The Day EMS Died ..........................

[celticcare]

Ok, I'll throw in my little bit as an RN working in CCU. We have standard protocols that we use, we can intubate, medicate, defibrillate and cannulate without a doctor being present. We have protocols that we can chart meds if we have patients that fit the criteria which we don't need a doctor there to do.

Those are great for us.... but I still am not impressed about them at my hospital, dumbing down our ACLS. Yes we cover alot of things in our time through in house training and every single RN is trained to insert an LMA, use an AED and the cardiac arrest drugs in the hospital, the front line stuff before we respond.

The hospital got tired of too many nurses and doctors and support staff and paramedics, failing ACLS, that they took out chunks of it and called it ECLS *extended cardiac life support* and then a year later, ACRC - Advanced Cardiac Resuscitaton Care*. in ECLS you only have to identify Vfib, Vtach, PEA, Asystole and NSR. those were your only rhythms, know the meds and how to manually defib. There is also an option for nurses to only do an AED module. Impressed HELL NO.

The ACRC course covers intubation, TCP, more meds and advanced protocols. ACLS is dumbed down too damn much. Yes I have a bachelors degree in science majoring in nursing but come on, we do the courses for a reason, to enhance the underlying knowledge in an applicable manner and expertise.

I don't take kindly to some RN bashing in this thread, we are health professionals too and some of us give the rest a bad name as do some EMS personel give the rest a bad name. It's down to showing ability.

I think ACLS is something that should be reviewed and brought to a 21st century standard, its too damn PC everyone can pass if they sing kumbiyah and hold hands. Oh and our ECLS and ACRC does'nt cover paeds or trauma as we apparently have no need to learn that. Pity the poor family member who has a baby code in the waiting room or we come across a trauma patient. No second guesses, no lets just give a cert, its you learn, you do, you show and you apply, not we need the numbers to make the books look good.

Scotty

[cynical_as_hell]

I won't speak for the rest of the EMS world on this but for my area, I think I know what the problem. Now I am not a paramedic, however I just recently sat through a paramedic refresher class because my partner needed it. What I noticed is that there were guys in there teaching that have been in the field for 15-20+ years. They were still going over the way they learned things, and barely touched on any of the updates. Drugs weren't discussed at all. The instructors would get frustrated when one of the newer (1-5 years) paramedics would question them on something, or explain to them why what they were saying was wrong. The updates that were discussed were the ones our medical director changed and of course the current standard for CPR.

EMS cant advance if no one is teaching the new stuff. EMS cant advance if those ancient medics arent willing to change the way they do things. Now I may be completely off base here, but this is just one of the things I saw wrong with my area's current system. The other thing would be that because field workers are teaching other current field workers, everyone just blows through everything because they all figure, "Well you've seen me work in the field. You know I know how to do my job." That would be the second problem in my opinion.

Edited March 29, 2009 by cynical_as_hell

[Ridryder 911]

About four years ago, I found a video from a physician that was describing the demise of AHA ACLS courses and more so other similar courses such as ATLS and all the other alphabet courses.

The problem began that we assume that all could provide efficient and quality emergency and critical care. AHA attempted to train (not educate) providers in all hospital arena to be able to provide emergency care. More so they limited emergency cardiac care to strictly resuscitation measures. Then even more so dilute it down where true ALS is not performed or the best iniatially started to be followed up by specialty care teams. Amazingly, he was an a National Affliliate Faculty for AHA.

Oh, if you want; one can purchase and pay to attend for those speciality care courses such Advanced Airway, Experienced ALS providers, I/O courses, etc.. so on and so on.

Was ACLS the demise.. no not the sole reason but one of the many waves. We are allowing anyone with $$ in their pocket to attend a 8 week course. We even brag about taking short cuts and not being knowledgeable in the speciality of our profession... How ludicourous?

We need to redefine EMS programs. Remove the basic level all together from the EMS programs. Offer them alike they are.. first aid courses. Alike nurse aide courses are in regards to nursing.

Don't allow just everyone into EMS programs. Only those that profess and have demonstrated completion of pre-courses, well written references and continues evaluation of them during the program. Let us make it difficult to enter as well to exit the program. Bring back intergrity to delivering emergency care.

Alphabet courses should not be needed if we really as a profession knew what and how to perform our jobs. Unfortunately, our education systems is not really an education rather a training system. We have not as a profession grasped what it takes to be a medical profession because many are not within the medical profession rather only wears that hat when needed to.

I personally recommended that ACLS be removed from the re-registration of the NREMT. I was informed unfortunately, that is one of the few ways that they are aware that Paramedics have kept abreast of new standards and kept current. How unfortunate!

R/r 911

Edited March 29, 2009 by Ridryder 911

[celticcare]

Here Here Rid

[Just Plain Ruff]

I am going to have to disagree somewhat. Yes the course has been dumbed down but.. I also put some fault at the training entities (the AHA training sites) that did not put up a fight to get the standards changed.

The site I was affiliated as a Regional faculty many moons ago was flabbergasted that we were told that no-one failed. To remediate a failing student over and over again until they "got it". The training sites should have made more noise to get this god-awful standard reversed.

I'm not sure of the other sites but our site was run by an old school doc who said that "yes you can fail ACLS" and he wasn't going to change his stance. Up until about 6 months before I ended my relationship as a RF for AHA we did indeed fail people. Our thought process at the time and it was squashed by the AHA is that these are medically trained people who NEED to know this stuff and know it well. If they still didn't get it they went to another class for free. We resisted being assimilated by the BORG (AHA) and failed people.

On a side note, does anyone like the computer version of the ACLS Class?

[wrmedic82]

It just blows me away that RN instructors can teach this program when very, very few have ever actually run a code nor ever intubated anyone ... sheesh.

Flash box ? Funny thing that's a BLS skill set ? I even had one bystander tell me we were not following 30:2 with an intubated patient ... hmmmm.

Last course I was on a senario was presented ... Pulmonary Emboli .. The RN instructor told the student that "Coarse Rhonchi" heard over the affected side .. I quietly protested to the MD oveseer and it was never corrected ..... OMG shock and awe.

Because they set the standards ?

cheers

Was the bystander a health care provider or someone who took a heartstart coarse ? That would explain that. If they were health care providers...then they just dont know any better. But anywho, about ACLS. I guess you cant ding EMS or say that's the day EMS died as much as healthcare as a whole.(going off the main topic not the quote above) MD's RN's EMTP's and so forth take the same class, same tests, and everything for the class. If Im getting this wrong feel free to let me know. Ive been known to put my foot in my mouth a time or two. Spenac can testify to that. But is there really any data out there that suggests true competency or incompetency with ACLS providers?

Edited March 30, 2009 by wrmedic82

[spenac]

Spenac can testify to that.