has been a paramedic for any length of time should recognize these needs.(not a comprehensive list by any stretch of imagination)

1.Somebody to help navigate the healthcare system. How to find a doctor, where, how to get there, what programs are available to help pay.

2. Education, when to call for help. (identifying MI for example) how various OTC meds are used for. When and who they are appropriate for.

3. Social support. Everything from psych support to finding resources for alcoholics. Welfare checks for the elderly. Making sure they are getting their medications refilled on time.

I could go on. Just like in the hospital, most patients are not emergencies. But the service the hospital provides reflects peoples needs. Having a bunch of people sitting around waiting to help "with the big one" while people march hopelessly towards it without prior aid and intervention is just foolish.

Every year I ask new paramedic students why they want to be paramedics. Every year they lie to me.

They tell me they want to "help people." Going to pick up the drunk for the 40th time this month helps him. Carrying the 10 bags of belongings of the homeless person on the way to the hospital helps them. Going on a lift assist so an elderly person can find comfort living their last days at home instead of an institution helps people.

I have met very few paramedics that want to "help" people. But many who can tell me how indespensible they are.

Many fight with everything they have to avoid expanding their education and scope of responsibilities that would help people. As always the ones who are willing to go the distance find themselves moving on from EMS.
 
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I understand what your saying but most people are not going to go above and beyond to be a great pt advocate.and i highly doubt it will ever be that stressed in the school part of the paramedic programs because there is a lot to learn already and i guarantee the schools don't care because the more people they can run thru there program at a faster rate the more money they are going to make and that's the bottom line.
 
I understand what your saying but most people are not going to go above and beyond to be a great pt advocate.and i highly doubt it will ever be that stressed in the school part of the paramedic programs because there is a lot to learn already and i guarantee the schools don't care because the more people they can run thru there program at a faster rate the more money they are going to make and that's the bottom line.

That looks like a straw man argument to me.

The student decides which school they attend.
The student decides what education they are paying for.
The student decides how motivated they are to join the profession.
The student lives with the poor job prospects and pay if their education is substandard.
The student decides if they want to obtain an education in a saturated field where supply is high and demand is low.

"educational" institutions that rush people through to make money are not ripping off patients. They are rippping off students. It is the student with the power to stop this practice.

The solution is simple, don't give these places any money.Demand a proper education both in depth and length.

The purpose of educational institutions is not to get people to pass their certification test. The purpose is to give people the knowledge and skills needed to perform a function in society.

It is society that determines your value, not your certifications, morals, values, or hero fantasies.

I could certify you to be omnipotent and omniscient but clearly that certification would not confer upon you such abilities. There are many certified paramedics without the knowledge or ability to be of value to society. That is not the fault of the school. It is the fault of the student.

If your school teaches you that "patient advocacy" is merely a behavior, that teaching what consumers want or need from you takes up too much time, or that it is your skills that matter most. I would demand my money back. In fact I would sue them for it back if need be.

If there is too much to know in too little time, it is the student that has the power and responsibility to demand more time.
 
People call an ambulance for help, not necessarily an ambulance. All that is provided seems to be an ambulance.

The ambo of the future needs be a public or mental health nurse/paramedic/social worker/GP.

Words like "prehospital", "emergency" and "life support" need to stop being used.

Total intergration is required here; no more take people to the hospital but rather help people get to the right people for help and/or care. That might mean putting somebody in the car and dropping them off at a community care centre with thier broken arm or Rx'ing somebody some panadol and using thier tablet PC to make an appointment with the pts GP after entering in some notes thier doctor can see into the system.

After that thier next job might be a cardiac arrest or an anaphylaxis, then they might have lunch and go to check on somebody who thier computer tells them they went to two days and missed a doctor's appointment that was made for them at that time.

A model of care such as this has no place for traditional advanced life support and demands a radical shift in education to a ~70/30 balance between assessment and management of patients with a small emphasis on emergency care rather than the sort of 90/10 mix we have now in favour of emergency care.
 
People call an ambulance for help, not necessarily an ambulance. All that is provided seems to be an ambulance.

The ambo of the future needs be a public or mental health nurse/paramedic/social worker/GP.

Words like "prehospital", "emergency" and "life support" need to stop being used.

Total intergration is required here; no more take people to the hospital but rather help people get to the right people for help and/or care. That might mean putting somebody in the car and dropping them off at a community care centre with thier broken arm or Rx'ing somebody some panadol and using thier tablet PC to make an appointment with the pts GP after entering in some notes thier doctor can see into the system.

After that thier next job might be a cardiac arrest or an anaphylaxis, then they might have lunch and go to check on somebody who thier computer tells them they went to two days and missed a doctor's appointment that was made for them at that time.

A model of care such as this has no place for traditional advanced life support and demands a radical shift in education to a ~70/30 balance between assessment and management of patients with a small emphasis on emergency care rather than the sort of 90/10 mix we have now in favour of emergency care.

You should get some kind of award for this post in fact it should be a sticky. Absolutely inspired.
 
In the US though usually our "help" is limited to transporting to the ER. Sometimes people call 911 because they don't know what else to do, and for various reasons we can't do anything but transport them to the ER, even if that isn't really what they need.

For example, in my area a homeless person called 911 recently because he got too cold and was worried he wasn't going to stay warm enough through the night. We go and respond, and determine he isn't sick/injured, he hasn't developed hypothermia yet, he just doesn't think he can stay out all night. There were several shelters available, but all were at least a few miles away.

This guy flat out admitted that he didn't know what else to do but call 911 and go hang out in the waiting room until morning. Now, what this guy really needed was a ride to one of the shelters, not an ambulance and the ER. The problem we ran into was that there wasn't anyone who could drive him over there. There is no system set up to handle situations like that, leaving us with transporting the patient to the ER.

Luckily in this case one of the LEOs who wasn't doing anything gave him a ride over to the shelter, but only after a lot of grumbling and being promised coffee. It wasn't even that the LEO didn't want to help, but that technically he wasn't really supposed to be doing it in the first place.

I agree that we need to have additional options to help patients. I'm not sure that it is going to happen anytime soon though.

Aside from all the roadblocks within the medical community, I can see a potential problem from the patients themselves. American's have become accustomed to instant gratification. They want medication NOW. They want to feel better NOW. They don't want to wait, even if there is no reason they can't.
 
People call an ambulance for help, not necessarily an ambulance. All that is provided seems to be an ambulance.

The ambo of the future needs be a public or mental health nurse/paramedic/social worker/GP.

Words like "prehospital", "emergency" and "life support" need to stop being used.

Total intergration is required here; no more take people to the hospital but rather help people get to the right people for help and/or care. That might mean putting somebody in the car and dropping them off at a community care centre with thier broken arm or Rx'ing somebody some panadol and using thier tablet PC to make an appointment with the pts GP after entering in some notes thier doctor can see into the system.

After that thier next job might be a cardiac arrest or an anaphylaxis, then they might have lunch and go to check on somebody who thier computer tells them they went to two days and missed a doctor's appointment that was made for them at that time.

A model of care such as this has no place for traditional advanced life support and demands a radical shift in education to a ~70/30 balance between assessment and management of patients with a small emphasis on emergency care rather than the sort of 90/10 mix we have now in favour of emergency care.

This model has already been considered and is in place in a number of places, most notably I believe in the London Ambulance Service. Paramedics have further training in assessment, diagnosis, wound care and suturing and have limited prescribing rights as well as the ability to order further testing or refer to other providers.
 
This model has already been considered and is in place in a number of places, most notably I believe in the London Ambulance Service. Paramedics have further training in assessment, diagnosis, wound care and suturing and have limited prescribing rights as well as the ability to order further testing or refer to other providers.

I recently had the pleasure of listening to Malcom Wollard who is a professor of paramedicine in the UK and one of five consultant (attending) level paramedics within the NHS.

He said the Emergency Care Practitioner model in the UK had the right sort of aim but was totally and utterly flawed in its implementation and has become a joke internationally. While it may not have all the things you describe, it should have, and that is what a system that is going to meet future demand needs.

People do not necessarily call ambo because they have a medical emergency, they call because they have an inability to cope with some sort of crisis which may be slightly medical in nature.

Until we figure that out and implement a system to deal with it, we are going to get nowhere.
 
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