Your Controversial EMS-Related Opinion

[DrParasite]

1) Not every ambulance needs to be ALS
1a) requiring every ambulance to be ALS leads to poorer providers

2) paramedics don't belong on the engine; first response ALS is a waste

3) there is no evidence that degrees will make paramedics better, so why need them?
3a) if we are going to mandate degrees, then every paramedic should be required to get a degree in paramedicine with less than 3 years.

4) Private EMS companies should be banned from the 911 system
4a) every AHJ should be mandated to set up a 3rd service EMS system, funded by the taxpayers, and elected leaders should be held accountable for its performance.

5) FD should have a very limited role in EMS; cardiac arrests, MVAs, and heavy lifting. EMS agencies should have enough EMS units to handle their call volume without the FD to stop the clock.

 

[ffemt8978]

We need to look at scope practice for each level compared to call volumes (rural vs urban) with an eye towards maintaining an effective proficiency. While there are benefits to a standardized system, there are also drawbacks that are oft overlooked.

 

[DrParasite]

The current tiered system is totally backwards. Sending someone with apx 120 hours of training to see if someone needs an actual assessment from a provider with formal education is backwards. You don’t know what you don’t know.

I haven't been in seen 120 hour EMT classes since the 90s... are you saying your state only requires 120 hours to become an EMT?

 

[CCCSD]

Needle decomp is life saving when needed, but it is also invasive and not without serious complications, and the biggest single failure point is employing it when it is not indicated which automatically adds potential for complication. For that reason alone in a non-combat environment, I can see the argument for keeping it above the EMT level, even though the actual skill is less complex and less difficult than other things that EMTs do. But it should be in the hands of AEMT at least.

What part of AEMT creates this magic zone of knowledge?

 

[Summit]

What part of AEMT creates this magic zone of knowledge?

AEMT is another 10-12 credit hours with clinicals past EMT so there is a little bit of extra knowledge and experience in patient assessment and care versus a freshly minted EMT.

Needle thoracostomy would be new content to add on top of AEMTs slightly more in depth coverage of A&P and assessment (vs EMT).

Most of all, you can focus training and education a bit better on a smaller population of providers that encompasses AEMT and above versus all EMTs (there are over twice as many EMTs as there are EMS providers above the EMT level).

 

[E tank]

Hospitals are direct beneficiaries of EMS. They should have some skin in the game. They provide medical clinic office space, personnel and capital expenditure for providers who then admit and refer patients for lucrative, billable procedures. They've been getting a pass on EMS for way too long.

 

[Tigger]

I care about EMS, but the optics often will be "you're raising my taxes for what?!" in many places. That said, most of the public does agree that taxes should fund EMS (see pg. 2 of Carson & Shepperd, 2020)

Public perception of EMS is fascinating as an area of research (e.g., Crowe 2016, Carson & Shepperd, 2020).

I love this. It is indeed a totally backwards model. This is where fly car medics come in! That said, I do enjoy a good critical BLS call...

If they were even dispatched. Or if the crew on scene requests them. Or doesn’t cancel them because the patient doesn’t “look” sick to them. 120, 150, 180, whatever the number is, it’s not enough. The inability to interpret EKGs alone is troubling to me.

At the end of the day, when you go to an ED, you’re seen by a provider. Even if it’s quick, somebody with formal education in medicine evaluates you. Whether or not that’s a paramedic is open to discussion, but it’s not an EMT.

 

[E tank]

At the end of the day, when you go to an ED, you’re seen by a provider. Even if it’s quick, somebody with formal education in medicine evaluates you. Whether or not that’s a paramedic is open to discussion, but it’s not an EMT.

But is that the job of scene personnel? Final definitive, accurate diagnosis and treatment (hopefully) isn't supposed to happen in the field. Isn't it the role of EMS to get the patient to where that happens? Whoever shows up...job one is getting the patient to the hospital. If there are those that don't appreciate their own limitations, that's another conversation.

 

[Tigger]

But is that the job of scene personnel? Final definitive, accurate diagnosis and treatment (hopefully) isn't supposed to happen in the field. Isn't it the role of EMS to get the patient to where that happens? Whoever shows up...job one is getting the patient to the hospital. If there are those that don't appreciate their own limitations, that's another conversation.

Which is what concerns me. If a lower education provider doesn’t recognize a sicker patient that requires transport and allows them to refuse without any sort of education as to what is wrong, that would be bad.

 

[EpiEMS]

If they were even dispatched. Or if the crew on scene requests them. Or doesn’t cancel them because the patient doesn’t “look” sick to them. 120, 150, 180, whatever the number is, it’s not enough. The inability to interpret EKGs alone is troubling to me.

At the end of the day, when you go to an ED, you’re seen by a provider. Even if it’s quick, somebody with formal education in medicine evaluates you. Whether or not that’s a paramedic is open to discussion, but it’s not an EMT.

No disagreement from me as a target state, with resources allocated to proper third service or hospital based EMS at the level that, say, FDs see. That said, the great bulk of research in the urban setting (OPALS, namely) doesn’t show improved outcomes from ALS care for major trauma and cardiac arrest, so I could imagine calibrating a model for urban vs suburban vs rural where you may not get medics on every call for efficiency’s sake.

 

[VentMonkey]

Keeping ALS fly cars in the outskirts (i.e., suburban/ rural areas) where they’re more likely to make a difference ~vs.~ keeping BLS in the urban areas closer to the hospital where “life saving” interventions take precedence until definitive care?…

Pffth, common sense, how dare I…

 

[DrParasite]

Which is what concerns me. If a lower education provider doesn’t recognize a sicker patient that requires transport and allows them to refuse without any sort of education as to what is wrong, that would be bad.

I honestly wonder if hospital providers (doctors, nurses, PAs, etc) think that most paramedics are incompetent due to their relative lack of education, in the same way, that some paramedics think most EMTs are incompetent due to their relative lack of education

 

[Tigger]

I honestly wonder if hospital providers (doctors, nurses, PAs, etc) think that most paramedics are incompetent due to their relative lack of education, in the same way, that some paramedics think most EMTs are incompetent due to their relative lack of education

Probably many do. I work hard to show that I am not and develop relationships with my receiving EDs.

I don’t think EMTs are incompetent. I don’t think the level has enough education or diagnostic tools available to them to provide a thorough enough assessment.

 

[Comfort Care]

I honestly wonder if hospital providers (doctors, nurses, PAs, etc) think that most paramedics are incompetent due to their relative lack of education, in the same way, that some paramedics think most EMTs are incompetent due to their relative lack of education

Yes they do, especially those ED nurses. Large majority have no clue what type of training goes into EMS providers. However there a nurses,MDs, and PA's that were prior EMT/P. We appreciate you guys.

 

[mgr22]

Yes they do, especially those ED nurses. Large majority have no clue what type of training goes into EMS providers...

Kind of a broad statement, wouldn't you say? Some of my preceptors were ED nurses.

 

[jgmedic]

Ive found its more the med surg types who are that way. ED, ICU, Flight I've always felt mutual respect.

 

[NomadicMedic]

Convert EMT to be the new “first responder” and make the minimum level for 911 response Advanced EMT.

Rename AEMT to primary care paremdic, rename NRP to Advanced Care Paramedic.

 

[DesertMedic66]

Convert EMT to be the new “first responder” and make the minimum level for 911 response Advanced EMT.

Rename AEMT to primary care paremdic, rename NRP to Advanced Care Paramedic.

*Canada enters the chat*

 

[CCCSD]

Convert EMT to be the new “first responder” and make the minimum level for 911 response Advanced EMT.

Rename AEMT to primary care paremdic, rename NRP to Advanced Care Paramedic.

And who’s paying for all this?

 

[PotatoMedic]

And who’s paying for all this?

People who want an ambulance to show up when they call 911.