NREMT-B Test (WARNING: Mean-spiritedness inside)

[cosgrojo]

:tweety: I disagree. We can get the patient moving to the hospital. We can get a baseline set of vitals. We can give O's. We can run a strip (our protocols allow basics to apply a 12 lead). We can provide the ER with a good assessment, giving them a head's up. We can get a good history. We can begin excellent patient care and if ALS doesn't show up, at the least they get good BLS. If ALS does show up, we've done a whole pile of stuff that they don't half to mess with. It does make a difference and in services all over the world that don't have access to ALS providers, what BLS does is of consequence. C'est la vie. I know a number of BLS providers that I would be happy to have dealing with my chest pain. I would take good BLS anyday over iffy ALS.

Assessments are good, fast transport even better. But none of that manages my chest pain. I'll take a medic. Granted I want a GOOD medic. And I agree that there are good and bad medics, as well as good and bad basics. And good Basic's can assess and transport well enough, but that doesn't actually DO anything for my chest pain.

OK, so you'll take good BLS over iffy ALS.... would you take good BLS over good ALS? Didn't think so. ALS wins. :wink:

[Dustdevil]

The interesting thing about that theory is the fact that so many basics actually believe they would know the difference between a good medic and an iffy one.

Puhleeze. :roll:

[TechMedic05]

Cosgrojo- Knowing the area in which you are employed [Read: New Hampshire, for everyone else], I happen to know your protocols. BLS can do a lot more than many think. In NH, anyways, Assess assess assess. Just because a provider is BLS doesn't mean they can't become familiar with, and provide, ALS assessments. You have oxygen at about any quantity you'd like, Aspirin is normally a good idea. And also, if the patient has their own nitroglycerin you can 'assist' them with it x3 as long as their blood pressure is over 100/p. A couple more things NH is getting to is, as recently added to almost all of our protocols: "Minimize On Scene Time.", and also Basics are now allowed to perform 12 leads to Fax to the receiving ED. Sure, asking basics to go and learn how to interpret 12 leads may be a bit too progressive, but fax them to someone who can. Early notification to a receiving facility is also a huge part of this system we work in.

[Now, yes...I understand the company you work for doesn't have 12 leads for BLS trucks...Hell, as an ALS truck I didn't have 12 lead a portion of the time...and I know said company also doesn't like providers to think. ::bangs head on wall::]

And I'd take good BLS over bad ALS any day.

[MedicNorth]

Damn, Dust - This rates as the least thought out post of yours that I have ever seen! I have worked with many different medics, and have to tell you that some of them make me cringe. If they are indecisive, miss obvious symptoms, mistreat patients or co-workers, etc, I am quite capable of telling who is good and who is iffy. You don't have to be a pro baseball player to tell who is or is not good enough for the team.

I also find it ridiculous that someone would state that they "wouldn't want ANY EMT-B dealing with my chest pain." Personally, if I was having chest pain, I would want it to be happening in a fully equipped and staffed ER, but that just is not reality. Would you not want someone who can help administer basic meds, supply O2, do CPR, call ALS, present vitals and use an AED? ALS is better than BLS in that situation, yes, and BLS is better than a CPR trained bystander, which in turn is way better than dying alone.

This is stupid. Once again we illustrate why EMS is not as it should be. We beat the crap out of each other, instead of supporting the profession and working together to make it better for us and our patients.

[cosgrojo]

Cosgrojo- Knowing the area in which you are employed [Read: New Hampshire, for everyone else], I happen to know your protocols. BLS can do a lot more than many think. In NH, anyways, Assess assess assess. Just because a provider is BLS doesn't mean they can't become familiar with, and provide, ALS assessments. You have oxygen at about any quantity you'd like, Aspirin is normally a good idea. And also, if the patient has their own nitroglycerin you can 'assist' them with it x3 as long as their blood pressure is over 100/p. A couple more things NH is getting to is, as recently added to almost all of our protocols: "Minimize On Scene Time.", and also Basics are now allowed to perform 12 leads to Fax to the receiving ED. Sure, asking basics to go and learn how to interpret 12 leads may be a bit too progressive, but fax them to someone who can. Early notification to a receiving facility is also a huge part of this system we work in.

[Now, yes...I understand the company you work for doesn't have 12 leads for BLS trucks...Hell, as an ALS truck I didn't have 12 lead a portion of the time...and I know said company also doesn't like providers to think. ::bangs head on wall::]

And I'd take good BLS over bad ALS any day.

You are fiesty little $%#@& aren't ya? I think you know what I am saying here. At least I think you know me well enough to know what I'm saying. I agree that our protocols may be much more aggresive than the average, but that doesn't stop me from wanting a medic if the shiz hits the fan. In the state of NH, Medics are good for 2 things.... pain control, and cardiac calls. Well my friend, chest pain is a cardiac call... so I'm still callin' for a medic on the chest pain, even if I know the medic who's likely on the way isn't very good. :bootyshake:

[cosgrojo]

I also find it ridiculous that someone would state that they "wouldn't want ANY EMT-B dealing with my chest pain." Personally, if I was having chest pain, I would want it to be happening in a fully equipped and staffed ER, but that just is not reality. Would you not want someone who can help administer basic meds, supply O2, do CPR, call ALS, present vitals and use an AED? ALS is better than BLS in that situation, yes, and BLS is better than a CPR trained bystander, which in turn is way better than dying alone.

This is stupid. Once again we illustrate why EMS is not as it should be. We beat the crap out of each other, instead of supporting the profession and working together to make it better for us and our patients.

This was said in a way that meant that I would prefer to have ALS to BLS, which furthermore was in response to someone who was frightened having BLS personnel that failed the registry exam role up on a chest pain call. I am a basic, I am not trying to put Basics down..... *cough* unlike Dust *cough* I was just indicating what I would WANT..... which is a personal decision. If you want a Basic working on you, just say so.... I'm sure it can be arranged. :hippy2:

[MedicNorth]

Oops- sorry Cos. I get onto my soapbox, and sometimes read into things that are not really there. Of course I would prefer ALS, if it was available. My frustration got the better of me.

[TechMedic05]

Yeah, I smell what you're stepping in for sure.

I am going to have to continue to be feisty and correct something else...Medics are good for more than just pain management and cardiac. Something like...Airway?...hrmm...and a few other things.

And I'd even bet many are familiar with BLS, too.

[chazmedic]

TechMedic05

am going to have to continue to be feisty and correct something else...Medics are good for more than just pain management and cardiac. Something like...Airway?...hrmm...and a few other things.

Medicare ALS reimbursement.

What? You were thinking like..care? :shock:

[TechMedic05]

omg. Chaz, you are SO correct! I so completely forgot about that.

All joking aside, the Goffstown, NH Fire department likes to staff it's ambulance(s) with at least one Intermediate to be able to bill for ALS...If it's a B/I crew, the Intermediate can not triage any patient to the Basic. The Basic is only allowed to drive. Why? For the all mighty ALS billing.

Stupidity runs amok.