Your Controversial EMS-Related Opinion

Carlos Danger

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That's not how this works... you made a claim that you said was backed up by research... and when you are asked to provide that research, it falls to you to provide the research that you came exists. If you want, I will say I looked and its not there... since it's that easy, why don't you share all the research that you came exists?
You are correct; a generally accepted rule of discourse (and one that I've pointed out on this forum more than a couple of times) is that a claim of fact should be supported. However, that presumes that I am actually trying to convince you of something, which I am not. I was simply stating my position on the issue the same way that you did. Yours was based (presumably) on personal experience, where mine was based on that and articles that I've read on the topic as part of my training as an educator. If you want to learn more about it, you will gain more looking for the info yourself than just looking at an article or two that I linked. If you don't feel very strongly about the topic or really care to learn more - which I assume is the case - than I would be wasting my time finding sources to share. Either way I have nothing to gain by doing homework for you, and you probably don't either.

To be fair, there are a lot of variables involved in comparing in-person vs. computer based training (CBT). If you are comparing a great instructor to a lousy CBT, then sure, you will probably get better outcomes from the in-person instruction. But these days there are many educational programs that rely heavily on CBT and still produce good outcomes.
 

Carlos Danger

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Medics should abandon the notion that they are as smart as nurses....
Obviously this was tongue-in-cheek and meant to spur a little controversy, which it did and always will. I hate to wade into the nurse vs. paramedic debate but I usually do because I'm dumb like that.

I will point this out: paramedics receive a pretty in-depth education in a VERY narrow area, whereas RN's are trained less in-depth in any one area but in an immensely broader range of topics overall. There is little question that it takes more knowledge on more topics to pass the NCLEX than to pass the NRP. There is also no question that many RN's function with more autonomy than most paramedics imagine they do.

One of the big differences also is that many paramedics seem to "peak" in their career within a year or two, whereas at that point many nurses are just getting started in what will be their specialty. I think this has a lot to do with why so many people burn out in EMS and don't stay in the field very long as compared to nursing (obviously there are other reasons as well, like compensation).

I've known great nurses and lousy ones, and great paramedics and lousy ones. Most nurses could never hop on an ambulance and do what a paramedic does without quite a bit of focused training. By the same token, practically zero paramedics could go into any specialized nursing unit and do what those nurses do, without a lot of training both broad and focused. As always, there are exceptions. I've seen a few flight nurses learn the job really quickly and get so good so quick that you'd swear they must have had prior EMS experience even though they did not.
 

EpiEMS

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I believe intubation should be removed from the scope of most paramedics.

Where should it be retained? Presume sufficient volume of intubations per medic and sufficient post-licensure education & skills verification are prerequisites for this — probably leaves a small cadre of flight, critical care, and some other specialized folks who could consider ETI in scope?
 

NomadicMedic

Pot or Kettle? Unsure.
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Where should it be retained? Presume sufficient volume of intubations per medic and sufficient post-licensure education & skills verification are prerequisites for this — probably leaves a small cadre of flight, critical care, and some other specialized folks who could consider ETI in scope?
in a nutshell, yes.
 

RocketMedic

Californian, Lost in Texas
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Where should it be retained? Presume sufficient volume of intubations per medic and sufficient post-licensure education & skills verification are prerequisites for this — probably leaves a small cadre of flight, critical care, and some other specialized folks who could consider ETI in scope?
Pretty much everywhere that’s more than fifteen minutes to a hospital. Caveats~ VL should be a thing everywhere and routine training needs to be a thing.
 

NomadicMedic

Pot or Kettle? Unsure.
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Yes. We're exposed to a constant thematic storyline of "burnt out paramedics". See also, Michael Mores and "Rescuing Providence" or most facebook EMS groups. It's offputting and teaches our new people that it's expected to be salty and "broken"
 

E tank

Caution: Paralyzing Agent
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Yes. We're exposed to a constant thematic storyline of "burnt out paramedics". See also, Michael Mores and "Rescuing Providence" or most facebook EMS groups. It's offputting and teaches our new people that it's expected to be salty and "broken"
Got that...and I think the term 'burn out' has lost its meaning if it ever had one...but you are drawing a distinction between what you cite and real, unprocessed, unresolved critical incident stress/traumatic stress injury, right?
 

mgr22

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Yes. We're exposed to a constant thematic storyline of "burnt out paramedics". See also, Michael Mores and "Rescuing Providence" or most facebook EMS groups. It's offputting and teaches our new people that it's expected to be salty and "broken"
I agree. We can't seem to find the middle ground between case-specific trauma and obligatory burnout.
 

NomadicMedic

Pot or Kettle? Unsure.
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Got that...and I think the term 'burn out' has lost its meaning if it ever had one...but you are drawing a distinction between what you cite and real, unprocessed, unresolved critical incident stress/traumatic stress injury, right?

Absolutely. I don't discount that critical incident stress is real and needs to be acknowledged... but when I see IFT EMTs bemoaning "the stuff I see..."

Well... it's distasteful.
 

EpiEMS

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Pretty much everywhere that’s more than fifteen minutes to a hospital.
That reminded me of this Pew survey. I'd wager that would mean most major cities, almost every sizable suburb, and even well into the exurbs, your exceptions being true rural areas.
 

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
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Opinion - the psychomotor skill of intubation is nowhere near as difficult as we make it out to be.
You win the Academy Award for the Most Accurate Assessment of this topic! I couldn't agree with you more. Bravo!
 

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
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The skill itself is easy, it's everything that goes into intubating that makes it hard. But we (accreditation boards, teachers, managers) focus on "you must have XX number of intubations to be competent.

I'd argue you must have XX exposure to stress management and critical thinking to be successful at airway management. Shock index and acid/base balance (yes, that is actually important in clinical practice) can be taught in the classroom and reinforced through simulation to the point where it becomes second nature and will be easily incorporated into live airway management situations.

I disagree, the actual skill of intubation is not difficult in a live situation as long as you have the stress management and the wherewithal to work through any issues that come up..

There aren't really an infinite number of possibilities that can happen when you get in there, there's only a few..
Yep!
 

GMCmedic

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Categorizing a Bougie as a “crutch”, or rescue device. And, viewing alternative airways—when needed—as SGA’s as a provider being “weak” at airway management.
A service shouldn't allow intubation in 2021 if they don't stock bougies.


I'll take it one further, if your service isn't spending covid money on video layrngoscopy they should no longer allow intubation.
 

MackTheKnife

BSN, RN-BC, EMT-P, TCRN, CEN
572
148
43
A service shouldn't allow intubation in 2021 if they don't stock bougies.


I'll take it one further, if your service isn't spending covid money on video layrngoscopy they should no longer allow intubation.
Bougie and video or no intubations? That's pretty myopic. A Miller #3 and a stylet for most adults works fine although I'm not against bougie and video.
 

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