No MEDICS!

[aussiephil]

My kiwi and aussie friends NM does not allow the emt-i to do much. This community is remote and should have quicker access to Paramedic level care. 1 life saved by having a Paramedic justifies the few hundred extra dollars a year it costs.

Isnt that more reason to have a complete review of EMS (no I do not want to debate fire here as well) systems, skills & increase their skills?

[Kiwiology]

I agree Phil. We've just had a huge, several year review of our total system and have decided it's time to move to a system that has less levels (from 6 to 3) and more education (Diploma/Bachelors/Post Grad vs. vocational training).

The new EMS Agenda for the Future goes a little in the direction you're speaking of although it lacks any substantive, meaningful change in my opinion. The model (which is voluntary by the way) will increase education somewhat and skills a little although in some ways it is a backwards step or no step at all.

Speaking from an international perspective the "less levels with higher education and scope of practice" is certianly the trend; Canada and Australia have already done it (can't speak for the NT/WA systems at all there), New Zealand is moving towards such a system over the next little while and well I'm not sure what to make of what the UK has done with the "Emergency Care Assistant" thing.

From a business perspective there is a concept (I forget the name of it) which basically amounts to having quality people who can do what they need to do to fix a problem at the recieving end rather than passing it on. From your own experience how many times have you heard "I have to talk to my Supervisor" or "Hey man I don't know, I will have to check" or "I dunno I just work here". The same goes for EMS, if you have people who are well educated and can do what needs to be done without having to call backup then the system is more efficent, it costs less and patients benefit because they get the required treatment sooner.

About five years ago it was worked out that most requests for backup fell into one of several categories; adrenaline, morphine, GTN or glucose/glucagon. The intermediate level was given adrenaline and morphine (Upskill Paramedic) and the BLS level (Technician) was given GTN and IM Glucagon and wow ... the requests for backup fell quite a bit.

[spenac]

Isnt that more reason to have a complete review of EMS (no I do not want to debate fire here as well) systems, skills & increase their skills?

To increase skills requires an increase in education. If they are going to increase education why not complete their Paramedic education? As someone else mentioned they can get Paramedic in just a few hundred more hours. It is actually scary how little education is required here in the USA for all levels.

[joesph]

Isnt this a reaso to look at an across the board skill set change?

Lets face reality, times have changed & what changes have been made in the past 30 years to an EMT-B or an EMT-I?

To demand a medic is not always the most appropriate thing, we have many stations that do not have 'medics' on them, with the nearest, i some cases over 1 hour flying time away, but with upgraded skills that have been developed over 30 years, we can adequatley treat these patients & get them to appropriate care.

In my humble opinion, that is, right across the country, going to be more beneficial that stamping your foot demanding medics in 1 area.

As a suggestion, if you have some down time, go back over your cases for the past 12 months & work out how many really (not just might have) needed the services of a medic. I think you will be genuinly surprised at how little they are needed.

Wow Phil I am humbly surprised at your response always figured you as a medic or bust guy. My apologies. So to be weird I agree with your statement that medics are not always needed but at the same time their like a gun. Sure you might never need one but when you do you want it handy and ready to go. As for the original poster my thoughts are how would your actions best serve the public.

[BushyFromOz]

Wow Phil I am humbly surprised at your response always figured you as a medic or bust guy. My apologies. So to be weird I agree with your statement that medics are not always needed but at the same time their like a gun. Sure you might never need one but when you do you want it handy and ready to go.

The standard and capability of the average Australian Paramedic (note, not ICP, MICA, US ALS etc etc) means that we need not have IC Paramedics in abundance as blokes like myself and phil are more than capable of handling a vast majority of pre-hospital cases.

[chbare]

The standard and capability of the average Australian Paramedic (note, not ICP, MICA, US ALS etc etc) means that we need not have IC Paramedics in abundance as blokes like myself and phil are more than capable of handling a vast majority of pre-hospital cases.

I am not sure that translates well to the United States, however. RSI was used as an earlier example; however, paramedics do not perform RSI in New Mexico save for special skills qualified services (flight services). Therefore, we are not actually asking for a highly advanced provider when looking at having paramedic availability in certain areas. Specifically areas that can support a college, state fire academy, and state police academy. This is even more interesting because a little town about an hour south of Socorro, of maybe 8,000 people that has a five bed ER and highly limited medical facilities manages to employ paramedics.

Take care,

chbare.

[Kiwiology]

I am not sure that translates well to the United States, however. RSI was used as an earlier example; however, paramedics do not perform RSI in New Mexico save for special skills qualified services (flight services). Therefore, we are not actually asking for a highly advanced provider when looking at having paramedic availability in certain areas. Specifically areas that can support a college, state fire academy, and state police academy. This is even more interesting because a little town about an hour south of Socorro, of maybe 8,000 people that has a five bed ER and highly limited medical facilities manages to employ paramedics.

I think it comes down to budget really and how bad the people want ALS care.

Let's say for what it's worth we pay a Paramedic $20 an hour, he works 4x 12 hour shifts and then had four days off with five weeks of paid vacation a year. 365 days in a year minus the 35 days he will get in vacation time. That leaves 330 days, which if we divide by 8 means 41 blocks of eight days. Half of that time he will be at work, and half the time he will not. Four work days a cycle multiplied by 41 is 164 days (or 1,968 hours) that our Paramedic will be at work. The three days left over we will give to paid CCE time. At $20 an hour that's $39,360 per year plus say 10% retirement (401k) means it is costing the city, in this example, $43,593 a year to employ one Paramedic.

Now we need more than one Paramedic.

[spenac]

I think it comes down to budget really and how bad the people want ALS care.

Let's say for what it's worth we pay a Paramedic $20 an hour, he works 4x 12 hour shifts and then had four days off with five weeks of paid vacation a year. 365 days in a year minus the 35 days he will get in vacation time. That leaves 330 days, which if we divide by 8 means 41 blocks of eight days. Half of that time he will be at work, and half the time he will not. Four work days a cycle multiplied by 41 is 164 days (or 1,968 hours) that our Paramedic will be at work. The three days left over we will give to paid CCE time. At $20 an hour that's $39,360 per year plus say 10% retirement (401k) means it is costing the city, in this example, $43,593 a year to employ one Paramedic.

Now we need more than one Paramedic.

And you still have to pay the emt-I. So not a big jump in cost. Based on your example safe to say the emt-I gets $35000 thus costing $39000 roughly. So my family's life is not worth $4593? Then factor in you can bill more for Paramedic level care and you more than offset the difference if not actually come out ahead. There is no justification for it.

[Kiwiology]

There is no justification for it.

Exactly, I am sure if we went through the cities budget we could find money.

Of course we need to also look at the important issues of recruiting, retaining and developing EMS providers out in Bumblweed, NM so this his skills dont rust out and he gets bored and skips town.

[aussiephil]

I am not sure that translates well to the United States, however. RSI was used as an earlier example; however, paramedics do not perform RSI in New Mexico save for special skills qualified services (flight services). Therefore, we are not actually asking for a highly advanced provider when looking at having paramedic availability in certain areas. Specifically areas that can support a college, state fire academy, and state police academy. This is even more interesting because a little town about an hour south of Socorro, of maybe 8,000 people that has a five bed ER and highly limited medical facilities manages to employ paramedics.

Take care,

chbare.

chbare,

that is why i suggested a total review of EMS service delivery. The primary function of a medic is Cardiac. This is why we call them Intensive Care Paramedics. If you have a basis that allows a platform of quality pain managment (morphine as a minimum), the ability to control seizures etc, then you can offer these officers different options.

Instead of having 1 option - Intensive Care - why not look at Competency Assessment for referral to community based, in home care, or extended care, take basic medicine to the people who most need it & can least afford it?

A complete review can allow for this to happen, all the time remembering we are not doctors, we treat symptomatically. That is, if a person has chest pain, we treat them with ASA, nitro, O2 & morphine with transport to hospital for difinitive care. We do not look at lifestyle, blood work, diet, smoking, ETOH consuption etc, all contributing factors. Nothing to do with EMS. What we are seeing is a manifestation of (in most cases) years of self abuse, obesity etc. Alternativley, if we see someone with Hypoglycaemia, is it our position to be looking at lifstyle etc or treat the presenting problem & at the very least reccomend a visit to their local Dr?

A total review can put these processes in place & deliver better services to the public. Relicance on Intensive Care, & thinking that they are the be all & end all is misguided to say the least. Reality is the main time we here use ICP's is in a Cardiac Arrest situation. Lets look at it objectivley. How many survive? Regardless of a piece of garden hose (yep we secured the airway) & some embalming drugs (I am sure we got some fine VF there, or was it artefact) the results are very similar. The latest guidelines tell us that CPR & defib are the priority, even before airway. Most definitley well before drug therapy.

The most common problem we encounter is pain. By upskilling & allowing the use of pain managment (quality) at an intermediate level is paramount. Understanding pain is also paramount.

I say again, we really need to consider is having medics the be all & end all, or should we completely review current practices & upskill them at the basic level, then the intermediate level, to provide better care for our patients?