In Your Opinion, What Is Holding USA EMS Back?

[Chief1C]

I changed my mind..

Everything that is wrong with EMS, I blame on everyone that isn't in EMS>

[riskynremtp]

Dust, I believe based on how my statement was written, it may have been taken out of intended context. What I was meaning is simple, If our problems were only those that are listed in my commentary, we could have already corrected them by eliminating volunteers, eliminating any other credential, other than that of paramedic and above, and mandating federal educational requirements for ems professionals, other than National Registry, which is a "joke" in itself, especially in South Carolina. Yes, you're right, based on my written content, I probably did make an idiotic "initial" statement. But, from what I've seen, it is not the most ignorant at this city, and this you already know.

[scott33]

some medics seem to have a feeling that they should have the ultimate power in decision making healthcare providing.

In the prehospital arena? Why not? Has been proven to work in other systems which do not have a medical control system. Complete autonomy. Complete accountability.

until you put M.D. after your paramedic title, med control physicians are only gonna allow so much, to be put in a paramedic's standing orders.

See above.

[Ridryder 911]

While I do agree, that there should be a high standard of training, and that's what it is "training", I find that some people are taking it too far. Based on "some" of the posts I've read, some medics seem to have a feeling that they should have the ultimate power in decision making health care providing.

Actually there is quite a bit of difference between training and education.

Why would I want a Bachelor's Degree in Science, to memorize dosages, or to calculate drip rates? If you don't know it when you come out of medic school, you've got issues. We are not doctors. Yep, the degree helps pay in "some" agencies, but until there is more governmental influence at the Federal level, the pay can only go so far. And, until you put M.D. after your paramedic title, med control physicians are only gonna allow so much, to be put in a paramedic's standing orders.

Sorry, if one goes for four years and only memorized anything that is crappy education. Whom is to say how much limitation a medical director will allow? Can you imagine if Physician Assistants had this attitude? Remember, there are still PA programs that are an associate degree level and even non-degree and they prescribe and perform minor surgery! I have been in 30+ years, I have seen from calling in for IV's to central lines and ultrasound in the field; things that many "Paramedics" swore would never occur in the field.

So, at least for now I wished we could focus on the issue of applying pressure on our governments to bring a "standard" to the business. EMS is a really simple process, treat life threatening, and transport. All the in between is ok to further your assessment skills, and to gain a further knowledge of the medical conditions that some individuals face. We are forever preached to about ABCs, that's because this is the "primary" issue for EMS providers. Some where along the lines, some people lose sight of our objective, and try to be field doctors. Remember, that no matter the condition of the patient, we are only equipped to treat so much. And, trying to "overdiagnose" certain conditions, may make you look good in front of the doc while you're giving a report, but you as the medic did not intervene on the treatment required. That's because your truck is not equipped (and never will be) for conditions that are gonna require long term care for the patient in most cases. I do also believe in the fact that the different levels, such as basic and intermediate have their place, as does voluteers in "certain" remote locations, and certain conditions. There will "never" be a situation that we as paid medics will ever be able to be everywhere all of the time. Citizens in this country and abroad need to have someone that can be there for them in their time of crisis. We as EMS, would love for that to be us, but it just can't be that way. They could never manufacture enough ambulances, or hire enough people. As long as we are in healthcare, we must have help from somewhere. Please don't misunderstand me. I would never belittle our profession. But, I assure the answers we're looking for is not in eliminating EMTs or volunteers, or even higher education. If, and I do say "if" that were the case, our problems would have already been solved.

Quit thinking inside the box! Why do we have to only provide emergency care? You are right, there is no incentive for pay structure changes, why should there be? Until we focus on what really pays and quit trying to be Johnny & Roy, and expand ourselves as a health care and not strictly a transport & taxi we will never be reimbursed. Actually, Medicare should demand more from EMS! A nice little ticket for simple first aid care and transport for a hefty costs.

There is a lot EMS can do, first change the mind-set of Emergency Medical Services and get out of the "pre-hospital" thinking. Instead mobile health care. Not all patients need to be transported, many can be treated and released or monitored. Our role will drastically change within the next ten years. It has too. There is not enough ER's and hospital beds to ever meet the demands, as well as the lack of staff to care for those that could be admitted if there were beds. We have not even seen the tip of the iceberg.

Instead of transporting, our role will be to triage to see who gets to be seen in the ER. As well, many more ill type patients will be discharged to and be treated at home. So yes, more in-depth; and more in-home treatments will be given. This will be the payment structure to off set the emergency calls that does not pay. Remember, those that usually get shot & stabbed usually does not have Blue Cross & Blue Shield. Medicare is tired of paying for expensive taxi bills.

Technology and advancements has superseded our progression of care. Many patients never need to be transported and can be evaluated by their PCP the next day. Insurance companies are quite aware of this and have placed NP's and PA's in some. Saving them billions of dollars a day.

We have the choice, either we take the reins or allow another group do it for us. It is our choice for now, like it or not; but it will occur... it has to.

R/r 911

[JakeEMTP]

Instead of transporting, our role will be to triage to see who gets to be seen in the ER. As well, many more ill type patients will be discharged to and be treated at home. So yes, more in-depth; and more in-home treatments will be given. This will be the payment structure to off set the emergency calls that does not pay. Remember, those that usually get shot & stabbed usually does not have Blue Cross & Blue Shield. Medicare is tired of paying for expensive taxi bills.

R/r 911

Going along this line of thinking, our Medical Director wants us to start visiting FF's in between calls. Check up on them to see how they are, are they taking their meds, are they almost out of their medication etc. The thinking being, if we can stop them from calling 911 except for, surprise, emergencies, the system could quite conceivably save millions. The patient's will be in better health hopefully since they aren't left to their own devices to care for themselves, relieving the burden on the 911 system.

We haven't implemented this yet as they are still collecting data. It sounds in theory, that it might do some good. I'll let you know how it goes.

[Dustdevil]

Going along this line of thinking, our Medical Director wants us to start visiting FF's in between calls. Check up on them to see how they are, are they taking their meds, are they almost out of their medication etc. The thinking being, if we can stop them from calling 911 except for, surprise, emergencies, the system could quite conceivably save millions. The patient's will be in better health hopefully since they aren't left to their own devices to care for themselves, relieving the burden on the 911 system.

Wait... is firemen abusing 911 really a significant problem in your area? :shock:

[NREMT-Basic]

:dontknow:

[JakeEMTP]

Wait... is firemen abusing 911 really a significant problem in your area? :shock:

Sorry for using an acronym. I meant frequent flyers. If I was suggesting fire fighters, I would have said hose monkeys :wink: .

[Dustdevil]

Whew... that's a relief!

I was picturing a city full of fat, hypertensive, hyperlipidaemic, diabetic, chain-smoking, sixty year old firemonkeys with COPD and angina creating a burden on the EMS system. And an amusing picture it is!

[spenac]

There is a lot EMS can do, first change the mind-set of Emergency Medical Services and get out of the "pre-hospital" thinking. Instead mobile health care. Not all patients need to be transported, many can be treated and released or monitored. Our role will drastically change within the next ten years. It has too. There is not enough ER's and hospital beds to ever meet the demands, as well as the lack of staff to care for those that could be admitted if there were beds. We have not even seen the tip of the iceberg.

Instead of transporting, our role will be to triage to see who gets to be seen in the ER. As well, many more ill type patients will be discharged to and be treated at home. So yes, more in-depth; and more in-home treatments will be given. This will be the payment structure to off set the emergency calls that does not pay. Remember, those that usually get shot & stabbed usually does not have Blue Cross & Blue Shield. Medicare is tired of paying for expensive taxi bills.

Technology and advancements has superseded our progression of care. Many patients never need to be transported and can be evaluated by their PCP the next day. Insurance companies are quite aware of this and have placed NP's and PA's in some. Saving them billions of dollars a day.

We have the choice, either we take the reins or allow another group do it for us. It is our choice for now, like it or not; but it will occur... it has to.

R/r 911

Rid really liked your post. Thankfully my medical director has some of that forward thinking. We do say no to people. Tell them to go get some over the counter meds or to go see the doctor if they still feel bad in the morning. We actually are allowed to administer some over the counter meds as well as administer some of the meds in the drug box wait around to see no adverse reactions and go back in service. This may mean being on scene for an hour but thats 3 hours less than our transport turn around times.

EMS must move forward as healthcare providers not as taxi drivers. The vicious cycle of transport all callers regardless of need must be broken. We must establish a system that educates it's providers well enough to as you said triage, treat and release, and only transport those with a real emergency.