"You don't need all those fancy gadgets...

[mycrofft]

Consider being the medical director or ambo company manager/owner. Not every employee is a Greg House (Thank God), and the majority of runs don't need Michael DeBakey in the back. Plus, who gets every single griping commo from MD's or EMSA or family members? So-called LCD's (and face it, we are each and all someone's LCD, at least in some areas of expertise) are appropriate for many runs. Pre-hospital EMS workers are not afforded proper clinical refreshers, (if they even had any significant clinical experience before they got their name tag). If it were me and enough of my peers and receiving MDs were hot for Gadget X, and it seemed to make care more recordable and transmissable (record it for documentation and for pass-on to the receiving MD),I'd probably get it too. However, slapping candyapple red metalflake paint and flame decals on a Yugo still doesn't make it a top fuel dragster.

The people deciding on what to buy may not be educationally or professionally qualified to decide. The EMSA may be over-politicized so decisions and protocols are tainted and slanted. Salesmen start to propel the standard of care.

Finally, deep breath, the device is the tip of the iceberg. Factors almost never accounted for include: parts and maintenance system including qualified techs; amortization (how often will we get to use it before important parts wear out or it dies or is likely outddated?); documented and professional training and recurrent training of staff about the machine; recurrent evaluuation if a system/machine is (still) relevant;. etc etc.
PS: go to any rooom in a hospital where a woman is labor. All eyes are on the monitor:blink:

 

[Veneficus]

To me, this should translate well to the paramedic and EMS; we should be experts in prehospital emergency care.

Could you define what this means please?

(a) improve our ability to treat immediate life-threatening conditions,

I propose that whether it is realized or not, EMS does not treat life threatening emergencies.

They simply begin intervention in chronic conditions and when pressed with an acute condition such as trauma or toxicology, thier primary role is to transport to somebody who can help.

or (b) smooth the transition of care to receiving physicians (STEMI activation, stroke activation, etc).

I humbly suggest better education will do this better than technological advances. It might even save a few jobs too.

or unnecessarily complicate treatment and transport.

I would say this is the issue that lead to my original post. Just not at the EMS level.

Is it a case of EMS trying to be too much, especially in light of the current educational standards here in the U.S.?.

I don't think so.

Is it a case of providing too much to under-prepared providers?

This might be more reasonable if I understand you correctly. Basically too much data to add to people already struggling to remember basic concepts and actions. Information overload.

The point at which diminishing returns are reached is hard to define and it will be highly subjective and dependent on provider and locale.

The people who pay for it don't seem to think so. You may find this suprising, but most research is actually to create evidence to convince somebody to pay for specific diagnostics or treatments.

This is another great example of why there needs to be more research done in EMS.

Like what?

 

[mycrofft]

"I propose that whether it is realized or not, EMS does not treat life threatening emergencies.

They simply begin intervention in chronic conditions and when pressed with an acute condition such as trauma or toxicology, thier primary role is to transport to somebody who can help."

A fine distinction many won't "get". I reddened the pivotal words.

 

[Jambi]

seeing as I started the titration of ETOH already, I'll see if I can string together some coherent sentences... :beerchug:

Could you define what this means please?

I was referring back to your characterization of specialties. I interpreted your use of such as meaning that added technology in the EMS field is useful, however, seeing that Prehospital care is such a narrow slice of the medical pie, there is no reason not to be experts in the field. There shouldn't be a need to compensate of the LCD...in my opinion. That fact that this is or may be occurring via added tools is the fault of the profession...

I propose that whether it is realized or not, EMS does not treat life threatening emergencies.

They simply begin intervention in chronic conditions and when pressed with an acute condition such as trauma or toxicology, thier primary role is to transport to somebody who can help.

Agreed, and honestly I like how you put that because it should bring into perspective what we should be achieving.

I humbly suggest better education will do this better than technological advances. It might even save a few jobs too.

I agree with this, but I do think that judicious use of of technology has it's place. What still remains undefined, and what prompted my musings, is where the tipping point is between enough vs LCD compensation.

This might be more reasonable if I understand you correctly. Basically too much data to add to people already struggling to remember basic concepts and actions. Information overload.

That is what I was getting at.

The people who pay for it don't seem to think so. You may find this suprising, but most research is actually to create evidence to convince somebody to pay for specific diagnostics or treatments.

This is something that I was aware of. The most recent thing that comes to mind is with Zoll and the Autopulse. Bledsoe had some serious and appropriate reservations about the data being used to promote the device.

Like what?

I believe the entire EMS industry currently relies on tradition instead of evidence. We should be operating off of EBM shouldn't we? This looks like a prime example of how research could help achieve the baseline of diminished returns for the use of technology in the field. To find the tipping point. Some of the key elements will be hard to control for, namely the inconsistency of paramedic education here in the states, and the strong desire to practice in a CYA mode.

such research may be feasible outside the country where the educational model and litigious factors can be better controlled. Canada, UK, and AUS come to mind.

And as I type this it occurs to me that such data may be available via retrospect in examining practice patterns in those places and examining the use of, and the influence of technology on such practices.

another part of me also wonders if such efforts would simply be wasted as the U.S. EMS system is just too resistant to changes in both changes in educational models and practice patterns...

I hope this makes sense as my gin and tonic has now reached therapeutic levels.