Shiny new toys...

[triemal04]

This is one of those pet peeves of mine that, unfortunately keeps coming up over and over again and was recently brought up in another thread. With that being said, feel free to ignore this.

EMS in the US is pretty substandard in almost every area; not geographical, but in what we are supposed to know/do/treat. As it stands right now we can't even come up with a real, enforceable national standard for what a paramedic is and what it takes to be one, let alone what one should be doing.

We can't ensure that every, or even a large majority of paramedics are able to know when to start/not start IV's...give/withhold medications...accurately interpret a 12-lead beyond a machines interpretation...know when to intubate or not intubate...do so proficiently...use/withhold/use modified spinal restrictions...recognize abnormal but still common presentations of illnesses...and the list goes on and on and on.

Basically, with how things are far to many "paramedics" don't know how to appropriately use/do the things that we are allready using, and in many cases have BEEN using for decades.

Why in the fuck would anyone advocate adding something new to our repetoire?

Wouldn't it make sense to truly learn how to use all the equipment that we ALLREADY have, do all the things that we ALLREADY do and THEN start looking at what else could/should be added?

Wouldn't it make sense to to create an educational system and standards that ensures that ALL paramedics can do that or at the very least have a high likelihood of being able to do so?

If people don't even know how to use and read a pulse oximeter does it really sound like a good idea to add something like the Infrascan?

[Kiwiology]

You sir are absolutely correct; but if all of my time in the US has taught me anything, its that even if the US is dead last in something getting people on some sort of systemic level necessary to enact change is just near impossible cos "DIS B 'MURICA!"

Sorry I am not more agreeable mate, In days gone by I would type up a two page massive rambling deconstruction of everything you had said and provide evidence that you are right, because you are, however I can't be bothered.

My advice is to either valiumz yourself into submission and just accept it, or get the hell out.

If you ever want to get out, I recommend teh Australia.

[Arctickat]

No doubt people were saying the same thing 30 years ago about AEDs, 20 years ago about SPO₂, and 10 years ago about etCO₂. Question is, why should those countries that have their shit together wait on the American prehospital paradigm to finally shift before we can advance? However, as you've mentioned, the American system is what is substandard and what needs to change. Maybe, one day those in power will recognise the problem and deal with it.

Oddly enough, these shiny new toys being used to advance health care beyond U.S. borders originated in that very country.

Edit:

I can see where you are coming from though....Already has only one "L".

Edited April 29, 2013 by Arctickat

[island emt]

Somebody urinate in your cornflakes this morning ???

Did you cross horns with a hoser today?

While i will agree on the lack of a national standard causing some issues, At the present time most states are relying on a third party for hire testing agency to decide what standards are to be taught to whom.

In all the decades since I started in EMS there has never been a national standard across the board. Some places teach & test to the lowest common denominator and others have extremely high standards and expectations for prehospital providers, with very active educational components and active involvement from the medical control teams.

PS I've been at this long enough to remember when radio dispatched was painted on the side of our Pontiac ambulances, so there have been many changes in technology since then.

Edited April 29, 2013 by island emt

[chbare]

Take feelings and pejoratives out of the mix and look at the evidence. In spite of perceived or actual deficiencies within the EMS system as a whole, can we say that some of these new toys have in fact improved care and decreased the incidence of problems?

[Bieber]

I agree that by and large paramedic education in 'Murica is substandard and far too preoccupied with individual skills than didactic knowledge. That said, I think that there are additional skills we could add to our repertoire which would be both simple enough to ensure high success rates and also provide a clinical benefit. Some of these could be available to all paramedics; others to a smaller group of specialized medics.

Of the examples you provided, I'll point out that, with regards to spinal motion restriction, given that there's no evidence to suggest spinal immobilization is beneficial to anyone, under any circumstances, I would be more concerned about paramedics APPLYING spinal immobilization than I would be about them withholding it. I'll also add that I think from what I've read about the Infrascan it sounds like a fairly reliable machine with relatively little room for operator error. And finally with pulse oximetry, I'm not sure I've read anything suggesting paramedics are unable to accurately use it? Have you read something else? Unless you're talking about their inability to recognize that a non-hypoxic patient probably doesn't need supplemental oxygen...

That said, I haven't seen any signs of the educational system in the U.S. moving toward mandatory degrees or higher education anytime soon. There's a reason why there are an increasing number of services and colleges moving above and beyond the national standards, and I think that that reason is because there are paramedics in EMS who want to grow and improve are unwilling to sit around and wait for the national system to catch up to them. Personally, I think we need to focus on growing and empowering these advanced services (and mercilessly shame the barely homeostasing hoser/loser services into either following suit or getting out of the biz).