ljugaitafa Posted February 21, 2012 Posted February 21, 2012 Hi everyone! I'm new to the boards and came across them while trying to figure out a way to do a small consensus on a research proposal I'm doing for a EMS Research Design class. Theres a full manuscript that delves into the the background of my research proposal, as well as the design, methods, etc. to the study, but as far as this week is concerned I'm just looking for a small consensus to build a sample population of results. So here is my proposed research question. Would standardization in delivery of EMS care be supported nationally, by counties, or by region? I'm very interested in seeing how we deliver care to our patients being standardized across the country. This falls in line in terms of protocol and treatments rendered. I'm aware that it is dependent on the systemm MPD, and type of area (i.e. urban vs rural) and that these differ as times of transports and patient acuity can make a difference in what some areas allow providers to perform. Hopefully, the survey I created works without too many flaws and I hope to see what some of you think. Please attach the filled out form in your reply if that is possible. Thanks! LJU - Survey.xml
DwayneEMTP Posted February 21, 2012 Posted February 21, 2012 Hey Brother, I deleted your other thread for posting to more than one forum. No offense intended, it was placed properly in both places, but only allowed in one or the other. This is an excellent topic...Thanks for posting. I think that most career prehospital professionals would, and have, supported standardization in EMS. The problem that arises is with the vollies and fire services. A huge percentage of vollies want radios and tshirts, but have no desire to truly learn how to provide real prehospital care. The fire services want the EMS budget, but have no desire to do anything really, that isn't likely to get them on the news. (Speaking in VERY broad strokes to address the national issue. Not meaning to imply that there isn't a minority that is excellent in each category.) The standard of care would have to be raised if it was to be national, to something realistic, but any time the attempt has been made the vollies claim poverty and abuse of their generous hearts and the fire services claim that we're we're incarcerating their heroes in class rooms instead of allowing them to be on the street saving a gazillion babies from a gazillion burning buildings every day, where they belong. If you want to drop the national standard lower, so that even more bozos will get in than do now, then perhaps... So, the answer to your question, in my opinion, is until you solve those two issues that there is no chance of a realistically professional EMS standard being implemented nationally. Welcome to the City! Dwayne 1
Kiwiology Posted February 21, 2012 Posted February 21, 2012 Let me give you an international comparison which may prove helpful In New Zealand, EMS (known as "Ambulance" the term EMS is very uncommon here) is delivered by about 1,000 paid and 3,000 volunteer Ambulance Officers to nationally consistent standards. Ambulance Officer is a generic term for anybody on the ambulance although we have three distinct levels Emergency Medical Technician (volunteer level, some paid Officers, one year course) OPA, NPA, LMA, PEEP, tourniquet, defibrillation, 12 lead ECG acquisition, single lead rhythm interpretation, entonox, methoxyflurane (where used*), paracetamol, oral ondansetron, loratadine, nebulised adrenaline, aspirin, GTN, salbutamol, ipatropium, oral 10% glucose, glucagon, IM adrenaline for anaphylaxis only (upon direction of an Intensive Care Paramedic) Paramedic (Bachelors Degree) EMT + 12 lead ECG interpretation, manual defibrillation. synchronised cardioversion, IV cannulation (including external jugular), adrenaline, amiodarone for cardiac arrest, morphine, fentanyl, ceftriaxone, naloxone, midazolam for seizures Intensive Care Paramedic (Graduate Certificate) Paramedic + intubation, intraosseous access, midazolam for sedation, pacing, atropine, ketamine, suxamethonium, vecuronium, chest decompression, adenosine While most ambulances have two Paramedics some have a Technician and a Paramedic, a few have two Technicians (mostly volunteers) and "ALS" will have an Intensive Care Paramedic + another level, most of the time it's a Paramedic but sometimes a Technician. All of our actual patient care is delivered consistently using guidelines, we do not work to protocols and can choose what is best for our patient at the time, we work totally autonomously and do not have "online control" Hope that helps you draw some comparisons, if you have any other questions I would be happy to try to answer them for you! 2
ljugaitafa Posted February 21, 2012 Author Posted February 21, 2012 Dwayne, Hey brother, I didn't realize that a thread topic could be placed in only one forum section, sorry for that! Thanks for your reply! I appreciate the input!
systemet Posted February 21, 2012 Posted February 21, 2012 if you're looking for some similar systems for comparison, consider looking at the UK NHS ambulance system, and some of the provincial systems in Canada in British Columbia, Alberta and Nova Scotia.
ljugaitafa Posted February 21, 2012 Author Posted February 21, 2012 if you're looking for some similar systems for comparison, consider looking at the UK NHS ambulance system, and some of the provincial systems in Canada in British Columbia, Alberta and Nova Scotia. Not so much looking into systems in particular to compare. The purpose of my design study is to get a concensus from all pre-hospital providers on their opinion, as well as DOH administrations, EMS managers, training officers, and ultimately the MPD's. Basically for a push towards raising the bar overall across the U.S. as far as the delivery of care and standardizing those elements of care. I.e. like how in some systems paramedics are allowed to RSI, while in others your not. If we're all supposed to be held to the same standards nationally, why can't we practice and deliver the same time of care..nationally? I believe we should. Thanks for your input though, Ive yet to look very much into outside systems although I've glanced here and there and I am interested in the progression other systems in various countries are set up. Especially, with their education requirements.
Kiwiology Posted February 21, 2012 Posted February 21, 2012 The reasons why are complex. Whatever power is not explicitly granted in the Constitution to the Federal Government is the domain of the particular state (10th Amendment) and each state has done its own thing as it sees fit. The EMS Systems Act of 1973 does provide a standardised framework and some requirements that must be met to receive Federal funding but there is much variation as at the state level there is often additional legislation. Each state has sort of adopted to what it needs for its purpose; for example when determining levels of certification e.g. Virginia used to have a "Mine EMT" or something of that nature, which would not be appropriate in say, Nebraska. At one point I petitioned IDHS in the Great Nation of Indiana to create an EMT-Tractor because I sick of going to blokes stuck under tractors who were still stuck when we got there because the local volunteer Firefighters were too busy closing the road in preparation for the Lifeline helicopter landing than digging ole' Jim Frank the farmer out from under said tractor, hmm looks clear, Fire have closed the road, yep look there, he's still under the bloody tractor I gather by the gaggle of people around it; Lifeline descending will call you again airborne .... OK I'm taking the piss but you get the idea Historically the development of EMS in US was very much led by Physicians (originally Cardiologists like Nagel (Miami, Cohen and Cobb (Seattle) and Criley (Los Angeles)) and has just been "one of those things" that has just never died. Part of it is that EMTs and Paramedics do not have independent legal ability to supply or administer prescription medication to patients and need an instrument of delegation (a standing order). There is little Paramedic-led interest in changing things and there is also no single national body that represents EMS across the US; there are some pseudo organisations like NAEMT, NASEMSO, NAEMSE etc and this makes change, especially positive change very slow. The EMS Agenda for the Future: A Systems Approach is a great example it was created off the back of something called the EMS blueprint (or near equivalent) in 1994 and nearly twenty years later there has been very little positive change. By international comparison places like New Zealand, Australia and Ireland have achieved 50x as much is as much or less time. This document did not really consider what is going out outside the US which would quite easily highlight the gross inadequacy of it. It is the stated policy of the International Association of Firefighters and the International Association of Fire Chiefs to run EMS wherever possible. Both of these organisations are industrial unions. Let me repeat that, because it is quite important. It is the stated policy of the Firefighters union to run (including running by taking over) EMS wherever possible within the US. They have poured millions and millions and millions of dollars into this goal and pursue it aggressively; which I must say they have done a fantastic job of it as far as industrial representation and marketing go they are just expertly awesome at getting what they want, the problem is what they want is not good for patients or Paramedics. The Fire Service is an organisation steeped in tradition and structure going back many hundreds of years so be can quite change resistant. Also many Firefighters have no interest in EMS and go and get their Paramedic card to look good and get a Fire job; some places forces Paramedic certification on Firefighters (LA County, Houston, Dallas, most of Florida etc) so the Fire Service (and their unions) have a vested interest in keeping education standards as low as possible. The IAFC EMS Section is actually on record as opposing increases in EMS education, I did an awesome post about two years ago picking apart a document they submitted on the topic of EMS education but I cannot find it now, bugger! In some places Paramedic education is as little as 12 weeks plus a couple hundred hours of "skills internship" (Houston) and in some places you must have a college two year degree (Oregon and Kansas). Most Paramedics out there get a quick watered down couple of weeks of A&P and a week of pharmacology. Because of this each Medical Director will give his or her Paramedics what he or she is comfortable with. I have had a medical director tell me that he does not know from where his Paramedics are coming e.g. a 12 week patch mill or a two year college program taught by a University School of Medicine so he has to take the view that the worst possible Paramedic in the world will be using the protocol he writes. There is also little interest in Paramedic led research in the US which doesn't help as research drives practice especially with the push towards evidence based medicine. Some states have state-wide protocols e.g. MA, GA, PA but they are not overall particularly good; they are at least a state wide standing order so that's a step in the right direction.
ljugaitafa Posted February 21, 2012 Author Posted February 21, 2012 Very well written post Kiwimedic and I'm fairly familiar with how things are run from across the U.S. I'm not a fan of the 12 wk or short term paramedic courses that are run through out the U.S. and feel they do little to nothing in terms of helping the occupation or practice of the field. "Most Paramedics out there get a quick watered down couple of weeks of A&P and a week of pharmacology. Because of this each Medical Director will give his or her Paramedics what he or she is comfortable with. I have had a medical director tell me that he does not know from where his Paramedics are coming e.g. a 12 week patch mill or a two year college program taught by a University School of Medicine so he has to take the view that the worst possible Paramedic in the world will be using the protocol he writes." That statement in and of itself proves it and I'm in full agreement with the MPD. We are limited by what we are allowed to do based on what an MPD feels comfortable with what we are doing. That's where not only ourselves, as "Prehospital Professionals" should take ownership towards pushing our MPD's to raising the bar and making requirements not only per their own areas, but legislatively in their respective states/regions to ensure Medics are educated properly, so that they are comfortable allowing them to perform to capacity. I'd really be interested in seeing your post if you could ever find it!! So, my question still stands though, what is your opinion on it? Would standardization in delivery of EMS care be supported nationally, by counties, or by region? Why or why not? and finally, should it be? why or why not? in your own opinion of course! Thanks!! And by the way just for reference to you who read the post a little background on myself. I've been involved in EMS for going on 5 years now, so I'm relatively young into it, I'm working on finishing my B.S. in Paramedicine from Central Washington University. I'm a new boot Medic fresh out since August after a year + of coursework and interning and now working in Yakima, Washington for the larger of two private ambulance companies that provide ALS services for the county. Our calls range from <2 min transports to 40+ min transports running code from outlying towns from the main city throughout the county. Which makes our call volume fairly diverse in many aspects. If you guys have any other questions about me or my county please feel free to inbox me! Also again for those of you reading, In my original post is an attachment of my survey. If your interested in participating in it, that would be great! Just download the survey and check the boxes, fill out the spaces, save it as Survey- "your Screen name or name here", and attach to your thread posting. Thanks! LJ
Kiwiology Posted February 22, 2012 Posted February 22, 2012 You can read the IAFC EMS Section response to the National EMS Education Standards below; there are other documents but I can't find them http://www.iafc.org/files/ems_NtlEMSeduStandardsSectionComments070731.pdf To directly answer your question yes I think care should be standardised but at what level (state, county etc) I am not in the best position to answer that; most of the other nations that have uniform guidelines or protocols are small (Ireland, South Africa, NZ etc) but Australia has state wide guidelines as do several US states so I think starting off at the state level is a good idea. A single standard of care ensures that patients receive the same treatment regardless of where they are and gives providers portability to move between areas and not have to reacquaint themselves with a totally different operating model (somebody who moves from Texas to Los Angeles for example). It also provides a platform from which to develop research and advance practice
ljugaitafa Posted February 22, 2012 Author Posted February 22, 2012 A single standard of care ensures that patients receive the same treatment regardless of where they are and gives providers portability to move between areas and not have to reacquaint themselves with a totally different operating model (somebody who moves from Texas to Los Angeles for example). It also provides a platform from which to develop research and advance practice Very well put, thanks a bunch for your input!!
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