Appropriate use of ALS providers.

[Asysin2leads]

The problem is bbbrammer, that every person working in the system should have the capability and desire to be a medic. Anybody else is in the service for the wrong reason. If we changed hiring standards, attitudes, requirements, and pay grades, we could attract a whole lot more job-oriented, professional minded, educated people into our workforce. Even if you have a BLS job, a good ALS provider will do a better job for the patient than a good BLS provider will. This statement usually ruffles a lot of feathers, and I get the anecdotal "Nuh uh, because I had a medic who...", and I agree, a lot of paramedics have trouble tying their own shoelaces. Thats why I said a GOOD ALS provider. In fact, I think the next step in EMS should be to move away from the whole "ALS/BLS" notion, and look at every treatment as a part of a continuum of care. Imagine if when treating a minor trauma "BLS" case we took steps in the field to insure humane pain management techniques, prevention of infection, and took steps to insure maximization of rehabilitation. A well educated prehospital care professional would be useful in that situation. This isn't to say all ALS providers are well educated, but for the most part they should be better educated, and its a step in the right direction.

[UMSTUDENT]

I disagree that everyone needs to be "educated" to perform a job. The military has "trained" people who perform their job rather well in my opinion. A lot of procedural things we do, at least in some respects, can be taught through good, hardened training in academy fashion.

An education allows you to formally think through, and understand, the consequences of your actions. Something that I believe is absolutely essential to a competent paramedic.

Something Dust said on here the other night that intrigued me was his statement about insurance companies. Every insurance company, having half-a-brain, should realize the amount of money that could be saved by utilizing a properly equipped advanced practice, formally educated, paramedic. An insurance company should assess fees to customers, and their employer, if a person lives in an area that does not provide full 24/7 ALS coverage. A subsequent fee should be assessed if the majority of those paramedics possess less that an Associate's degree.

Theory: Less coverage= Less access to early advanced care=increased cost of hospitalization later.

Theory: Advanced practice= lower cost, less diagnostic test, and decreased hospitalization with a reasonable level of clinical confidence.

Theory: Paramedics w/o degree=less educated= less knowledgeable= increased chance of malpractice=new medical problems + lawsuit!

This puts pressure on big business, which in turn puts pressure on cities and municipalities to provide properly educated, 24/7 ALS coverage. Biggest benefit? State workers generally have great insurance packages with the cost being deferred to the tax payer. If the state had to start paying out of pocket, because they’re geographically not up to par in EMS, I guarantee overnight education requirements and state funding would shoot through the roof. It’s a great deal for insurance companies. Initially there are increased profits from the fees, and years later after reform, you get decreased healthcare cost with lower customer premiums. PLUS, as an insurance company, you can defer angry customers to local municipalities by fooling them that their out-of-pocket cost will decrease with better service. In all reality, the state will defer the cost to the taxpayer…

[Ridryder 911]

Actually you summarized it up well. Insurance companies dictate the treatment, whom the treatment will be performed, how much education should be required, etc.. all back to $$$

I don't care how poor your community is, how hard it is to get volunteers, or if your a damn good basic EMT... Insurance corporation will institute on whom, how much, and what they will pay.. and yes EMS will follow; just like the physicians followed.

I remember when EMS allowed anyone to drive an ambulance without age restriction and it was the insurance companies that mandated age and yes even EVOC training. When they refused to insure.. guess what.. yep, administrators was very willing to comply.

Now, rumors are insurance companies are tired of high $$ taxi rides.. they want more for the bucks. Want more report on .. why the EMS was needed, more detailed examination, and more treatment (EMS is cheaper). So yes, we will have them to thank for our changes..unfortunately, it will not be us (EMS) that will making the decision.

R/r 911

[zippyRN]

Ever person employed on an EMS providing unit should be a degreed paramedic.

I really don't care what training ambulance drivers do or do not have. It has nothing to do with EMS.

overkill

realistic answer

All calls recieve assessment face to face by a higher education qualified Health Professional Paramedic , Paramedic advanced practitioner or Registered Nurse Pre-Hospital Advanced Practitioner - still gives the option for that person to turf to better trained than EMT-B BLS / middle tier ambulances or Paramedic and (better trained than EMT- Tech ALS Ambulance

[zippyRN]

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.

what happens when you increase the training for your most basic Emergency ambulance personnel to 250 -350 contact hours for clinical, plus the driving course + 12 months probationary period with actual teeth ( mandated field based assessments, further academic work ... ) vs 120 hours ...

as has been said before, volunteer crew in the UK and so called 'middle tier' crew do 200 + contact hours and especially in terms of middle tier NHS crews have quite a set of limitations to their practice compared even to the NHS tech, and both groups have major restrictions on the meds they can give and on their cardiac care interventions, Technician training (where it still exists rather than HE paramedic training and middle tier as driver) is around 300 contact hours on the clinical stuff, even the none emergency crews do around a month's training (150 hours) although - one week of that is driving

[Timmy]

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

Wait, don't you have to have a Diploma of Paramedical Science to be a PTO in NSW or is that just vic??

[Timmy]

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

Wait, don't you have to have a Diploma of Paramedical Science to be a PTO in NSW or is that just vic??

[BushyFromOz]

Wait, don't you have to have a Diploma of Paramedical Science to be a PTO in NSW or is that just vic??

Oh Timmy, i could tell you the great story of BS that became the CSU degree, and how its not worth nearly as much in contrast to the monash university degree, but that would take a long time.

As far is am aware, no, PTO's on NSW dont require a diploma, as NSW still recruits its ambo;s strait off the street. There are pros and cons with this and i think that the victorian services are starting to find out the limitations of graduate entry only programs :?

[OzMedic]

The one smart thing that Vic are doing is offering great money for medics. How do you get a QAS ICP to drag his arse off the beach and move to freezing Victoria? Offer them 120k per year, thats how! The trick is not to go to the effort and expense of training medics, far cheaper to poach them from other states with the offer of better conditions :wink:

[Timmy]

The one smart thing that Vic are doing is offering great money for medics. How do you get a QAS ICP to drag his arse off the beach and move to freezing Victoria? Offer them 120k per year, thats how! The trick is not to go to the effort and expense of training medics, far cheaper to poach them from other states with the offer of better conditions :wink:

So that’s why the station were I live has just employed 4 QAS paramedics lol…