Progressive EMS Systems

[EMT281]

I did a search, but it was last discussed in 2008 as far as I can see. I'm doing a research project and I'd like to know about your progressive EMS system, or one you know of.

What makes it stand out from all other systems? What protocols differ? What makes it cutting edge/advanced? Any new equipment few people have?

Also, part 2 of my questions. In what direction is EMS headed? (ex: Primary Care Paramedics?)

Thanks

[NYCEMS9115]

Check out Wake County, NC EMS... They are very progressive EMS Service. They've established an Advance Practice Paramedic... Check it out... Email their Chief; he will respond quickly... He's a contributing author for EMS World... The Medical Director is well known in the EMS Community...

http://www.wakegov.com/ems/staff/app.htm

Wished NYC was more like Wake Co. EMS. We're so behind...

[UMSTUDENT]

I did a search, but it was last discussed in 2008 as far as I can see. I'm doing a research project and I'd like to know about your progressive EMS system, or one you know of.

What makes it stand out from all other systems? What protocols differ? What makes it cutting edge/advanced? Any new equipment few people have?

Also, part 2 of my questions. In what direction is EMS headed? (ex: Primary Care Paramedics?)

Thanks

First, thanks for searching. I'm sure plenty of people are privately commending you for using the feature.

Second, my EMS system is not progressive. Where I work the protocols are statewide and widely considered "conservative." I used to say "not progressive at all," but recently the state has made some leaps towards accepted practices like CPAP, nitrates for acute pulmonary edema, and now corticosteroids for asthma. None of these things are cutting edge, in fact I'd say they're really just the accepted standard of care, but it's an improvement from even 5-6 years ago when no amount of literature could have convinced them to step toward the future. We're still flowing high flow oxygen on pretty much everything, rushing every cardiac arrest to the hospital, intubating everything under the sun, and just starting to pilot hypothermia (in limited ways). The protocols are restrictive, contradictory in many places, and long (over 300 pages). To avoid getting yourself in trouble, even for things that really are of no consequence, you need to have an encyclopedic knowledge of the protocols. So I'm not really sure I could help.

I do have friends who work in what I would call "progressive" systems, but I think the word is pretty subjective. Places that I would consider progressive tend to have a few things in common: competitive hiring, better than average pay, an involved medical director(s), and local protocols. The last thing really seems to set these systems apart. I have yet to see what I would call a "progressive" system, or for that matter happy paramedics, in a state that has restrictive statewide, or even multi-regional, protocols. I have one buddy who works in Colorado. He constantly remarks about the general autonomy of the paramedics, short and sweet protocols, and close interaction with his multiple, yes multiple, medical directors. There is a general expectation that they are A) Qualified paramedics and Educated. The protocols do not dictate every tiny way, shape, or form of when a medication can be used, how to do intubate, etc. There is hands on training, a robust QA program, and a collegial culture.

As for what direction EMS is headed I'd see the "Advanced Practice Paramedic" discussion to see a variety of opinions from many well qualified sources. This is a very contentious issue and very young discussion in our profession. It is probably many years away, if it happens at all, but I think the subject is at the very bleeding edge of what's coming.

[Kiwiology]

In New Zealand ...

- Bachelors Degree for Paramedic and Graduate Degree for Intensive Care Paramedic are almost mandatory

- Paramedic and Intensive Care are being made registered health care practitioners

- We have no medical control, for anything, ever

- We have no "protocols" designed for barely trained, non educated skill monkeys

- We threw out spine boards and head blocks years ago

- We can leave people at home and do alternate referrals

[fiznat]

Around where I work I can think of one or two truly "progressive" services. They are similar in that they are both small services with very tight QA/QI, they both have very solid and continuous relationships with their sponsor hospitals/medical control, and they both do 911 only (no private interfacility transport).

[UMSTUDENT]

In New Zealand ...

- Bachelors Degree for Paramedic and Graduate Degree for Intensive Care Paramedic are almost mandatory

- Paramedic and Intensive Care are being made registered health care practitioners

- We have no medical control, for anything, ever

- We have no "protocols" designed for barely trained, non educated skill monkeys

- We threw out spine boards and head blocks years ago

- We can leave people at home and do alternate referrals

Is there anywhere I could read some good literature on New Zealand's system? Sounds pretty good.

[EMT281]

Is there anywhere I could read some good literature on New Zealand's system? Sounds pretty good.

Same thoughts.

[Dustdevil]

What makes it stand out from all other systems? What protocols differ? What makes it cutting edge/advanced? Any new equipment few people have?

A LACK of "protocols" makes a system progressive to me. If you're still cooking by the book, you have no right to call yourself a chef.

So, LOTS of education and very few protocols is the key to "progressive.'

Unless you are up north, or some other kind of Weinercrat, then lots of protocols and federal grants make you progressive.