Which is better? Hospital based or College Paramedic Courses

[CTXMEDIC]

What you will learn and do as a basic will not prove any real benefit and actually lead to you harming patients." so you didn't say what you learn as a basic will not prove any real benefit? i got the above from your statement. and you still have not explained how i as an emt b can harm a pt. unless of course i drop them

Sorry for posting this again. Im going to archive this so the next time a basic whines about doing dialysis runs, i can repost this. I really dont know what else to say, Im actually speechless. :shock:

[VentMedic]

If the sole criteria for necessity is:

"Bed Confined: All three must be met before a patient is bed confined,

however bed confinement is not the sole determinant of medical

necessity.

i. The beneficiary is unable to get up from bed without assistance;

and

ii. The beneficiary is unable to ambulate; and

iii. The beneficiary is unable to sit in a chair, or a wheelchair"

Then they don't need an ambulance. They need a stretcher van with two strong backs.

Some do require additional medical needs documentation.

Dialysis the procedure is NOT the only thing that must be considered. What caused the dialysis may be of some importance also. Too many EMT(P)s, due to inadequate education or whatever, just view dialysis itself as a "disease". If the patient had a hx of many MIs, some type of transplant or hx of cardiac arrests, the physcians might feel the patient need a little extra observation when traveling to and from dialysis. Both to and from are critical times for some dialysis patients. Obviously some in the ambulance services view these patients as "BS" and unworthy of an EMT's time. Yet, very few even know that much about the patient's past history to make an honest judgement or to make an accusation of fraud against the patient and doctor.

Again, ambulances are used for a very small percentage of the total dialysis patients a center sees each day.

[tamaith]

I am speechless too because how do you figure i am whining about my job or doing dialysis runs. I love my job.

[Dustdevil]

I am speechless too because how do you figure i am whining about my job or doing dialysis runs. I love my job.

I am speechless three because how do you figure he said you were whining about your job or doing dialysis runs. I have no job.

[JPINFV]

Some do require additional medical needs documentation.

If additional medical monitoring is needed, then the patient meets criteria besides being bed bound. That said, how many patients that need monitoring are coming/going from their private residence? I find it kind of hard to argue that a patient is more unstable right before/after dialysis if the patient is coming from their own residence. I harbor no illusions that a patient is significantly more or less stable after a 5-10 minute ambulance ride than before.

[tamaith]

dust, ctx quoted me and then said the next time a basic whines... therefor i took that as ctx saying that i whine thats how i figured.

[CBEMT]

That said, how many patients that need monitoring are coming/going from their private residence? I find it kind of hard to argue that a patient is more unstable right before/after dialysis if the patient is coming from their own residence. I harbor no illusions that a patient is significantly more or less stable after a 5-10 minute ambulance ride than before.

I tried that argument about 2 years ago and got nowhere with it. Apparently the thousands, if not tens of thousands, of paramedicless dialysis transports made every day without anyone dying are just aberrations. :roll:

[VentMedic]

I tried that argument about 2 years ago and got nowhere with it. Apparently the thousands, if not tens of thousands, of paramedicless dialysis transports made every day without anyone dying are just aberrations. :roll:

How do you know the patient doesn't die? Do you follow ALL the patients that get dialysis every day at a busy center? Our center opens at 0500 and closes at 0030. It can seat 30 patients at a time and that is considered only a moderate sized center. We also have 5 RNs that stay busy doing bedside dialysis in the hospital. That is besides the CVVH we do in the ICUs. There are days when we work more codes have more Rapid Response Team calls or work more codes in the Dialysis center than we do in the ED or SNF.

Some patients start out from their residence and get diverted to the nearest ED before reaching the dialysis center. This is done either by the BLS ambulance or transport van with a driver. The patient may be stabilized and if that hospital does not have dialysis, a Paramedic or CCT truck may take the patient on to a dialysis center, ussually hospital based, that is capable of monitoring. I have taken many dialysis patients to a monitored center on CPAP/BiPAP via the LTV 1000.

Patients usually get dialysis 3x/week. Occasionally if there is a holiday or even over their 2 day stretch, some patients have a difficult time making it through. If a patient is bed bound at home or in a LTC facility, a care provider may call 911 when it doesn't look like the patient will last until their dialysis transport and the BLS truck will have one less routine transport. If the person is fairly independent, they may try to make it to dialysis because they don't want to be a bother by calling 911. Too bad your messages about not calling 911 makes it to the people who don't want to be a bother but need 911 the most.

What is more unfortunate is when the BLS EMTs pull up to a dialysis center with a dead patient that they thought was just "sleeping". This happens more times with the BLS ambulance and 2 EMTs than it does with the van drivers who bring several patients to the ED before they crash. The van drivers seem to recognize something isn't right even though they are driving while the BLS truck has an EMT who is looking (supposedly) right at the patient. What is also interesting is the recorded BP which is almost always 120/80 with a HR of 80. However, when asked what arm they took the BP from, they stumble because they can't remember which arm has the fistula or shunt.

Yes, I know, every healthcare professional can screw up. But, how hard is it to watch JUST ONE PATIENT?

I rant a lot about dialysis patients but that patient is probably where the most mistakes are made by EMS providers because they don't understand the causes and complications of dialysis as well as the "BS" stigma around the call makes some just too lax and careless in their assessment of the patient if they even bother to do one.

[Arkymedic]

Here in Arkansas all a Basic can do is drive. During EMT school EVOC is not taught and that is basically all they are allowed to do to other than assisting an Intermediate or Medic. As assbackward as this state is, almost all of it is covered with ALS. In OK a Basic can work with a NR 1st Responder and be the lead, or work with an Intermediate or Medic assisting. Truthfully during that year of waiting, what all have you learned driving that will continue over to medic school? I am not discounting Basics, but I would rather see ALS Medic/Medic. I also commend anyone that can work EMS and go to school because I could not. I worked my ass off with 4 part time jobs to make ends meet and to pay the bills to make my goal come true. I also wanted it bad enough to drive 60+ miles 3 days a week and over 100+ miles one way for the majority of most of school for my clinicals. It is very possible and you just have to want it bad enough to do whatever it takes to make it happen.

i was under the impression that in medic school they don't go over anything you've learned in basic school. so what the first couple of days is a review or something?er

and jpifnv if you go back to what was said by spenec " learning the basics has no real benifit " and go to what you said learning how to use a stretcher should take no more than 4 pt.s aren't you learning the basics if physicians and rn's know how to give an oral report or use o2 thats because the learned the basics or were they born with that knowledge. im still confused on how i can hurt the pt if i follow protocol. i think if you don't know the basics yes you can hurt the pt. the person who had the question in the beging is going to do what they feel like regardless of what anyone on here says they should trust their gut. and what about tuition? some places charge 10,000 or 25000 depending on where you are? as said before yes you can work while in school but the ones i know that work while in school can only work maybe 2 days the rest of the time they are studing or doing clincal. you cant survive by just working 2 days/ wk. loans? what if you get denied? or just don't want a loan? again this is just how i feel my OPINION . i rather work in the field for a year make sure this is what i want to do for the rest of my life than pay 25,000 and then decide i hate this type of work.

[Arkymedic]

I would honestly say that most Basics do. I did wait a few years but looking back I do not know what I really gained. Sure I had a bunch of good calls, had stories, did CPR on numerous codes, but what did I really take from that? I did pay attention to my partner and asked a million questions. I eventually got frustrated and realized as a basic that I did not do shit for my patient and felt helpless in my role. Had I realized it earlier it probably would have helped more than my time as a basic did. What amazes me is the # of basics and students coming out of school that have not been taught ALS "assist" skills like spiking an IV bag, placing electrodes for the monitor, etc.

Hopefully you would have been paying attention to your medic and learned non-emt skills such as lead positions for the monitor, setting up IV equipment, why we draw blood, what 'x' drug does and when is it required, how to operate IV pumps/monitors, signs when someone is actually 'sick', how to do a patient assessment beyond "Does that hurt?" and most importantly, how to TALK to your patients. and yeah, you learn all this in medic school but you could have had a head start if you paid attention.

It seems to me like you wasted your time as a basic.