5 things EMS must do in 2012

[DFIB]

I hate to say it, but I have to agree with flaming a little. For all the increased education standards, have we really improved in EMS. Can you point to any definitive studies that says we are saving more lives today percentage wise, than the guys in the 80s. Sure we have better technology, but I am not sure I can prove beyond a shadow of a doubt that we are better.

I would be inclined to believe (without a definitive study) that the reflection of better EMS education woulld translate into the saving of more life but more importantly I think it increases a better quality of life after the incident.

I would have to wonder what would happen to EMS if we lowered the educational requirements or simply ceased to improve.

[paramedicmike]

I have said it before and I'll say it again. Education is the single most important issue facing EMS today. Fix education and everything else will begin to fall into place.

Fixing education calls for becoming our own discipline. We need increased educational requirements. We need formally trained EMS educators. We need a national standard in terms of education and training programs much like medical or nursing education. Then, and only then, will we begin to see changes and forward progress of the industry and profession.

[Just Plain Ruff]

I think getting rid of the EMT certification and just having a paramedic certification. Make it a degree'd program.

If that's too drastic, keep the EMT cert for the people who don't want to become medics.

Just allow those who want to go to medic school enroll in medic school without having to go through emt school first.

Leave the EMT for the firefighters who have to have emt for their jobs but never plan on going onto medic school.

[romneyfor2012]

I am not so sure, medics of the 80s had to pass real ACLS, and had less technology to make decisions. As far as ROSC and being released from the hospital in a productive state, I am not sure the numbers have changed a whole lot. To me its is kind of like the new whiz kid from college who got an agricultural degree, battling the farmer who has farmed for 50 years.

[Bernhard]

As far as ROSC and being released from the hospital in a productive state, I am not sure the numbers have changed a whole lot.

My personal experience is otherwise - sure, this doesn't count as a scientific study, but I really did improve my personal statistics. When I started in 1985 we had only one defibrillator in one of four ambulances, no defib/ecg in the others and no real concept for managing arrests or trauma. We just did, what came to mind. Only standard was 15:2/5:1 cpr and that was it. A drug here, some intubation there, occasionally a defibrillation, central i.v. line for the look and declaring death on scene or transporting under cpr to declare in hospital was the result. Only two sufficient long term survivors on my list in those years up to the end of 1990ies, and I was fulltime provider then (now I'm just parttimer). Now we have 12leads, fastpatch AEDs, a scientific based concept for resuscitation including drugs and team management. Meanwhile my personal statistics are about 10 arrests per year, where at least one or two get out alive on long term, two or three others at least make it ROSC to the hospital. Five will be dead on scene, four of them already smell a bit funny, statistically spoken.

But it's not just scientific research in emergency medicine and education of the providers but also education of the public (first aid, emergency numbers), technical possibilities (mobile phones, navigation help, AEDs) and the whole system (dispatch standards, more ambulances, decentral first responders).

Therefore, my personal opinion: I've seen A LOT of improvements in the last 30 years in our EMS system. Maybe just because it was so crappy when I started back then, it couldn't get worse...

However, i would like to see more improvements. This list is a good thing to discuss (it's a little too U.S.-centered to allow me to real enter the detailed discussion).

To me its is kind of like the new whiz kid from college who got an agricultural degree, battling the farmer who has farmed for 50 years.

I was in this position (both, the new whiz kid and the long-year-practitioner) in more than one occupational field and I just can say: some people call the errors they make for 50 years "experience"...

Now, I'm beeing far away from a whiz kid fresh out of something and try to remember that it almost always is the mix of new knowledge with any type of long-term experience (even the errors, if we know them as such) which makes a good improvement.

[chbare]

Real ACLS? Back when we gave bicarbonate and calcium to every arrest patient, pumped trauma patients full of crystalloids and likely put many, many tubes in oesophaguses.

[Doczilla]

I am not so sure, medics of the 80s had to pass real ACLS, and had less technology to make decisions. As far as ROSC and being released from the hospital in a productive state, I am not sure the numbers have changed a whole lot. To me its is kind of like the new whiz kid from college who got an agricultural degree, battling the farmer who has farmed for 50 years.

Our experience locally after institution of therapeutic hypothermia is that for patients who are cooled after ROSC, we have a 39% rate of neurologically intact survival to hospital discharge. This is consistent with data from other areas, posting an overall out of hospital cardiac arrest survival rate of around17%.

'zilla

[Happiness]

Education is the best place for paramedics to learn, but one thing that is forgotten is the experience of the partners. I have learned more from the flightmedics, the nurses and the drs on any given call. A text book and a teacher is going to show you the inside the box information where as the others above are going to teach you the outside of the box information and are going to show you how to apply it in the real world.

Just my opinion

[romneyfor2012]

I did not mean the drugs they pushed in ACLS way back, but the old guys tell me they did convert more with 2 amps of bicarb off the top. I was referring to a time when you could actually FAIL ACLS, which meant you had to come into class knowing the book cover to cover, versus being read the test just before you take it, and then getting multiple chances to retake it now if you fail.

[Just Plain Ruff]

I always had problems with reading the book. Each time I got to reading it I ended up waking up a couple of hours earlier. The original Rufie if you ask me

There were many times when I couldn't get to sleep at night that I'd whip out my ole 1994 version of the ACLS book (yes I still have that copy) and begin to read about acid base imbalance or some other topic and next thing I know my alarm is going off waking me up.