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

[vs-eh?]

I'm going to mirror a lot of what JPINFV said...

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 ?

Pre-hospital (and in many cases in hospital) medical cardiac arrests need 4 things (traumatic arrests need 1....a phone ). Right people, at the right place, at the right time, with the right equipment. Loose any of those elements and mortality (my inference) increases rapidly. Let's face it, if you have a cardiac arrest you aren't doing to well in the first place. PAD programs and public CPR (and hell, first aid) are great...but how often do you go to an arrest, even with peoples own family members...and no one is doing anything? A lot...

RSI is available in only a handful of communities

Again, judging by the education that the majority of EMT-P's receive, RSI is a no go. When you start doing 50 OR tubes and 10+ field tubes PRIOR to practicing autonomously then MAYBE you could start to think about it. RSI should only be reserved for REAL critical care paramedics and special teams. PAI (which I'd be more open to) is often just as effective. Once you start introducing a paralytic, vastly more problems ensue.

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

Again, pretty useless for practical land EMS use and should only be reserved for special teams who have a real use for it.

Have we impacted trauma deaths, which was our original mission -- probably, but hard to prove it is our accomplishment versus the surgeons.

If you die from a trauma prior to reaching the hospital, then whelp...you very well would have likely died anyway. Secure ABC's and drive safely to the hospital.

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)

We are getting computer based ACR's soon (apparently). Money better spent on other things IMHO...But yes...working in a large service I do see the benefits.

[flight-lp]

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.

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.

You can't help people who do not want to help themselves....

The main reason why we do not see more trauma centers is because the public usually votes against it, plain and simple. Same reason why many tax districts refuse to go with a full time paid service instead of keeping their "free" volunteer service.

And I'm sorry, but if you need an I-Stat to assist you in destination determination, then you shouldn't be on an MICU truck..........

[Ace844]

"Flight,"

I wouldn't need the I-stat, for destination determination, but it certainly would help with patient care for those of us who know and understand what the values mean, and correlate the data clinically.

Out Here,

ACE844

[TechMedic05]

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.

Perhaps what GA wants every licensed or certified EMT or Paramedic to do is go door to door educating people to put down the Twinkies, stop smoking, and inform them that "Death is bad, and you should really really avoid it." Yes, CPR and early defib is most likely a benefit to nearly dead patients, or those who wish to soon be, but your analogy is off. You keep using building codes. Well, that's something that can be changed and enforced before hand. Besides, Fire Dpeartments have the ability to also inflict monetary damages to the owner of a building, like shutting it down if it does not conform to standards. Some can even place fines. Who is going to be the agency that will place a fine to Mrs. Smith who didn't take her lasix this morning? not me. The appropriate end to your analogy would be that "Look, Fire departments have stations set out across a city, to lessen response times! Woohoo!" Most places 'mobile post', so we've got that down pat. And, like JP, Ace, and VS have stated - dead is dead. Some people need to die.

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.

Preaching to the choir here. I hate to say what Ace has, but search for it. Your computer will freeze with so many hits.

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 ?

Uh. Honestly, not knowing much about portable laboratories, I don't really see a great need in many systems for this technology. Long transports with specialized crews, definitely more appropriate. Regular run of the mill 911, I dun think so. I'll stick it out without this stuff until I can get my own tricorder. Those look cool.

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.

Pharmaceutical references - Book. It always starts, the batteries are never dead. Intradepartmental communications? Sounds like you need a radio. Dispatch? Not so sure on, honestly. I've never had the pleasure to be dispatched by computer.

As far as documentation goes, it's a great idea, but I don't believe many are 'ready' for it. In one company where I have worked, where some had tablets - they sat in front of the patient and asked questions to answer each little open box in the form. There are over 300 separate info points on this. For some, it got tedious. Granted, on the other end - run reports of many have sucked. Education is the key. And it's been beaten to death...three or four dozen times already...NEXT!

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

The golden hour is still the same, we've just [hopefully] done better things within that time. Again, sometimes people just aren't going to be able to get the appropriate level of care in the time needed. [i'm thinking like 9th grade algebra- Distance = Rate * Time, where Distance is constant, and speed is extremely limited] What can you do? A level 1 trauma center in every little town in America? Money plays this game. We don't have much. Can things be improved, absolutely. Will having someone come and lecture other active and progressive members of this field change all that much? No.

[Ace844]

To take this point a step further, "GA," read the trauma journals, the trauma surgeons are having a real hard time finding jobs, and paying bills....yet i noticed your not over at www.Trauma.org selling this..so perhaps you knew that and misread your audience!?!?!?

ACE844

[vs-eh?]

Pharmaceutical references - Book. It always starts, the batteries are never dead.

I missed this point before...

http://www.amazon.ca/gp/product/1882742427...ce&n=916520

Great little thing. Everyone should have one on them at work.

[TechMedic05]

I missed this point before...

http://www.amazon.ca/gp/product/1882742427...ce&n=916520

Great little thing. Everyone should have one on them at work.

Hey! That's my book!

It's an awesome book. Their other ones are good, as well.

[Ace844]

8)

I missed this point before...

http://www.amazon.ca/gp/product/1882742427...ce&n=916520

Great little thing. Everyone should have one on them at work.

That's one o those new fangled fancy contraptions from Canada, eh? I can never figure out what all those little letters mean L, <K, P3, etc... it's so confusing... :wink: :roll: 8) :shock: 8)

[GAmedic1506]

Everything you'all say is true, but that doesnt mean we cant or shouldnt try to change it. Forty years ago, an ambulance was little more than two guys and a hearse. I imagine if you told those "ambulance attendants" that one day we would intubate and administer medications, would have computers on trucks, have cardiac monitors, 12-lead, and pulse-oximetry, they would have laughed in your face. If we wanted to, we could make big changes in the EMS Industry, but it is easier to gripe about problems than it is to fix the problems.

[Ace844]

Everything you'all say is true, but that doesnt mean we cant or shouldnt try to change it. Forty years ago, an ambulance was little more than two guys and a hearse. I imagine if you told those "ambulance attendants" that one day we would intubate and administer medications, would have computers on trucks, have cardiac monitors, 12-lead, and pulse-oximetry, they would have laughed in your face. If we wanted to, we could make big changes in the EMS Industry, but it is easier to gripe about problems than it is to fix the problems.

Please refer yourself to ALL the other posts, this was adressed, also kindly read 'the white' papers from California, and you'll see that this was not necessarily the case.

ACE