Nebraska Mother Sues EMT, County over Death

[Bullets]

Sorry i clearly intruded on something that i cant possibly wrap my mind around. I didnt realize that this place was for "serious" EMS personell only or that only Medics were allowed.

I know enough about NJ to know there is a shortage of medics in the state, and that they have a hard enough time retaining them before they move on to RN or PA jobs as it stands right now. I also know that despite having some of the highest taxes in the country, we are still going to have budget shortfall again and the government may actually SHUT DOWN because we literally do not have the money to operate. There is no money to pay to staff full time ALS service in NJ. Taxes are going up this year again both in the state and municipal governments and that's just to cover the cost of doing business without any sort of budget increase from last year. I know about the financial situation we are in here. We have six ALS unit to cover 53 towns in just ONE county of 665 sq Miles and its a similar situation in the other 20 which can be even larger. We have the highest taxes, so we should raise them more?

Whats wrong with volunteer service? With proper training why cant they be effective and usefull?

Not every call is an ALS call, in fact id say most arent. You seems to have worlds of experiance, howe many calls really need all those drugs and interventions? Most squads are looking at 5-10 minute transport times to the closest hosptial, maybe a little longer for serious trauma, ALS care in unnessecary when your call time is 20 minutes from dispatch to OOS. I dont understand this vehemence towards volunteer First Aid Squads.

I also dont understand how a.) I am "unprofessional" or have a "Lack of Knowledge" or might "get hurt" and B.) how you could be able to tell based on an anonymous online post.

[Dustdevil]

Sorry i clearly intruded on something that i cant possibly wrap my mind around. I didnt realize that this place was for "serious" EMS personell only or that only Medics were allowed.

Situational awareness. What a concept.

I know enough about NJ to know there is a shortage of medics in the state..

Ever spent a few minutes thinking past the end of your nose to figure out why that is? Few jobs and low pay, you say? Again, ever wonder why that is? Look no further than the FAC to find your answer. THAT answers your next question about "what's wrong with volunteer service". Volunteers are the reason why there are no paramedic jobs, resulting in few people choosing to go to paramedic school. And volunteers giving their services away for free to communities that can damn well afford it is the reason that your citizens don't think that EMS is worth paying for. After all, if those doing it don't think they are worth being paid, then we certainly can't expect citizens to think differently, can we. And all just so you can have a hobby. Nice.

I also know that despite having some of the highest taxes in the country, we are still going to have budget shortfall again and the government may actually SHUT DOWN because we literally do not have the money to operate. There is no money to pay to staff full time ALS service in NJ. Taxes are going up this year again both in the state and municipal governments and that's just to cover the cost of doing business without any sort of budget increase from last year. I know about the financial situation we are in here. We have six ALS unit to cover 53 towns in just ONE county of 665 sq Miles and its a similar situation in the other 20 which can be even larger. We have the highest taxes, so we should raise them more?

Nonsense. You don't have to raise taxes. You have to stop spending money on all that bullshyte that is less important than EMS. That's all. It's that simple. I realise that living within your budget is a foreign concept these days, especially north of the Mason-Dixon, but it works. What other governmental function or healthcare service do you see relying strictly on volunteers? School teachers? Bus drivers? Police dispatchers? The street department? The water department? The janitors at city hall? Trash collectors? Guys who mow the laws in the parks and other city properties? How is it that they pay all those people if there is no money? If you think that they would not quickly find the money to pay paramedics if all the volunteers disappeared tomorrow, you are delusionally naive.

Not every call is an ALS call, in fact id say most arent. You seems to have worlds of experiance, howe many calls really need all those drugs and interventions?

Doesn't matter. If they don't need ALS, what are we taking them to the hospital for? Because, in order to determine what they need, it takes a competent advanced assessment, which an EMT is incapable of performing. And if an EMT determines that the patient needs ALS, at that point, it's too late. You might as well get on the road to the hospital. And aren't those worst case, EMERGENCY patients exactly what EMERGENCY Medical Services is supposed to be about? If all you are doing is driving people to the hospital, incapable of rendering the medical care they need to deal with a true emergency, aren't you lying to your citizens by calling yourself EMS?

Most squads are looking at 5-10 minute transport times to the closest hosptial, maybe a little longer for serious trauma, ALS care in unnessecary when your call time is 20 minutes from dispatch to OOS.

What do you really know about ALS medicine?

I dont understand this vehemence towards volunteer First Aid Squads.

Well, careful reading of this response should start you on the road to enlightenment, but only of you are open minded enough to dare to hear anything that conflicts with your hobby. We don't see that much in NJ.

I also dont understand how a.) I am "unprofessional" or have a "Lack of Knowledge" or might "get hurt" and B.) how you could be able to tell based on an anonymous online post.

Again, you should have a better understanding now. But the bottom line is that, if you are denying your community full-time, advanced, professional medical care and transportation simply because you want an exciting hobby when you're not off doing your real job, that pretty well defines unprofessionalism. And if you think that is really a good idea, then that epitomises a "Lack of Knowledge".

There is a big world outside of your little state, where many communities, and even entire states have managed to make professional ALS EMS work with far less money than your state blows on their fancy volunteer meeting halls. There is no reason that NJ can't either, except for the people there lacking the commitment, imagination, and intelligence to do so. But I suspect that NJ will be the last state in the nation to ever pull out of the 1970s.

[Bullets]

It seems the issue lies with EMT-B just not having the training to handle a medical emergency. So should we just get rid of the EMT-B cert all together? Do you think they just dont have a role in the prehospital stage of care anymore? What about specific rescue based squad, should they all be paramedics? These are serious questions, not me trying to be sarcastic or anything.

And i think most people are realizing the insanity of the FAC and with the EMS task force its a step in the right direction.

Right now there just isnt an incentive in NJ to be a paramedic for any period of time. Unless your attached to a Swat or ERT team or a Water/Extrication Rescue Truck and even then its still a "hobby" or a 2nd job even if it is paid.

Would it be worth bring back the EMT-I or just eliminate everything below P and have the whole country be P only?

[Dustdevil]

It seems the issue lies with EMT-B just not having the training to handle a medical emergency.

That is the unfortunate truth, and it only gets worse every time they try to improve it. Every time they decide to hand another "skill" to EMTs, they fail to increase the hours for the course to compensate for the added curriculum. What happens is that the EMT curriculum has become so watered down in the last twenty years that they are learning nothing but "skills", no longer receiving the theoretical foundation that they used to. And even the old foundation was extremely weak. You simply can't teach anything more than simple first aid skills in a class that lasts only 120 hours.

So should we just get rid of the EMT-B cert all together? Do you think they just dont have a role in the prehospital stage of care anymore?

We will always need first responders, and that is the ideal role for the EMT, so no, there is no reason to get rid of them. They simply have no business on an emergency ambulance.

What about specific rescue based squad, should they all be paramedics? These are serious questions, not me trying to be sarcastic or anything.

And I sincerely appreciate your commitment to serious and intelligent discussion! I'm just afraid I don't understand your question there. I don't know what a "specific rescue based squad" is. Do you mean a non-transporting, first responder only type of organisation? Or do you mean an organisation that does only ambulance service, without fire affiliation? Or do you mean "rescue" as in technical rescue (SAR, extrication, etc...) without a primary medical responsibility?

And i think most people are realizing the insanity of the FAC and with the EMS task force its a step in the right direction.

I dunno, man. We all read the state's report on the state of EMS in NJ, as well as their recommendations, and it doesn't appear to me that they are going to accomplish anything other than spending money on more studies and bureaucrats. And the FAC would fight them strongly at every attempt anyhow. Nothing is going to happen there in my lifetime.

Right now there just isnt an incentive in NJ to be a paramedic for any period of time.

Sure. But again, that could very easily be changed if there was a single politician with the guts to tell the FAC to F-off. But again, despite all their BS about wanting to help their community, none of those guys want to give up their blue light hobby to help make things better. If they did, they could begin to establish that incentive. But as long as they continue to selfishly tell the community that they don't need paramedics, and that EMS is not worth paying for, it'll never happen. And that is the number one reason why those communities don't have it.

Would it be worth bring back the EMT-I or just eliminate everything below P and have the whole country be P only?

The Intermediate level outlived any usefulness it had over two decades ago, when we realised that we shouldn't be playing on scene with trauma victims. They are given "skills" without the requisite theoretical education to make them useful as anything more than paramedic helpers. And most professional and well educated medics don't want a helper. They want a partner. Anything less than a full paramedic is less than a partner. The intermediate lacks the education or sophistication to perform a competent ALS assessment, and lack the ability to provide the interventions needed even if they could make such an assessment, so really, they serve no useful purpose. The worst part of the EMT-I concept is that it prevents the advancement of EMS education by maintaining a piece-mail approach to education that seriously diminishes the effectiveness of the educational process. The practice of medicine is not just a collection of skills to be memorised and practised by some cookbook formula. No other medical profession operates that way, and with good reason. It doesn't work. The competent practice of medicine requires an education that progresses in a linear fashion, first establishing a solid theoretical foundation, and then building upon that foundation with progressively advancing concepts. The EMT-I concept does not utilise this process, and results in practitioners that are poorly trained, and ill equipped to perform the function they were intended to perform, which again has already been proven to be un-needed in the first place.

Revamp the EMT program to focus solely on preparing competent first responders, eliminating all the ambulance specific curriculum and replacing it with better assessment and treatment skills training. Separate the EMT-B completely from the Paramedic educational process, eliminating it as a prerequisite for paramedic school, and allowing paramedics to be educated properly from the very beginning, instead of trying to transform them from EMT's, which wastes a great deal of time in paramedic school. One of the few things that I believe that NJ has gotten half right is their separation of paramedics from the fire departments and rescue squads. It prevents a tonne of medic patch factories from popping up and rushing guys through in 10 weeks just so they can get on a fire department hiring list, when really they have no desire to be a paramedic in the first place. This prevents a glut of medics, which would bring wages even further down, prevents fire departments from taking over more EMS systems, and keeps medics under a greater degree of integration into the medical community through the hospitals. So, while it is obvious that the hospital-based directive is not serving NJ well, and should be changed, there are good points to that system that should be maintained. And keeping EMTs and Paramedics separate as industries is one of those good points. If you want to be a paramedic, go to paramedic school. If you want to be a first responder or non-emergency ambulance driver, go to EMT school. But they should be completely different choices and career paths, with no reliance upon each other. While I believe in advanced specialities and degrees of education, basically I believe in only one licence level for 911 ambulance providers, and that is paramedic.

Edited March 16, 2009 by Dustdevil