What's the point of dual medic?

[OzAmbo]

That way it's easier for 18yo Ricky Rescue to go woowoo down the street to save somebody's life...

:lol::lol:

 

[nocoderob]

That way it's easier for 18yo Ricky Rescue to go woowoo down the street to save somebody's life...

:lol:

 

[OzAmbo]

Whats the point of even having EMTs?

Why not all Paramedics?

I would have thought EMT would be an excellent base from a first responder point of view, but as far as crewing an ambulance or non emerge IFT truck.... i have to wonder....

 

[DPM]

I would have thought EMT would be an excellent base from a first responder point of view, but as far as crewing an ambulance or non emerge IFT truck.... i have to wonder....

One argument is that if someone has to drive (and thus while driving cannot provide patient care) then that person doesn't require as high a level of training.

 

[NYMedic828]

One argument is that if someone has to drive (and thus while driving cannot provide patient care) then that person doesn't require as high a level of training.

Then why not just hire a CPR certified ambulance driver.

 

[DPM]

Then why not just hire a CPR certified ambulance driver.

I'm not saying I agree, I'm just saying that's the argument.

 

[medicsb]

One argument is that if someone has to drive (and thus while driving cannot provide patient care) then that person doesn't require as high a level of training.

I do not get this argument. At all. For this argument to be true would mean that the sum of patient care is performed during transport and that next to nothing is done on scene. Is this how EMSers tend to work? Throw the patient on the stretcher and haul-*** to the hospital? Suspend all thought until the patient is in the ambulance?

(PS: DPM, I'm not picking on you, just the argument.)

 

[NYMedic828]

I do not get this argument. At all. For this argument to be true would mean that the sum of patient care is performed during transport and that next to nothing is done on scene. Is this how EMSers tend to work? Throw the patient on the stretcher and haul-*** to the hospital? Suspend all thought until the patient is in the ambulance?

(PS: DPM, I'm not picking on you, just the argument.)

Do you really want the answer to that question? People don't think we are ambulance drivers for nothing...

 

[DPM]

I do not get this argument. At all. For this argument to be true would mean that the sum of patient care is performed during transport and that next to nothing is done on scene. Is this how EMSers tend to work? Throw the patient on the stretcher and haul-*** to the hospital? Suspend all thought until the patient is in the ambulance?

(PS: DPM, I'm not picking on you, just the argument.)

That's alright. When viewed as a cost analysis, the extra expensive EMT-P training isn't needed while driving... so EMT-B is a good compromise. They have a good, basic level of training which they can use to assist the medic, and then drive the medic & PT to hospital...

Obviously lots of flaws in there, but that's what the argument is.

 

[Jambi]

Throw the patient on the stretcher and haul-*** to the hospital?

as evidenced by numerous studies, our patients in urban areas would benefit from this process.

 

[STXmedic]

Meh. Removed.

 

[medicsb]

as evidenced by numerous studies, our patients in urban areas would benefit from this process.

For penetrating trauma, which is a rather small subset of patients (who also are easily identifiable - not much guessing involved) to base a silly practice of load-and-go upon. Not saying that you should not treat on the go or that you have to pitch a tent, but what is the rush outside of a few relatively rare cases?

 

[Jambi]

For penetrating trauma, which is a rather small subset of patients (who also are easily identifiable - not much guessing involved) to base a silly practice of load-and-go upon. Not saying that you should not treat on the go or that you have to pitch a tent, but what is the rush outside of a few relatively rare cases?

There is no rush, but I believe, as least in my area, that we spend way too much time on scene.

I agree that trauma is really where ALS doesn't make much of a difference overall, but it's more than just a small subset of penetrating trauma patients. It's trauma in general.

http://www.ncbi.nlm.nih.gov/pubmed/8611068

CONCLUSIONS:
Patients with severe trauma transported by private means in this setting have better survival than those transported via the EMS system

and

http://journals.lww.com/jtrauma/Abs..._Prehospital_Advanced_Life_Support_on.10.aspx

Conclusion: ALS procedures can be performed by paramedics on major trauma patients without prolonging on-scene time, but they do not seem to improve survival.

 

[Shishkabob]

It's been my experience that Intermediates are the worst partners with the worst attitude as they have the education of an EMT with the arrogance of a Paramedic. :blink:


When you have a dual-medic truck where the partners get along, and they switch off every call, it's great. I had that kind of truck for the past 6 months, where my partner and I traded each call, splitting the load, and one runs the call while the other helps with the physical tasks, and bouncing ideas off each other when needed.


Having said that, I prefer M/B with a basic first response. That way, only one can ever be viewed as 'in charge', and let's be honest, most calls don't require two Paramedics. (Though I'm lucky at my agency where if such a call pops up, I can have a second Paramedic, either another truck, a supervisor, an advanced Paramedic, or heck even a physician on scene in minutes)

 

[DrParasite]

That way it's easier for 18yo Ricky Rescue to go woowoo down the street to save somebody's life...

you mean vs a 20 yo Ricky Rescue who completed a paramedic course and can now go woowoo down the street and end up killing someone?

Then why not just hire a CPR certified ambulance driver.

exactly why you need to have regulations that state you need two EMTS or two paramedics on a truck. Otherwise every for profit private ambulance company will do just that, hire an emt or paramedic and just have a taxi driver drive them around.

B/P is a great concept, but there are calls that having 2 paramedics on the truck can make the job go smoother, especially when you have incompetent paramedics (as judged by NYMedic828, not me) who shouldn't be allowed to be the sole provider in charge of a patient.

when you have a dual medic crew, and they only see life threatening patients, studies have shown that they are better clinicians, and a P/P or B/P that deal with a call volume that is 80% BS and doesn't need their advance skill or education.

 

[NYMedic828]

B/P is a great concept, but there are calls that having 2 paramedics on the truck can make the job go smoother, especially when you have incompetent paramedics (as judged by NYMedic828, not me) who shouldn't be allowed to be the sole provider in charge of a patient.

when you have a dual medic crew, and they only see life threatening patients, studies have shown that they are better clinicians, and a P/P or B/P that deal with a call volume that is 80% BS and doesn't need their advance skill or education.

You do raise the excellent point that I left out of the issue with NOT being dual medic. The other half can't be left alone...

I had a patient the other day who ate fish at a sketchy Jamaican restaurant and 30 minutes later was vomiting to no end. Patient was hyperventilating, and complained of "itching." She was obviously experiencing an anxiety exacerbation along with presumed food poisoning. My random partner for the day began to draw up benadryl... Story ends with giving the patient 4mg of zofran and everything started to feel better. A good example of checks and balances, and at the same time, a good example why single medic probably would fail.

 

[DrParasite]

I had a patient the other day who ate fish at a sketchy Jamaican restaurant and 30 minutes later was vomiting to no end. Patient was hyperventilating, and complained of "itching." She was obviously experiencing an anxiety exacerbation along with presumed food poisoning. My random partner for the day began to draw up benadryl... Story ends with giving the patient 4mg of zofran and everything started to feel better. A good example of checks and balances, and at the same time, a good example why single medic probably would fail.

I know I'm not a paramedic, but my little EMT brain (which is a DBP brain more than EMT nowadays) never knew that excessive vomiting was a sign of an allergic reaction, esp when you eat sketchy fish.

But then again, I'm not a paramedic, so apparently I am pretty useless in an emergency until I get my P card, right?

 

[EpiEMS]

You do raise the excellent point that I left out of the issue with NOT being dual medic. The other half can't be left alone...

Do you think that this is a consequence of the educational system? More directly, what do you see as the cause of the problem of incompetent providers (especially at the level where they can actively kill somebody rather than sit by and let them die)?

I know I'm not a paramedic, but my little EMT brain (which is a DBP brain more than EMT nowadays) never knew that excessive vomiting was a sign of an allergic reaction, esp when you eat sketchy fish.

DBP = death by powerpoint?

 

[NYMedic828]

I know I'm not a paramedic, but my little EMT brain (which is a DBP brain more than EMT nowadays) never knew that excessive vomiting was a sign of an allergic reaction, esp when you eat sketchy fish.

But then again, I'm not a paramedic, so apparently I am pretty useless in an emergency until I get my P card, right?

I know your sarcasm by now, but I also know you either worked for, in or with NYC at some point. (I think?) You know what goes on here...

Mind you this partner is 3x my senior.

Do you think that this is a consequence of the educational system? More directly, what do you see as the cause of the problem of incompetent providers (especially at the level where they can actively kill somebody rather than sit by and let them die)?

It is primarily consequence of the educational system, be it original teaching or the standards in general, and a consequence of quality improvement systems.

Ultimately it all falls back to the fact that to be a paramedic, is 10 months or so out of your life, maybe longer depending on how many days a week you attend your program. My program was 8 months at 40 hours a week. It isn't long enough to teach what needs to go along with the ability to properly provide the treatments we do. I am pretty certain I would be another incompetent mindless drone if I didn't spend half of my shift on my iPhone self educating.

Only those who care to improve themselves, become competent. This holds true everywhere, but in EMS we have a much higher majority of people who just don't care or already believe they are the best of the best, the masters of pre-hospital care. The doctor on wheels at 60mph. The ones fending off the reaper himself. They are all sadly mistaken...

 

[firecoins]

Same in NJ. In our back-asswards system, all ALS providers are hospital-based. Unless a city's 911 service is contacted with a hospital-based ALS service, all primary ambulances to a scene are BLS only. On ALS calls, the dispatcher can dispatch an ALS crew (2 medics in either a rig or an SUV) at the same time as the BLS crew or the BLS crew can request ALS on scene.

It's a waste of resources and adds to on-scene time on our most critical patients while we wait for ALS to arrive or attempt to meet them enroute to the hospital.

Why wwould you wait ? Transport. I did when I worked jersey.