Collegiate EMS

[Dustdevil]

No sarcasm was intended. Well, maybe the whole "16lpm instead of 15" thing was a little sarcastic. But really, I was just wanting you to explain the system a little clearer. You said you hoped to turn this thread into something of substance, but you didn't really give us any substance to do that with in your original post.

The second post doesn't go much further though. Carrying a monitor/defibrillator/pacer that you cannot use doesn't exactly qualify as a huge "scope of practice." What can you do that nobody else can do? And what education did you receive in those practices that nobody else receives?

You say that "collegiate EMS is a great thing," but so far I can't see that you are providing your campus with anything they don't have without you. In fact, it seems like you are denying them ALS care and evaluation in a great many cases.

[EMT007]

That scares me. Not that you can read (and then not do anything about) the EKG. Props for learning it. What scares me is you have access to this and theres not a paramedic on board. Is there any type of lockout which requires a paramedic to activate the pacing/defib functions? I know how college kids think, and I know how EMS'ers think. Ponder this situation if you will:

21 y/o co-ed presents with SVT. 22 y/o male EMT wants to impress co-ed. EMT defibs, instead of synchronized carioversion. Co-ed enters V-Fib. EMT jumps out back of moving ambulance. The End.

Have a bit more faith in us We are a very professional organization, and I have had many cases of SVT and there was no sudden urge to slap on the pads and cardiovert the pt. No, there is no lockout for the pacing, and as for the defib - well thats a BLS skill anyway, and we use it on V-fib and pulseless V-tach just like anyone else. As for the EKG thing, its good for us to be able to recognize abnormality and the need for ALS (if no other ALS complaint to begin with). Like I said, we have a great training program.

[brentoli]

Define a situation where ALS would be requested on EKG readout only?

Does your defib switch into automatic mode? Or is it all manual? I don't know of manual defib being BLS anywhere.

I have faith in you until proven otherwise. I am just pointing out what the truth is. Maybe not the crew you have now, but somewhere someday it will go through someones mind.

[EMT007]

No sarcasm was intended. Well, maybe the whole "16lpm instead of 15" thing was a little sarcastic. But really, I was just wanting you to explain the system a little clearer. You said you hoped to turn this thread into something of substance, but you didn't really give us any substance to do that with in your original post.

The second post doesn't go much further though. Carrying a monitor/defibrillator/pacer that you cannot use doesn't exactly qualify as a huge "scope of practice." What can you do that nobody else can do? And what education did you receive in those practices that nobody else receives?

You say that "collegiate EMS is a great thing," but so far I can't see that you are providing your campus with anything they don't have without you. In fact, it seems like you are denying them ALS care and evaluation in a great many cases.

The county we are in is very restrictive in terms of SFTPs (for both BLS and ALS), but we are allowed to perform things like the selective spinal immobilization algorithm that is otherwise restricted to ALS providers.

And as much as some people would like it to be true, not every call requires ALS. We operate on a tiered response system and, if anything, we free up city ALS units to repond to other calls in the city. If there is a reason to call ALS, we call them.

When I say I want this to develop, I don't mean a discussion of ALS vs BLS issues, but rather what people who work in collegiate EMS think about it.

[EMT007]

Define a situation where ALS would be requested on EKG readout only?

Does your defib switch into automatic mode? Or is it all manual? I don't know of manual defib being BLS anywhere.

I have faith in you until proven otherwise. I am just pointing out what the truth is. Maybe not the crew you have now, but somewhere someday it will go through someones mind.

We get many calls from doctors offices for "abnormal EKG" where that is the only "complaint" that are ALS calls - same thing. Not to mention an otherwise asymptomatic STEMI 12-lead readout.

Our defib is automatic until switched into manual mode (and no, we don't do manual defibrilation without medics)

And as EMS providers, we all have things that are potentially harmful to patients. Our age doesn't make us more prone to misusing things so no, I don't think its "the truth of the matter". Hasn't happened yet in over 30 years - no reason to think it will now.

[brentoli]

Does your certification agency recognize your EGK ablities? Is it a BLS skill in your state? If not, how do you justify the actions you take on an ALS assesment?

I'm not arguing to argue. I am honestly wondering. Lets say you disregard ALS on a toothache because you show a normal EKG.

The hospital finds out diffrent on their EKG/blood work. What do you do in this case?

[Dustdevil]

Our age doesn't make us more prone to misusing things so no, I don't think its "the truth of the matter".

At thirty-seven years old, I would sure hope not. Although, it can be said that senility is every bit as dangerous as immaturity.

But your lack of medical education (not to be confused with all this "training" you keep mentioning) does make you more prone to missing important things, as well as being unable to care for them. If you are not a Paramedic, you are not competently prepared to decide what needs ALS and what does not. And, on those cases that you do decide needs ALS, most of the time the patient would be better served by just getting them to the hospital ASAP than waiting for medics, since you have already wasted fifteen minutes of critical time. Even more if you are spending time on-scene running EKGs that you can neither competently interpret (warning: you really don't want to argue this point) nor treat. Again, it sounds like you are actually more of a hinderance to quality emergency care for your students than an asset.

I am sure that, whatever an "SFTP" is, it must be really advanced and impressive, and that my system sucks for not using it. Can you tell us what it is?

And just how many doctors' offices do you have on your campus? :?

The worth of an EMS system is not defined by it's "scope of practice." It is defined by the benefit it provides the community it serves. Quite honestly, it seems to me that the only people who truly benefit from your programme are the participants who get a hobby out of it.

[EMT007]

If you are not a Paramedic, you are not competently prepared to decide what needs ALS and what does not. And, on those cases that you do decide needs ALS, most of the time the patient would be better served by just getting them to the hospital ASAP than waiting for medics, since you have already wasted fifteen minutes of critical time.

I would disagree with this - I think we are well prepared to decide what needs ALS and what does not. And we can usually figure this out within a minute or so of patient contact and request ALS (if the call didn't come out with an ALS complaint already). We also can cancel ALS response if we determine that there is no ALS complaint. And before you say something about this, I will only mention that this is also how the BLS engines and rescues of the city FD handle things as well.

I dont' want the EKG thing to become a point of contention. As I said, not all of our EMTs are trained in EKG interpretation (so it is not part of our standard assessment), but all of us are trained at least in application of 3 and 12-lead EKGs, and it is part of our protocol to initiate EKGs on certain complaints.

SFTP - Standing Field Treatment Protocol (I assumed this was a standard abbreviation)

And just how many doctors' offices do you have on your campus?

A lot...

The worth of an EMS system is not defined by it's "scope of practice." It is defined by the benefit it provides the community it serves. Quite honestly, it seems to me that the only people who truly benefit from your programme are the participants who get a hobby out of it.

Fair point, and I think we provide great benefit to the community we serve (in part, because of the extra things we can do for our patients prior to or independant of ALS). Our response time is much shorter than the city FD who would otherwise respond, and our excellent training makes us well suited to handle the calls that we get. However, I will not argue it any more, since it seems like you think that we are only denying patient's ALS tx. Thats fine, but fortunately, not everyone agrees.

[CBEMT]

I am a paid supervisor with a collegiate EMS service. No, I don't want to chat.

To cover Dust's questions to the other poster, we cover all of campus and any off-campus housing in the surrounding area if someone there calls the campus emergency number, which they are encouraged to do. Campus police also respond both on and off campus with us. We are also in the jurisdiction of the local fire department EMS. If 911 is called they will respond, or if we are unavailable our campus police will chop calls to them.

We run an ALS transporting ambulance with an ALS-level supervisor and student volunteer EMTs (there is always a supervisor on duty). The overwhelming majority of our student volunteers are either science majors of various fields, or pre-med. Students who attain ALS-level licensure are allowed to practice at their level. We have the option of transporting either to a local ED or to our campus health services (the FD will only transport to an ER). We have 100% physician QA of our runs.

[EMSGeek]

I too am part of a collegiate EMS agency. We are a transporting BLS agency which services our campus, off campus students, and has agreements with the surrounding city and town to provide an additional BLS bus should they need it. We are entirely volunteer and run approximately 350 calls a year.

I think collegiate EMS is a great place for people to learn about EMS who might otherwise not get involved.

Our corp. is a training corp in the sense that we try to give our members the skills to succeed both on campus and elsewhere. I volunteer with a FD and work for a paid ALS service when at home and between those two agencies I can see that the way we train our members on campus is pretty good because we have the luxury of time to train. We don't give our members any additional medical skills but we do try to get them some positive experience in the field. I think everyone will agree that there is a big difference between a green emt and a more experienced provider even if they are following the same protocols.