EMT's Performing Selected ALS?

[Asysin2leads]

$174,000? Wouldn't some Enzyte and an enlarger pump be a lot cheaper? Actually, our Type I's cost around $150,000, but part of that is of course associated graft and corruption, and remainder of the money goes into things like high security locks, reinforced doors and bumpers, and safety latches. For all my complaints, I do have to say that once the quirks and bugs of the Ford motor compaines dedication to quality are worked out by maintenence, we have some decent machines. I've seen SUV's who have totaled their front ends rear ending our ambulances and all the ambulances have to show for it is perhaps some bending of the diamond plate, a few paint scrapes, and a bewildered crew going "What the heck was that?"

Long story short, I'd rather have two well paid and qualifed paramedics work on me in the back of a converted Pinto than writhe in agony as a bunch of well meaning volunteers place gauze on me in the back of the ambulance that can win lowrider competitions and stuff. Besides, one of the primary rules of mechanical engineering is "Keep it simple, stupid." The more stuff you put on an ambulance the more stuff their is to break down. Air shocks require a compressor, hoses, actuators, etc, all of which must be kept finely tuned or your ambulance doesn't run. It shows a real lack of understanding of strategic principles for departments that insist on these things.

[Dustdevil]

It shows a real lack of understanding of strategic principles for departments that insist on these things.

Plus 5 for using "strategic principles" in discussion of a profession that seems to be wholly oblivious to the concept.

[Niftymedi911]

No joke Asysin, they aren't that bad, but it would be nice to have a type 1 ford instead. We have 3 of them for the islands and when I'm working on those, I much prefer them by far vs the Frieghtliners. It's rough trying to go code down 41 with a semi / ambulance.

Admin I think gets a woody by buying the trucks and utilize them.

[FL_Medic]

No, Asysin2leads, I can assure you no one who isn't a medic is playing around with Lopressor, its a new medication (to our agency) that our Paramedic's can use. To answer your question about supervision, protocol states that the EMT can start IV's under the Medic's supervision. Like for instance the Cardiac arrest we had today. I started 2 18 G IV's one in each AC for med and fluid acsess while my Medic was intubating. Like someone else said about down here before, the state gives the power to the medical directors on what BLS and ALS can do procedure wise. More then likely the medic is doing the LMAing and such, they control the airway. I either set the med's up (drawing them up, unless its a narc then its a no no for me) set the tube up, etc or start the IV's so the p/t is intubated and we have med access all in a few seconds. Rescue helps out in between doing the rest. There is a gray area in our protocol's, which is what your picking up on Asysin2leads, our protocol book is nothing but a bunch of guidelines, it doesn't mean that they are gonna be used everytime, in order and so on and so forth. and besides most of the time if its a Priority 2, we have time in the back b/c of our short transport times, unless your in the rural area of our county. The medic is there to watch you while they might be setting up and administering an updraft or setting up a tridol drip. That's what I'm talking about. And instances where we have a priority one, my Medic takes airway, I take IV's, and rescue takes whatever else needs to be done. It help the medics here out a lot when it comes time to deal with a P1.

To answer the question about the training. All EMT's and Medic's must attend monthly in-services where we bring in Trauma Docs, Pedi Docs, Cardiac Docs etc. to talk and instruct on certain topics. We also hear from our medical director about his instances in certain cases etc.

Also, all EMT's and Medic's must go through what's called a "Mandatory Skills Credentialing", every 2 years. We are tested on knowledge and skill of our BLS and ALS capabilities. (Yes, an LMA is one of the EMT's skills here). I learned for the first time how to use an LMA in my FTO program when I first started here 2 years ago. If we fail we are put into an FTO rotation (3 months) and are remediated on the skills before we can go back out and practice BLS or ALS again.

The biggest by far attraction for people to come here and work is the fact, that you have the freedom to practice your skills and medicine without having to call a doc every 3 sec for orders. Everything is offline in our protocol books.

My EMT training was also 3 months long, but I went further and took A&P etc while I was in EMT school. I just have to go back for my core Medic classes (Clinicals, Cardiology, and Pharmocology) and earn my AS degree. I already have the rest of my credits.

I'm glad that an EMT from my agency is on here to say something to these big-headed ego driven medics. Maybe they should check out the national numbers on failed intubations. We need to be more critical of ourselves before we bash EMTs. I personally allow every EMT I work with to start IVs, and push meds... especially if it is one planning on going to medic school. I agree that they should be, as well as us medics, extremely skilled BLS practitioners. I think we all need to check or CPR skills from time to time, concidering that's where you are really going to change the outcome.

[BushyFromOz]

Oh VS, I talked to Jesus and he says this is the dumbest f*cking idea he has heard since Ecce Homo!

LMFAO!!!

I missed this, thats a ripper!

[becksdad]

As one who is an EMT-B, I would like to see discussions take on a different focus. I think we need to get away from "skills" per se, and focus on 2 things: Assessment and Education. It just doesn't matter what we are able to do to people if we don't know why we are doing it. I, too, went through a period where I was enamored of learning new "skills", and honestly, I don't think I have ever seen an "ALS skill" that I couldn't master in a fairly short time.

But the ability to perform an intervention means absolutely nothing without good assessment. You can't decide what to do until you know why you are doing it. And with all the variables that thorough assessment entails, the knowledge of human anatomy and physiology, awareness of consequences of interventions..... it seems to me that there is quite enough to learn there to keep us occupied for a long, long time. I think great assessment skills are the result of 2 things: Education and Experience. To me, the mark of an excellent provider is in the ability to thoroughly and accurately assess patients. It is incumbent upon us to become educated and to practice all of the knowledge we accumulate towards improving our asessment capabilities.

As EMT's, we need to decide the direction to focus on. I would much rather give report to an Emergency Physician providing detailed assessment information, which will assist the physician with his own assessment and treatment decisions, than to exclaim "I started 2 IV's for you!" (and then expect them to be impressed).

[Dustdevil]

I'm glad that an EMT from my agency is on here to say something to these big-headed ego driven medics.

From what he tells us of your medics there in Lee County, it doesn't sound like either of you have anything to be proud of, outside of employment.

And to think that I actually respected you two short posts ago. :?

[EMSGeek]

If a system was in place which permitted Basics to become certified in certain skills after lengthy training/education on that specific skill would people support that? I'm talking about 40-50 hours of classroom and field time per skill. The training should include a solid amount of A&P related to the topic, indepth contraindications (why something contraindicates that procedure), complications, etc.

Looking at this debate from a strictly patient care side of things wouldn't it help a patient if they required a certain procedure and a well educated basic was able to preform that skill? Are we discussing just the two skills mentioned in the survey or any ALS skill at a basic level?

[medic001918]

I'm glad that an EMT from my agency is on here to say something to these big-headed ego driven medics. Maybe they should check out the national numbers on failed intubations. We need to be more critical of ourselves before we bash EMTs. I personally allow every EMT I work with to start IVs, and push meds... especially if it is one planning on going to medic school. I agree that they should be, as well as us medics, extremely skilled BLS practitioners. I think we all need to check or CPR skills from time to time, concidering that's where you are really going to change the outcome.

You sir are absolutely right in part of your statement. We should be more critical of ourselves before bashing EMT's. And if with a higher level of education we're still messing things up, what makes you think that allowing someone without the proper education to do things is going to improve the situation? Something to think about before anyone goes ahead and votes to add to the EMT scope of practice.

It's good that you allow your EMT-I's to perform to their skill level. Anything less and you'd be holding a provider back. You really haven't done anything ground breaking there since most paramedics who don't mind teaching or aren't control freaks would allow an EMT-I the same liberty.

We should check our CPR skills from time to time, but I strongly disagree with your statement that that is where we are "really going to change the outcome." It's statistically been proven (repeatedly) that our success rate with prehospital resuccitation is dismal at best. That's a product of many things...the biggest being time. There's not much we're going to do to defeat that. It takes time for someone to recognize a problem, activate EMS and for us to respond. I would go as far as saying that we provide the biggest change to a patient outcome in a patient prior to their arrest. When we just might be able to do something to prevent the arrest from occuring in the first place (think CHF, MI, etc). Once a patient arrests, their chances of survival are miniscule at best. Let's not kid ourselves into thinking that's where our best efforts lie.

Shane

NREMT-P

[PatrickW]

I'm kind of surprised at the amount of negative responses towards Basics inserting LMAs. Here in SC, not only are Basics trained and educated to insert LMAs and combitubes, but they may perform ET intubation as well.