Your Controversial EMS-Related Opinion

[Summit]

Ballistic armor... uncomfortable, bulky, heavy, and stuffy, and I run hot.

Even if someone said here is an ultralight II or IIIA I'd be like, but why tho? And I'm thinking stab proof probably would benefit more likely to benefit providers than anything ballistic. But I'm biased/lucky... the scene could be made safe like that. But I knew VFFs who CCW'd to Fire/EMS calls. Rural CO gonna rural CO.

But that partner who is like "Well I took my SAPI plates out today."
What do you say to that? "OK, I'm glad we aren't expecting to be engaged by enemy scout snipers firing AP rounds... and that you'll be able to get the stair chair up 3 flights of stairs without hyperventilating."

I had one guy tell me armor was to protect him in case the ambulance crashed. I was like... "so, where's your crash helmet?"

 

[OceanBossMan263]

Operating model wise, PD and EMS have more alignment than EMS and FD. If I had to combine services, I might rather combine PD and EMS rather than FD and EMS.

My county has this arrangement as part of the system. Police Dept runs a medic service. Single medic in ambulance, met on scene by PD who is usually dispatched to aided anyway. Cop drives the bus to the hospital.

Of course, it's only one part of the disjointed system which also includes 70+ fire departments, and villages who contract with hospital-based services.

 

[MackTheKnife]

The breadth of curriculum of paramedic school isn’t even in the same ballpark as RN school. Passing RN school requires an exponentially deeper knowledge of physiology, pathophysiology, and pharmacology compared to passing paramedic school. A new grad RN has significantly more medical knowledge than a new grad paramedic.

Thanks for stating the obvious (not being snarky). I am NOT talking about curriculum as an RN and a Paramedic I know this quite well. I am saying OVERALL a medic is as smart due to their autonomy, critical thinking, and diagnostic skills. A nurse, for the most part, couldn't operate independently as a medic can and achieve the same outcome. There are many variables, of course, such as the operating environment, which is not the same.

 

[MackTheKnife]

Come on, man? You have enough letters behind your name with both credentials to assure me you’re much more articulate than to use this as your retort.

Sure I get th controversy thing, but people are people. Some are more astute than others regardless of said job title.

See my detailed response to Fireman Mike. I'm not talking purely education.

 

[Summit]

I'm more curious as to your objection of having an RN involved with Paramedic instruction? What specifically is the objection and is it blanket or only in certain settings?

 

[MackTheKnife]

I'm more curious as to your objection of having an RN involved with Paramedic instruction? What specifically is the objection and is it blanket or only in certain settings?

Who's this written to?

 

[CbrMonster]

Medics should abandon the notion that they are as smart as nurses....

I don’t think that, my wife’s a nurse she’s beat my *** if I thought that way, but nurses work very differently to medics for the most part, with the exception of nurses who are medics and flight nurses.

Nurses here don’t use cpap, and use bipap. I **** you not my partner who is in medic school has a nurse teacher who didn’t know what c pap was. Now I don’t think she’s an idiot they just a lot of the times don’t use the same meds or the same equipment. They don’t do a lot of skills we do, they’re not doing frequent iOS, not intubating, use different pain meds, ej’s ect, and it goes the same for medics doing nursing skills.

Most floor nurses with the exception of say cicu or telemetry floors don’t even need acls or know their rhythms ( this I know from working in a hospital on a floor, and I taught my wife rhythms, now she works in the er and has to have acls

I don’t know that either are specific to only California.

I don’t have much info on how things work out of state, but it’s a huge problem in cali for dudes to get a p card to just become a firefighter knowing they hate running medical aids.

 

[VentMonkey]

They don’t do a lot of skills we do, they’re not doing frequent iOS, not intubating, use different pain meds, ej’s ect, and it goes the same for medics doing nursing skills.

Most ground paramedics in my area—yes in California—don’t intubate. Fire is BLS and will have placed a SGA most of the time.

Refer to my original post on page 1 (#13). I stand hard and fast by this statement.

I don’t have much info on how things work out of state, but it’s a huge problem in cali for dudes to get a p card to just become a firefighter knowing they hate running medical aids.

Do a little research on The Googs. Literally, it takes minutes.

As for the P Card—>FFPM route, this is nothing new, has been a thing long before you and I, and will not be going anywhere anytime soon, but for the sake of the thread…sure, fair point

 

[CbrMonster]

Most ground paramedics in my area—yes in California—don’t intubate. Fire is BLS and will have placed a SGA most of the time.

Refer to my original post on page 1 (#13). I stand hard and fast by this statement.

Do a little research on The Googs. Literally, it takes minutes.

As for the P Card—>FFPM route, this is nothing new, has been a thing long before you and I, and will not be going anywhere anytime soon, but for the sake of the thread…sure, fair point

I don’t doubt you, I know most counties are going to lma like igels and not intubating.

I would love to have rsi capabilities in my county it’s frustrating at times when I need to wait 20-30 minutes for a bird to have them do it.

And that’s fair that’s your opinion my differs but to each their own.

Haven’t had the reason to research it, just didn’t want to make it a blanket statement for everywhere. I mean I also don’t think firefighters should be running medical aids, I think medic should be medics and firefighters firefighters.

 

[Summit]

Who's this written to?

@CbrMonster

He answered, I think that paramedics can learn quite a bit from RNs. Sure some specific skills should be specifically taught with the medic in mind, but there is more to clinicals than skills.

 

[CbrMonster]

@CbrMonster

He answered, I think that paramedics can learn quite a bit from RNs. Sure some specific skills should be specifically taught with the medic in mind, but there is more to clinicals than skills.

1000000% agree, if I don’t understand something I ask my wife, wealth of knowledge or I ask her to ask the Ed physicians she works with for further explanations on certain things. Sometimes she asks me when a medic does something she thinks is inappropriate or why we do things a certain way.

But I think there’s a lot of difference between the way say a medsurge nurse works and a medic. Not saying anyone is smarter than the other but the two operate in very different ways and that’s ok. Everyone has their place in medical care from emt’s and cna’s up to doctors

 

[EpiEMS]

My county has this arrangement as part of the system. Police Dept runs a medic service. Single medic in ambulance, met on scene by PD who is usually dispatched to aided anyway. Cop drives the bus to the hospital.

Of course, it's only one part of the disjointed system which also includes 70+ fire departments, and villages who contract with hospital-based services.

Ahh, I know this fabled system. It’s one with many, many flaws - and though I love the concept of community volunteerism, I worry about its sustainability. Also, the staffing model seems risky to me, taking PD out of service for a transport + cleanup + getting back to their car. I was thinking more about using PD instead of FD as BLS first response or using shared administration.

 

[DrParasite]

Most ground paramedics in my area—yes in California—don’t intubate. Fire is BLS and will have placed a SGA most of the time.

and there are people who wonder why paramedic first time intubation success rates suck, because places (such of California) don't have their paramedic intubating real people on a regular basis. Here is a newsflash: if you don't practice or use a skill on a real person, the skill will atrophy, especially if the only time you use it is in a high stress life threatening situation, and you haven't actually done it in a similar situation in awhile.

As for all of the other nurse vs paramedic, who is smarter? I know a lot of dumb nurses. you know, the ones who aren't able to fart unless a doctors says they can? and yes, @FiremanMike is 100% correct that nurses have standing orders and protocols, just like paramedics.

and @FiremanMike is correct on something else he said: nursing school is much wider in it's scope than paramedic school, because they are (in theory) training a nurse who can operate in all aspects of nursing. However, you still end up with a ton of dumb nurses; actually, that's not a fair statement, as most nurses aren't as dumb as we think they are, but the further they get from nursing school, the more they focus on their specialization. And there are a lot of really smart nurses. really really really smart ones.

For example: paramedics are really good are emergencies, especially ones that are related to the heart and lungs. we use ACLS all the time, we are expected to be field cardiologists, and diagnose a stemi just like looking at the monitor. It's what we do, and we do it well. But are we as good at long term illness management? or case management? or bed management? or fall prevention? or wound care? or ICU stuff, like assisting with procedures, administering IV antibiotics, lab values, or whatever other specialized stuff they do? what do you really know about long term psychiatric care? or home health care?

We (EMS) do stuff in the field that make some really smart nurses shudder (like giving glucagon), for good reason; we do it on the fly, while they need a doctor's order, lab values, tests, and someone to monitor trends, as well as have a specialist evaluate the case before an intervention is given.

Nurses here don’t use cpap, and use bipap. I **** you not my partner who is in medic school has a nurse teacher who didn’t know what c pap was. Now I don’t think she’s an idiot they just a lot of the times don’t use the same meds or the same equipment.

so they aren't stupid; they are ignorant, because they don't use it, why would they know how to us it? Do you know what equipment an ortho nurse deals with on a regular basis? because I don't, and I guarantee you that if you throw a cpap machine at an ortho nurse you will get a deer in the headlights response. Similarly, if you throw a paramedic on an ortho floor, he or she won't know how to do half of the things that an ortho nurse does.

 

[mgr22]

When I was in medic school, I didn't care who was teaching us -- medics, nurses, doctors, whatever -- as long as they knew the material, knew how to deliver it, and answered questions. On practical rotations, I wanted instructors who taught me to do relevant stuff and let me do it with appropriate amounts of observation. Again, it didn't matter to me what licenses they held. The most educational rotations I had were with doctors and nurses, not medics, in psych, peds, the OR, and L&D.

I guess my "controversial opinion" is that teaching skills are more important than titles in a learning environment. Instructors who can't communicate what they know are pretty useless. That's been true for every industry I've worked in plus college.

 

[CbrMonster]

so they aren't stupid; they are ignorant, because they don't use it, why would they know how to us it? Do you know what equipment an ortho nurse deals with on a regular basis? because I don't, and I guarantee you that if you throw a cpap machine at an ortho nurse you will get a deer in the headlights response. Similarly, if you throw a paramedic on an ortho floor, he or she won't know how to do half of the things that an ortho nurse does.

never once said nurses are stupid, but they operate very differently and use different equipment that they may not be well versed in, same with medications. It’s not that I don’t think nurses can be intelligent, there’s just a lot of differences. Your ortho floor is a perfect example of what I’m trying to say.

 

[VentMonkey]

and there are people who wonder why paramedic first time intubation success rates suck, because places (such of California) don't have their paramedic intubating real people on a regular basis. Here is a newsflash: if you don't practice or use a skill on a real person, the skill will atrophy, especially if the only time you use it is in a high stress life threatening situation, and you haven't actually done it in a similar situation in awhile.

I can never tell who you’re talking to vs. at. I stand by my original post on the first page. Nationally.

And I assure you it isn’t the state, but the agency that decides what their re-education can or will be. What does your paramedic license dictate?

 

[CbrMonster]

I can never tell who you’re talking to vs. at. I stand by my original post on the first page. Nationally.

And I assure you it isn’t the state, but the agency that decides what their re-education can or will be. What does your paramedic license dictate?

I think along with agreeing with @DrParasite we slowly are losing everything, especially in California.

I think more formal education and training is what’s the fix not taking away potentially life saving interventions. Hell San Diego county doesn’t even have mag… and icema(San Bernardino)? Lost charcoal when some idiot filled a patients lungs with it.

 

[DrParasite]

I can never tell who you’re talking to vs. at. I stand by my original post on the first page. Nationally.

And I assure you it isn’t the state, but the agency that decides what their re-education can or will be. What does your paramedic license dictate?

I think it was pretty clear that I was responding to your post, which I quoted. And whether it's at the local level, county level, state, or national scope of practice, it doesn't matter; there is a lot of discussion questioning if paramedics should be intubating, and some saying it should be taken away altogether. and No, I'm saying saying it's your fault, but systems (in general) that operate like this are not helping the situation.

NEJM Journal Watch: Summaries of and commentary on original medical and scientific articles from key medical journals

NEJM Journal Watch reviews over 250 scientific and medical journals to present important clinical research findings and insightful commentary

www.jwatch.org

The Great Airway Debate

3 EMS physicians highlight the challenges that prevent a consensus on endotracheal intubation across EMS systems and the importance of case review

www.ems1.com

Should Paramedics still be intubating? - Simulaids

On 17th September 2020 East of England Ambulance Service NHS Trust (EEAST) announced they were removing endotracheal intubation from paramedic scope of practice.

simulaids.co.uk

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[EpiEMS]

Skill dilution is the proximate cause, I would think. Fundamental cause is having too many medics in a system.

 

[DrParasite]

never once said nurses are stupid, but they operate very differently and use different equipment that they may not be well versed in, same with medications. It’s not that I don’t think nurses can be intelligent, there’s just a lot of differences. Your ortho floor is a perfect example of what I’m trying to say.

Sorry, I was unclear; I didn't mean to imply that you said they were stupid... but some people (and I've been guilty of this too) will think that a person is stupid because they don't know how to deal with a situation, or manage a particular situation, because they don't have any recent experience in it.

My point was to say that they aren't stupid, but ignorant. Similarly, if you a physiatrist, nephrologist, or optometrist in the middle of an ER, ICU, or other area, and say "here, manage this stroke patient" yes, they went to medical school, and this was covered, but they don't deal with it day in and day out, and putting them in that situation is likely setting them up for failure.

As clearly demonstrated by this tweet:

https://twitter.com/x/status/1240321752455999488