EMS Research

[JPINFV]

BVESBC-

You have f#$ked up a perfectly good thread with your drivel.

And you have demonstrated a complete lack of situational awareness by taking this tack with the veteran providers represented in this thread.

Go away.

'zilla

In other words:

[Spock]

Back to the research topic. I recently completed a prehospital research study on inproving intubation success rates. Everything I have read suggests that paramedic intubation success rates are in the 50-60% range. My service was no better and experience led me to believe the reason medics miss the first time is that they do not have everything ready before putting the blade in the mouth. I postulated that regular practice would improve first time intubation success rates.

I got 25 medics in my service to sign up and agree to intubate the mannequin every shift. We developed a check list they had to follow and intubate the mannequin within 30 seconds. The study ran for 12 months with 4 mannequin tubes each shift for the first 2 months and then 2 per shift the last 10 months. All the medics thought it was a great ideas and pledged to follow the study protocol.

The results were disappointing to say the least. Most of the medics just blew it off saying they didn't have time to intubate the mannequin. I should note we have an airway lab in our training center and the mannequins and equipment were readily available. They couldn't take ten minutes to do the tubes during a 24 hour shift but they had plenty of time to watch TV, smoke in the garage and surf fire department web sites.

I had planned to compare the service intubation success rates for the study year and the year preceding but the poor compliance prevented that. I was able to compare 5 medics that were diligent in following the study protocol and all 5 improved their success rates on the order of 100%. The statistician has the data and if it rises to statistical significance I intend to submit it for publication. I may submit it even if it doesn't have statistical significance but I'm not sure it will be published. Time will tell.

The study did generate some interest from a larger EMS system in the area and I might try to repeat the study with incentives for participation since the large system is interested in perhaps funding it. My mistake was staying small and believing the medics in my service were dedicated professionals. My fault.

BVESBC--If you can't run with the big dogs stay on the porch. Res ispa loquitor.

Live long and prosper. (Anybody know how to say that in Latin?)

Spock

[scott33]

Live long and prosper. (Anybody know how to say that in Latin?)

Ago porro quod prospicio

[BEorP]

I'll be honest and admit that I did not read all of BVESBC's posts since it is frustrating to see one member ruining a good thread, but did he ever state him formal education?

[paramedicmike]

Spock:

You mentioned that the five who adhered to your study's protocol improved their success rates by 100%. What were their success rates pre and post study? And was that improvement based on non-lab, real-life intubations?

How would it work if you offered an incentive for those who agree to participate yet fail to follow the guidelines? I suppose buying participation could be questionable. But if colleges/universities can compensate for study participation why couldn't you? (Or you could just threaten to remove their ability to intubate in the field for failing to live up to their end of the bargain;) ).

Sounds interesting.

-be safe

[Ridryder 911]

I have to admit I had not participated because majority of EMT's do not understand or truly want EMS research. As I had assumed, that it was of course based upon "let's do more skills" instead of really performing scientific studies.

Instead of attempting to do empirical studies, and "justifying" procedures such as ALS in the field I hypothesize that we turn the table around and view it at another angle. If we stop the BS of defining ALS and BLS crap, and actually determine that we should deliver medical care (medical care as it should be defined as being able deliver the minimum of ALS) to patients.

It is well developed patients that need emergency care, need it immediately and by those that are educated in delivering it. Now, let's again turn the view that maybe we should have to justify why the so called "BLS EMS providers" even should be considered to justified to exist. That any care delivered by rescuers should be at the minimum of what is now considered ALS, anything less than that would be negligent in delivery.

Maybe the author of the original post should start some qualitative and quantitative studies (since they proclaim to be highly educated). Maybe the studies should emphasize why anyone with lesser education should be able to even be able to deliver care in an emergency scenario? Even, if those of such credentials; should be allowed to really be identified as a health care provider, since in reality, what "health care" do they really provide other than care that can be provided by the common layman with first aid? It is well known that even the common layman can assist in patient's medication, transport a patient safely, and if one wants to take an advanced first aid course and learn how to apply AED, splint and even administer CPR/oxygen if need be.

Again, maybe the emphasis should be reversed and the need to justify the so called "BLS" provider level. Again, we should have to be able to justify the care, provider level and even existence. Again, we know and realize people that truly need medical assistance may need medications, monitoring, possibility of aggressive treatments.

Since this is supposed to be "EMS Research" post; let us start at the first phase. Let us hypothesize that there is NO division of levels. There is really only one, and that one level can deliver the care needed and has the needed education, equipment and protocol advisement that is currently available in comparison to what we provide the substitute levels that are used today. As well, maybe another study could evaluate in lieu of all the money spent foolishly on so called BLS levels as a substitute for ALS , that money and time could be placed in public education to improve and deliver safe and appropriate "first aid "or BLS care. That responding parties, would always be able to deliver "medical care" instead of again nothing much more than was is already being delivered by the common layman already.

So again we want to discuss EMS studies, let's do so. Again, I am all in favor of evidence based studies and definitely those that follow scientific guidelines.

Alike most of the posts and posters, I doubt that I will see any further discussion from BLS providers wanting to really "study" anything. Again, all lip service and no real content.

R/r 911

[rock_shoes]

Or you could just threaten to remove their ability to intubate in the field for failing to live up to their end of the bargain

Restriction of licensure for failure to maintain competency? I like it.

[AnthonyM83]

Right on Spock. Good work for your efforts on that study.

BVESBC, you totally didn't have anything to say in reply to my or others' post...hmmm just like that last guy who came spouting stuff. Well, at least no posts are better than those posts.

[BVESBC]

Is someone proposing that every pt needs a min. level of care equal to that of ALS?

If there has been such a study where can I find the data?

I could only assume that any such study would show the opposite that of which I think has been proposed. Most Pt's I encounter don't need ALS. For the percentage that do we make every attempt to have that provided prior to arrival at a acute care facility. I am not proclaiming that any pt could or would not benefit from further assessment, but more so that more educated basics could provide better assessments along with appropriate interventions. Has anyone done any research on the cost of treating and transporting every Pt as a ALS Pt? I don't think that from a cost standpoint it would be justifiable. Lastly, I apologize for derailing the research topic and turning it in to a ALS-BLS skills debate.

I have found this data in our reporting system for this month.

62.23 % BLS transported (ALS never requested)

37.77 % ALS (requested at time of disp.)

11.2 % ALS treated and transported to destination.

These are the only stats our system tracks. So I could extrapolate that of the 37 % of ALS calls that we responded to they were either not available or were cancelled 26% of the time they were requested. We dont differentiate between not available and cancelled. This is from a urban area if someone else has similar or wildly diffrent stats I would like to see.

[Dustdevil]

Is someone proposing that every pt needs a min. level of care equal to that of ALS?

Yes.

• 1. Care includes assessment. Without an advanced education, you are not qualified nor capable of competently assessing what level of care your patient needs. Consequently, all emergency patients need a paramedic.

2. The public expects EMS to be capable of responding to the needs of the worst case scenario, not the lowest common denominator. Anybody who staffs their system based upon what minimum they can get by with on most patients is an idiot.

• Are you an idiot? I don't think so. You've had some intelligent things to say here in other threads. But you do appear to be a little slow on the uptake in matters that threaten your status as a basic provider.