Dustdevil

So... since you bring this up, but then fail to give us the results of the study, am I correct to assume they have not yet been published? Or are you just keeping us in suspense for some other reason?

Still trying to understand just exactly what you are getting at. Are you talking about movement towards the so-called "Paramedic Practitioner" concept, with field treat-and-release (diagnose-and prescribe) privileges? Clinical (non-street) privileges? Both? Or are you talking about an expanded scope within actual field EMS emergency care? Though the Paramedic Practitioner concept is an intriguing one, and could be viable with the right educational preparation, there are things that worry me about it. Not so much that paramedics couldn't handle it. They could (again, with the right education). But my two primary concerns are this: 1. I disagree that our future success lies within taking a bigger slice of the medical pie. I think our future lies in specialisation. Doing one thing and doing it well is almost always a better choice than trying to be all things to all people. 2. You think EMS is abused now, when all we really offer is a ride to the hospital? Wait til people get used to us making house calls for minor ailments! The impact will be overwhelming. Not to mention that the AMA will strenuously oppose this every step of the way. We barely have the political clout to get wanker plates in this country. There is not the slightest chance that, within the next twenty years, we will possess the clout to achieve practitioner status. Aside from a clinically expanded scope, I just cannot think of much ambulance EMS type expansion we could ask for.

For pretty much the same reason that peacocks have colourful tail feathers. Perpetuation of the species. Without them, the number of people attracted to EMS would dwindle to almost a complete stop.

No doubt. Can you better define for us what you mean by "unknown scene?" Do you mean a run that is dispatched as an "unknown medical emergency" or "unknown situation?" Or do you mean any run, no matter how it was dispatched, that you feel unsure about the safety of? Or something entirely different maybe? You're right; without definition, these things can be taken to extremes. Exactly. I agree. Get on with it.

Sweet! :thumbright: Welcome to the club! At least if you do kill anybody, they're just yankees.

Word. That's the bottom line. Weird how people try to complicate emergency driving. It isn't complicated at all. In fact, the rules are the very same as the rules for normal driving. There is only one special rule for emergency driving, and that is NEVER PASS ON THE RIGHT! Other than that, emergency driving should be done exactly as if you have no lights and siren on at all. Any deviation from that standard puts you at fault for any incident.

Absolutely! I am amazed that there are so many physicians who are even willing to extend their licence out to us at all! I sure wouldn't. Especially to persons I had never even personally met and evaluated. Of course, my reply may not be particularly relevant, since I have only practised with one field EMS system in the last ten years. That was a rural, county-wide system with only about twenty-five medics total, including part-timers. But we were all personally interviewed by the medical director before being allowed to practise. It wasn't a particularly in-depth interview, as we had all been quite rigorously screened before hand. Nobody was hired there with less than about 7 years experience. But the MD did take an active role in establishing that each medic was somebody she had a comfortable level of confidence in. That was ten years ago, and it was not at all common at that time. I would sure hope it is something that is becoming more and more common.

What do you think is missing from the current paramedic scope? Most states don't even define paramedic scope, other than to say it is whatever the MD orders. Considering that, I'd say our scope is pretty unlimited, except in places like Kalifornia and Maryland. And, as UMSTUDENT correctly implies, restrictions are currently a good thing in those places.

Ahhh... now you're making sense! Total agreement. It's just that, once you do that, they would no longer be EMT-Bs. So really, you're talking about eliminating the EMT-B level altogether and making paramedic the new entry level, no matter what you call them.

Of course you would know better about him than I, but are you absolutely, positively sure that you "can't" kick him out? Political ties aren't always protective. Not everybody has parents like Paris Hilton who will back them, no matter what. It is quite possible that not only would his ties not be interested in protecting him if he is a dick, but that they might also have great respect for you for doing the right thing without fear of politics. Not saying to do this, of course. But do consider realistically the personalities involved, because many of them would stand by your decision and beat his arse for embarrassing them. Tough call though. Ultimately, Ruffs final suggestion may be the most humane way to go. Save his family a lot of embarrassment, and possibly save the lives of many patients in the future. Sometimes you gotta crack a few eggs to make fruit salad. Until then, when he gets on a roll, just stop your instruction altogether and just let him go. Stare him down. Make no effort to stop him until he runs out of steam. By then, the whole class and you are staring at him in awkward silence. Peer pressure takes over from there. Good luck! P.S. You do mean National Guard, as opposed to like a lifeguard class or something, right?

You need to do a lot more reading here and a lot less talking before you forever soil your reputation here. Seriously, you don't have the slightest clue about ANYTHING involving EMS. Read. Ask questions. But spouting off uneducated, unintelligent views on things you know nothing about is just really silly. And annoying.

You're not defending your position. You're changing your position. In you previous post you said that EMTs should get more skills before they get more education. Now you are saying that if they get more education, they should get more skills too. Those are not the same thing. So which is it? Either way, I disagree. The current paramedic scope of practice (except in retarded places like Kalifornia) is more than sufficient and needs no expansion. In fact, the current paramedic scope of practice in most of the U.S. far exceeds the level they are educated to. And that is our point. Currently, most paramedics are performing medical practice well beyond their educational foundation. This isn't about getting more "skills." This is about catching up to where we should have been before we were granted those skills in the first place! And, of course, if you really believe that paramedic or EMT practice is about skills, you are, as Khanek generously put it, dangerously lacking in your understanding of EMS and life in general. For now, I'll write that off to your admitted rookie status in EMS and not being "slow." But seriously, dude, I really hope you get a clue soon so that you can become an asset to the profession and not just another clueless half-arse disgrace that holds us back in the 1970s. Stick around and read what the veterans have to say here and you can get a better idea of what this whole thing is about. Obviously, your school failed miserably at doing so. Good luck!

I assume you are saying you don't buy the original theory I was responding to, and not my response? Because you're basically saying the same thing I meant to say.

I long considered that theory, but it just doesn't bear out. Some n00b medics do indeed get too focused on the next drug they think they are supposed to push and forget about the basics. No doubt about it. But his medic partner is no less capable of being the one to remind him than an EMT is. As always, the EMT is not as prepared or capable of doing the job as a medic is. Consequently, the theory is just silly. And, of course, with all this talk around here about how EMTs are "useful" if they can set up a line, hand me the right drug, and get my laryngoscope for me -- not to mention all the EMTs who think that they too should be doing ALS interventions -- who does that leave doing BLS? Nobody. They are just as likely -- if not moreso -- to forget the basics as a medic is. That's why I'd just as soon they stick with what they were meant to do, not what they want to do because BLS bores them. You do, however, make an excellent case for further limiting the skillset and scope of practice for EMTs.

I would agree with that to an extent. I absolutely do not advocate adding pointless courses to the curriculum that do not lend tangible value to the focused education. Microbiology? An absolute must. Sepsis, anaphylaxis, and so many other common processes are simply not fully understood without it. Physics? Darn useful. And the lack of understanding that most medics have about physics is painfully obvious when they speak. But I would stop short of saying that it is an absolute must. Same with chemistry. They'll both make you a notably better medic, and I would like to see my medics have them. And they should be required for anybody who plans to teach medics. But for entry level practice, I think physics and chem are not absolutely necessary for a sufficient grasp of the concepts. Advanced math? Nah. Perhaps I am a little biased because I am mathematically challenged. But seriously, I have never ever had a need for anything beyond basic algebra and statistics in paramedic or nursing practice. In fact, I don't even see an instance where it might be beneficial to know trig or calc. Even in pre-med, calc is just one of those little hoops you jump through to thin out the herd. So, for medics, algebra is a must. Statistics would be a must for anybody who intends to teach. Advanced biology? Immunology, virology, comparative anatomy, botany, etc... are certainly worthwhile and useful in giving you a broader understanding of human function. And you will indeed find many instances in an EMS career where that knowledge comes in handy and gives you an edge. I would love to see my medics have them, especially for remote and independent clinical duty (as opposed to field EMS). But again, I do not see those as absolute musts for entry level practice. In my pipe dream EMS degree programme, I would actually require advanced English, communications, and psych classes ahead of advanced mathematics or sciences. Those are topics that apply to each and every patient I see. The knowledge and understanding that comes from them would be more beneficial to most field medics in their everyday practice than other advanced sciences or mathematics. I have long had trouble coming to grips with a really ideal paramedic degree plan, because I don't think it requires the advanced math and sciences of a biology degree, but it very definitely requires more than you can pack into an associates degree. So I am left looking at a three year programme plan, but who in the heck wants a three year associates degree? That's why I lean more and more towards entry level EMS being a 1 year sub-specialty course for Registered Nurses, as is done in The Netherlands, and other Europaean nations. As unpleasant as that may seem to most medics, it simply is the most intelligent way I can think of to ensure an adequately broad based foundation of the sciences and patient care process for which to build an emergency and critical care practitioner for the field without the growing pains of re-inventing the wheel.

Clueless. Absolutely clueless. Obviously not even worthy of a response or Mike already would have.

I take it you have not had a patient with a perforated bowel yet.

When all runs are ALS, nobody stays up all night either. And two trucks never get yanked out of bed for the same patient because one got there and figured out they needed the other. Clearly, tiered systems are the ones with the extra workload, without any benefit to the patient. And, of course, it goes without saying that any high volume system that works 24 hour shifts sucks. LMAO@NIMS A pox on the idiot that invented that nonsense. But again, you have to compare apples to apples. That means comparing levels to levels, not individuals to levels. You have to talk about the level of training as it currently exists. Period. You can't talk this nonsense about the rare BS in Biology EMT with 5 years full-time EMS and 4 years military ER experience and compare him to a 90 day wonder medic fresh out of school. You only invalidate your argument with that. I've worked with many EMTs who were great at what they did. I'm not saying they all suck. I am -- AGAIN -- saying that the level of training itself sucks, is inadequate, and is all but useless to an EMS agency, unless they are just trying to save money by gambling with people's lives. Doesn't matter how intelligent, experienced, or educated they are beyond EMT school. They still aren't a full partner with me, so I still would rather have a new-grad medic with me. Sure. A lot people like having illegal aliens around too. Plenty of medics love to have somebody that they can dump all their dirty work on. Somebody whose faces they can rub their disco ball patch into and feel superior a few times a day. Somebody that can take care of geriatric patients because they are beneath them. Yep, you'll find a lot of those medics in EMS, but it doesn't make EMTs useful to the system. It just gives medics an excuse to be lazy and uncaring. I fail to see how that is a benefit to a system or the citizens it serves. Prove it where? If they aren't thrown on an emergency vehicle, where are they supposed to prove their conpetence? On a horizontal taxi service, with another EMT who isn't qualified to train or evaluate their competence? Sounds to me like you're not really talking about proving competence. You're just talking about paying dues. That's just another elitist theory like dumping all the geriatrics on EMTs. I don't play that game. But no, you're right. They shouldn't be thrown on emergency vehicle. Not at all. Not ever. Not until they have finished a paramedic education. Still stuck focusing on individuals, I see. I know you are too smart to have actually misunderstood the point. So it is obvious that you are just trying to cloud the issue. It's about an entire level of practice, not about individual providers. Again, I don't care how wonderful of an EMT you or anybody else is. It is irrelevant. You still are not a full partner to me. You're just a helper. I don't want a helper. I don't want a gofer. I don't want a driver. I want a partner. And until you are educated to, and practising at the same entry level as me, I don't want you as my partner. And I darn sure don't want you out there taking primary responsibility for emergency patients. Very true. But at least then it is only one set of problems instead of two separate ones. That's progress. As long as people are intelligent enough to understand that this discussion is not about them personally, there is no reason it can't stay civil.

Sorry, but I don't get your point. I've been on dual medic trucks for the great majority of my career, working the BS runs right along side the emergent ALS runs. That's part of the job, and I accept that. I'm not one of those paragods who wants Basics around just to stick with all the un-glamourous patients that they think are beneath them. Only an arsehole would do that. Consequently, the paragod arseholes are the only ones who have any use for an EMT-B.

:shock: How long ago was this? And how long from that night before you started your education?

I would also hope so, but the sad fact is that most can't. Seriously dude, you read the horror stories on this board. A horrifying number of providers can't even figure out the obvious ones. You really think the average 120 hour EMT-B out there is going to know how to recognise the tough ones? Without significant ALS experience, are they going to have the knowledge necessary to develop that sixth sense and high index of suspicion? Not a chance. You may be in a Phi Beta Kappa system where the few people you work with actually are relatively competent, but I doubt it. And if so, that is the exception to the rule. And you don't know any of that until you have made the scene and assessed the patient, which an EMT-B is not educated to do. Check your math, bro. It's not adding up. So... Basics are useful because they can take the BLS runs? Well, so can medics. Basics don't put more trucks on the streets. They only bring some of those trucks down to the basic level. If all of those trucks were staffed by medics to begin with, the system would function just as quickly, more efficiently, and every patient would be afforded an advanced assessment. Nobody would be stuck waiting for an "intercept," or worse yet, stuck with an inappropriate level of care during a medical emergency. Funny how it always comes back to the invalid comparisons when there are no valid justifications left. If the medics in your system are up all night and burned out, so are the basics, genius. Compare apples to apples if you want any credibility. Medics in LA don't ride an ambulance, and don't make BLS runs at all, yet ask Anthony and JPINFV about how burned out LA medics are. So there you go, your theory about basics preventing medics from burning out fails. Again, you are trying to make this about individual people, and it is not. It is about a level of training. And no matter how smart that individual basic may be, or how great of a basic he is, he is still inadequate to perform primary EMS without those bells and whistles. And, as usual, you're back to focusing on the bells and whistles, when any intelligent practitioner of EMS knows that they are not what it's all about.

Education holds back the EMS profession? That's a novel theory. Care to expand on that for us?

Bingo! And that is my point exactly! The game is good. It is the playas that are farking it up! :wink:

What exactly is this "work to rule" thing? It's funny how the newspaper uses the term as if it is something that everybody knows, and doesn't require definition in the article. Is that the case in Canadia? It sure isn't in the U.S.

Nah... just as long as it is an actual JOB (as in your paid profession), and not just a hobby or a pipe dream for the future. The scanner scale should be relative to where the scanner is. If it is in your home, that's not so bad. But if it is in your vehicle, that is worth double points. Anyhow, I can't make any sense out of your quiz scale, Ruff. It seems as if you reversed the points on some of the questions, like #3 where you get more points for having NO stickers/plates than you do for having them. And a few questions had no option for "None." And, of course, the gender question was politically incorrect since you excluded our transgendered peers. Uhhh... yeah. Why not? Isn't that what every other profession on earth does? Ever meet any volunteer nurses? Physical Therapists? Engineers? Architects? Pilots? Mechanics? Carpenters? Prostitutes? It just continues to amaze me how otherwise intelligent people imagine that there is something so inherently special about EMS that it should be structured and administrated in a manner different from every other profession. :?