Hospital settles for childs death, faults EMTParamedic

[VentMedic]

What levels of cert or licensure do resp therapists have? Is Resp therapist the basic like EMT and are there more levels of expertise out there? I know that some resp therapists that I've worked with just like emt's and medics I've worked who are not worth their weight in secretions suctioned from a ET tube. Are there levels of cert that resp therapists have?

Yes, and now we have the opportunity to weed the garden of those that were minimally trained "tech RTs" from the 1 year programs. The minimun entry is an Associates from an accredited college Respiratory or Cardiopulmonary program.

I got my Associates in RT after my Associates in EMS. At least I had the college A&P to transfer but it was still two more years. It was trully an excellent choice which enhanced my opportunities in EMS later for CCT and Flight. I would not have gotten the opportunities just in EMS to work in ICU, NICU and PICU with the complex patients and technologies.

http://www.broward.edu/respiratorycare/res...m/page8021.html

After that, when the hospitals were pushing for Bachelors educated RTs, I went to UCF in Orlando.

http://www.catalog.sdes.ucf.edu/UCFUGRDCatalog0809.pdf

(page 130)

Then, I needed a Masters to advance in the profession as well as to teach. So:

http://www.education.miami.edu/Program/Pro...p?Program_ID=16

This Masters solved the teaching issue, enhanced my respiratory knowledge and opportunities in research and provided practical information on maintaining the body to avoid injuries. Now there are Masters degrees in Respiratory but teaching future generations is the focus now for growth.

I will not teach in a Paramedic program unless they require college level A&P. Without it, too much time is wasted trying to explain simple concepts that should already have been learned before getting to the "ALS" stuff. Of course, many instructors teach only what is to be memorized in the book.

Respiratory Therapy has two credentials for national certification by exam from the National Board for Respiratory Care (NBRC). They are Certificied Respiratory Therapist (CRT) and Registered Respiratory Thereapist (RRT).

www.nbrc.org

There are also specialty certifications through the NBRC that gives credibility and may be required in some states to work in those areas.

Neonatal Pediatric Specalist

Certified Pulmonary Function Technologist

Registered Pulmonary Function Technologist

RTs have a strong national organization that represents them in all levels of legislation.

http://www.aarc.org/

Each state has its affiliate organization to the national.

http://www.aarc.org/links/links_affiliates.asp

BTW, I retire from EMS with my vested 20 in November. That gives me 30 total.

[Just Plain Ruff]

It's amazing what you learn here. Thanks Vent

So what do you think would happen to EMS if he went the route that Vent just showed us. What would the ramifications be to our profession if we were as structured as RT seems to be with all the requirements?

[VentMedic]

When the college programs started in the late 1970s, that was the intended route. That is how I and a few others on this forum got a 2 year degree for Paramedic 30 years ago. Unfortunately, since it was a "skill" and "recipe" focused profession, it was cheaper and easier to do it the medic mill route. Some actually thought if the Paramedic did too much "thinking" on scene it could delay transport. You can't imagine all the excuses I've heard over the years from people avoiding "education".

[JakeEMTP]

So what do you think would happen to EMS if he went the route that Vent just showed us. What would the ramifications be to our profession if we were as structured as RT seems to be with all the requirements?

Onwards and upwards! Perhaps even EMS separating from Fire due to the "new"educational requirements (IAFF would have a stroke!). Current certification medics would have to take a "bridge" programme to a AAS Degree in order to continue to function.

I for one would be all for it. Paramedic would be the minimum provider on an ambulance much like our friends in the frozen tundra called Canada .

We can only dream. I am a firm believer that an AAS degree should be the minimum requirement for Pre-hospital care. This is one dream I'd like to see come true.

[ECC]

At many hospitals I have seen LVN's triage. I am confident that most Paramedics would be more qualified to perform an accurate triage than an LVN. Between an RN and a paramedic in some ways I would still say the education of a paramedic is geared more towards an accurate triage than the much better educated RN. Now an experienced ER RN would probably beat the pants off a paramedic but odds are they would be in back doing patient care rather than triage. Is my ideas clear as mud?

Are you kidding me?

BSRN...mebbe...An Rn with an Associates? not likely.

[medic2005]

As an EMT who worked in the ER and did triage as a basic, this is likely to happen more often.

It is called TRIAGE for a reason, you assess how the patient is at the time they enter, and move them to a room in the order of priority thus using field skills the same TRIAGE.

I used to second guess my skills and ask my nurse to go see a patient, I think that it is more likely that EMT's and other non nurses will be doing triage in the future as the nursing shortages get worse and as more people keep using ER's as a doctors office.

I doubt that anything could have been done to save this child, as stated, the doctor 2 days prior goofed, but that is what General practice and pediatricians do, they goof a few days earlier then the child comes to the ER, the ER doctor calls the GP or Pediatrician, who says yeah go ahead and send them to the Children's Hospital let them deal with it. Doctors cannot deal with their own patients, so they are rushing through them to get dough and keep hours short.

I heard the other day on the news if you paid like $3500/year in Florida, you got a doctor who had cut their patient list, and you were a VIP, you got the doctors cell phone number and home phone number to call for issues, you got to sit down and tell your doctor about your problems instead of the in and out trip we all are accustomed to.. This system is only going downhill.

I think a paramedic or any EMS provider should be adequate at TRIAGE, and think it is great training for what could happen in the field.... Too many patients and not enough providers.

[ECC]

In the majority of states, an RN is not allowed to delegate a responsibility such as triage. No arguement

If someone has to bring up a Paramedic with 18 years of broad experience to compare with a 1 year RN, then I am not the only one that thinks highly of RNs. None here either

The other factors to consider, why would a Paramedic of 18 years want to work in an ED? Burnt out or injury? Does it matter?

What was the Paramedic's initial education? 10 Months Full time (40 Hours a week) NYC EMS Academy Class 90-02 Then 2 AASs on top of that

How much effort was put into continuing education during those 18 years besides just the minimum to renew?Just as much as my AASRN Wife does :shock:

Define broad experience. Does that mean the paramedic has seen a few calls of peds, a few of geriatrics, a few belly aches and a few MIs? A few good war stories? A lot of attitude for "BS calls"? 5 years on a truck that ran 30 runs/24 hours...11,500 runs a year. ~ 3K for me

I'd be all for an 18 year experienced, educated and enthuiastic Paramedic to do triage. But, what about all the new Paramedics who might want to do the same job because they decided they didn't like the street? The job description would probably just read "EMT-P cert, some experience preferred". No arguement here

The new RN may have done 6 months med-surg and 6 months ICU. Both of which involves more education, training and lots of patient contact for 12 hours per shift. The RN could see almost as many patients in that time as an 18 year Paramedic who sees 1 - 2 patients per shift, 2 shifts per week. See the numbers above...your example is not well rounded...by any yardstick applied

The Paramedic is expected to do assessments after just 700 hours or about 6 months of technical training. What is so absurd about an RN with a 2 year college degree that includes 2 semesters of A&P, Pathophysiology and Microbiology with all these courses reinforced through 2 years of the nursing processes courses as well as the 1200 plus clinical hours.6 months is not enough to teach a monkey to intubate...these courses are getting shorter and shorter...and not necessarily better either.

It is this arrogance that always manages to show itself at the regional EMS meetings when the topic of education is presented. So many think that their 6 months of education makes them the same as RNs and continuously try to compare themselfves to other professions. So, instead of establishing our own identity the Paramedics make the case for "don't need no more book learnin'". I am not the same, and I do not want their job. But I am as well educated, and resent that there are plenty out there like me, but we always revert to the lowest common denominator

I defend Paramedics on a lot of things both inside and out of the hospital. However, I will not defend or stand for the belief that 6 months of training is sufficient to state that the Paramedic is prepared to take on more responsibilities than for PreHospital at this time. Any half-way decent attorney could take just the few questions I presented at the top of this post and make a case.

EMS has not broaden its education and it has become too blind to see the rest of the healthcare professions expand their knowledge and scopes.

Now Ruffems:

I know you didn't mean that...at least not the Respiratory Therapist part.

BTW, it hasn't been all roses for 30 years between RNs and RRTs either. However, when the RRTs got out of their "tech" status by achieving an Associates minimum for entry, Bachelors for some of the reimbursement Bills and minimum for some job descriptions with more Masters degrees in the professions, RNs took notes. They saw we were more than someone who just intubated, set up vents and put in A-lines when one was needed. We now had an education to compliment the technical skills.

I am only pre-emptively answering what I am sure is going to be directed at me for my previous remark

[Just Plain Ruff]

Forgive me but letting an emt do triage is similar to letting a 5 year old change your Electric breaker box. Sorry if this offends the emt's out there but really, you think that you can triage someone with 110 hours of emt class. That is absurd.

I am more comfortable letting a paramedic do triage(not because that was my favorite parts of the job at the ER I worked at and I did the triage) because at least in medic school you learn additional medical stuff (I know bad wording but the right words did not come to me during the typeing)

An RN is the absolute logical choice but paramedics could do in a pinch but triage to me is not the same as triage in the EMS world. Triage in the EMS world is triaging more than one patient into priority to be treated and transported and how many units and helicopters you need.

The minimum for triage in the ER should be a paramedic but ideally an RN is best. You also have to look at the hospital by-laws and see what exactly the EMT can do. Most hospitals that I know of and I've seen all the ER's in the KC area, most of all the ER's in the mid-missouri area and not one has EMT's as their triage nurses. I've worked with ER's to computerize them all over the country from Colorado (level 1 trauma center), New York City (level 1 trauma center), Detroit Michigan, Dubuque Iowa, Sioux city Iowa, Baltimore maryland(shock trauma and Mt. Sinai), Olathe kansas, Springfield Mass, Mayo Clinic In Jacksonville, St. Vincent's in jacksonville, St lukes in Jacksonville, St. Josephs, Patterson NJ, Jackson Health System, miami Florida, Butler MO, Nevada Mo and many others.

All those listed do not have emt's at triage. Maybe EMT's at triage for vitals and the like but never doing the triaging. All these above hospitals cannot be wrong.

Sorry, not

[ECC]

PS...Medics should not Triage in the ED if RNs are available...along the lines of why I do not want RNs out in the field. Our jobs are different. If they were not, RNs would have been staffing ambulances from the begining.

[JakeEMTP]

As an EMT who worked in the ER and did triage as a basic, this is likely to happen more often.

Wait, what?

I used to second guess my skills and ask my nurse to go see a patient, I think that it is more likely that EMT's and other non nurses will be doing triage in the future as the nursing shortages get worse and as more people keep using ER's as a doctors office.

If you have to have a nurse check behind you, maybe they should be doing the triage in the first place. Triage is a very important cog in the ED wheel. It is no place for inexperienced EMT's to be deciding which priority a patient is to be seen. The hospital we frequent has experienced ED RN's doing triage. Sure they're short staffed in the back like everywhere else. However, the importance of triage is paramount.

I doubt that anything could have been done to save this child, as stated, the doctor 2 days prior goofed, but that is what General practice and pediatricians do, they goof a few days earlier then the child comes to the ER, the ER doctor calls the GP or Pediatrician, who says yeah go ahead and send them to the Children's Hospital let them deal with it. Doctors cannot deal with their own patients, so they are rushing through them to get dough and keep hours short.

And you know this because you had a 120 hrs of advanced first aid?

I think a paramedic or any EMS provider should be adequate at TRIAGE, and think it is great training for what could happen in the field.

Say it's not so. Triage is no place to train.