Why don't some like the fire mix?

[Shishkabob]

There's a reason why those who work in construction have Leathermans', but also have dedicated tools: The dedicated tools work better at their job, while the Leatherman is there to skimp out on simple jobs.

As for why you continue to advocate for the most cost-effective way to give your citizens sub-optimal care, I do not know.

 

[Tigger]

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As I have said before in several different ways, you can buy a $30 pair of pliers, a $45 knife, a $15 screw driver and a $20 file if you choose. However, if you purchase a Leatherman and have ONE TOOL that can do all those jobs just as effectively 90% of the time, you have not only saved money, you have gained flexibility.

My goal is to be the most effective problem solver that I can be in my community. Medicine is one aspect of that goal and I take every aspect of that very seriously.

And any sort of repair job done with my Leatherman has always been a much larger pain than when I used the actual correct tool for the job. Hmm wonder why that is?

 

[Rialaigh]

I have read through this thread multiple times and appreciate many of the responses, there is a lot of good discussion going on here.

There's a reason why those who work in construction have Leathermans', but also have dedicated tools: The dedicated tools work better at their job, while the Leatherman is there to skimp out on simple jobs.

As for why you continue to advocate for the most cost-effective way to give your citizens sub-optimal care, I do not know.

My question to you (being you in general) about this is why do people continue to advocate for the least cost effective method of having more specialized dedicated tools for their job when our special single role dedicated tools in prehospital medicine have been shown for the most part to make 0 difference in patient outcomes. I find it hard to argue that the medic that is better trained on pushing cardiac drugs and EJ's and hanging prehospital drips and giving fluids...etc..etc..etc...is somehow providing better medicine and service then double role medics who may not be as proficient at many of those things and others (throw intubation, crics, etc... in there). When you look at the effectiveness of those interventions on mortality and morbidity how can you argue that even if someone is "better" at their job that they are providing "better service" to their community by making 0 effective difference in outcomes while being far less cost effective.

 

[MrJones]

I have read through this thread multiple times and appreciate many of the responses, there is a lot of good discussion going on here.



My question to you (being you in general) about this is why do people continue to advocate for the least cost effective method of having more specialized dedicated tools for their job when our special single role dedicated tools in prehospital medicine have been shown for the most part to make 0 difference in patient outcomes. I find it hard to argue that the medic that is better trained on pushing cardiac drugs and EJ's and hanging prehospital drips and giving fluids...etc..etc..etc...is somehow providing better medicine and service then double role medics who may not be as proficient at many of those things and others (throw intubation, crics, etc... in there). When you look at the effectiveness of those interventions on mortality and morbidity how can you argue that even if someone is "better" at their job that they are providing "better service" to their community by making 0 effective difference in outcomes while being far less cost effective.

Interesting, and a possible attitude changer if, in fact, what you say has actually been proven empirically. To that end, would you care to share any of the studies you've seen in which "...single role dedicated tools in prehospital medicine have been shown for the most part to make 0 difference in patient outcomes"? Or perhaps the studies you've seen that compare "...the effectiveness of those interventions on mortality and morbidity...." between single role and dual role medics? Citations will suffice - I have access to a number of academic search engines.

 

[Shishkabob]

My question to you (being you in general) about this is why do people continue to advocate for the least cost effective method of having more specialized dedicated tools for their job when our special single role dedicated tools in prehospital medicine have been shown for the most part to make 0 difference in patient outcomes. I find it hard to argue that the medic that is better trained on pushing cardiac drugs and EJ's and hanging prehospital drips and giving fluids...etc..etc..etc...is somehow providing better medicine and service then double role medics

Whilst the discussion on the effects of morbidity and mortality from EMS is a valid one, and most of what we do makes no difference (on the same hand, most of what people call for doesn't need any of what we can do anyhow), here's a question for you:

Your family member is short of breath. You call 911. The local EMS agency has RSI and other low-utilization, high-risk procedures that if done right can help, and if done wrong can kill. All other things being equal, would you rather have the one who focuses solely on medicine, or the one who was forced in to it and focuses more of their time and training on something completely unrelated to medicine?


Some will scream "straw-man!" but it's the truth. Fact is there are technicians and there are clincians: Just because two medics are equal skill at starting IVs doesn't mean they're equal at doing differentials and correctly treating (or not treating) when needed.

 

[Chewy20]

Whilst the discussion on the effects of morbidity and mortality from EMS is a valid one, and most of what we do makes no difference (on the same hand, most of what people call for doesn't need any of what we can do anyhow), here's a question for you:

Your family member is short of breath. You call 911. The local EMS agency has RSI and other low-utilization, high-risk procedures that if done right can help, and if done wrong can kill. All other things being equal, would you rather have the one who focuses solely on medicine, or the one who was forced in to it and focuses more of their time and training on something completely unrelated to medicine?


Some will scream "straw-man!" but it's the truth. Fact is there are technicians and there are clincians: Just because two medics are equal skill at starting IVs doesn't mean they're equal at doing differentials and correctly treating (or not treating) when needed.

Do you happen to work in central texas? lol Your rationale sounds familiar to me now.

 

[gotbeerz001]

Some will scream "straw-man!" but it's the truth. Fact is there are technicians and there are clincians: Just because two medics are equal skill at starting IVs doesn't mean they're equal at doing differentials and correctly treating (or not treating) when needed.

Technicians can become clinicians. Isn't that the process you went through?

The determining factor is not the patch on the shoulder but the determination of the individual.

For every sub-par fire medic, I know a burnt out single-role. In the end, we are fighting for the same argument from opposite sides.

 

[STXmedic]

For every sub-par fire medic, I know a burnt out single-role.

This is one of the biggest things I notice.

It makes since that single-role medics should be superior to fire medics on a fairly consistent basis. It may be a regional thing, but this has not been my observation. I do know some great single-role medics, but I know far more who are terrible at their job with no desire to improve. And these aren't just guys waiting to get on FDs, either.

On the flip side, many of the best paramedics I know are fire medics. Hell, one of the systems around here that's known to consistently have stellar medics is a fire-based system. Even in my very large FD, where I will readily admit a good portion of our medics are sub-par in my eyes, I would still trust many of our fire medics over much of the area's stand-alone medics.

The idea makes sense. I like it. Doctors, or mid-levels, or nurses, or whatever area of healthcare you choose do not act as plumbers as another part of their job function. Theoretically, a single-role medic should be superior in medicine to a fire medic, since that is what they specialize in. In my personal experience, however, that is not the case. At least not with any reliable consistency.

 

[vcuemt]

This is one of the biggest things I notice.

It makes since that single-role medics should be superior to fire medics on a fairly consistent basis. It may be a regional thing, but this has not been my observation. I do know some great single-role medics, but I know far more who are terrible at their job with no desire to improve. And these aren't just guys waiting to get on FDs, either.

On the flip side, many of the best paramedics I know are fire medics. Hell, one of the systems around here that's known to consistently have stellar medics is a fire-based system. Even in my very large FD, where I will readily admit a good portion of our medics are sub-par in my eyes, I would still trust many of our fire medics over much of the area's stand-alone medics.

The idea makes sense. I like it. Doctors, or mid-levels, or nurses, or whatever area of healthcare you choose do not act as plumbers as another part of their job function. Theoretically, a single-role medic should be superior in medicine to a fire medic, since that is what they specialize in. In my personal experience, however, that is not the case. At least not with any reliable consistency.

I think it's a hypothetical that we can't yet translate to reality. Fire is, in many cases, where the best medics will go because of pay, pension and stability reasons. However, the best firemedics I know do it for the medicine and the fire is part of the job because the job is the best a medic can get. That these medics would be equally great, if not better, if medicine was all they did makes sense, but one can't say for certain.