Converting system from EMT to Paramedic: Is it worth it?

[mobey]

WOW am I gonna get nailed for a title like that!!

Here is a background for ya. I work for a rural service in Alberta. We do about 1000 calls/year. We are registered as a BLS service, there for all our employees are EMT's. Our scope includes, King and Combitube airways, 3 lead ECG, I.V.,Salbutomol, Atrovent, Epi 1:1000, D50, glucagon, ASA, Nitro, AED, and oral glucose. We have about a 5 min transport time for calls within town.

Just to lower your blood pressure (you know who you are) I feel EVERY ambulance should have at least 1 Paramedic on it. However the powers to be in management disagree. What I am looking for in this thread is examples outside of cardiac arrest, where ALS is a definate benefit. I am only asking because I have not had alot of paramedic exposure.

The argument made by management is that with our short transport times there is no need for Paramedics, and the extra expence would be a waste.

[AZCEP]

With the scope of practice you describe, and the short transport times having paramedics around won't be of much service.

You are currently providing an ALS service, and unless you also do transports outside of your 5 minute time frame you will have a tough time getting the information you need.

Good luck to you in the meantime.

[mobey]

Ya the 5 min transport time is for in-town calls only, about a third of our calls are out of town. One argument I am making is the ability to bring less than critical patients to the ER means the on-call Dr. does not have to jump out of bed and get to the hospital immediatly. Such as: I can give Epi for anaphylaxis...But the doc better be at the hospital when I get there for definitave care. However a Paramedic can give Epi, Diphenhydramine, and Methylprednisolone, reducing the urgency for a physician.

[akroeze]

Are you folks able to give nitro for CHF? And if so, is it high dose?

If not, that could be an argument.

[BEorP]

What I am looking for in this thread is examples outside of cardiac arrest, where ALS is a definate benefit. I am only asking because I have not had alot of paramedic exposure.

The benefit of ALS treatment for cardiac arrests is debatable (unless they are able to treat an underlying cause).

[akroeze]

Getting Paramedics so the doc doesn't have to get out of bed as fast is not a valid reason unfortunately. Looking at the information you have posted, there is little benefit to having Paramedics other than the not overly common:

Symptomatic/Unstable SVT

Symptomatic/Unstable VT

Symptomatic/Unstable Brady rhythms

Tension Pneumo

FBAO

[AZCEP]

Just to gather the information take a look at the calls you've run for the last 6 months to a year. Objectively determine if there is something that a paramedic would have been able to do that would produce a benefit for the patients.

You can also look at any developments in the area you work. Increasing population, more elderly, changes in the demographics, etc. Once the information is gathered, you might consider looking for some support from the service population.

[Dustdevil]

Forget about your scope. It ain't about skills. It's about medical assessment, and how much more accurate your diagnoses are with a paramedic education. It makes a HUGE difference.

If you and your medical director are still thinking in terms of skills, you're still living in the first aid days. Join the 21st century. FORGET SKILLS!!! With a paramedic education, you'll decrease the number of patients you scream back to the hospital with because you will be better able to assess their actual condition. It's all about patient assessment and diagnosis.

Like AZCEP said, cardiac arrests are a poor statistic to work from. Those are not the be-all-end-all of EMS. It's the pre-arrest arrhythmic patients that you can do wonders for. We rarely save arrests of any kind. But that's not really what we're here for. Our strength is in preventing arrests in the first place. And anti-dysrhythmics and definitive airways is the way to do that.

[akroeze]

Forget about your scope. It ain't about skills. It's about medical assessment, and how much more accurate your diagnoses are with a paramedic education. It makes a HUGE difference.

If you and your medical director are still thinking in terms of skills, you're still living in the first aid days. Join the 21st century. FORGET SKILLS!!! With a paramedic education, you'll decrease the number of patients you scream back to the hospital with because you will be better able to assess their actual condition. It's all about patient assessment and diagnosis.

Like AZCEP said, cardiac arrests are a poor statistic to work from. Those are not the be-all-end-all of EMS. It's the pre-arrest arrhythmic patients that you can do wonders for. We rarely save arrests of any kind. But that's not really what we're here for. Our strength is in preventing arrests in the first place. And anti-dysrhythmics and definitive airways is the way to do that.

Dust,

Remember that this is Alberta we're talking about. I think (don't know for 100%) that they go through extensive education for an EMT similar to an Ontario PCP. Correct me on this if I am wrong. Therefore the educational foundation would be there for a thorough assessment.