PA state protocol update

[nypamedic43]

Chris's nearest medic is 30 miles away because he lives in a very rural area. BLS there usually transports towards the hospital and intercepts with an ALS unit if its needed. To be honest there are ALOT of rural areas in PA where it just isnt feasible for volunteer BLS units to staff a paid medic. Lets be honest there are very few of us medics that WANT to volunteer their time, we want to be paid. They dont have the means to pay them or the call volumes to warrent a paid medic and all of our bags of tricks and equipment.

Personally I am all for allowing basics to do blood sugars... the general public can..why cant basic's? It's not like they are cannulating a vein...it's a finger stick. I am also for giving them the skill of non-visualized airways such as a combitube, especially in very rural areas. As long as its positioned correctly and they are taught to use the correct tube to do ventilations. I know I am going to get backlash from the above statements..but I really am unconcerned about that.

I havent yet read the new PA protocols but it seems to me that maybe PA ought to up their recert requirements for medics....our cards never expire and we only need 18 hours a year. Considering the responsibility and liability that we have, I think they should require more...and not just classified as medical and trauma. It needs to be specific core knowledge. Right now I can do a PALS, an ACLS and a driving class and be done for the year. But in NY, I have to do 72 hours, in specific core classes to recert, done in the last year before my card expires. Pretty big difference.

Sorry if I ruffle feathers but I guess I see things a little differently. And I am unconcerned with the whole "I am a paramedic, I am the only one that can help a patient cuz I got drugs" mentality. BLS providers are a huge link in the chain of survival and without them getting there first in some cases, mortality rates in rural areas would be bigger than they are now. The old saying of "Paramedics save lives, EMT's save Paramedics" cant be truer because unless we remember where we started at? all the drugs and IV's and C-PAP and cardiac monitoring wont save a patient if we dont have the very basic skill of opening an airway.

Just my $.02 worth

[Chief1C]

We've had a fully paid MICU, three different services between '86 and '05, two went bankrupt; and the last one, the money just ran out. We're working on something, but I don't have the time or energy to explain the number of roadblocks and citizens, elected and municipal officials that just don't care. We have enough people to make sure every call is answered, quickly. There was a good number of calls last year, considering the majority of our population is seasonal.

Paramedics save lives, EMT's save Paramedics

No offense, but that quote irks me. I've been on thousands of call, helped a lot of people, and I can say that a lot of lives have been saved - people resuscitated, before we even saw the medics vehicle. Every call that meets criteria at the 911 center, has the nearest ALS unit attached. Takes fifteen minutes to a half hour, of course depending on weather. Only takes fourteen minutes to get a chopper, but I make damn sure we don't over use that option. It's not a cash cow, EMS doesn't bring in a lot of money in rural areas, so we do the best we can, with what we have to work with. You'll find the same equipment, maybe even better, as anywhere else; same training, just different faces.

[nypamedic43]

Chris I only used that quote to push home the fact that Medics need to remember their basic ABC's before advanced interventions are done. I am quite familiar with the area that you are in and am aware of the ability to get ALS from Memorial or Western and a helicopter if needed. As far as I am concerned strong BLS makes my job a little easier. It was in no way meant to imply that the EMT's in your area cant take care of a patient or that people's lives haven't been saved because your squad was there and did what was necessary.

[Carl Ashman]

Sorry if I ruffle feathers but I guess I see things a little differently. And I am unconcerned with the whole "I am a paramedic, I am the only one that can help a patient cuz I got drugs" mentality. BLS providers are a huge link in the chain of survival and without them getting there first in some cases, mortality rates in rural areas would be bigger than they are now. The old saying of "Paramedics save lives, EMT's save Paramedics" cant be truer because unless we remember where we started at? all the drugs and IV's and C-PAP and cardiac monitoring wont save a patient if we dont have the very basic skill of opening an airway.

I agree entirely. There is a very important role for EMT's in the First Responder role. But that isn't to say that they should replace paramedics because of cost issues. That's the issue, to me, that needs fixing.

Carl.

[Chief1C]

Chris I only used that quote to push home the fact that Medics need to remember their basic ABC's before advanced interventions are done. I am quite familiar with the area that you are in and am aware of the ability to get ALS from Memorial or Western and a helicopter if needed. As far as I am concerned strong BLS makes my job a little easier. It was in no way meant to imply that the EMT's in your area cant take care of a patient or that people's lives haven't been saved because your squad was there and did what was necessary.

I wasn't suggesting you meant anything negative. I was generally speaking.

[1EMT-P]

I have not had a chance to review the new PA updates, but it sounds like they are trying to encourage the Paramedics to be more active in assessing the patients & that they are trying to encourage them to function as the provider in charge of the EMT's much like the RN's are in charge of LPN's in the hospital setting.

[Medic7714]

I am a Pennsylvania Paramedic and am really liking the new protocols. It's nice to see research driving EMS care. As far as the ALS and BLS interface. I completely agree with it. If you have an EMT and Paramedic on the same unit, the the higher level provider should be the one making initial contact and performing the patient assessment irregardless of the patients complaint. If the Medic feels the EMT can handle then fine. But then again, if the Paramedic has to type a PCR for their assessment they may as well just ride with the patient. I'm not sure how this will work with billing if an ALS assessment is performed but patient is then accompanied by EMT on same unit.

Another reason I agree with it is I have the belief that an EMT level provider is too minimal to be a primary care provider on an ambulance. And I am not saying that to be condescending. How can 140hrs be sufficient to address a patients needs? I was a career EMT for commercial and 911 FD EMS for about 16yrs prior to becoming a Paramedic. And late into those years I really started to question my benefit as an EMT to the patient which is why I became a Paramedic. With the exception of rare, life-threatening calls all an EMT can do is an assessment and O2. And for those keeping up to date with the latest in O2 therapy, even that has fallen out of favor as it has shown to be harmful in many cases and is reflected in the new PA protocol as titration of oxygen to SpO2> 94%.

Just my opinion.