Once more, EMS is not a sham. And a research study is not needed to justify every single action a health care provider takes. Yes, studies are very important but people get carried away.
Please if you could answer the question why other healthcare providers do studies on their value and effectiveness and all EMS presents is anecdotes and smoke and mirrors. (aka lies and cons)
- When a patient is in pain and a Paramedic reduces it from a 9 to a 1. Is that not benefit? Do we really need research to tell us pain management is effective and necessary?
- A nausea rating from an 8 to a 2 and an obviously more comfortable patient? Do we really need research to tell us antiemetics make people feel better?
-A resp distress patient who is having a severe exacerbation of their disease, an SpO2 of 84%, EtCO2 of 50mmHg, and tachypneic. A Paramedic arrives and on arrival at the ED, the patient now has a normal SpO2, ventilation improved with EtCO2 showing 38mmHg, and resp rate of 20min, and steroids onboard at the very early onset of symptoms. Do we really need research to tell us we made a difference with this patient type?
- A patient is stung by a bee with a severe anaphylactic reaction. Pt. needs IV epi due to circulatory collapse, benedryl, albuterol, solu-medrol, and advanced airway management. Is BLS and an epi-pen really gonna suffice? Do we really need a research study to tell us that these interventions are highly time sensitive, effective, and mandatory?
- A seizure patient is status. Closest hospital is say 15mins away. Do we really need a research study to show that this patient type needs intervention now with benzos and airway and not over 15mins later?
You can type up individual circumstances and what if's until your fingers fall off. But you have not demonstrated any reason why an skills based provider at less than 1/2 the cost of a modern US paramedic cannot follow the same skills based approach as is common in a majority US based paramedics.
You have offered no rebuttal of my inqusition other than to retype your original statement in different words.
I am most interested in hearing my points addressed, not just your reciting of self serving dogma.
-When does intelligence start to become like ignorance and common sense gets left out of the equation. Your honestly going to argue with the above examples and claim that Paramedic care is a sham in those instances and the many more like it? Would ED care not consist of the same thing?
It was once common sense to bleed the bad blood out of wounds. It is still common sense apparently to put people on long spine boards. It was even once common sense to burn witches to avoid offending God.
Common sense is a weak academic argument.
I will argue that those instances are the 5-10% of all emergency calls and that it is not cost effective to maintain ALS services for them. If we are going to pay providers for 5-10% then we should value it accordingly. I also argue that in those same instances, protocol driven medicine allowing the same treatments is likely to provide equal benefit.
After all in every instance you spelled out the exact treatment you thought indicated without regard to any variables and then stated how much it helped as "common sense."
-And no the intentions of the leaders 50yrs ago should not solely influence the attitude of providers today. But it does play a strong part. You cant instill a certain mind set and embed it into everyday practice and then all of a sudden turn around and say your all wrong, why are you being a minimalist, etc, etc like it's their fault to begin with. You act like its totally up to us field providers and its not.
But it is up to providers. LIke it is has been up to all other providers. Nursing etc. did not advance because a group of physicians pushed them. They took responsibility for their own destiny.
You expect physicans to decend from on high and sudenly improve paramedicine like magic or divine power?
Why should an established profession be responsible for helping another?
The only answer is that EMS isn't a profession. Without the high level of knowledge and responsibility, it is a skill. Skills can be taught for less than the cost/benefit of maintaining ALS for the rare instances where they actually make a difference following preset instructions.
-Trust me, more then a few skills and technology has been added over the years. I went to school for two years, took A&P, etc... in fact the Paramedic program at my College is almost identical to the RN program. The only difference is the obvious core courses. The general education track is the same except for like two classes.
Becase you went to a superior program that translates into advancement for all or even a majority of EMS providers in the US?
Does your edcation permit you anymore clinical latitude than that of a 6 week medic mill graduate?
Is the Education you went through a minimm requirement for medics around the country?
You may have went to one of the few exceptional programs, but your program is an outlier, not the norm.
-And please enlighten me how an EMT-Basic is gonna fix a severe COPD exacerbation with only oxygen and a BVM? I guess trying to ventilate lungs with such poor compliance and with such high pressure that it causes gastric distention and aspiration is considered equal care to you? No inhaled or IV bronchodilators, CPAP, or steroids is okay? No way to measure ventilation and response to treatment with EtCO2 is acceptable? And the probable dehydration and fever should be ignored as well? Your argument for substituting ALS with BLS is very weak and very flawed.
Teaching basics to perform the same interventions as an ALS provider is flawed when you just listed everything that needs to be done in an itemized less in less than 30 words?
Doesn't sound that hard. I'll bet I could do it in a few weeks. Trying to exclude providers from rendering treatment based on your current system and not modification of it is where the flaw in argument is.
I have a PA paramedic card too. Without an expiration date. I am also well aware of what constitutes ALS and its requirements in a majority of PA. Just because your service exceeds that and has a specific way of operating does not make it the only way.
-I think your getting confused. An EMT-Basic as is standard today is not able to provide ALS.
Says who? We have had many providers here detail the expanded scope of Basic EMTs in various parts of the US. If it can be done there. It can be done anywhere. It is also much easier to get people to agree to when you show them how few instances all those expensive ALS providers cost to maintain and how much money they would save.
-You keep talking about adding this and adding that which eventually leads to an ALS type provider with nothing but skills which I always hear you argue against. So why would you advocate in this debate what you normally argue against?
Taking the hardline as the Devil's Advocate.
Your argument has been measured and is found wanting.
You provided nothing but unproven EMS dogma in your response. Maybe if you say it enough it will become true.
-I don't profess to know everything and health care is a never ending journey with something new to learn and improve everyday. But I am not so jaded as to realize when Paramedic care makes a difference.
The original argument was that it doesn't make a difference in a short transport environment, not that it doesn't make a difference at all. But when I challenged to idea it made a difference the only reponse I have seen is the party line and "common sense."
-I guess if you were the one at this moment who couldn't breathe and a Paramedic showed up in your living room with his jump bag and started to alleviate your dyspnea and lessen your anxiety you would feel a bit different..
Would I care if that person was a paramedic, a nurse, an EMT-B or a doctor?
I think not.
-Would you as a patient not be smart enough to figure out A) hmmmm... I cant breathe, B) Somebody showed up and gave me medicine and made me breathe better and improved me all around. C) hmmm...The EMS system really works
Where I sit today I am just as likely to get a doctor. Who may even decide after my treatment I don't need an ALS ambulance bill and a Emergency room bill, because he was able to help me without automatically transporting me to the hospital. In many nations a paramedic can do the same thing. What makes you worth more than double the cost of an EMT with the same skills and treatments you possess again?
My point bolded.
-Do we really need research to show that putting black paint on a wall really does make the wall black?
We are not disputing what treatment helps. Only Who is capable of providing it and at what cost.
And before you say just give albuterol to Basics problem solved, we both know that is lame and a ignorant approach.
It sure is. But it is cheaper than having a paramedic do it.
If Paramedics can not or will not diversify their education and practice, why pay more when you could get the same for less?
Patient's on constant nebs especially with age need cardiac monitoring along with EtCO2 monitoring to gauge current resp status and trajectory. A Basic is not able to do this nor do they understand the pathophysiology well enough.
Neither do most paramedics. Anyway the problem is solved by simply calling a medical control physician on a webcam with a wireless internet connection. Which is still cheaper than training and maintaining paramedics.
It's obvious your very jaded which I can understand.... but I too, am finding many flaws with your perception and thinking.
Yes, I am jaded.
Yes, I do support expanding the value of US paramedics.
But if my argument, as the devil's advocate, cannot be refuted, how do you plan to convince the people who truly do see EMS as a waste of money that can be reduced?
Shout dogma at them and tell them they have no common sense?
They will bury your argument with an OPALS study and a host of expert physician opinion. Including with multiple anti-EMS physicians who are former paramedics.
As friendly advice, I would start putting together some studies and gathering some evidence as well as diversifying the value of your service.
"EMS is not a sham" says the guy who makes his living at it and as proof cites "common sense,"
and no other evidence.
