Leaderboard

All right. I've held off on posting in this thread because, as usual, this is gonna be a big one. I've said it before, and I'll say it again, guys. We are NOT that good at managing emergencies, and very little of what we do has been shown to actually make a difference in an emergency. So exactly WHY are we limiting ourselves to solely emergency care? Let me ask you all this, exactly what do you think we're going to do when our local governing bodies figure out that paramedics really aren't as vital as we like to think, but we're in a tight budget situation? Do you really think that they're going to keep paying for anything or anyone that hasn't proven themselves invaluable and non-expendable? The medical environment we find ourselves in is this: if you want us to pay up, you better show up with something more than emotional pleas about how important you are. And we in EMS are NOT prepared to respond to that kind of scrutiny. We absolutely HAVE to start showing more for our cost than an IV, O2, monitor and transport. Uh uh. That's not cutting it anymore. Every single person here needs to take a hard look in the mirror and ask themselves, "What am I doing that is changing this patient's outcome?" You may be surprised by the answer, and even if you're not if you're not thinking beyond emergencies you're already up the creek without a paddle. Transport to the ER isn't cutting it, so we have got to start doing more than providing little more than that. We have got to start adamantly advocating for higher educational standards, and more definitive (or perhaps conclusive is a better term) care options. We've got to start performing sound triage, treat-and-release, release-and-refer, and offering more than what we are right now. Emergency medical services is a flop. It's a failure, doomed from its inception. If you want to go down that path, if you want us to just take people to the hospital, you're going to soon find that that's all we're EVER going to be paid for. We can't do that anymore. It's time to step up, own our own education, put on our big boy pants, and start providing true mobile health services. That doesn't mean everybody needs to go to the ER, and that also means that we have got to take a hard look at what the socioeconomic environment of our communities is. A lot of you bring home up health nursing and how it's not our area and it shouldn't be because that field belongs to the home health nurses. You know what? Home health nurses exist, that's true, but how many patients with chronic care issues that need chronic care treatments do YOU run on a yearly basis? Quite a few, I'm guessing. So what does that say about the effectiveness and reach of home health nursing practitioners? It says that while they may be out there, and they may be doing their jobs just fine, there's still a gap that needs filling. And that gap is one that we as paramedics can fill if we will just get our heads out of our asses and put the rulers away for one second. I didn't become a paramedic to run emergency calls. And I didn't become a paramedic to only handle the worst of the worst. I became a paramedic because I wanted to make a difference in people's lives, and I wanted to provide vital, necessary medical care to folks. And you know what I found out? Just doing the emergency stuff, I'm not all that great at doing what I set out to. But you know what? I'm willing to learn, I'm willing to educate myself so that I CAN do more for those patients that don't need emergency care. I am sick to death of transporting so many patients that I can't do a damn thing for. They're sick enough to need medical care, but not sick enough to need anything in my drug box. And that's the majority of my patients. The majority of my patients, and I suspect the majority of your patients, need more than what we can offer them, but what they need isn't emergency care. I know this. You know this. And sooner or later, the politicians are going to realize this and start asking what the hell they're funding us for when we're undertrained and unwilling to handle these kinds of medical situations. Nurses aren't. Nurses are trained to handle these kinds of patients, AND they're willing to do so. And in the time it takes us just to revise our educational standards, nurses could have a system of RN-based mobile health services in place that turns a profit AND provides better medical care than we could ever provide. We're an odd bunch, we paramedics. We fight when we ought to listen, listen when we ought to fight. But I'm telling you, like I have so many times so far that I fear I'm becoming redundant, that if we don't adapt and overcome; if we don't change the way we operate from the ground up; if we don't give up these notions that increased education isn't going to make a difference to our wallets, and that "we're emergency medical services so we're only going to handle emergencies", we are going to fail. Not today, not tomorrow, probably not even five years down the line. But we will fail, and we will be replaced by people who are smart enough to know that medicine is fluid and to be in medicine you have to be fluid as well. Business as usual isn't cutting it anymore. So in conclusion, I support Wake County's APP program. I support the NHS' ECP program. Wake County isn't a college, they can't create a Bachelor's degree for APP's, but they're on the right track. They see what lies down the road and they're securing their own position in the future by looking beyond emergencies. I hope that we as a profession will advance our educational standards to meet the need we're seeing, and that in the future the paramedic practitioner will be a Bachelor's degree or higher. Until then, all I can do is take my hat of to those who are doing as much as they can to provide within their means and adapt to the changing medical environment.

Here we go, the forum regulars crucifying a new person who comes to post here. Don't let a lot of these people get you down. It is a cult. To the OP: Stay clam, remember you aren't the one dying. You are an EMT, and realistically there isn't much you are going to do to hurt this person. Board/Collar 'em up and get 'em on the way to the ER. Your assessment can be done in route. You'll be fine kid, just take a deep breather and stay level headed. It will fall into place soon enough.