Can You Justify The Continuation Of The Current EMS Model(s) ?

[chbare]

To start what exactly? Home health paramedics, or something else?

[ERDoc]

Like I've said in the past, if you want to increase the standards of EMS you need to start by having an organization such as ACEP start the ball rolling. They are an established national organization that has large roots in Washington DC. I think making EMS a board certified sub-specialty is a step in the right direction as it justifies EMS as a lefitimate medical field. We are still in the infancy but as more EMS physicians focus more on EMS than ER work I think you will see some movement. FFs and vollies are going to be hard to fight. How do you argue against, "We do it out of the kindness of our heart to help our community (insert puppydog eyes here)."

One way I see for fighting the fire service is to use their arguement agaisnt them. They claim they should have medics because they are often on scene first and it is these first few minutes that often make the difference. I think we should agree with them 150%. In fact, those first few minutes are so important that we should have the most highly educated and capable providers possible and that the current system falls short of this. We need to increase the standards of these brave men and women who go into harms way to save their fellow man and woman .

[mikeymedic1984]

I wonder if it would be better if we went to regional systems that shared fire/ems/dispatch capabilities, and used that savings to do something else. Think about how many different departments there are within 50 miles of you, that each have Admin overhead, billing systems, and independent dispatch centers ?

[Asysin2leads]

From an educational and practical, I can't in good conscience justify the current EMS model. During the American Civil War, people with traumatic injuries could receive, if they were lucky enough, ether to help with pain control. Failing that, they at least got a shot of whiskey and a bullet to bite on. In many parts of the United States, 150 years later, people with traumatic injuries don't even get that. There is no excuse for that. No volunteer organization, or IAFF representative, can ever say anything to dissuade me from my notion that the lack of pain control, in of itself with no other factors, is a glaring example of why EMS in the United States needs rapid overhaul.

If I had my way, EMT-B would be a non-transport title only. I mean, it would be a good title to have for people who do hiking, or for firefighters first on scene, something like that. I would add a 2 week pharmacology component to it so that at least nitrous or some other relatively benign analgesic could be administered until such time that more advanced care arrived.

I would also create a separate title for IFT transport EMTs. This isn't to say that IFTs are not important, or have anything to with healthcare, I think you learn more doing IFTs than you do handing out band aids or picking up drunks, but I think a separate skill set could be developed and implemented to help beef up both the standards for IFT and 911 response.

In short, I think the current standards of prehospital care in many parts of the United States do not deliver the appropriate care needed to the population. I would also implement a $50.00 fine for anyone who says "BLS BEFORE ALS!!!"

[ERDoc]

I would also implement a $50.00 fine for anyone who says "BLS BEFORE ALS!!!"

Would I be given an exemption if I had the bumper sticker on my car prior to the law? lol

I agree that we are in bad need of a huge overhaul. It is one thing when the hospital is a few blocks away, but when most of our country is a great distance from a hospital, the providers need to be able to manage a pt and should be able to do it without input.

[Kiwiology]

During the American Civil War, people with traumatic injuries could receive, if they were lucky enough, ether to help with pain control. Failing that, they at least got a shot of whiskey and a bullet to bite on. In many parts of the United States, 150 years later, people with traumatic injuries don't even get that.

I say we bring back the hacking off of limbs with a rusty saw by a Chiurgeon while the patient is awake and then their haemmorhaging stump can be cauterised with boiling oil

Half will die from infection or exsanguination and the other half will not make it out of surgery

That way there will be no need for an overhaul and the IAFF and volunteers will not complain especially not them upstate NY vawlenteeha's with buff several hundred thousand dollars fire halls and vehicles brimming with lights and tech but no blood pressure cuff

Oh you may find it interesting that Andreas Pare the inventor of the modern technique of surgical suturing was a barber Chiurgeon during the battle of Turin in 1536. It took over 300 years for his technique to become accepted practice.

Would I be given an exemption if I had the bumper sticker on my car prior to the law? lol

No, not for your Nissan, for my Jeep yes.

Edited April 13, 2012 by Kiwiology

[Asysin2leads]

I say we bring back the hacking off of limbs with a rusty saw by a Chiurgeon while the patient is awake and then their haemmorhaging stump can be cauterised with boiling oil

If the extreme right wing has its way, then that is a distinct possibility. No more of this namby-pamby liberal modern medicine crap. Let's get back to the good old days when men were men and saws were saws. Anyway, compared to someone with multiple limb fractures being transported over rough terrain with no analgesic, cauterization with boiling oil seems down right humane.

Half will die from infection or exsanguination and the other half will not make it out of surgery

I know of a few hospitals where those odds would reduce the Morbidity and Mortality stats.

That way there will be no need for an overhaul and the IAFF and volunteers will not complain especially not them upstate NY vawlenteeha's with buff several hundred thousand dollars fire halls and vehicles brimming with lights and tech but no blood pressure cuff

Oh you may find it interesting that Andreas Pare the inventor of the modern technique of surgical suturing was a barber Chiurgeon during the battle of Turin in 1536. It took over 300 years for his technique to become accepted practice.

It'll be an easy enough transition. The Upstate volunteers can just switch over to patches that depict a bottle of whiskey and a hacksaw instead of the Star of Life. They can use the town's budget to buy state of the art, diamond encrusted saw blades and use the finest, extra virgin-olive oil for the cauterization, because, you know, they want to go all out when its about saving lives.

[tgulch]

I am the EMS supervisor for a unique island community. During the winter we have MAYBE 300 residents on all 9 islands (We cover 160 something square miles, and only about 7 are land, 9 island only 3 are inhabited year round). During the summer though the population of the island swells to as many as 20,000 on a busy holiday weekend. The island has become known as a party island in the summer. The only way on or off the island in the summer is to take a auto/passenger ferry, a passenger only ferry, personal boat, or airplane. There is also the Air Ambulance for emergent transport off the island. The Airport is a daylight airport only, and the ferries stop running by midnight at the latest and begin again at 6am. In the winter, air is the only way on or off the island. Our run volume is about 500/year, with a majority of runs occurring between May and September. Usually about 50-75 runs outside of those months.

We have a very progressive Medial Director, and have incorporated a very progressive medical treatment. A majority of patients are treated and released. Fractures, lacerations, etc are bandaged, steri stripped, and sometimes even non narcotic pain meds given, and the patient is left in care of self or family and friends and told to transport themselves off the island for definitive treatment. Patients that have had too much to drink are given a 2000cc Bolus of NS and if they are responsive able to walk, and alert enough, they are sent home to sleep it off. We regularly clear C-Spine on falls and simple traumas. We fly anyone who has injuries or illnesses that need that transport, and have even transported on a ferry with just the cot to turn care over to a service on the other side.

I foresee more EMS entities entering into a system similar to how we run. We even have the right to refuse Air Ambulance transport to patients who are demanding it, but do not have injuries or illnesses to justify an air ambulance.

[rock_shoes]

I am the EMS supervisor for a unique island community. During the winter we have MAYBE 300 residents on all 9 islands (We cover 160 something square miles, and only about 7 are land, 9 island only 3 are inhabited year round). During the summer though the population of the island swells to as many as 20,000 on a busy holiday weekend. The island has become known as a party island in the summer. The only way on or off the island in the summer is to take a auto/passenger ferry, a passenger only ferry, personal boat, or airplane. There is also the Air Ambulance for emergent transport off the island. The Airport is a daylight airport only, and the ferries stop running by midnight at the latest and begin again at 6am. In the winter, air is the only way on or off the island. Our run volume is about 500/year, with a majority of runs occurring between May and September. Usually about 50-75 runs outside of those months.

We have a very progressive Medial Director, and have incorporated a very progressive medical treatment. A majority of patients are treated and released. Fractures, lacerations, etc are bandaged, steri stripped, and sometimes even non narcotic pain meds given, and the patient is left in care of self or family and friends and told to transport themselves off the island for definitive treatment. Patients that have had too much to drink are given a 2000cc Bolus of NS and if they are responsive able to walk, and alert enough, they are sent home to sleep it off. We regularly clear C-Spine on falls and simple traumas. We fly anyone who has injuries or illnesses that need that transport, and have even transported on a ferry with just the cot to turn care over to a service on the other side.

I foresee more EMS entities entering into a system similar to how we run. We even have the right to refuse Air Ambulance transport to patients who are demanding it, but do not have injuries or illnesses to justify an air ambulance.

Are you by any chance from Long and Brier Islands in Nova Scotia? If I recall correctly that's one of the longest running primary health integration projects in Canada. Has any of the more definitive data been published? Are the educational gap analyses completed? I'm very interested in seeing the data and reccomendations.

[tgulch]

Are you by any chance from Long and Brier Islands in Nova Scotia? If I recall correctly that's one of the longest running primary health integration projects in Canada. Has any of the more definitive data been published? Are the educational gap analyses completed? I'm very interested in seeing the data and reccomendations.

No I am in Ohio at the Put in Bay EMS service. The islands are actually the Bass (South Bass, Middle Bass, and North Bass). We have 1 full time paramedic year round on South Bass with support from the Volunteer EMT's. In the Summer we supplement the staff with part time paramedics and EMT's. We run with 2 medics during the day and medic/emt combo at night, on weekends we run with two medic/emt teams on south bass and a 2 EMT (or AEMT) team on Middle Bass. Those are the only two islands with any EMS staffing at all and the only two islands with any EMS equipment on the islands. If we have to respond to any other island, it is by boat and we are pack mule with whatever equipment we think we may need. And I had forgotten, there are 4 islands with year round residents. One island is a Campus for OSU for Marine Biology program used only in the summer, and 3 of the other islands have some people living on them from time to time. There is one island that no one ever lives on.

Our practice is actually limited by the Scope of Practice for the State of Ohio. If sutures ever got added to that, I am certain we would be doing those also.