Should we add ?

[flamingemt2011]

I have frequently read posts regarding the same type of question, "Should we add this "drug", "protocol", or "equipment" to our truck ? It is usually something that is outside or nearly outside our scope of practice, and would have minimal benefit to our industry or our patients. It sounds as if we are bored, and are wanting to stretch our wings. I would suggest that before we spread our wings towards new stuff, maybe we should master what we already have in our scope. Cardiac Arrest Survival statistics have not improved in over 20 years, and the common belief among physicians is that Paramedics can't intubate worth a damn. So before we start something new, maybe we should master what is already in our scope. Toodle-Loo

[island emt]

"Cardiac Arrest Survival statistics have not improved in over 20 years,"

Last time I checked ,we are not god. We can't fixed dead in spite of what you may have been told.

statistics for in-hospital arrest survival pretty much mirror what is seen on the street.

I do agree that there is a push for some folks to do more with less, but that is generally coming from management and the insurance companies that expect more service for less cost.

Edited May 22, 2011 by island emt

[hatelilpeepees]

I disagree that we can not change the statistics in out of hospital cardiac arrest, look at what is going on in North Carolina and Seattle:

http://www2.nbc17.com/news/wake-county/2011/may/17/w-ar-1042367/

If they can get their survival rates up to 40%, surely we can get ours above 10%.

[fiznat]

I disagree that we can not change the statistics in out of hospital cardiac arrest, look at what is going on in North Carolina and Seattle:

http://www2.nbc17.com/news/wake-county/2011/may/17/w-ar-1042367/

If they can get their survival rates up to 40%, surely we can get ours above 10%.

This is a bit misleading. The "survival rate" in Wake County is not 40%. That (37% actually) is the rate of ROSC in a very specific population of patients (non traumatic arrest, VF or VT, over the age of 16, etc etc etc). The percentage of all patients who make it to discharge from the hospital is more like 11%, and if you insist that they are neurologically intact (not broccoli), you're looking at a dismal 7.8%. True "code saves" are a real rarity across the U.S., even in Wake County.

Also, the improvement in survival rates that was observed in Wake County was with the combined changes of the 2005 ECC guidelines (no more stacked shocks, focus on CPR, etc) and the addition of induced hypothermia. I think the argument could be made that most any system who made these combined changes would have seen a similar increase in ROSC if they had studied it like WC did.

http://wakeems.com/saem/

As far as the OP's point, I agree that we need to learn to do our own jobs better. Don't forget though, that there are some limitations to our care that aren't exactly "our fault." Intubation competency is directly related to experience (which is limited in the field), and cardiac arrest survival rate is very much limited by the science and state of medicine. It's not like every code gets saved in the hospital, either.

[Lone Star]

I have frequently read posts regarding the same type of question, "Should we add this "drug", "protocol", or "equipment" to our truck ? It is usually something that is outside or nearly outside our scope of practice, and would have minimal benefit to our industry or our patients. It sounds as if we are bored, and are wanting to stretch our wings. I would suggest that before we spread our wings towards new stuff, maybe we should master what we already have in our scope. Cardiac Arrest Survival statistics have not improved in over 20 years, and the common belief among physicians is that Paramedics can't intubate worth a damn. So before we start something new, maybe we should master what is already in our scope. Toodle-Loo

How do you propose we 'master what is already in our scope' if you can't even advocate taking Anatomy & Physiology classes at the EMT-B level?

I do not see much reason for taking an A&P course for EMT school, but I would suggest one prior to Paramedic school. I think you should get into EMT, make sure you like it, then decide what other courses will benefit you.

In order to be able to master the skills at the Paramedic level, one MUST have a solid foundation at the EMT-B level which SHOULD include (among other classes), Anatomy & Physiology!

You're either FOR increased education, (which should include A&P), or you're AGAINST it... you cannot advocate higher educational requirements for 'some' but not 'all'...

[flamingemt2011]

I am not against higher education, I am against wasting money on courses for a career you are not already in. I think you should take courses that help you advance in your career and in your personal life. I think that the entry level EMTB is taught the amount of A&P they need for their level in their EMT B class, when considering their limited scope of practice. Should that EMT B student become an actual EMTB, and then they decide they want to progress, it would then be appropriate for them to take those higher level courses. You can argue that I need to have an advanced degree in chemistry if I work with chemicals every day. At face value that is a true statement. But if my exposure to chemicals is only because I am a custodian mixing cleaning products, then maybe an advanced chemistry degree is a bit much, unless I want to leave custodial work behind and become a chemist. The question was asked by someone who isnt even a student in our industry yet, who knows, she may end up in a totally different industry a year from now, so I feel it is a waste to take medical courses until she has decided that this is her calling. Sorry you misunderstood, toodle-loo.

This is a bit misleading. The "survival rate" in Wake County is not 40%. That (37% actually) is the rate of ROSC in a very specific population of patients (non traumatic arrest, VF or VT, over the age of 16, etc etc etc). The percentage of all patients who make it to discharge from the hospital is more like 11%, and if you insist that they are neurologically intact (not broccoli), you're looking at a dismal 7.8%. True "code saves" are a real rarity across the U.S., even in Wake County.

Also, the improvement in survival rates that was observed in Wake County was with the combined changes of the 2005 ECC guidelines (no more stacked shocks, focus on CPR, etc) and the addition of induced hypothermia. I think the argument could be made that most any system who made these combined changes would have seen a similar increase in ROSC if they had studied it like WC did.

http://wakeems.com/saem/

As far as the OP's point, I agree that we need to learn to do our own jobs better. Don't forget though, that there are some limitations to our care that aren't exactly "our fault." Intubation competency is directly related to experience (which is limited in the field), and cardiac arrest survival rate is very much limited by the science and state of medicine. It's not like every code gets saved in the hospital, either.

I would agree if you told me that your department had a VERY AGGRESSIVE citizen CPR and PUBLIC AED PLACEMENT initiative. But if you are like most departments and only being reactive (responding to calls) in between naps and TV time, instead of being proactive and preventing calls through education and partnerships with your community, then I dont think you can say you have done everything that is in your control. Is there really anyone in this room who doesnt believe you could improve survival rates if you found a way to place 1000 AEDs throughout your community ?

Edited May 22, 2011 by flamingemt2011

[Dustdevil]

I am not against higher education, I am against wasting money on courses for a career you are not already in.

Damn, man (?). I gave you a +1 for your opening post, but then had to take it back when I read the above post.

So you're saying that people shouldn't bother to learn their job until they are hired? It don't work that way. When you see someone with MD after their name. you can pretty safely assume that they have already attained the educational foundation necessary to begin competently "practising" to perfect their craft and charge for it. Our patients should be able to safely assume the same thing about us, when we show up to care for them during the worst hour of their life, shouldn't they? Yeah, I realise that might cramp the plans of a lot of 3-week wonders, who think that qualifies them as a big hero, who gets to play with the siren and eat half-price at Dairy Queen. Oh well.

[donedeal]

can someone provide the link for the thread on A&P class requirements for emtb. I dont want to highjack this thread, but i have some thoughts on that...didn't pull anything in a search.

[Dustdevil]

http://www.emtcity.com/index.php/topic/20164-where-to-begin/page__pid__259212#entry259212

[BushyFromOz]

ROSC rates in melbourne, Victoria, Australia are over 50%, survivial to discharge is over 30%

In country victoria, ROSC rates are over 30%, survival to discharge is a tad over 20%

So yeah, cardiac arrest survival rates have not only changed in the last 20 years here, we have tripled the survival to discharge rates in the city and quadrupled those in the country.

Your physicians might think you cant intubate worth a damn, our IC paramedics not only intubate, but they have empirical evidene that not only are they good at it, RSI improved our patients outcomes.

We master our scopes of practice, and they keep improving it on evidence gained through retrospective analysis of our electronic pcrs and various trials and studies run by our service and health system which lead to our latest inclusion into air wings clinical practice. Which is our IC flight paramedics now carry whole blood on the choppers.

Toodle-Loo...

Edited May 23, 2011 by BushyFromOz