"What's in a name?" Dr. Bledsoe's article

[Sasha]

Rid.. you do make some valid points I must admit.... I'm in no way saying we shouldn't step up... 'cause we definitely should... but let's be realistic and not so critical and recognize the many different components that exists within EMS that don't exist elsewhere in healthcare. This make it a more difficult and time consuming thing to accomplish.

Sasha.. please share with how the entire State of Florida can provide funding for ALS coverage to all of their residents (as proclaimed) and not have County systems or tax payer funding. Curious as to where they drawl the funds for that.

Oh, they are a lot of county systems, didn't say that. But you imply that we must have to pay outrageous taxes for them, and we don't. There are poor and rural areas of florida, too, and even the poverty stricken areas somehow manage to have ALS.

And we have lower taxes than a lot of other states, we don't pay state taxes, only federal.

 

[Shishkabob]

But, do you know our tax base for some areas?

Can't say that I do.

IT's been over 12 years since I lived there

 

[ResTech]

That's a very interesting website and information on The Freedom House. Thank's for sharing that!

 

[VentMedic]

Each county has a tax system or fee system to fund part of their EMS. Some may have imposed a sales tax (usually a penny) to pay for their trauma system. The State has a tax statute for allocation of funds from various fees including property taxes to ensure not only the rich (Boca Ratoa, Palm Beach) but also the very poor regions are covered. Of course some counties do struggle and it is a constant battle for funding in some areas as other services do compete for attention. However, EMS is one area Florida has promised its residents.

 

[VentMedic]

That's a very interesting website and information on The Freedom House. Thank's for sharing that!

If only EMS has followed this path I can only imagine how different things might have been. It was just the wrong decade which is a very unfortunate part of our history in the U.S.

 

[JPINFV]

How can anyone call the statement BLS before ALS improper?

Because medical care is medical care. Should a patient in obvious acute pulmonary edema due to CHF have to wait to see if a NRB would stabilize the patient before the paramedics go to nitro and CPAP? Alternatively, if the paramedics assessment indicates a need for nitro and CPAP, should the paramedic put 'ALS before BLS' and jump to nitro and CPAP instead of trying a NRB?


There's very few things that I've heard in EMS that are worse than the "BLS before ALS" cliche. Namely things like "Everyone gets a NRB (or really, any supplemental O2) because everyone needs O2 to live."

 

[ResTech]

Don't miss the context of the statement. It is mainly geared towards explaining the importance of ensuring the basics of airway, breathing, and circulation. As an ALS provider with a bigger toy box, sometimes important modalities such as the immediate manual opening of the airway, or immediately inserting an OPA and getting good ventilation going with a BVM, etc. are overlooked in favor of the more "fun" advanced modalities. These are just two examples of what that statement serves to reinforce... and further it is intended to instill the importance of emphasizing good solid and basic but important supportive patient care.

It doesn't mean don't ever go straight to an ALS skill if indicated. It is more for illustrative purposes to reinforce a concept of priority thinking... I guess thats a good way to explain it.

 

[Shishkabob]

Because medical care is medical care. Should a patient in obvious acute pulmonary edema due to CHF have to wait to see if a NRB would stabilize the patient before the paramedics go to nitro and CPAP? Alternatively, if the paramedics assessment indicates a need for nitro and CPAP, should the paramedic put 'ALS before BLS' and jump to nitro and CPAP instead of trying a NRB?


There's very few things that I've heard in EMS that are worse than the "BLS before ALS" cliche. Namely things like "Everyone gets a NRB (or really, any supplemental O2) because everyone needs O2 to live."

That's different. Pulmonary edema cannot be corrected by any normal BLS skill, only ALS.

However, when you go to an OR, some docs intubate, and some just do the good ole OPA, which is "BLS".

"Why go over what you have to to get the same results" is what the statement means.

 

[Guardian]

I've been trying to make this point for years. Hopefully, now that Bledsoe is on board, people will listen. Large scale professionalism starts with a good job title.

 

[VentMedic]

Let's go back to the history lesson again.

In the 1960s, some MDs saw a need for trained providers to do more than what a basic first aider was already doing and providers who could provide a better response time than the nurses and doctors from the hospital. Thus the concept for modern day Paramedics was formed.

This was the concept of bringing medicine to the people to improve survival until they got to the hospital.

Every ALS provider does "BLS" but not every BLS provider does ALS. As with the issues from long ago, a severe problem was not recognized because of the limitations of a BLS provider and nor could treatment be provided at a higher level.

We have had "BLS" trained providers with many of the civilians who were morticians and provided ambulance service, veterans who were trained in first aid and many factory/coal mine workers were very well trained in first-aid. These workers also actually had more hours of first aid training than today's 110 hour EMT.

Thus, it is time to get out of that ALS/BLS way of thinking and approach it as medicine as Dr. Nagel and Dr. Nancy Caroline promoted 40+ years ago. Canada and other countries have managed to do this very well. For the U.S., some in EMS are just holding on to the BLS vs ALS to justify their jobs and make excuses for not moving forward with their own education. It puzzles me even more when some Paramedics also use it as an excuse to not do a full assessment and turf the patient to a BLS truck so they can return to their station.

As a note, Florida has still just maintained two certs, EMT and Paramedic. It has tried to stay with the concept of providing EMS as it was originally intended. You can use both Freedom House and Miami as examples of that. Of course there was Seattle that had a role also.

 

[paccookie]

Kind of high-horse, isn't it?


Difference between a fast track EMT and fast track Medic is what, 20 weeks?

Heck, difference between a college EMT and college medic is still only a year. So why is it acceptable to you to call a LVn and RN both nurses, being a year apart, but EMT's can't be called medics, having even less time separation.

Well, EMTs and medics are both EMTs...just as LVNs/LPNs and RNs are both nurses. But calling an EMT-B or I a paramedic is just not the same. I spent a year for EMT-I, two years for core classes and another year for medic classes. That's four years. I worked hard for my title. I'm sure others would agree. It may seem petty or silly or "high horse" or whatever. Call it what you will. I understood that the system was being renamed soon, but I thought it was going to be something like First Responder, EMT and Paramedic, cutting out the B and I differentiation. That makes a lot more sense than just calling everyone medics.

 

[daedalus]

Well, EMTs and medics are both EMTs...just as LVNs/LPNs and RNs are both nurses.

Well, not anymore. Paramedics are no longer EMTs. Both the National Registry and new provider levels have removed EMT from Paramedic, because paramedics are not supposed to be techs, but real providers.

 

[paccookie]

Oh yes, he wants to do that again.



I will soon be able to use the term "doctor" in my title. We have professors, Physical Therapists and a whole host of other medical and non-medical people that use the term "doctor". Have you not ever been to a college and noticed the titles of the educators? Even in college EMS programs there is usually someone over the department that has a doctorate degree although it is usually a nurse.
------
Just like the handful of doctors that took offense to nurses gaining another degree, EMS will meet the same opposition from others if they ever start to advance. EMS has already encountered these arguments and many have just taken the low road to education. Unfortunately most of the opposition has come from within EMS. There are perceived enemies of EMS providers in other healthcare professions but much of that is a myth.

Congrats on getting your doctorate!!! There are many doctors of various types that absolutely deserve the title. MDs and DOs are NOT the only type of doctor worthy of being referred to as "doctor."

You are correct that most of the opposition in advancing EMS education comes from within EMS. It's sad to see this, but people are so resistant to change. Changes have to start at the bottom, from within, before the rest of the world will recognize EMS as a reputable profession. Unions would be a good first step, along with raising the requirements for all EMS programs - Bs, Is and Ps. Mandating degrees for Ps would be a huge step. Look at what nurses have done - they've required degrees as a starting point in their profession and their pay has risen along with the respect of the medical community.

 

[paccookie]

Well, not anymore. Paramedics are no longer EMTs. Both the National Registry and new provider levels have removed EMT from Paramedic, because paramedics are not supposed to be techs, but real providers.

Has that gone into effect already? I hadn't heard, just that it was planned.

 

[Ridryder911]

Has that gone into effect already? I hadn't heard, just that it was planned.

Been in affect for a while. Most states just have not adopted it yet.
So yes, you will see Paramedics that NEVER was an EMT.

R/r 911

 

[CAOX3]

:deadhorse:

 

[Aidey]

Rid, do you mean never were an EMT as in they went straight from layperson to Medic, or that there will be Paramedics who never had the title EMT-P? (Sorry, I'm just a bit confused).

I think the point about LPNs and RNs both being called "nurse" is a good one, however I'm not sure you can apply it to EMS providers for one main reason. People often encounter EMTs and Paramedics at the same time, in the same place. ie an EMT and Medic show up on an ambulance. Calling them both Paramedic when they can't do the same things I think would cause a lot of confusion. Say the titles were changed to Basic Paramedic and Advanced Paramedic, I bet people would just end up being referred to as "basic" and "advanced" rather than paramedic.

In the cases of LPNs and RNs in my experience you don't usually encounter them at the same place at the same time. ie, I've always seen RNs in the ED, and LPNs when I've gone to the doctor. You don't expect the nurse at your private MDs office to be able to do the same thing as the nurse in the ED. Or at least I don't.

Imagine how confusing it would be for patients if there were both LPNs and RNs working in an ED, and both were called nurses.

"Hey nurse, can I have some more nausea medicine please?"
"Oh yeah sure, let me go get the other nurse who can give it to you".
"But you are a nurse"
"Not the right type of nurse"

Direct example, but I'm trying to be clear about what I'm saying.

I've also noticed that the scope for LPNs varies by state, for example some allow LPNs to start IVs and others don't. Whereas the scope for RNs is much more generalized and more likely to be restricted by where the RN works rather than their state (an ICU RN is going to have a different scope than an RN at an nursing home is what I'm talking about).

Anyway, hopefully I've made some sense with what I've been trying to say.

I personally don't like the EMT designation, I think it's a misnomer for the current scope of practice for EMTs. Right now I'm failing to think of anything that would be a decent replacement.

To be brutally honest, most of the health care designations annoy me. There multiple groups that provide similar levels of care, and all have different names. For example, the CNA vs MA vs LPN**** There are also some names, like Physician's Assistant, which really don't do the profession justice, are misleading, and are unclear.


**** Where I used to work an MA had a larger scope than an LPN, not sure if it's like that anywhere else.

 

[VentMedic]

I've also noticed that the scope for LPNs varies by state, for example some allow LPNs to start IVs and others don't. Whereas the scope for RNs is much more generalized and more likely to be restricted by where the RN works rather than their state (an ICU RN is going to have a different scope than an RN at an nursing home is what I'm talking about).

The same is true for EMT(P)s. A Paramedic working a BLS transport truck won't be doing the same as one one an ALS truck or 911. There will also be a differernce for CCT and Flight.

In CA, the EMT-Bs work the CCTs with RNs and not the Paramedics.

An EMT(P) working in a hospital might only use their cert as a proof of some medical training and then work under an entirely different title or scope. An LPN or RN will not have to change their profession license titles.

Actually the nursing designations are fairly clear as are their scope of practice. It is how they are utilized and the structure of the organization.
LVN/LPN: Licensed Practical Nurse, Licensed Vocational Nurse
Both tites designate a tech school training.

MAs are only certified and hold no licensure in the states.
LVN/LPNs do hold a license and their scope has been utilized in critical care units. MAs rarely work in a hospital setting due to their lack of licensure under the title of MA. If they meet the requirements to be a PCT, then they can work under that title.
An EMT(P) may also be in the same situation when in a hospital and may work under a different title with the hospital's designated job description as allows by the regulations for unlicensed staff.

Hospitals do not approve of a mish mash titles or of anyone with a cert working under whatever job description they feel entitled. They have guidelines for what licensed, certified (those recognized by hospitals) and unlicensed persoonel can do. Professions such as nursing, RT, PT, OT and SLP also have guidelines for professional scope of practice both in and out of the hospital as well as a reimbursement structure that makes their profession appealing to various agencies. EMT(P)s have not defined their titles and do not always have the same appeal when it come to employment scope/limitations and reimbursement.

 

[Ridryder911]

What I meant is that some may enter Paramedic school but unless required to take the EMT examination, may never ever have been an EMT. True most schools require some form of license or certification while in Paramedic school, but I know of ideas of possibly removing this as well. In comparrision to those of other allied health care professionals where there is not step stone levels, rather to enter and complete the program as designed.

R/r 911

 

[VentMedic]

In Florida one can state Paramedic school without an EMT cert but may be required to take the exam before the first semester clinicals. I see that changing also in the future.

An RN does not need a CNA cert to prove he/she knows how to take a BP.

To clarify some of my previous post, other professions don't need the 50+ individual skills certifications designated by the states as EMS has established. Their scope of practice covers the skills and then it is up to the employer to determine their job description. The EMT-B needs to be elevated to match education with skills to include those if their MD sees it is appropriate. There should not be all the different EMT-A-B-C-D-E-F stuff each time someone adds just ONE skill.

For nursing, the LVN/LPN has faded into the background. Few hospitals believe their level of training and education is appropriate to work in the EDs and units. Nursing is continuing to advance and will eventually eliminate their lowest common denominator. RT is also in the process of doing that and have established the education and requirements for their lowest entry level. The same with all the other heathcare professions.