BLS vs ALS

[Kiwiology]

Why would we need more than one title?

You do make a good point Dust but I think its somewhat utopian to say that we can move to a single level system just like that (snaps fingers). Any system is going to have to adjust and even the best sysems in the world have more than one level, at the very least they have two; either Technician/Paramedic (UK) or Paramedic/Intensive Care or Advanced Care/Intensive Care.

Nursing has public health nurses, coronary care, emergency, renal, operating theatre, mental health etc. Fire has firefighters, engineer/operators, station officers, captains, cheifs etc. There are really differnt levels of specalities within each profession just as there are to many types of professions; a pilot might fly a 737, a helicopter, a twin Cessna or an Airbus but he is still called a pilot.

A "Paramedic" might be a Paramedic but she might specialise in (well, hopefully in my truck but failing that .....) neonatal care, community care, intensive care, critical care etc. They all have the word "Paramedic" in them. Get rid of this Technician crap and just call every ambo a Paramedic. I know this is a departure from some of my rant on other topics but I do really feel that it's a good thing.

You might realistically have ...

Intensive Care Paramedic (ALS)

Critical Care Paramedic (CCT)

Community Care Paramedic (ECP)

Neontal Care Paramedic etc

[armymedic571]

I was referring to Primary, Advanced, and Intensive Care Paramedic but since you had to bring it up sure, Stanley my big grey pet elephant needs somebody to bring him peanuts and take him for a walk.

Also very true

Sorry, I couldn't help myself

[Dustdevil]

Nursing has public health nurses, coronary care, emergency, renal, operating theatre, mental health etc.

Not relevant. There is only one licence title. The rest are specialisations of the same licence.

That is exactly what we should be doing, and quit trying to be "different".

Even less relevant is what firemonkeys and pilots do.

[ambodriver]

BLS before ALS

you have to be an emt for a year atleast before you can start to be a medic.good emt skills is what makes a good medic.i dont give a damn if you are ALS is you cant to the basics then you are no good to me.think about how many ALS calls really go down on any given day,where i work(in manahttan) alot of calls get upgraded by the callers because they want an ambulance to get there faster but when you get there its bullshit.

yes ALS is hard,i was in medic school til i got hurt at work and had to drop out but so is emt work.medics need us and we need the medics.alot of places double as bls/als and are usually run by fire and thats the true issue imo. if you are a fire fighter then thats great but the system should be kept seperate.ems should be run by someone who has medical traning and not by a fire fighter.

getting back to which is better,neither is better,its what you know and how you do it.i can start a line,do the leads and push drugs better than some of these medics out here but i have seen als do better immoblization and basic bleeding control better than some of the techs who have been on the job for 20 years.

if you are an medic then you need to keep up your emt skills because all als protocols say BLS interventions first and just because we are on scene there to help you otu doesnt mean have us do all of that because you dont want to.learn the new tricks from your emts as for the techs learn the simple things from the medics like how to spike a bag or how to put the leads on the pt.

ems isnt going to go anywhere if we keep bashing eachother,als saves bls but its bls skills that saves als

This is flawed logic. An EMT-P is an EMT-B. Most paramedic programs require you to be a basic for awhile before you become a medic. Basic skills.....are basic. That's why its a one semester class. How many times do you need to backboard and splint someone before you master it? Direct pressure and a trauma exam isn't rocket science. It's more common sense. I've seen way more clueless basics on calls then I have medics.

[JPINFV]

Not relevant. There is only one licence title. The rest are specialisations of the same licence.

That is exactly what we should be doing, and quit trying to be "different".

Even less relevant is what firemonkeys and pilots do.

To be fair, it is similar to what pilots do. One common commercial pilot license (common license) with additional ratings below it (specializations on that one common license). We can even call a private pilots license a first responder certification and a recreational pilot license a first aid certification.

[daedalus]

So what titles do you suggest we use instead, I have mine above but what do you all think?

I would like to preface my post by giving my support to the changes being made at the national level as we speak. EMT-Basic turns into EMT, EMT-I turns into AEMT, and EMT-Paramedic turns into paramedic. The accompanying changes to education are also a step in the right direction. None of this is perfect, but it is a small step in the right direction.

If I could do whatever I wanted, I would have Emergency Medical Responders and Paramedics. That is it. The EMRs would be firefighters, dual role department (like harbor patrol and life guards), etc. It would closely match the EMT in skill set, with an expanded classroom and clinical time. EMRs could also, with further training, work with a paramedic on a transporting unit. Paramedics would be on transporting units, and could be placed selectively as first responders. Systems would limit the amount of paramedics on shift at any one time so that experience is kept up. There would be no ALS or BLS. There would be medical first response provided by the EMRs who acting within the scope of their education, preform medical care to reduce morbidity and mortality until paramedics arrived. Paramedics would bring emergency department level care to the field (what is practical to bring and supported by evidence.)

[stcommodore]

How about I don't care about your silly non-american systems. In a big urban fire systems your emt's are firefighters and have very little but a fast ride to offer as patient care/skills. Paramedics are king here and minus burnout and laziness if you want advanced care you hope you get them.

Get over the terms they are not going to change.

[WelshMedic]

How about I don't care about your silly non-american systems.

Well, that says a lot about you and your contribution to this discussion.

The only way is the American Way......

Arrogance AND stupidity, you'll go far.....

WM

[Dustdevil]

If I could do whatever I wanted, I would have Emergency Medical Responders and Paramedics. That is it. The EMRs would be firefighters, dual role department (like harbor patrol and life guards), etc. It would closely match the EMT in skill set, with an expanded classroom and clinical time. EMRs could also, with further training, work with a paramedic on a transporting unit. Paramedics would be on transporting units, and could be placed selectively as first responders. Systems would limit the amount of paramedics on shift at any one time so that experience is kept up. There would be no ALS or BLS. There would be medical first response provided by the EMRs who acting within the scope of their education, preform medical care to reduce morbidity and mortality until paramedics arrived. Paramedics would bring emergency department level care to the field (what is practical to bring and supported by evidence.)

Exactly. However, I would not have EMRs under the same regulatory body as Paramedics. One is a profession, and the other is not. Nurses Aides are not regulated by the Board of Nursing. And essentially, anything less than a Paramedic is simply an aide. Let the Red Cross handle them, or create a national registry of whackers.

JP, I agree with you about the pilot analogy in the sense that a Commercial Pilot is a profession, and a Private Pilot is a hobby. That is directly analogous to EMRs/EMTs and Paramedics.

Edited February 9, 2010 by Dustdevil

[sirduke]

I thought we'd already had this fight.