Remove 12 Lead from ambulances ???????

[Ridryder 911]

I guess it always goes back to the education or lack of. Until we have really met the needs of the basic education we should not expect anything but ambulance driver pay and really should not do anything more than that.

If I was Medicare or Insurance payer, I would look into detail why I am paying several hundred dollars to a few thousand for a glorified taxi ride. Seriously, just placing oxygen and a set of vital signs on someone, justifies such a bill?

I know we have soap boxed this to death, but until we quit trying to live inside the box we will never increase revenue, and never pay what salaries should be. Then the vicious circle is we have to have the required education to accompany it.

In regards to checking internal ear, yes I do educate Paramedics the use of the otoscope and opthamaloscope as well. Yes, they are taught to check for bulging, detached ear drums, redness, etc.. The same as in the use of opthamaloscope use to evaluate retinal artery, etc... Is it always appropriate to perform and need to perform? No. Is there a time and place? Yes.

Again it is dependent upon how well you what your Paramedics to be educated.

[crotchitymedic1986]

I would also challenge the "leaders" in our company, which is not always the people with brass on their collars. Look around in the morning, the employee that has everyone gathered around him/her is a leader --- they may be a negative leader who is undermining the company, but they are a leader. TOo often, the bar is set too low, with the only expectation being "lets get through today's call volume". If the brassed and nonbrassed LEADERS set a higher expectation, most employees will rise to it. If you set a low expectation, they will settle to that as well.

[VentMedic]

Times are changing.

Unfortunately EMS is changing differently than other medical professions and facilities. It is reverting back to the "Public Service" mentality rather than advancing as medicine. EMS is the only medical profession that has managed to maintain or decrease its standards for job entry and patient care. What initially started out to be a two year degree program in the 1970s is now measured merely by a few hours of training. The skills that made us proud to be extensions of the physicians in the field have now been watered down by lack of education and adequate training.

While the 12-lead may have been the standard for some Paramedics for over 20 years, it is not heard of for many. Those that do attempt to incorporate it do so haphazardly (ex. LA county) with bad results and frustrated hospitals.

If Paramedics did have some of the very essential basics in physiology, the 12-lead would be little problem to introduce with some proficiency for interpretation in a timely manner.

Many services are abandoning ETI for alternative airways that require less education and hours in a lab or OR to perfect. Too many have so little of the fundamentals that it makes something like CPAP a struggle to initiate in some services. We could also use the ETCO2 monitor as an example. Too few understand it and just use it for the pretty wave forms to "check a tube".

So, maybe this profession should rethink itself if it continues the path it is taking with medic mills and FDs training their own again in minimal time for just the bare minimums required and states are not agreeing on any one or two levels. The profession as a whole has failed to police itself and thus has allowed this to happen. It has failed to monitor the very essentials that made this profession unique and now having taken the easier route. A person with as few hours of training as many Paramedics in this country would not even be allowed much patient care responsibilty in most hospital settings where education, knowledge and competency are expected.

If this profession continues to turn back to the "public safety" days, maybe it should streamline and accept the fact that many areas will not ever be able to increase their standards, knowledge or skills because to the mentality that exists. As long as the insurances continue to pay for an ambulance ride regardless of quality, there will be little incentive to improve. As long as tax payers are footing the bill for the FDs to provide EMS without the ability to hold them accountable for their medical knowledge and expertise with immunity statutes or tying the hands of medical directors, there will be little progression. Thus, as long as we have people providing this service who have no ambition to be medical professionals doing a few "ALS" skills and merely wanting a paycheck knowing they cannot be fired with union protection, this profession will continue to fall to the lowest denominator in the eyes of the government, insurances and tax payers.

Unfortunately, the hospitals will continue to bear the brunt of the responsibility because the path EMS is choosing will be of little help. Those EMS systems that have raised their standards should be applauded because they did so with little help from their own profession. They will also struggle to continue even if their system works because someone will always want to break what isn't broken just to get by with the expectations of the lowest denominators.

[Ridryder 911]

Unfortunately, you are correct many (even educators) are promoting Fire Service. Why? Well, they fill the classrooms with paying bodies. Then again, what in the hell is EMS Administrators doing?

Then the viscous old "not enough education" pops it ugly head up again. This time in EMS Administration level. Shameful, that even Fire Service may even have us beat on this one too. How many EMS Administrators actually have formal training other than being a medic prior to promotion in Health Care Administration? What does American Ambulance Association (AAA) promote other than either large corporate philosophy?

How shameful, that there is not a real type of accountability in EMS. As much as a Nurse Manager, I loathe JCAHO but at least it has made some advances in hospital regulations. Yes, we have one in EMS but it is a joke as well as most State EMS Councils and Divisions.

EMS will never go far for a couple of reasons only. Medics will take the easy way out and never give the support needed.

They even blew their own wad when adjusting Medicare rates in comparison to air EMS. How embarrassing. Medicare would had adjusted rates accordingly but the administrators groups could not justify net raise in rates and distribution. Why? Number of potential qualified applicants versus pay structure and costs off-sets. Where as aeromedical could state: "We have to have this $$ much for this qualified applicant".. and Medicare said ... Okay, name the minimal price.

So ground EMS is suffering for our boss's mistakes. Meanwhile don't provide more intense care cause it will costs more to offer, don't become more educated- you will want a raise, let's promote Paramedic mills and flood the market.. You know the supply and demand issue..

[crotchitymedic1986]

Let me play devils advocate ---- we have been bitchin about education for as long as i can remember, and it hasnt improved. Conversely, in my humble opinion, just about every major improvement that has occured in EMS has been an intoduction of a new technology or has been driven by a new technology. The discussion of the ability or inability to read 12 lead, were it not for 12 leads making their way into ambulances. I am not sure if succesful field intubations percentatges are worse or better than they were 15 years ago (depending on what you read), but pulse oxs, followed by portable vents, and then capnography, and RSI have pushed the issue further than education has. Not to mention pacing, glucometers, computers, and iv pumps.

[VentMedic]

Let me play devils advocate ---- we have been bitchin about education for as long as i can remember, and it hasnt improved. Conversely, in my humble opinion, just about every major improvement that has occured in EMS has been an intoduction of a new technology or has been driven by a new technology.

****************************

but pulse oxs, followed by portable vents, and then capnography, and RSI have pushed the issue further than education has. Not to mention pacing, glucometers, computers, and iv pumps.

More technology does not necessarily equate to more education. Even the pulse oximeter is poorly understood and misused by some as a crutch to replace inadequate physical assessment. Many use devices such as the ETCO2 for only one purpose such as confirming a tube but often the education stops there. The 12-lead can have a computerized print out for the interpretation which has been the down side of it. We've already seen many of the misadventures of RSI as well the benefits. Ventilators vary from ATVs to some really sophisticated machines. However, without adequate education, even the most expensive machine is little more than an ATV and can cause just as much if not more harm to the patient in the hands of poorly educated and trained.

On the forums that have so called advanced providers of Critical Care transport and Flight, you will still find people asking very basic questions that should have been answered in a classroom long before they touched a patient with advanced procedures. Or, they still want a recipe for some devices or shortcuts to critical care protocols. Others still ask for memorization tricks for complex protocols or procedures that are best learned through education. Some are clueless as to the differences in the technology to even know why or why not it is appropriate for different patients. Many companies get talked into too much or too little technology for their service due to inadequate preparation through education. You could compare it to shopping for an expensive high performance car. If you don't do your homework, you could still end up with a Yugo.

[jbanagas]

Again, 12-Leads = BIG racks.

[spenac]

Again, 12-Leads = BIG racks.

I hope someone recognizes your name and turns it over to the girls that filed on you. Your unprofessional attitude is really not something to be proud of or to flaunt.

[UMSTUDENT]

When I started my current job I began with three other people from my university with Bachelor's Degrees in EMS, specifically paramedic science. On the night of our graduation from the fire-monkey academy the division director stood up and said that he "couldn't remember" the last time "so many well-qualified, well-educated individuals" had graced their service. He got a lot of jealous stares...

Since I began, it hasn't been uncommon for the four of us to meet up at local hospitals bringing in patients. We hear tons of complaining and whining. "Here comes to cocky college sh*ts." The degradation that has followed us has been appalling. What's interesting though is how some people, not many, but some have started coming to us and asked us about our education. They've seen us do something in the field, or they've just been interested. They talk for a bit, maybe balk at the idea in the end, but nevertheless they are interested. I've heard more talk about "going back to school" in the last couple weeks than I've ever heard at any other gig.

The fact of the matter is that education is scary for people who lack it. The idea of a younger, more qualified, more capable provider makes them...well...obsolete. In some cases people see the shortfalls in their own understanding of things. How is it that some "kid" in his twenties knew to do that?

If you offer the classes people will adjust. More importantly, a degree never expires. It always follows you.

[jbanagas]

I hope someone recognizes your name and turns it over to the girls that filed on you. Your unprofessional attitude is really not something to be proud of or to flaunt.

If you can't have fun with this job, what's the point