Appropriate use of ALS providers.

[island emt]

Okay : so now we have two blokes with their four year degree in Paramedical sciences who show up at work and ONE of them spends the entire shift holding the steering wheel or totin shit in & out of patients homes. Excellent use of a four year education. kinda like askin if ya want fries with that!

[BushyFromOz]

Okay : so now we have two blokes with their four year degree in Paramedical sciences who show up at work and ONE of them spends the entire shift holding the steering wheel or totin Ca Ca in & out of patients homes. Excellent use of a four year education. kinda like askin if ya want fries with that!

Break it down bone head...

2 said people show up at MVA with 2 or more patients

2 said people call additional crews, get a firemoneky to drive and you have 2 frogs in the back with the patient

2 said people show up at arrest, and instead of farting around running lights and sirens for ALS, they dispense it on the spot

1 guy is going to be able to help the other guy better than a first aider would

2 guys will burn out much less quickly as they will not be treating as many patients on every shift

So do you want more examples of just how stupid your smart ass reply is?

[OzMedic]

Further to Bushies frank and succinct response, if 2 medics are on the same unit by some accident of rostering then they will soon be split and partnered up with 2 ALS guys to maximise the resources. The majority of ICP's work as single responders anyway backing up ALS crews when needed.

[island emt]

Bushey : from someone who's been in this business much longer than you've been on the Earth pay attention. The calls that you mention are few and far between, unless your working in an urban combat zone less than 8 % of call volume is going to require a paramedical intervention. Yes when you need it it's great to have but requiring two medics on every single truck all the time is not the answer. One of them is going to spend most of their day being the basic. Better to put a second truck on the road with a basic /medic team and provide less work for the crews. I've worked in both scenarios and much rather prefer the basic / medic format.

My crews here also prefer the split teams.

[BushyFromOz]

Its obvious you have not read the rest of the thread about raising the minimum standrds then, cause if you did, you would see the thread was mostly devoted to having dual medic cars, and the educational requirements for those positions, so your medic/basic partnership just become void.

Yes when you need it it's great to have but requiring two medics on every single truck all the time is not the answer.

Answer to what exactly? I guess whatever the US is foing is the right way, as opposed to the different way agin... :?

For the record, we call basics in Oz "first aiders", it might not even get them a job as a patient tranport officer :shock:

[OzMedic]

Medics in my system are valued for for far more than their on-road skills and ability to be a bum on a seat. They are the mentors, educators, QA and the testing ground for new interventions. The idea of having these guys circulating around is that they bring the standard of the whole service up by the way they lead by example and support the staff with lower clinical qualifications.

[Eyegor]

The constant comparison to nursing is ironic. This same battle was fought several years ago in hospitals and skilled nursing facilities all over the US. Administrators started hiring fewer RNs and more allied health people, (LPNs, CNAs, etc.) Why? The bottom line was money. Who won? The bean counters. Why? Because health care is a business. Did the quality of pt. care decrease? Yes, in some areas. Not in others. The techs and assistants loved the opportunity and rose to the challenge. Now the same question is being raised in EMS.

While I feel that the goal should be to have every ambulance an ALS ambulance and to have Paramedic become a degreed, licensed professional; I disagree that EMTs don't have a place on the road. Basic/Medic crews provide IMVHO the best bang for the buck.

[everyminutesucks.com]

I don't really know where to start with this one! What is with the focus on RN's in an ambulance? It's just a bizarre logic! You keep proposing that it is a higher standard of education than medic and that may be the case where you are from but placing an RN or Dr for that matter in the back of an ambulance is not achieving anything! Yes there are many highly trained RN's and other allied health people in ambulances but ask any of them and they will agree that their previous training did nothing to adequately prepare them for the intricacies of prehospital care. When guys like Dusty and others go on the road in EMS they are not doing it as an RN they are medics. As for the level of training of RN being higher that is also not the case. An RN goes to uni, earns a degree and begins to practice as an RN. In my service you earn your degree in pre-hospital care, practice for 5 years minimum and then apply for medic which is another year full time at uni plus another 6 months of placements etc to earn your post graduate diploma of intensive care paramedic practice. This is a far higher level of education in prehospital specific education than RN training. I am now completing my Masters and after that will move on to doctorate level. Prehospital care is a specialist field and the education should be reflective of this. If you dragged an RN or junior Dr for that matter from the local hospital and put them in my job for a day and told them what was expected of them most of them would wet their pants (As indeed I would if asked to perform certain specialist nursing interventions in a hospital). Remember also that RN's without any postgraduate education perform their duties in a controlled and supervised environment with plenty of checks and balances for support. Most of what they do is ordered or Ok'd by a doctor. I perform my interventions in a myriad of difficult environments often as a single officer autonomously with nobody else to ask for help or advice. If you want a higher standard of medic where you are then replacing them with RNs is not going to do it! Improving the standard of prehospital education is the only way you will achieve your goals. Along with that will come industry recognition and renumeration commensurate of the standards achieved. It is certainly the case here and I earn more than any level of nurse or junior Dr with the exception of high level management.

Hello again. I get home and decide to check on any updates and did not expect to see this.... Wow

I have only quickly read over the posts but I think that it needs to be noted that when talking about the UK or elsewhere. There are already MAJOR differences between how things are done in the US and elsewhere. I think before I left it was left off at us "the US" needing to increase our standards to something more resembling yours. Our medic training programs (correct me if I am wrong or if your location differs) do not have "degree in pre-hospital care, practice for 5 years minimum and then apply for medic which is another year full time at uni plus another 6 months of placements etc to earn your post graduate diploma of intensive care paramedic practice". We have 1000 hours aprox of uni or tech school as the only requirement. In my area most of them have jobs as medics before they are finished with school. We have very very lax requirements compared to yours. What I was getting at in my posts earlier was that we need something more like what you now have. As far as my using "RN" repeatedly in my posts I will leave up to debate. I am used to RN's in my area, the lower class is a LPN and they don't hold a candle to our medics. There is no requirement for a medic to even have a 2 year degree. They get out of high school (post secondary? if that is the same for you. sorry i can't remember they are about 17-18 years old anyways.) go through 1 year of Medic training (or an accelerated program that last from 3 to 6 months!) and presto bob's your uncle and your a Medic.

That is what I was getting at. Again there are some good medics here but most of them have gotten that way from experience not training. In my area again they are often the most senior and experience person on a rig even with an EMT-B partner and have all of 6 months under their belts... Scary In that case I would hope there were 2 medics but it does not always happen. They are it!

I work in a system that has Medic/EMT units and if you ask the medics they hate it. Our EMT's don't know crap. Experience or not. I blame most of that on the company I work for and the very very crappy training they have.

Again lets not forget that we are not comparing apples to apples here. I made the mistake myself first thinking I was talking to another from the US. I was wrong. We first need to compare the differences in requirement here and abroad before anything else.

And Oz as far as the pay. Congrats. But that is far from the case here. In Minnesota a medic starts from about $12.00/hr to $16.00 per hour. Nurses start somewhere aprox. around $24.00 to $32.00 and have far better overtime rates from 2X to 3X per hour so $48.00 to $72.00 up to $96.00 /hour. Again this is ballpark so dont quote me on the rates. So you have it much better in the pay department, and probably due to the fact you have more training than our medics.

[Ridryder 911]

Short and simple .. We have a failed system. Does every call and everyone need ALS personnel .. ? No. Does every trauma patient need to have a surgeon in house .. no; but does our patients deserve such? Yes!

We have always attempted to place a band-aid on an arterial bleed and have done nothing but bled out the system, with the patient making the sacrifice.

Can any EMT actually state that their patient should not have at least ALS capability on every call? No.. If they can, they are in it for themselves and self ego's and not for the patient sake.

Should we require a medic/medic combination.. you bet! Our patient deserves at least the highest level to perform care, and at this time it is the Paramedic. Do basic's have a role YES! But; not in the ALS transport system. Their role should be only as a first responder approach.

I have worked almost every imaginable configuration, and yes medic/medic is the best. Yet again our patient deserve the best.

Now, everyone has compared nursing ...okay let's do that. Only RN's are permitted to work in critical areas (ICU/ER) as the primary nurses.(assessment, triage, responsibility) . I hear the same yadda ... yadda; when they phased out LPN's in the ER and ICU setting across the nation. You know what? Somehow they were able to do it. It is amazing, communities & the medical institutions manage to meet such requirements everyday. The same requirements in EMS should be true, the highest level of care each & every time when a patient summons help, not doing so is just an excuse.. period.

Yes, we have to bring educational standards up. At this time the Paramedic should be compared as the same level as an LPN. Unfortunately, in comparison using the current national curriculum, length in hours, clinical hours, etc. it is usually the same or maybe even lower than the LPN level. The Basic EMT is now about the same length of an approved nurses aide course. Unless, one has attended a collegiate level one cannot compare themselves equivalently to an RN. Sorry, I don't care how many "classes" or what your "protocols" are; in a professional and educational comparison it does not equal out. Compare..

Basic's , Intermediates, and all "comparison" levels should be outraged that their patients are not receiving the "highest" level of care each time a response is made. Rather than thinking of themselves, maybe we should be thinking "what is the best for your patients".

Dual Paramedics would assure such, decrease stress levels, more detailed exam and history, higher percentage of successful ALS skills will be performed.

Utilize EMT's at the appropriate level.. first response, stabilization until ALS transport can arrive, assist while enroute. There will still be plenty to do.

R/r 911

[bbbrammer]

I don't think everyone should be paramedics simply because not everyone is cut out to be one. I have met alot of people who were basics that were extremely good at their job, but even if they had the desire to go to medic they would have been mediocre at best. I should think the more relavant question would be "What licensing level should I be at that I can be the very best at my job?". Not everyone is cut out to do ALS. Not everyone is cut out to be only BLS either. It just depends on the individual.