Why are a number of us "Dissing" on California?

[Richard B the EMT]

In the strings on the TV show Trauma, numerous times I have seen folks taking nasty pokes at California protocols. Are they so bad, or disassociated by region? Or is it something I am totally unaware of?

I'll use an example of where NY State DoH must be ridiculous, to be compared to California: EMTs are not allowed to apply a "Band-Aid", per NYS DoH, as that is considered a completed procedure, yet we can hand the Band-Aid to the junkie mom to put on her kid's scraped knee.

[JPINFV]

I'll let Orange County EMS's protocols stand as an example of California EMS.

Bottom of page 3 has the ALS-No Contact requirments. Any patient not meeting that criteria means that the paramedic must make base hospital contact. Base hospital contact is essentially repeating everything on the PCR over the radio to a MICN. This includes, for example, details like what size IV was started. http://ochealthinfo.com/docs/medical/ems/treatment_guidelines/01%20Introduction/I-40%20BH%20Contact-Report-Tranport3-09.pdf

Similarly, I think there's major issues when paramedics aren't trusted enough to start a saline lock or use a pulse oximeter without a cookbook describing the procedure.

Saline lock: http://ochealthinfo.com/docs/medical/ems/treatment_guidelines/10%20Procedures/ALS%20Procedures/PR-75.pdf

Pulse Ox: http://ochealthinfo.com/docs/medical/ems/treatment_guidelines/10%20Procedures/ALS%20Procedures/PR-65.pdf

[Kiwiology]

California gets dissed because they are one of the poorest examples of prehospital medicine I can find

- The legislated scope of practice are very, very restrictive and I venture a guess haven't been updated since Wedsworth-Townsend or there abouts!

- The statewide EMS Authority has downloaded scope-of-practice and the use of "add on packages" to each regional or county level EMS Authority

- This means what a Paramedic can do in Los Angeles is different to one in San Bernardino who is different again to one in Fresno

- There are no Statewide standing orders and they vary by each regional EMSA jurisdiction

- The standing orders that do exist are notoriously inadequate and (as JP points out and I have done before) require base hospital contact for just about everything!

- Education is kept at a level that is acceptable (again, mainly to the Fire Service) for example Los Angeles County Fire Department Paramedics are not taught to interpret a 12 lead ECG and rely on the machine interpretation, which is notoriously inaccurate.

- Local and regional tax is such a taboo subject, almost akin to witchcraft, that many jurisdictions have given EMS to the spare-capacity of the Fire Department for cheap, and get cheap when it comes to quality of service

- Most services are intergrated with the Fire Department using dual role Firefighter/Paramedics so you get alot of people who need a quicky cert to get on the Fire Department

Why did Michael Jackson get taken to the hospital? Because the Los Angeles City FD Paramedics have to transport despite thier trialling an out-of-hospital field termination for cardiac arrest without ROSC in the late 1990s or early 2000s. Then there was the 1992 intergration of Firefighters and Paramedics and the abolition of single-role civillian Paramedics.

On October 18, 1992, the single-function EMS personnel ranks were consolidated with existing firefighter ranks. In September 2000 in response to the large numbers of "Firefighter-Paramedics ... decertifying and requesting to get off the ... [ambulance] and back onto fire companies" (source) what did the LAFD do? Why they came up with a plan to put a Paramedic at every Fire Station!

Did I mention Los Angeles recently?

On a positive note, the Paramedic programs in California are mainly all community college based and they are required to be accredited by CoAEMSP.

Well, I know at least one place I will be visiting in Los Angeles ... the local neighbourhood fire station!

Could somebody give me an example of the ubiquidos "base hospital contact"; like I immagine it just allows you to go further down the standing order with physician authorisation?

Edited April 8, 2010 by kiwimedic

[VentMedic]

Leaving each county to do its own thing can be a little fragmenting of state control

List of Paramedic scope of practice by county.

http://www.emsa.ca.gov/paramedic/files/scopechart.pdf

Local optional scope of practice:

http://www.emsa.ca.gov/paramedic/files/EMTSOP3.pdf

Example of "CCT" expanded (?) scope:

http://www.emsa.ca.gov/paramedic/files/contracosta_scope.pdf

And this is their additional training requirment:

Total time related to the above topics, including lecture, skills demonstration and practice,

written and skills exams, shall be no less than 4 hours.

Written exam of 25 questions, with passing score of 80% (see below)

I also believe they are only allowed to use ATVs as ventilators which is not appropriate for "critical care transport". Thus, the RNs are on the CCTs with their LTV 1200s.

Example of limited use device:

It is a good thing most of their FFs are encouraged to be Paramedics.

Co-oximeter

http://www.emsa.ca.gov/personnel/files/PositionCoOximeter.pdf

Another drawback with the county system is that the county medical director can pretty much do as they please for discipline issues. Also, if the medical director likes you he/she can still get you certified regardless of your felony convictions even though the state says it frowns upon it.

Convicted Felon Certified as California EMT

http://www.emsresponder.com/web/online/Careers-and-Staffing/Convicted-Felon-Certified-as-California-EMT/6$9571

But then he only shook and threw a 2 year old to her death.

[Just Plain Ruff]

Another drawback with the county system is that the county medical director can pretty much do as they please for discipline issues. Also, if the medical director likes you he/she can still get you certified regardless of your felony convictions even though the state says it frowns upon it.

Convicted Felon Certified as California EMT

http://www.emsresponder.com/web/online/Careers-and-Staffing/Convicted-Felon-Certified-as-California-EMT/6$9571

But then he only shook and threw a 2 year old to her death.

But let's not forget, it was just a 2 year old. I'm sure she had yet to be a benefit to society. Now if he had shook a 30 year old and killed them then he probably couldnt a license.

[VentMedic]

Here is a good example about California I borrowed from the "other forum".

http://www.emtlife.com/showthread.php?t=17693

[Dustdevil]

California EMS is horrible. Rock bottom. While there are some great exceptions, the educational programmes there are notoriously weak, teaching cookbook medicine and catering to the firemonkey contingent, who doesn't even want to be a medic in the first place. Consequently, they run little more than an advanced first aid course, with monkey see-money do protocols that supposedly even an idiot could competently perform. State and local laws tend to reinforce that system.

I did my last recert in SoCal a couple of years ago and was appalled at the attitudes of those in attendance. Anytime a lecturer started talking about anything that was even mildly advanced, more than half the class started groaning and rolling their eyes, throwing down their pencils and yelling, "Is this going to be on the test?" In the scenarios, nobody knew ANYTHING. What they did know was outdated or just plain wrong, and they'd argue it to death. I met like four people in a class of fifty that I had any respect for at all. Two were AMR guys, and two were CHP flight medics. I still keep in touch with a couple of them. But that was it out of the whole bunch. Even the instructors and lecturers were disgusted.