Are we (EMS) Lazy, Scared, or Indifferent ?

[GAmedic1506]

I started a thread a few weeks back that asked what have you improved at your EMS Agency ? The results were miserable, hardly anyone could cite a single improvement. Atleast the Fire Departments can point to improved building code, reduced fire-deaths, and the overall reduction in actual fires. What can we point to:

* Are cardiac arrest survival rates improving ? Seattle showed us the way to do it years ago, how many other agencies

have stepped up to the plate ?

* RSI is available in only a handful of communities

* The ability to do lab work in an ambulance is now available through ISTAT, but only a handful of providers use it.

* Have we impacted trauma deaths, which was our original mission -- probably, but hard to prove it is our

accomplishment versus the surgeons.

* There are many EMS services that do not have computer-based reporting, even though computers are cheaper than

many of the other pieces of equipment we buy (stretchers, monitors, stair-chair)

When the rookies ask what our generation did for EMS, what will you say ?

[JPINFV]

* Are cardiac arrest survival rates improving ? Seattle showed us the way to do it years ago, how many other agencies

have stepped up to the plate ?

Realize that dead is dead. You aren't going to be able to save everyone, and that cardiac arrest with no CPR prior to arrival is essentially dead. PAD's is more of a public health then EMS issue.

* RSI is available in only a handful of communities

RSI isn't appropraite for all communities. See all the research presented in other threads that shows that a good number of medics shouldn't be making people apneic to place a tube.

* The ability to do lab work in an ambulance is now available through ISTAT, but only a handful of providers use it.

Does it matter what the lab values are if the provider has neither the education or means to do anything about it?

* Have we impacted trauma deaths, which was our original mission -- probably, but hard to prove it is our

accomplishment versus the surgeons.

Passive hypotension, no more MAST/PASG , etc shows that critical traumas turn EMS into a fast cabulance. Untill, at the very least, ambulances are stocked with either blood or a blood substitute, this isn't going to change. It doesn't matter how high your education or how good your skills are if you can't stop any internal bleeding and the patients H&H bottoms out.

* There are many EMS services that do not have computer-based reporting, even though computers are cheaper than

many of the other pieces of equipment we buy (stretchers, monitors, stair-chair)

What benifit does computer based reporting have for patient care, if any? It might make QA easier, but people are still going to have to read it.

[Ace844]

"GAMedic,"

The evidence and information as "JPINFV," has taken the time to point out to you is ALREADY HERE. My suggestion is to do a search and leave the preaching for whatever religeous or public platform you prefer. There are many posts here to which are still awaiting your reply with evidence and actual factual information. Until then, good luck and have a nice day,

ACE844

[GAmedic1506]

IF we are about saving lives, then we should be involved in the things that save lives, just as firefighters are involved in building code. If we do not push for CPR and AED placement, who will ? And dead doesnt have to be dead if CPR is started sooner and an AED is available.

As far as RSI, I agree with you, but our intubation failures are due to inadequate training, which is something that could be fixed. How many departments have REAL training every month, versus some canned pencil-whipped program where you just shuffle some papers to meet requirements.

The value of lab work: Knowing the white count of someone with a fever, knowing the H&H of a trauma patient shortly after incident, knowing the calcium, potassium, and magnesium level on your dialysis patient, being able to do cardiac enzymes on a chest pain patient -- would it change what you do now, maybe maybe not ? Could it open new treatment doors, yes ?

Computers can open a variety of doors besides patient reporting. You can load programs that improve safety -- such as Pharmaceutical Reference Guides, Haz-Mat/Cameo Programs. You can improve intradepartmental communication, dispatch capabilities, and probably several more things.

Trauma -- no we cant do surgery, but how many people still have to wait to long for an ambulance, or do not have access to a trauma center ? Have we significantly improved the golden hour

[Ace844]

IF we are about saving lives, then we should be involved in the things that save lives, just as firefighters are involved in building code. If we do not push for CPR and AED placement, who will ? And dead doesnt have to be dead if CPR is started sooner and an AED is available.

As far as RSI, I agree with you, but our intubation failures are due to inadequate training, which is something that could be fixed. How many departments have REAL training every month, versus some canned pencil-whipped program where you just shuffle some papers to meet requirements.

The value of lab work: Knowing the white count of someone with a fever, knowing the H&H of a trauma patient shortly after incident, knowing the calcium, potassium, and magnesium level on your dialysis patient, being able to do cardiac enzymes on a chest pain patient -- would it change what you do now, maybe maybe not ? Could it open new treatment doors, yes ?

Computers can open a variety of doors besides patient reporting. You can load programs that improve safety -- such as Pharmaceutical Reference Guides, Haz-Mat/Cameo Programs. You can improve intradepartmental communication, dispatch capabilities, and probably several more things.

Trauma -- no we cant do surgery, but how many people still have to wait to long for an ambulance, or do not have access to a trauma center ? Have we significantly improved the golden hour

AGAIN, KINDLY DO A SEARCH, THOSE DISCUSSIONS HAVE OCCURED, AND THE INFORMATION IS AVAILABLE!! If you'd like to post those seperately in the applicable threads, thats one thing...this is preaching from a pulpit..

ACE844

[GAmedic1506]

apparantly i am only preaching to you, please make a donation as the plate comes around.

[JPINFV]

IF we are about saving lives, then we should be involved in the things that save lives, just as firefighters are involved in building code. If we do not push for CPR and AED placement, who will ? And dead doesnt have to be dead if CPR is started sooner and an AED is available.

You can't force people to act. AED's are becoming abundent, for the most part, where I live. Unless you think we need to require AEDs to be placed with every fire extinguisher. I'd rather see my tax dollars, though, going to improving education, pay, and equiptment then fullfilling a pipedream that will go underutilized.

Equating this to proactive fire protection has two problems. Problem 1. Early CPR, early defib, early ACLS, etc means nothing without early detection. Unlike a fire, which under most cases tends to announce its presence, cardiac arrests can be hidden. Having an AED in every building isn't going to save the person who has a cardiac arrest while working alone, while in the john, or while sleeping at home.

Problem number two. You can prevent fires, but everyone will die eventually.

As far as RSI, I agree with you, but our intubation failures are due to inadequate training, which is something that could be fixed. How many departments have REAL training every month, versus some canned pencil-whipped program where you just shuffle some papers to meet requirements.

You can train all you want, but the hospitals have two big advantages over EMS. Hospitals have controlled settings [doing dangerous [dangerous to the patient] procedures in less then ideal conditions in an argument for not doing something vs more training. You might only have one shot. Make that shot with everything in your favor that you can].

The value of lab work: Knowing the white count of someone with a fever, knowing the H&H of a trauma patient shortly after incident, knowing the calcium, potassium, and magnesium level on your dialysis patient, being able to do cardiac enzymes on a chest pain patient -- would it change what you do now, maybe maybe not ? Could it open new treatment doors, yes ?

Again, what good is H&H if you can't do anything about it. Unless you're going to stop at the local hospital for a unit or two of blood [read EMTALA problems, protocol reworking, etc]. Cardiac enzymes are again useless prehospital unless you can do something about it. Why should a system that doesn't even allow its medics to read a 12 lead [they have to go off of the machine interpretation in my county] allow their paramedics to advance to a higher level? If your area has the ability to make prehospital lab values usefull, then go for it. I have a feeling that a lot of other areas have bigger dragons to slay [education, pay, better working hours/conditions, etc] then increasing their paramedic's SOP.

Computers can open a variety of doors besides patient reporting. You can load programs that improve safety -- such as Pharmaceutical Reference Guides, Haz-Mat/Cameo Programs. You can improve intradepartmental communication, dispatch capabilities, and probably several more things.

So we go from computer based charting to something completely different now. Are computers helpful? Sure. Are there other things that need to be improved first? Yes. There is a big difference between equipting every unit with a palm pilot [which would have your Rx reference, etc on it] and buying every unit a tablet PC and networking them together.

Trauma -- no we cant do surgery, but how many people still have to wait to long for an ambulance, or do not have access to a trauma center ? Have we significantly improved the golden hour

Because paramedics can just up and start a new trauma center or ambulance company anytime they want to, while making enough money to cover expenses. Can we at least stay in the realm of plausable for the average person?

[Just Plain Ruff]

Let's remember the 3 cardinal rules of EMS here.

1. Blood goes round and round - if we fix all the plumbing and do preventative maintenance then we can improve on that part.

2. Air goes in and out - if we fix the ventillation system and do preventive maintenance then we can improve on that

3. ALL PATIENTS EVENTUALLY DIE!!!!!!!! Well bubba, there aint anything we can do about this piece.

2 out of three aint bad

[GAmedic1506]

On AEDs, who said anything about tax dollars ? Why cant the local EMS just educate the community to the issue. Let those businesses figure out a way to buy their own. If you only saved one life this year with a community AED, woudn't it be worth the 30 minutes you spent convincing that business to buy one. You cant convince me that if your department facilitated the purchase of 20 more AEDs in your community, that a life would never be saved.

The value of lab work doesnt change alot right now, other than it may change your destination choice. If you knew for a fact taht someone was having an MI, you might take them to a facility that can do open heart versus your local hospital. A low H&H on a patient that looks uninjured might direct you to a trauma center. Again, I see it more as opening up future doors.

I see computers in the same way. They open up alot of future doors.

I disagree with your comparison of fire and arrests. Fires happen less because the fire department educated the public, used technology to minimize risk (sprinklers, alarms, and building code -- along with inspections), and forced changes in standards. If EMS did the same for cardiac arrest, the numbers would improve (more CPR taught -- taught the warning signs of MI, pass ordinance that any new business that is over 2000 sq ft or employee more than 50 persons must have an AED installed)

And no, Paramedics cant open a trauma center, but they can be activist to the media and legislature to get more opened. We cant do it alone, but our voice can be used.

The few things I listed are just sample suggestions. You bring up many "bigger issues" that need to be addressed, and you are right, they should be. My question is why arent they ? We all know what the problems are in EMS, but ask who is doing anything about it, and the answer is usually no one. But one thing that I have discovered is, that half of the battle is just deciding to tackle the problem, instead of ignoring it. We tend to say, it cant be done, and then we move on. But I am glad you brought it up, instead of just talking about it, why dont we see if we can actually solve one of those "bigger issues" that you mentioned.

JPINV (or anyone else that is up for a challenge), If you could fix one of those big issues, which one would you choose ? Please post it, and lets put all of our brains together to solve it.

[Ace844]

"GA,"

It's called ADVOCACY...Contact PRPG and or CAPEM; and they can put your preaching to work...where you will be doing more than just taking up space on a forum..

ACE