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

[VentMedic]

Firstly ... most RRTs are no where near your diligence level, that said the are educated in the principles of ACLS but are very limited as to input with so many MDs running around, they will keep up ACLS, or PALS or NRP only if it applies to their specific area ONLY.

My mistake. I thought the Canadian RRTs were educated professionals.

So why is it you take to bashing other professionals the minute a mention of education comes to play.

I just can not believe you would rely on a 2 day course to be all that for the Paramedic and that is meant to replace medical oversight and competency.

The RNs, MDs and RRTs you may see in your class are there probably because they know they don't know much about ACLS and didn't want to embarrass themselves in their own house. You will probably not see the ICU RNs and RRTs since they are usually trained in their own classes by their medical directors. Remember that some hospitals also do their own research for the ECC and their GUIDELINES may be different.

However, the first thing you do is jump on them for being "RNs" or "RRTs". I could also get on my soapbox, just as this thread is promoting, about the substitution of qualtiy education for a weekend cert. It seems that is what the Paramedic education is still all about. I also have been in EMS to have seen the changes and now see where some still have not dropped their dependency on a "cert" even though the AHA has reevaluated their teaching methods. It is long overdue for EMS to change with the times.

[spenac]

My mistake. I thought the Canadian RRTs were educated professionals.

So why is it you take to bashing other professionals the minute a mention of education comes to play.

I just can not believe you would rely on a 2 day course to be all that for the Paramedic and that is meant to replace medical oversight and competency.

The RNs, MDs and RRTs you may see in your class are there probably because they know they don't know much about ACLS and didn't want to embarrass themselves in their own house. You will probably not see the ICU RNs and RRTs since they are usually trained in their own classes by their medical directors. Remember that hospitals also do their own research for the ECC and their GUIDELINES may be different.

However, the first thing you do is jump on them for being "RNs" or "RRTs". I could also get on my soapbox, just as this thread is promoting, about the substitution of qualtiy education for a weekend cert. It seems that is what the Paramedic education is still all about. I also have been in EMS to have seen the changes and now see where some still have not dropped their dependency on a "cert" even though the AHA has reevaluated their teaching methods. It is long overdue for EMS to change with the times.

Vent we often take our alphabet courses at the hospital. The ones that have to stay for remediation are most often the doctors, RN's including ER and ICU and yes the airway people :shock: . I have only seen one EMS have to remediate and that was an EMT-B in his first ACLS. So your theory may work where you are but does not mean all hospitals are the same.

[VentMedic]

Vent we often take our alphabet courses at the hospital. The ones that have to stay for remediation are most often the doctors, RN's including ER and ICU and yes the airway people :shock: . I have only seen one EMS have to remediate and that was an EMT-B in his first ACLS. So your theory may work where you are but does not mean all hospitals are the same.

I didn't say ALL hospitals. And, rarely will the hospital's Code and Rapid Response Team be in an ACLS class for the general public. Those are usually led by the medical director.

Again, why do people in EMS turn to the "they can't do it" attitude when there is a question of education.

Those RNs and RRTs that you see in these open ACLS classes may not work in CCU or on a Code Team. They may just be taking it for CEUs because nothing else was offered or to see what it is all about. But, Paramedics seem to put their whole credibility into a weekend cert class. The RNs will usually still have their education and job to go back to if they pass or not unless they are on a team. They may be able to do many other skills and knowledge that you have no clue about.

Does tossing the spotlight on a few RNs and RRTs that don't know ACLS all that well really make it okay for the Paramedic to trust a weekend cert to provide everything you need to know about ACLS? Talk about a cookbook mentality. Unfortunately, the Paramedic education is taught as a bunch of "certs".

Do you think the Paramedic education and medical oversight could be improved instead of relying on an outside association, AHA, to provide "the standard" to determine your competency?

Your standard may also not be good enough for those RNs and RRTs that work in CV units. Running a code in an ICU when the patient is hooked up to a dozen different meds is very different that in the street. You do not have all the other meds and technology to be concerned about as a Paramedic in the field. You don't have lab values to consider. You are able to follow the recipe you memorized.

So don't assume all RNs and RRTs are too dumb to learn ACLS.

[WolfmanHarris]

Vent, I'm not sure if everyone is placing their full stock in a weekend cert as much as they're arguing that the quality of the cert is declining, making it more and more irrelevant and yet it's still required of them.

I'm not saying medics don't rely on their merit badge courses for competence, but that's not the main point I'm drawing from most of the discussion here.

You're absolutely right, we need to rely on more for education than a one weekend course. But the one weekend course should still be relevant and worthwhile as an update or refresher on key concepts; otherwise what's the point? Without relevance, ACLS will become like the CPR recert we have to do yearly.

You're also absolutely right when it comes to comparing ourselves to other healthcare providers. Who cares? "But so and so is doing it too!" is school yard. Keep your own backyard in order first.

[spenac]

I didn't say ALL hospitals. And, rarely will the hospital's Code and Rapid Response Team be in an ACLS class for the general public. Those are usually led by the medical director.

Again, why do people in EMS turn to the "they can't do it" attitude when there is a question of education.

Those RNs and RRTs that you see in these open ACLS classes may not work in CCU or on a Code Team. They may just be taking it for CEUs because nothing else was offered or to see what it is all about. But, Paramedics seem to put their whole credibility into a weekend cert class. The RNs will usually still have their education and job to go back to if they pass or not unless they are on a team. They may be able to do many other skills and knowledge that you have no clue about.

Does tossing the spotlight on a few RNs and RRTs that don't know ACLS all that well really make it okay for the Paramedic to trust a weekend cert to provide everything you need to know about ACLS? Talk about a cookbook mentality. Unfortunately, the Paramedic education is taught as a bunch of "certs".

Do you think the Paramedic education and medical oversight could be improved instead of relying on an outside association, AHA, to provide "the standard" to determine your competency?

Your standard may also not be good enough for those RNs and RRTs that work in CV units. Running a code in an ICU when the patient is hooked up to a dozen different meds is very different that in the street. You do not have all the other meds and technology to be concerned about as a Paramedic in the field. You don't have lab values to consider. You are able to follow the recipe you memorized.

So don't assume all RNs and RRTs are too dumb to learn ACLS.

Vent I do not assume. But lately you seem to be assuming that all paramedics are uneducated back water in bred trailer trash flunkys. I mentioned what I mentioned because you brought up that the type of nurses and docs failing were those w/o the responsibility do perform these skills often. I just showed you that there are those that are expected to run a code really just as we are in the field that were unable to pass. So now that brought out the why fight education. I do not fight against education. I have advocated increased education. Do I think any of these card courses are worth more than a refresher of what we should already know? No I don't. I do not even admit to having them except when required to update my file so my pay check keeps coming. I even think it is stupid that some services give a little extra each check for each alphabet card you have.

So my point vent is try and not lump us all as stupid, lately you really have gone from productive posts that I learned from to always bashing in my opinion.

[tniuqs]

My mistake. I thought the Canadian RRTs were educated professionals.

Whoa Vent thats not your style, dont think you want to take cross border standards at all, as that would be a serious error.

So why is it you take to bashing other professionals the minute a mention of education comes to play.

Is it bashing or constructive criticism, standard of care and maintaining competency are a hottly debated topic's in every field. I am saying the STANDARD in the delivery ACLS is of huge concern to me IMHO it has been sewered to incude Proffessions that will NEVER be providing these all inclusive courses.

AND the cost for me easily exceeds $1000.00 every 2 years in addition to all the other registration fees I am FORCED pay to just keep my registration ... just wanting better bang for my buck is all.

I just can not believe you would rely on a 2 day course to be all that for the Paramedic and that is meant to replace medical oversight and competency.

Exactly we are arguing the same side of the coin, the "examination" of ACLS skills should not take longer than 2 days but teaching it should take considerably longer ... point being they are not and without proper prep, ie being provided a real text book, thing is these days one CAN walk into an ACLS course no prep and pass ... pity.

The RNs, MDs and RRTs you may see in your class are there probably because they know they don't know much about ACLS and didn't want to embarrass themselves in their own house.

If the shoe fits wear it ... so whose fault is that then ? The majority of the ACLS Instructors here used to be Paramedics ... That were experianced and had actually worn that hat in conditions that would make the vast majority of other health care providers shake in the boots ... EMBARESS has jack to do with anything

You will probably not see the ICU RNs and RRTs since they are usually trained in their own classes by their medical directors. Remember that some hospitals also do their own research for the ECC and their GUIDELINES may be different.

Some propigate the same myths too .... just as in EMS, We all have to look really hard at ourselves first.

However, the first thing you do is jump on them for being "RNs" or "RRTs".

Jump On ? or just point out the differences of the different disciplines just what RN (other than an NP) or RRT takes the team lead role in any facility .. lets be realistic please.

I could also get on my soapbox, just as this thread is promoting, about the substitution of qualtiy education for a weekend cert. It seems that is what the Paramedic education is still all about. I also have been in EMS to have seen the changes and now see where some still have not dropped their dependency on a "cert" even though the AHA has reevaluated their teaching methods. It is long overdue for EMS to change with the times.

I must disagree the certification is the culmination of education, in my hood EMS is trying to change with the times ... generally speaking the new ACLS teaching needs more reevaluation and a serious focus to real frontline workers actually calling the shots ... I see the new ACLS standards as a failure !

And its not a soapbox, just my opinion.

:shock:

[tniuqs]

Your standard may also not be good enough for those RNs and RRTs that work in CV units. Running a code in an ICU when the patient is hooked up to a dozen different meds is very different that in the street. You do not have all the other meds and technology to be concerned about as a Paramedic in the field. You don't have lab values to consider. You are able to follow the recipe you memorized.

And central lines already placed, triple lumin and CXRay, and invasive art line's, and bedside stat lab patient is intubated and on a Vent and educated support up the ying yang and aortic Ballon Pump around the corner, Nitric in the next room, Warm Dry well Lighted with Pharmacy and D.I. Angio down the Hall, and someone to clean up the mess.

Just in the middle of the road, in the rain, in the snow, in the dark, first contact with this patient just the essentials (plus a lot of good folks that are looking at you to call all the shots and lead) and thats not just one patient too it could be a dozen ....

The general concesis here is ACLS only .... is grossly inadequate !

cheers

[VentMedic]

spenac

So my point vent is try and not lump us all as stupid, lately you really have gone from productive posts that I learned from to always bashing in my opinion.

Weren't you trying to imply the same thing with your statement about RNs?

ACLS class expects nothing. Everyone is in the class for a different reason. Some are there for the CEUs. Some just want a little knowledge. No one at the AHA says the class is closed to only those that lead. Even med-surg RNs may be expected to bag a patient or give meds in a code. It is nice to have some introduction or additional education for those situations.

In some hospitals, if the RRTs and RNs have completed all of their yearly mandatory Code and Rapid Response Team education, ACLS is not required. Does that make them lesser in value? No, because the other education exceeds well above what is taught in an ACLS class.

tnuigs

Jump On ? or just point out the differences of the different disciplines just what RN (other than an NP) or RRT takes the team lead role in any facility .. lets be realistic please.

How much more insulting can you get to other professionals?

When was the last time you worked a progressive ICU, CVICU, NICU or PICU? When someone codes, nobody stands around looking stupid waiting for the doctor to call back. Do the RNs and RRTs in Canada really just stand around and be totally helpless without a doctor? Many RNs and RRTs in our ICUs work under very extensive protocols and guidelines.

When the code team responds, it is the RN and RRT. When the Rapid Response Team responds, it is the RN and RRT. Unless you are in a large teaching hospital, you may not get an M.D. Even in the teaching hospitals, the level of the M.D. must be checked before they are allowed to "run" a code. Do you think the RN and RRT just runs to the patient and stands there waiting for the doctor to return their call?

Guess what? RRT and RNs are on helicopters that do HEMS. They are also on many, many specialty teams which take them hours away from home. Do they just page a doctor to hop another helicopter to work the code for them? These RNs and RRTs also train for these situations in the ICUs.

It is a shame that there are some Paramedics worried and lost since the weekend ACLS class has changed? It is those Paramedics that my remarks are directed at. Those that have a solid education, adequate medical oversight and don't rely solely on a weekend cert will probably have no argument.

Surely a medical director could come up with 16 hours of inhouse education to monitor a Paramedics ability to do ACLS.

[tniuqs]

Jump On ? or just point out the differences of the different disciplines just what RN (other than an NP) or RRT takes the team lead role in any facility .. lets be realistic please.

How much more insulting can you get to other professionals?

Oh if I wanted too WAY more, I have observed so may screwups I could bash any so called proffessional group, some with more gusto than others ... oh and Paraidiots too ... I have absolutely no hangups about that little group either, all is fair game on the internet.

Thing is I am not being insulting, RNs are simply secondary health care providers in the vast majority of cases, yes, some RRTs are trying to be more proactive but unfortunately are strictly limited in the majority of facilites to the medical directors, once the tube is in and secure or a ABG is requested well thats it at an arrest situation. RNs here assist the residence in some cases, but only the most senior of Unit Managers or CCU RNs will do anything but follow direction, the Gods still rule, the intesivists all have a different way to skin cats, ventilate, or wean, Monday mornings suck at change over. :roll:

Guess what? RRT and RNs are on helicopters that do HEMS. They are also on many, many specialty teams which take them hours away from home. Do they just page a doctor to hop another helicopter to work the code for them? These RNs and RRTs also train for these situations in the ICUs.

Specialty teams are that not the common denominator AND I don't do a lot of short hops, lately, I do know what its like for cell coverage at 42 thousand feet, unless its pure rescue or recovery with helo.

Surely a medical director could come up with 16 hours of inhouse education to monitor a Paramedics ability to do ACLS.

I have no less than 8 medical directors sometimes it get confusing which one wants what some days, some ask for stuff I dont even carry .... so I just wing it most days. :shock:

cheers

sorry to the OP for going way off topic ... I have said enough in this thread to make my points, ACLS has been dummied down so much I am embarressed. :oops:

Standing down.

[VentMedic]

Thing is I am not being insulting, RNs are simply secondary health care providers in the vast majority of cases, yes, some RRTs are trying to be more proactive but unfortunately are strictly limited in the majority of facilites to the medical directors, once the tube is in and secure or a ABG is requested well thats it at an arrest situation. RNs here assist the residence in some cases, but only the most senior of Unit Managers or CCU RNs will do anything but follow direction, the Gods still rule, the intesivists all have a different way to skin cats, ventilate, or wean, Monday mornings suck at change over.

Okay, Canada's RNs and RRTs are not educated or well respected. I got that.

But, just like I have tried to avoid lumping all Paramedics into the typical 700 hour FD wonder that I most commonly see, you should not assume that all RNs and RRTs function at that low level of care. Many in the ICUs work from protocols and guidelines. Do you honestly believe RNs and RRTs must be told or "ordered" to do every little titration? It is sad that RNs and RRTs in your area of Canada have not progressed into respected professions. The scope of practice for RNs and RRTs in the U.S. is very broad. The Paramedic scope in the U.S., however, is often very limited except for those situations that are considered prehospital emergencies.

Specialty Teams are huge in the U.S. with everything from transplant to ECMO to NICU to PICU to CV etc. Hospital based CCTs with RNs (sometimes RRTs) are also growing in popularity. Yes, the RNs can intubate and do everything a Paramedic can plus what the RNs do in the ICUs. They also get to work on their skills in the hospital intubating whenever the opportunity comes along.

The title of this tread is The Day EMS died....

Some seem to believe that they are less a Paramedic if they don't have that one little cert class and that EMS is dead because of it. While EMS sees it as Death, other professions move on to create their own classes with the AHA guidelines and their own standards for care.