No MEDICS!

[Kiwiology]

What you are talking about here really are two different things and they are both ones I have been saying we need for some time.

Personally I distain the term "prehospital" because it gives the illusion that Ambulance Officers are always tied into transporting. I think "life support" (BLS/ILS/ALS etc) is an outdated term that needs to be scrapped because it ignores 90% of patients, well, 90% of the patients I go to anyway.

The new term being used here as the Ambulance sector in NZ moves forward is "emergency community health" which I think is a much better term. Ambulance Officers do not always have to transport a patient and have a much broader range of options and referral pathways, like the CARE program in NSW and ECPs in the UK.

Now as far as upskilling goes I think this is another thing we have flogged over and over. You and I are used to very high levels of skill at the base levels, our Technicians are getting scope-of-practice creep and our Paramedics are in line for the biggest changes in how treatment and the dispatch grid works in probably at least 30 years

In NZ the majority of the workload is carried out by "Paramedic" (IV/Cardiac) level Officers with some upskilled in IV drugs (adrenaline, morphine, naloxone, ondansteron) but with our new clinical structure we are upskilling all "Paramedic" level Officers in those IV medications plus (I suspect, touch wood) amiodarone and midazolam.

As I have said above, and you say too, with the right skills (and education) there is really very little need for an ICP.

[aussiephil]

Personally I distain the term "prehospital" because it gives the illusion that Ambulance Officers are always tied into transporting. I think "life support" (BLS/ILS/ALS etc) is an outdated term that needs to be scrapped because it ignores 90% of patients, well, 90% of the patients I go to anyway.

The term prehospital is a relevant one.

We work in a prehospital area. Some patients need hospital (still referred to as inpatient) some can be treated on an on going basis at home (outpatient).

We are too hung up on making ourselves sound more important than we really are. Paramedics (a generic term) now calling themselves Emergency Medical Technicians, Police are now Law Enforcement Officers etc. Lets cut the BS. We provide in essence a care level that is pre hospital. To break the word down, dictionary.com states that

pre- 

a prefix occurring originally in loanwords from Latin, where it meant “before” (preclude; prevent); applied freely as a prefix, with the meanings “prior to,” “in advance of,” “early,” “beforehand,” “before,” “in front of,” and with other figurative meanings (preschool; prewar; prepay: preoral; prefrontal).

&

hos·pi·tal - an institution in which sick or injured persons are given medical or surgical treatment.

. we are providing care before the patient goes to hospital. If they refuse, or, as described in some cases choose not to go is irrellevant, we are providing care before the hospital does.

[Kiwiology]

I would not say I am into making Ambos sound "flasher" or "more important" just IMHO, more accurate.

With many systems developing alternate pathways and treat-and-leave (which we've been doing for years anyway) the hospital may never treat the patient for the problem they present with today.

Maybe its just me but I don't like "prehospital" - yes, in some situations its relevant and in others it is not.

[spenac]

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.

Yes money can be found. Cancel a few parties and decorations for the holidays and you could pay the difference.

As to maintaining skills there are large hospitals an hour or two away and they could work out an agreement that would allow them to spend time a few times a year. As to retaining there are many of us that the more rural the better as long as they pay enough for us to survive. Many times these rural communitys have lower costs of living so even paid less than big cities you can live as good if not better. Now to protect the communitys investment if they pay for the education create a contract so the money has to be returned in order for you to leave.

[LyonN]

Now its not Just the paramedic level skills that are needed, because your right they are not used often. I think paramedics would be a valuable asset to the fire department as a hole. I think paramedics for the most part are more dedicated, they desire to use there skills and know them. Keep in mind that this is an "old school" department that is not open to change. We use the good-ol-boy system, if its not broke, why fix it? Let me tell you why, we promote to officer based ONLY on how long this person has been in the department, this leads unqualified officers with high school level education running a fire department, right down to the chief. I have made entry into working structure fires by myself, because nobody in Socorro has ever died. Now don't get me wrong because I love doing it, but its stupid! these officers are in charge of EMS training, but it does not exist! our guys don't even really update their CPR card they just put their name on a piece of paper and BAM! We had some rookies take an in house CPR class a few months back the minute they walked out i asked them a series of simple BLS-CPR question and they were clueless! i think paramedics will help this, anytime i bring up treatment the persons response is PARA-GOD! its because paramedics are not in the system.

Now i'm not saying that paramedics are the only ones dedicated to continuing education because I know there are a lot of dedicated basics and intermediates. I'm saying they will never end up in Socorro because "its not broken". Socorro is living in the 80's its time to update.

As far as medic skills go, how can you deny some one the skills of a medic, just think about a code worked at an ILS level, lets say by the time the patient goes down to the time that the ambulance is on scene its been at best 5 minutes AT BEST! lucky for the patient the department really goes out of their way to teach lay person CPR Now the two ILS crews of 2 people each, secure an airway and start CPR with AED start and IV all while trying to load the patient up in the unit and get in route to the hospital. by the time this is all done almost always 20 minutes has lapsed, or more. Now its time for the 5 minute drive to the hospital, two of your members have left one driving each ambulance, while the two riding are messing around with BVM,AED, EPI, Radio report.... am I forgetting something? ah darn!, I knew it! CPR! Something has got to give guys! are 8 minute chain of survival is long out the window.

Now lest add just One paramedic to a crew of three intermediates, its all done on scene so there is not trying to load the patient, the entire time we have one EMTI doing good CPR (rotating) one EMTI can start a line one EMT I can set up monitor medic can tube, you give them 4 on scene minutes and I truly think you can have your first round drug into the patient with never ending supply of good cpr. Now will the patient survive? I doubt it, but you gave him a fighting chance.

as far as pay goes I made 32k last year, we are below the state average despite being one of the few transport agency, so give the one medic per shift 8k per year that is only 24k the city is out, or hell give them 15k that is 45k per year our city is not even going to notice it. the mayer and city council just got a 20% pay increase, so the city is not hurting.

[Just Plain Ruff]

Now its not Just the paramedic level skills that are needed, because your right they are not used often. I think paramedics would be a valuable asset to the fire department as a hole. I think paramedics for the most part are more dedicated, they desire to use there skills and know them. Keep in mind that this is an "old school" department that is not open to change. We use the good-ol-boy system, if its not broke, why fix it? Let me tell you why, we promote to officer based ONLY on how long this person has been in the department, this leads unqualified officers with high school level education running a fire department, right down to the chief. I have made entry into working structure fires by myself, because nobody in Socorro has ever died. Now don't get me wrong because I love doing it, but its stupid! these officers are in charge of EMS training, but it does not exist! our guys don't even really update their CPR card they just put their name on a piece of paper and BAM! We had some rookies take an in house CPR class a few months back the minute they walked out i asked them a series of simple BLS-CPR question and they were clueless! i think paramedics will help this, anytime i bring up treatment the persons response is PARA-GOD! its because paramedics are not in the system.

Now i'm not saying that paramedics are the only ones dedicated to continuing education because I know there are a lot of dedicated basics and intermediates. I'm saying they will never end up in Socorro because "its not broken". Socorro is living in the 80's its time to update.

As far as medic skills go, how can you deny some one the skills of a medic, just think about a code worked at an ILS level, lets say by the time the patient goes down to the time that the ambulance is on scene its been at best 5 minutes AT BEST! lucky for the patient the department really goes out of their way to teach lay person CPR Now the two ILS crews of 2 people each, secure an airway and start CPR with AED start and IV all while trying to load the patient up in the unit and get in route to the hospital. by the time this is all done almost always 20 minutes has lapsed, or more. Now its time for the 5 minute drive to the hospital, two of your members have left one driving each ambulance, while the two riding are messing around with BVM,AED, EPI, Radio report.... am I forgetting something? ah darn!, I knew it! CPR! Something has got to give guys! are 8 minute chain of survival is long out the window.

Now lest add just One paramedic to a crew of three intermediates, its all done on scene so there is not trying to load the patient, the entire time we have one EMTI doing good CPR (rotating) one EMTI can start a line one EMT I can set up monitor medic can tube, you give them 4 on scene minutes and I truly think you can have your first round drug into the patient with never ending supply of good cpr. Now will the patient survive? I doubt it, but you gave him a fighting chance.

as far as pay goes I made 32k last year, we are below the state average despite being one of the few transport agency, so give the one medic per shift 8k per year that is only 24k the city is out, or hell give them 15k that is 45k per year our city is not even going to notice it. the mayer and city council just got a 20% pay increase, so the city is not hurting.

You lost me just then. Seems like that post wanted to be cohesive but it got caught up in the desire to have a bunch of stuff said in a short period of time.

[JTpaintball70]

So they're still making you work at an ILS level Nick? That sucks beyond belief.

EDIT: Didn't read all of the thread as I'm posting from phone.

Edited March 5, 2010 by JTpaintball70

[LyonN]

Ruffems yeah sorry its a little sloppy I was in a hurry and worse didn't have spell check. I use a lot of sarcasm in my writings.

In short we have no leadership, no one to direct us, no desire to do this job. The department is ran much like it was in the 80's unsafe and uneducated. our priority are focused on the days off. Everyone in this department thinks that the skills and training that a medic have are worth nothing. Medics can help get this service back on track.

JT nope cant work, They wanna stone me even if i bring up medic skills. I have my fingers crossed that BCFD will come through for me starts in April. I cant figure out who you are.

[JTpaintball70]

JT nope cant work, They wanna stone me even if i bring up medic skills. I have my fingers crossed that BCFD will come through for me starts in April. I cant figure out who you are.

I had heard from Anna that you might be trying out for BCFD. Good luck on getting on with them!

This is Nathan, from Socorro and the cohort right behind you.

Edited March 6, 2010 by JTpaintball70

[Kiwiology]

I went to ten jobs last night; none of them required an Intensive Care Paramedic and we did 12 leads, fluids, drugs, IV analgesia all quite comfortably without ALS, why? because our Paramedics have the skills and knowledge to do what needs to be done and keep the ICPs free for when they truly are needed.

Now, we did get one along for a look with regard to ketamine but that was more a nice to have, not a have to have.

As far as medic skills go, how can you deny some one the skills of a medic, just think about a code worked at an ILS level, lets say by the time the patient goes down to the time that the ambulance is on scene its been at best 5 minutes AT BEST!

So? How does this change be it a volunteer First Responder in his jammines or a crew of two Intensive Care Paramedics? Irrelevant and not worth mentioning.

Now the two ILS crews of 2 people each, secure an airway and start CPR with AED start and IV all while trying to load the patient up in the unit and get in route to the hospital. by the time this is all done almost always 20 minutes has lapsed, or more. Now its time for the 5 minute drive to the hospital, two of your members have left one driving each ambulance, while the two riding are messing around with BVM,AED, EPI, Radio report.... am I forgetting something? ah darn!, I knew it! CPR! Something has got to give guys! are 8 minute chain of survival is long out the window.

Well then your way of working sucks and needs to come into something more modern than say, the eighties.

There is no evidence that transporting primary arrests (or really, any arrest) to the hospital makes any difference and travelling back to hospital priority one creates an exponential amount of risk which is not outweighed by benefit.

If your Officers are forgetting to do CPR on cardiac arrests, that is not a fact I would state pubically.

Good CPR and defibrillation are far more important than IV drugs.