Should we add ?

[usalsfyre]

and the common belief among physicians is that Paramedics can't intubate worth a damn.

This isn't physician opinon or belief, it's medical fact.

To answer the question, I've seen far more cases where too large a scope caused patient harm than too small a scope. I think our current scope needs to be adjusted more than anything, for instance as I noted in the other thread I don't see a convincing reason early antibiotic therapy couldn't be started for sepsis patients in the field, but have real reservations about RSI and even intubation. Lasix is probably inapproprite in the field but the homeopathic doses of pain control authorized by the same places are madening. And so on and so forth.....

Education is of course the elephant in the room, as usual.

[fiznat]

I'm not sure that there is much evidence out there that says paramedics are "bad" at intubating. Sure we probably miss more tubes than they do in the hospital on average, but then again we're not tubing prepped people in the OR either. Unrecognized esophageal intubations has been at ZERO percent where I work for several years thanks to continuous end-tidal CO2 monitoring. I really don't think this is a competency issue. It's been a little while since I looked at the research, but the evidence was more geared to whether ETI actually makes a clinical difference in the field-- which most research says it doesn't. There's no point in "getting the tube" if the patient won't benefit from it- high success rates or not.

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

...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....

Wow, if that is correct that is super impressive. I kinda doubt it though. Can I see this evidence and research you referred to? Not that I think you're lying, but a lot of people make the mistake that the other poster (above) did and forget about which populations are being studied. 30% survival to discharge is unheard of around here.

Edited May 23, 2011 by fiznat

[BushyFromOz]

Wow, if that is correct that is super impressive. I kinda doubt it though. Can I see this evidence and research you referred to? Not that I think you're lying, but a lot of people make the mistake that the other poster (above) did and forget about which populations are being studied. 30% survival to discharge is unheard of around here.

No kidding they circulate the results every quarterly in a newsletter, those came out a couple of weeks back along with a bunch of other data on response times, adequate pain reief, number of substantiated complaints and stats on how many clinical stuff ups the service has done

But, theres a catch, at the moment the document is a controlled one and as such i cant relay it here. I wish they bwould publish this stuff internationally.

Edited May 23, 2011 by BushyFromOz

[Richard B the EMT]

I wish they bwould publish this stuff internationally.

Please post, if available, their www dot address, and then, It will be international.

[Just Plain Ruff]

"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.

But on Rescue 911 doesn't everybody survive a cardiac arrest?

[BushyFromOz]

Please post, if available, their www dot address, and then, It will be international.

Unfortunately the info is an inernal publication so i cant link it.

The registry that the data comes from is run by monash university, so it may not even be ours to publish.

[Richard B the EMT]

it may not even be ours to publish.

OK, then, I won't invite a second copyright violation case.

[R0B]

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?

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'...

I completely agree with you statement on the A&P, however my arguement is that anyone wishing to further their education and strive to provide the highest, most competent level of care to their patients has every availability to do so. I drove 3.5 hours recently to take a Stroke specific class. I wasn't on the clock, but the class was free so myself and a partner of mine rode together. Free CE classes are available constantly at every hospital and every decent EMS agency around. If worse comes to worse and you care about making a positive difference in the outcome of your patients, fork out a little cash and take the classes in your area you feel the need for improvement in. Thanks, Rob