Innovative EMS Services, Where Are You?

[Asysin2leads]

The only thing I raise my eyebrows to is the notion of working for years as an EMT to become a Boston paramedic, that just smacks of New England old school Harvard type elitism. Oh... right.

[CBEMT]

The only thing I raise my eyebrows to is the notion of working for years as an EMT to become a Boston paramedic, that just smacks of New England old school Harvard type elitism. Oh... right.

Maybe they don't believe in letting any nitwit off the street practice ALS As soon as they walk in the door.

With a 40%+ SCA save rate, I'm willing to give them the benefit of the doubt on their methods.

[Asysin2leads]

Look, there's a difference between letting "any nitwit" coming in off the street and letting a qualified and experienced provider get depressed and discouraged by having to do BLS all the time. I'd also like to see this "40%" save rate. If their save rate is really that high either someone's playing with the data or Boston is not getting people with serious illnesses to the hospital before they arrest in the street. Maybe they carry IV's full of "The good lord Jesus"???

Look, there is really only so much you can learn at the BLS level, then you need to move on and start practicing your ALS skills and assessment. Your splinting skills can only get so good. Not only that, but there are far better measures of an EMS service's efficacy than its prehospital save rate. Let's say your 40% save rate is accurate. We'll also say I have the winning number for Megamillions in my pocket and Santa Claus is my real dad, but we'll play in your world. I would like to see the rates on other things that ALS is handy for, like what is their rate of people laying screaming on a stretcher in a BLS ambulance because no one can manage the pain? What is the rate of CHF patient's filling up with fluid because medical director Edwin J. Stuckworth just doesn't fancy some people? You see where I'm going with this?

BTW, I think the name Edwin J. Stuckworth is pretty darn funny, if I do say so myself.

[FormerEMSLT297]

The only thing I raise my eyebrows to is the notion of working for years as an EMT to become a Boston paramedic, that just smacks of New England old school Harvard type elitism. Oh... right.

Yeah that was kind of my point. I'm not going to work for years on a BLS unit if I'm already a medic just so I can get a spot in that "GREAT" system.,,,

I just wonder how they keep people long term if all the new hire medics work BLS for years until a spot opens up.

Sounds a little elitist.

[paraloco]

How do the French and Germans do EMS? what is their model? I was told that physicians responded to calls in France.

[CBEMT]

Look, there's a difference between letting "any nitwit" coming in off the street and letting a qualified and experienced provider get depressed and discouraged by having to do BLS all the time.

Look, there is really only so much you can learn at the BLS level, then you need to move on and start practicing your ALS skills and assessment. Your splinting skills can only get so good.What is the rate of CHF patient's filling up with fluid because medical director Edwin J. Stuckworth just doesn't fancy some people? You see where I'm going with this?

[CBEMT]

How do the French and Germans do EMS? what is their model? I was told that physicians responded to calls in France.

Ask Princess Di what she thinks of the system.

[kevkei]

USA Today came up with the save rate. Seattle actually came out slightly ahead of Boston.

A 40% save rate as found and reported by USA Today, now that is reliable. I'm assuming they have no knowledge or understanding of the Utstein Method which is the standard. What method did they use to come to their conclusion?

[Dustdevil]

Well, I certainly can't argue with that theory. It is indeed a sound one. But their solution is about as unsound as it gets. :?

We don't allow brand new doctors to practice at their full licensed level either, but this is why we have internships and residencies. We don't send them back to be a nurses aid until a new slot opens up. We have them practice under the guidance and supervision of experienced residents and attendings. I fail to see how denying somebody practise makes them better. And, since they are getting no practise for all those years they are waiting for that elusive spot, I am going to have to say that yes, they DO put just any nitwit off the street to work practising ALS. They are putting people with no ALS experience to work. Why is it any different after five years than it was five years prior? Answer: it isn't. It's just as retarded as putting a new grad out there with no guidance. In fact, it is worse.

I suppose you believe in the tooth fairy too?

[CBEMT]

And, since they are getting no practise for all those years they are waiting for that elusive spot, I am going to have to say that yes, they DO put just any nitwit off the street to work practising ALS. They are putting people with no ALS experience to work.

Actually, once a BLS member (paramedic or not) is selected to be promoted to Paramedic, he or she then goes through an additional period of ALS training with the BEMS in-house training staff and their physician medical directors, followed by more ride time (internship) and an additional probationary period with a senior member (hmm, residency?).

I can't say for certain whether or not the training equals out to a full paramedic program. Since there ARE quite a few actual EMTs running on BLS trucks (who have all been through 500+ hours of training and ride time before hitting the streets), I would find it only logical that those individuals would have to go through a medic class. But I digress.

So like I said- the medics awaiting promotion within BEMS are working part time/per diem for private 911 companies elsewhere in Massachusetts (I also have it on good authority that if a BLS medic is working a patient with a full-fledged ALS member, the junior man will often be offered the opportunity to get some skills in under the supervision of the senior). Once promoted, it's back into the academy. From the academy back to ride time, and from ride time to probation.

So no. Not just anybody is practicing advanced care in Boston.