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

Linuss said:
Heck, Canada, who everyone "looks up to" for EMS, still has an EMT-B equivalent.
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But as pointed out in OPALS, the "BLS" for EMS in Canada had almost a year of education and training, not 110 hours.
 
Woah there Vent, I never ever said to keep the EMTs at the same level they are now, or that they don't need more education or anything like that. I just said that the position, in some form is needed. Please stop trying to make me out to be the bad guy here.
 
VentMedic said:
But as pointed out in OPALS, the "BLS" for EMS in Canada had almost a year of education and training, not 110 hours.
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And I said ours is inadequate and needs to be upped.


Where are we disagreeing?
 
The part which I bolded. The Canadian view of BLS EMS is not the same as that in the U.S.

(Apologies if you were actually meaning that.)

As well, for IFT in the U.S., how many of these patients need "first-aid"? Most IFT patients have medical problems and the U.S. EMT-B is not properly prepared to do a medical assessment.
 
VentMedic said:
The part which I bolded. The Canadian view of BLS EMS is not the same as that in the U.S.

(Apologies if you were actually meaning that.)

As well, for IFT in the U.S., how many of these patients need "first-aid"? Most IFT patients have medical problems and the U.S. EMT-B is not properly prepared to do a medical assessment.
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Here, IFT or Non-Emergency Patient Transport (NEPT) as we call it is handled by Patient Transport Officers (they essentially have BLS skills in case a patient crashes, and I think they have a diploma in 'paramedic science' or 'NEPT') and private companies, its a completely different sector. The state ambulance service does still fill the gaps, esp in rural places, and handles the Emergency/CC transports. PTOs nor the private companies they work for are never 000 (our 911).


All our 000 trucks here are dual medic, state run and have nothing to do with the fire department (although our medics are somewhere in between what you would consider I and P) and backed up by dual ICPs if needed. All medics have a bachelors degree or have done the degree conversion course (for the older medics). The three years of university is not about training in skills that we can then be told to perform by medical control (which we don't have). The time is about developing us as medical practitioners, about giving us the underlying knowledge to make sound decisions. While out in rural areas (with low call volumes) there are many variations of first responder teams, but they don't transport. A dual medic team goes to every case, not necessarily because they're ALS skills are needed but because they have the education to make sound clinical decisions on treatment and transport. I realize I'm bias, and maybe it seems like I'm bragging, but I can't help but feel this is the best level of care.

The thing that strikes me so strongly about American EMS is the focus on skills and licenses but not on the knowledge needed to know when and when not to use them.
 
Melclin said:
Here, IFT or Non-Emergency Patient Transport (NEPT) as we call it is handled by Patient Transport Officers (they essentially have BLS skills in case a patient crashes, and I think they have a diploma in 'paramedic science' or 'NEPT') and private companies, its a completely different sector. The state ambulance service does still fill the gaps, esp in rural places, and handles the Emergency/CC transports. PTOs nor the private companies they work for are never 000 (our 911).


All our 000 trucks here are dual medic, state run and have nothing to do with the fire department (although our medics are somewhere in between what you would consider I and P) and backed up by dual ICPs if needed. All medics have a bachelors degree or have done the degree conversion course (for the older medics). The three years of university is not about training in skills that we can then be told to perform by medical control (which we don't have). The time is about developing us as medical practitioners, about giving us the underlying knowledge to make sound decisions. While out in rural areas (with low call volumes) there are many variations of first responder teams, but they don't transport. A dual medic team goes to every case, not necessarily because they're ALS skills are needed but because they have the education to make sound clinical decisions on treatment and transport. I realize I'm bias, and maybe it seems like I'm bragging, but I can't help but feel this is the best level of care.

The thing that strikes me so strongly about American EMS is the focus on skills and licenses but not on the knowledge needed to know when and when not to use them.
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I would love to work under a system like that. I agree that most EMS in the US is way to focused on skills and not on education.
 
daedalus said:
There is no BLS before ALS. There is only medicine.
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So my learned colleugue, if there is no BASIC life support, do you immediatley commence drug therapy with a patient before a proper assessment, considering patient assessment is a BASIC skill that we, regarless of medical qualification, perforem, as is our secondary survey, do you give morphine sulphate to every patient with 'pain' or do you consoder doing something as BASIC as using posture first?

I am sorry to correct you, but there is no ALS without BLS.
 
downunderwunda said:
So my learned colleugue, if there is no BASIC life support, do you immediatley commence drug therapy with a patient before a proper assessment, considering patient assessment is a BASIC skill that we, regarless of medical qualification, perforem, as is our secondary survey, do you give morphine sulphate to every patient with 'pain' or do you consoder doing something as BASIC as using posture first?

I am sorry to correct you, but there is no ALS without BLS.
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You use the term "BASIC" skill as in fundamental skill which is how it should be.. Unfortunately in the U.S. it may mean a skill performed by an EMT-B with 110 hours of training and not an assessment that would be similar to a Paramedic or nurse. The assessment by an EMT-B is very limited due to the lack of A&P or pathophysiology so it is a "Basic" assessment and that is what "BLS" refers to here. In true terms, as Bledsoe pointed out, every provider provides BLS as in basic life support as it was meant to be and not as in a title such as one referring to an EMT-B.
 
downunderwunda said:
So my learned colleugue, if there is no BASIC life support, do you immediatley commence drug therapy with a patient before a proper assessment, considering patient assessment is a BASIC skill that we, regarless of medical qualification, perforem, as is our secondary survey, do you give morphine sulphate to every patient with 'pain' or do you consoder doing something as BASIC as using posture first?

I am sorry to correct you, but there is no ALS without BLS.
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There's proper assessment and treatment and improper assessment and treatment. Going directly to drug therapy without a patient assessment is improper and goes beyond the "BLS before ALS" cliche.
 
Part of the confusion as well is the assumption that a lesser trained or educated person would ever be deemed in charge or responsible for patient care.

For example, nursing tech or assistants has been referred to as well as LPN/LVN. The CNA would never be given the responsibility to assess for the primary focus of injuries, illness or wounds. Even the LPN/LVN who is licensed according to authorities are not educated enough to perform the primary assessment for patient care. Ironic since both of those levels are longer than EMT course and the LPN/LVN is usually equivalent in hours and training to those of the non-academic Paramedic programs.

The lower level of nurses work within their own scope, but one of the major differences as well is that they also must work under the supervision of a Registered Nurse. Yes, physician may write the orders but it is the authority of the RN to whom will assign and monitor their treamtent and care.

The only and sole reason for even the wording of BLS was to make a distinction for EMS providers. Most of the resuscitative measures involving what is now called ALS was performed by physician level providers. Unfortunately, it was assumed that as EMS matured that all providers would naturally go the highest and best level possible for patient care. Again, unfortunately as EMS usually does it placed a band-aid on an arterial bleed and made excuses. Developing titles and levels that was always compared to the gold standard of the Paramedic and describing .. "well it's almost" ...."the best we can do, for now"... All excuses, nothing more. There is NO reason for non-rural communities not to have providers that can actually provide true resuscitative measures as a Paramedic and not the so called BLS/common laymen methods.

I can assure you, somewhere during the course of the past 40 years the community has purchased or funded other programs that exceeded the cost more than to provide true emergency health care. Again, it is the priority given and requirement attached that makes it either essential or luxurious. If healthcare insurance was pro-rated or industries received a tax deferment dependent upon the level of EMS, we would we see more ALS EMS. Alike we now see aggressive Fire Services due to ISO ratings.

Yes, there is no true thing as BLS or ALS. It is either initial first-aid or medical care. All treatment has degrees of in-depth. Would performing an immediate CABG or immediate surgical intervention be Advanced Advanced Life Support or Superior Life Support?.... one could only imagine the levels. It is just simply providing medical care. Period.

R/r 911
 
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