Should EMTs Have to Babysit Their Medics?

[DwayneEMTP]

I completely disagree with the idea that talk is cheap.

I'm pretty new to EMS, don't yet have my degree in emergency medicine, so talk is what I need.

I wasn't born knowing the issues surrounding EMS, I have to learn them. I had no motivation to do so up to this point, so I haven't. But now that I do, and I've become passionate about the issues involved, I need the intelligent banter and challenges to my logic that talk brings. It would have taken me years, if ever, to be exposed to the ideas and moral/mental/educational/professional situations that I've brooded over here, if I was instead required to encounter them out in the field.

I have no idea if becoming involved in EMS politics/development is in my future, but if so, I think all that I influence will be better served because I was exposed to a multitude of ideas, and ran those ideas to a logical, rational conclusion with others of the same, and very much different opinions, than if I came armed with my own experience alone.

And to those that feel the drive to be involved in the politics/changes in EMS at the state and/or national level, I can't see how you don't benefit, when it's time to sell those changes, by an EMS body that is more educated, has argued the issues, and more intelligently able to support or combat new ideas, such as the one created here.

I've tried some of the more political EMS boards. I've found them to be often populated by those that want to talk about the big things they are going to do, as well as to be a giant love fest with thread after thread talking about what great ideas each poster has. I have failed to see the threads listing their actual accomplishments. I prefer the debates.

There is a huge need for change in EMS, and those that have the required personality to spearhead them. But a new rule, or a new law, or a new protocol can not cure the ills of EMS alone.

There is just as big a need, or bigger, for a place for EMS to unite, digest and become indignant so they are prepared to make the smaller changes that are just as necessary, day to day.

Dwayne

[Ridryder 911]

I still disagree Dwayne talk and even posting is cheap. One does not have to have sheepskins to change things. You can participate on a local, state and even Federal level. There are multitudes of tasks and research that can be performed.

Being informed about EMS and its profession should had been covered in your education but alas alike many others as we have discussed numerous times the education level is poor. Again, unless we actually do something nothing will really occur again just talk.

The discussions on the forum are alike discussions at conferences located in a bar; all have good points but nothing occurs from them but good comradely. Something different than other medical professions, they actually take action, thus they get results. Sure they cuss and discuss but they actually do much more than that, they demand results. Hence they have professional benefits, salaries according to responsibilities and peer recognition something we do not have.

I have been very active on this site for over three years, and what I am seeing is the same repeated discussions of the same thing over and over.. but in reality no changes. Just a few that are actively responsible for changes... even some of the popular posters are just dreamers and talkers, but that is not what causes real change.

How many EMS students, EMT's, Paramedics, etc.. actually participate in EMS progression? Sure to come on here and discuss "how things should be" and "progression of education in EMS" is easy, but in the real world changing them is not that easy.

With the membership we have, we could influence such organizations, ask for participation, and maybe actually cause a change. Propose some of the ideas that have been discussed and promote those ideas within their organization and help get these changes to occur.

I still say; if your not part of the solution then your part of the problem. Why talk about it, if you plan to do nothing to correct and change it?

R/r 911

[brentoli]

Rid,

Someone needs to step up and be the leader, the rally-master, the organizer. With out leadership and orginization, a group can not collectively form itself into one body. You say that this site and its membership could influence EMS. I agree. Someone has to step up and lead the charge. You have experience in these arenas. Much more then quite a few here.

[akflightmedic]

I agree with Rid, valid points as always.

At this time, I am not involved on a national level, only informed.

I am active at the local and state level in Florida and have been for many years.

Currently I am a member of the Florida Association of EMS educators.

http://www.faemse.org/index.shtml

We have two position statements of which I disagree with the first one. Getting this stuff changed at the state level will be crucial to us ever changing anything at the national level. (click the link and go read it)

I know it isn't much but it is the least I can do right now with all my traveling over the past few years.

[Scaramedic]

I notice once again that the 'S' word keeps coming up again. As has been stated about a 1,376 times on this forum it is not about 'skills' it is about education. I can teach a monkey to start an IV, I cannot educate it to understand why it is starting the IV.

[brentoli]

They are improving lines of communications with the primates though. Just need to jump this "New Math" hurdle.

[DwayneEMTP]

I still disagree Dwayne talk and even posting is cheap. One does not have to have sheepskins to change things.

It has nothing to do with sheepskin. It has to do with being initiated into the the environment one wants to change.

Being informed about EMS and its profession should had been covered in your education but alas alike many others as we have discussed numerous times the education level is poor.

As you like to remind us often, your education has been much superior to ours. At the end of next month I will have 80 college credits dedicated to EMS specifically. An you are right, at no point did they teach me the politics of Fire v Privates, Privates v Volunteers, Medic v Basics, and on and on. Which course did you take that covered those?

The discussions on the forum are alike discussions at conferences located in a bar; all have good points but nothing occurs from them but good comradely. Something different than other medical professions, they actually take action, thus they get results. Sure they cuss and discuss but they actually do much more than that, they demand results. Hence they have professional benefits, salaries according to responsibilities and peer recognition something we do not have.

You have labeled us "impotent hens" for posting here. I have been involved in local politics most of my life, as well as those surrounding Special Olympics and autism specific research and issues.

I'm curious about you personal political history. For this reason. Anyone that has seriously campagned to create change will tell you that having ignorant people on your team is much worse than having no one at all. Yet you are here, in part, insulting people for attempting to become educated on the issues. You claim to want people to act, and at the same time explain to them that it doesn't matter what they act on, or if they understand it, "simply do something!" you say. That is a great mentality if you want to organize a mob, not so hot if you want to organize a profession. How have you ever created change with that agenda?

Perhaps you'll be insulted. It's my hope that you won't, but your logic here simply does not add up to positive change. You say that you're involved on other boards that actually do something. Could you send them to me in PM please, so I can see for myself why I waste my time with the hens, when the "real Doers", are moving the world elsewhere? And how do we find a list of your, and their, actual achievments? I believe you are as important as you say you are, I'd simply like to be able to put it into perspective.

I have been very active on this site for over three years, and what I am seeing is the same repeated discussions of the same thing over and over.. but in reality no changes. Just a few that are actively responsible for changes... even some of the popular posters are just dreamers and talkers, but that is not what causes real change.

EVERY significant change begins with dreamers and talkers. And I would argue that you have seen many of the same subjects discussed over and over because that is a necessary process when the community continually changes. Many of us say the same things, but if we continue to say them to different people, then perhaps that time is not wasted. I don't understand why, when you've decided that we're such a waste of your time, you continue to post? That's not meant to snipe, but as an honest question. Why does an intelligent person continue to waste substantial amounts of their time over a three year period?

Again, I would like a list of the achievements that others are producing, that the rest of us "followers" have neglected. Please.

With the membership we have, we could influence such organizations, ask for participation, and maybe actually cause a change. Propose some of the ideas that have been discussed and promote those ideas within their organization and help get these changes to occur.

So as a leader, as you've said of yourself, why don't you organize the 18,000 members here and spearhead those changes? Isn't that what a leader does?

I still say; if your not part of the solution then your part of the problem. Why talk about it, if you plan to do nothing to correct and change it?

I have never been involved in anything that I didn't influence when I felt I could create positive change. But as I said before, I don't yet understand all of the issues that concern me in EMS and refuse to run off yelling and screaming for change until I feel confident that I know what I'm talking about....

I look forward to the list of accomplishments with your name on them, and those that the rest of us are hiding behind.

Dwayne

[Asysin2leads]

Fair enough. Two medics working together one a student one not... are being very proactive to package and treat a patient, trauma from an MVA with a questionable Blood Pressure. In their eagerness to "load and go" which by all means needed to be done, they immediately started to strap the patient down and quickly began to prepare to place IV's... HOWEVER I simply asked if there was any thing they wanted to do prior to strapping this patient to the back board. I felt we needed to expose the patient and do a quick assessment. After the DUH look I received they quickly joined me in removing the clothing and discovered a bleed behind the right knee that COULD HAVE BEEN life altering for the patient. You can provide all the IV fluids you want but if your patient bleeds pink what good is it going to do you? YES they had done a quick once over to the patient (who was covered in blood from the death of the occupant in the back seat of the car with him) but I felt something else was prevalent and they had a mind set to push IV'S meds and such. Patient was +LOC but had a patent airway. BOTH medics admitted to being focused on the bad blood pressure and what they where going to do to treat it, not stopping to think about finding the initial cause. They just zoned on one thing. It happens. I guess. I didn't spend much time in the field, it wasn't practical for me and NO I won't sit here and say another medic wouldn't have done the same thing I did.

Nope, it's not overwrought with emotion. Not at all. It is a statement of observation being made and a question asked as how it is THESE Forms do not reflect the real time setting I exist in. Doesn't add up, and certainly doesn't make sense.

And again NO this is not being taken personally. I can not speak for any one but myself and I only have my experience to go by so by all means I tell what I have witnessed and I ask the question that I have. But no I am not taking this personally YOU however, as it seems to me, are taking this out of context.

Okay, you know, this is what really pisses me off about this fucking profession. I will take all the of the "you're anti-EMT-B" brunt that goes with this, but here is my little rant.

People here have posted some really intelligent, well thought out, well researched posts, and mixed in with them is this crap.

I mean, what use is it training for years and years and years, suffering, struggling, studying, years of trying to be the best prehospital care provider I can be to friggin' be put in the same boat as people who think that by their "exceptionally keen eye" alone they found the problem?

At this point I am really sure there is a factory somewhere that issues the mystical "medics too focused on X to see condition Y" to every EMT-B in the country, because if I had a nickel every time I heard this same exact line, right along with the "ya the saline don't do nuthin' iffin' the bleedin' ain't controlled" line, I could retire. Maybe I'm just blessed. Maybe I am in such a good system that even the dumbest medics I have ever worked with would have immediately snapped to finding a bleed when they saw a lower blood pressure on a traumatic patient. Maybe my paramedic course is the only one in the fucking country that made me go over diagnostics and mechanism of injury until my eyeballs fell out of my skull. Maybe that's it.

I assume that after you found this bleed, a tourniquet was tied right? Because, in my mind, the only thing that could stop a bleed that has gotten to the point of actually managing to lower the blood pressure would be one that could only be controlled by tourniquet in the field. I also assume that the person was cool, pain, diaphoretic, with altered mental status? Because usually that is what happens when you have a really bad extremity bleed, and usually, they are fairly obvious.

Or maybe this is exactly what is wrong with our field. Maybe this is exactly why medics have the attitude they have when it comes to who's in charge. Maybe there are people out there with patches on their shoulders who have such a lack of basic knowledge about medicine that they don't know what they don't know. Maybe that's it.

[Ridryder 911]

Dwayne,

Personally, I do not understand the antagonist attitude. Your entering the profession, then I would expect that you would want changes to occur before you retire. Exactly how much information does one need to recognize the troubles in EMS? Even consumers, participants can see EMS is in crisis.

Ever consider why this site as others have only a few members posting in comparison to the hundreds of thousands of professional medics that work out there?

My experience is simple. As medic and also as a Paramedic student I was active and remained active in the development of changing EMS in our state and even working at a national level on legislation, in the late 70's and early eighties. I learned the process as a Paramedic student and EMT involved in the profession. I knew early on that anyone can recognize problems, but someone has to actually do something for change. How do you think such educational blue prints appeared, Federal funding for EMT training. ambulance specifications came about? I later went onto full time research into Trauma Research as a consultant/researcher. This involved bureaucracy and understanding legislative changes, knowing there is always a lot of talk out there but no backbone to it.

I now teach part time at a Paramedic program at a local college. They have an active EMT student organization. Part of the professional development portion of the course requires having an understanding of needs and changes of the system, not just patient care. Again, similar to other health care professions that actually take the time to teach that it is just as important as patient care. In fact in just two weeks; two classes will spend all day at the State Capital meeting their legislature and discussing EMS needs. This started a few years ago, and became popular & now most of the other schools have now picked up the same agenda. Similar to nursing programs that do the same, and visit their Board of Nursing to understand their profession.

Like to decrease the medic shortage, increase educational requirements, have better funding so medics can in return receive better pay? The majority of the topics that is posted on this forum, then one should be involved. Just discussing here is NOT going to change anything. Will it inform some? Possibly. I doubt that anyone that has worked more than a few weeks as a professional medic could can make the same interpretations without reading it from other medics. Again, the typical discussion anyone can overhear at any EMS gathering. Not busting chops for sparking ideas, but there is a difference from fantasy and reality.

Want to know what agencies that I am involved in that make changes? Simple. Check out ANA, AACN, ENA web sites. Look at the legislation that is occurring. Look at the salary ranges, the educational requirements and changes that occurs daily. Compare that the changes mandated for their profession has been limited time, and that they continue to change daily. One can see that they too have problems, such as the shortage, but compare the educational opportunities allowed to students in comparison to those of in EMS. Again, why? The members of the profession are pro-active and does more than "talk about it". I even suggest to view forums and organizations of physical therapist, respiratory therapy, etc.. Compare their growth and structure in the past ten years to those in EMS.

One does not have to be an "expert" to realize the changes needed. Shortage in EMS providers, not having appropriate funding for EMS, poor educational systems in EMS. Again, all the same repeated subjects that are in these forums daily. Unfortunately, these problems are not in a limited or specific area.

In fact, you ask how to become "experienced"? By being active and involved. Alike any organization that needs changes within a problem. I know each state has funding problems, educational problems, and legislation that needs to be supported. Are most of these posters even aware of what is occurring within their own state or national movements?

As much as I respect Dust and usually agree with 100% of his opinions, there is not squat he can do or anyone else can do to change EMS without getting involved and getting legislation to occur. As much ranting that can occur, that is all it will be, it will continue to be the same.

Ironically, in another posts and others we continue discuss the fire service. The difference is to ask the firefighters the names of their legislatures and they can tell you, if not they can direct you to a fire rep that has them on speed dial.

Information is only so much, then what one does with that information is what makes the difference.

The reason I continue post is simple. I alike many others read and interact with others, as well as learn of changes occurring in EMS. As an educator discuss topics, and yes to socialize. Just because I do post on multiple EMS forums, does not exempt me from actually doing something to change the system, in fact quite the opposite.

The reason I left nursing full time and return to EMS is to change the system. Alike what Dust described nothing really has changed in the past thirty years. Is that not long enough? So, I work 10/24 hour shifts and most of my "free time" is being involved on committees and developing programs as the coalition such as the one I posted, so EMS will change. It has to or it will be replaced.

I can or will invite respected members of associations to participate on this forum if they would like too. One can only speculate that they are already quite aware of the needs without reading multiple posts, but again probably need help in changing those problems, as I have addressed.

My intent of my post was this; with a site at least 10,000 strong, advocating changes and possibly supporting such agencies would help promote their/our causes. Signatures, letter writing and endorsing legislation may actually cause a change.

R/r 911

[mediccjh]

I may not that be old of an old-timer like Rid, and Dust, but I think my 12 years speaks for me, most of them in very high call-volume systems.

I will only reply to the original poster's topic, and nothing more. So far.

Every time I have a new EMT partner, I give them the getting-to-know you speech. I sit them down in the back of the box, and tell them exactly what I expect of them. I give them my simple rules to follow:

1. Deer have antlers. Sweeties are made of sugar. Honeys have bees buzzing around them. Everyone is a "sir" or "ma'am."

2. If you don't know how to do something I ask you, tell me. I will either show you right there, or after the job. Usually, I swipe an ETT from the ER and show them how to do it, and let them keep it. That's how I learned to spike an IV bag 12 years ago, and I still have that bag.

3. If you have a question about why I'm doing something, wait until after the job is over. My explanation is simple: if you question me in front of the patient or family, then it makes us BOTH look bad.

3a. However, if you see something that needs my attention, whistle at me. I tend to use the Hawkeye Pierce whistle from the M*A*S*H movie.

I love to teach, and I tell my newbies and rookies that. I explain to them that just because I'm a medic doesn't mean I won't learn something from them; however, give me the I-know-everything attitude, my job will be to make you cry by the end of the shift. I have made grown men cry before.

Long story short, if the provider is doing something that you know will kill the patient, speak up then and there, in a non-confrontational matter. Otherwise, wait until the job is done.