Oh, Oh here we go again, new NAEMSE draft to replace DOT

[stcommodore]

But yeah... I can think of several good reasons why your EMTs shouldn't be starting IVs. I bet you can too, if you're honest with yourself.

amen

[medic5740]

If the EMTs have had the education, the training, and the clinical, I really don't see why they can't start IVs. In Michigan, an EMT-Specialist can intubate and start IVs with about 90 more hours of education, training, and clinical. Doing the easy math of two topics in 90 hours, that makes an EMT-IV in about 45 additional hours of education, training, and clinical. Remember that clinical is not based upon hours, but upon successful IVs. So, the question is not whether they can do them if educated, it is whether they are allowed to do them.

Please tell me why, if they are educated, trained, and have clinical experience, why EMTs should not be doing IVs?

[Dustdevil]

Please tell me why, if they are educated, trained, and have clinical experience, why EMTs should not be doing IVs?

Simple. Because if they were educated, trained, and have the clinical experience, they aren't EMTs anymore. They're paramedics.

And conversely, if they are not paramedics, they do not have the education, training, and clinical experience. It's not really a complicated concept. Which part are you having trouble with?

[stcommodore]

You can teach a monkey to do a skill but its knowing 'why' the skills is done that makes the difference. Having the ability to start an IV, a lock, maybe give NSS or D50 is the dangerous middle ground that gives patients half the care they should (lack of als) be getting or half the care they shouldn't be (emt overkill)

[medic5740]

I'm having trouble with the "all or nothing" concept. In your system of logic, it appears that a person must either complete the entire paramedic curriculum and training based upon a national standard, or they are not able to do any (I repeat, ANY) of the paramedic skills. That logic does not work in my rural area. Just because this is the model in use for many years does not mean that it is the only model that makes sense. It may make sense in your area, but not in mine.

I'd like to have a scope that spells out minimum levels, and be able to provide services, after serious discussion and education, that are needed in specific areas.

If my community has several brittle diabetics and anaphylactic emergencies, if my medical control physician allows the training and the treatment, and if my EMTs are educated and trained in assessment of diabetic emergencies and anaphylaxis, IV administration, SQ injections, and D50 administration, I want them to be able to provide that definitive treatment in my community without a National Scope of Practice that denies this ability.

This is just one example. Albuterol neb treatments, Nitro and aspirin administration in cardiac events, and epi SQ administration are others. We have several anaphylactic events each year. Why are we spending hundreds of dollars for epi-pens when our EMTs can easily be trained to properly administer the proper dose for a much lower cost? Each of our ambulances carry two adult epi-pens and two child epi-pens. This is more than $200 in costs. One vial of Epi, a syringe, alcohol prep pads, etc. for an Epi-kit would cost less than $15. The gain is more than the $185. The gain is measured in better educated EMTs and a community that receives the needed treatment. I don't care whether you call them EMT-Specialists. EMT-Intermediates, EMT-IV, EMT-SQ, EMT-Advanced, EMT-II, low level medic, or any other label. I just want my friends and neighbors to get the needed life-saving treatments.

With a minimum transport time of over two hours to the nearest hospital, some of these treatments are necessary not just desired. There are even times when our patients cannot be transported due to weather, such as fog (like this morning), blowing snow or freezing rain. We don't need a National Scope of Practice that denies our patients needed treatments. As long as my EMTs are trained, educated, and have received clinical, I need them to be able to provide these treatments. I might be the person having the heart attack one day.

This small, very rural, community cannot afford paid paramedics. It just isn't going to happen here.

[Dustdevil]

I'm having trouble with the "all or nothing" concept. In your system of logic' date=' it appears that a person must either complete the entire paramedic curriculum and training based upon a national standard, or they are not able to do any (I repeat, ANY) of the paramedic skills.[/quote']

First of all, none of my beliefs have anything to do with any "national standard." It doesn't exist. And second, yes, I believe a person must have ALL of the education of a paramedic in order to perform ANY ALS interventions. The human body does not function in a vacuum. Everything is connected. Every intervention has an affect on the entire person, not just on a remote portion of him. An IV is not just a hole in the back of the hand that is not connected to the rest of the body. What you put into that IV affects every organ in that body. When you change a person's fluid and electrolyte balance, acid-base balance, and fluid volume, you are affecting an entire human organism. Consequently, you need to be fully educated on that entire human organism. Otherwise, you are no more a medical professional than the guy at Jiffy Lube is a mechanic. You're just a trained monkey, and a dangerous one at that.

Well then people are idiots in your area and have no business providing EMS in the first place.

Uhhh... that is exactly what we are trying to tell you. Just because people have been performing dangerous medical interventions without the necessary education for years does not mean that it should continue. You aren't helping anybody with any of this. You're just feeding your need to do "cool stuff" without all that book learnin.

You have it already! And that "serious education" is called paramedic school. You see, you have exactly what you want, but it's too much for you because you are not seriously committed to being a professional. Who wants somebody with no education providing half-arse invasive interventions on them? Certianly not me or my family.

There it is. You just told us what this is all about. It's all about what YOU want to do, not what your community needs. If you really cared about the needs of your community, you'd be at every city council and county commissioners meeting that is called, and calling for extra meetings to discuss it. When was the last time you told a community leader that their EMS was seriously inadequate, and that they really needed to push for a professional service? I know the answer to that. Never. Because if that happened, heaven forbid, you'd be out of a hobby.

Your system is completely broken, and all you can do is sit around and nickel and dime the issue in a lame attempt to put lipstick on a pig? Get real.

If you want them to receive them from people who are EDUCATED to know exactly how and when to perform these interventions safely, then you and your people need to become nothing less than HIGH level paramedics. How's that label for ya?

And yet, you still aren't motivated enough to push for paramedics? Then your whole purpose is a lie.

Sounds like another big reason that you need paramedics, not just IVs and medications you don't understand.

That's true. Your Medical Director should be taking care of that without any help from a National Scope Of Practice.

Wait... you think that an EMT-B can be "trained" to give competent and intelligent treatment for a heart attack without at least finishing a full paramedic school, which can be completed in less than 6 months? So, just how short do you think it should be? How quickly do you think you can teach your inbred country bumpkins all the things necessary to assess, diagnose, and treat a myocardial infarction? Or to be able to tell the difference between anaphylaxis and an MI? Or the difference between a PE and an MI? Or which types of MIs they should not be giving NTG to? You think a few days of "training" is going to make all that knowledge, and the critical thinking skills necessary to use it, magically appear and solidify in their heads? And you think the few runs they make (after all, if they made a lot of runs, you could justify paramedics) is enough to keep them current on what they learned in a weekend of "training?" After eight years of college education and thirty-five years of practice, I still sweat every MI patient I care for. Too many things can go too terribly wrong entirely too quickly, no matter how good you are. Anybody who honestly thinks cardiac care is a no-brainer is, well... a no-brainer.

You may honestly think you are trying to "help" people. I dunno. But you are not recommending anything that will be helpful to your community. In fact, everything you are advocating puts your community at increased risk. You may be able to shanghai some 70 year old GP into signing off on things like that. I've seen it happen. But you're playing a very dangerous game with human lives just for your own cheap thrills.

Oh well. Then die. Here lies medic5740, because he couldn't be arsed with all that book learnin'.

[Ridryder 911]

I'm having trouble with the "all or nothing" concept. In your system of logic, it appears that a person must either complete the entire paramedic curriculum and training based upon a national standard, or they are not able to do any (I repeat, ANY) of the paramedic skills. That logic does not work in my rural area. Just because this is the model in use for many years does not mean that it is the only model that makes sense. It may make sense in your area, but not in mine.

Actually, your area is MY area! If I drive through there, or a family members so happen to be located there, and becomes sick or injured then guess what .... that is my area too! I expect my family, myself and others to be treated by professionals that actually have a knowledge to know what they are doing! If I was going to the local physician, should I expect them to be stupid or only have attended portions of a program because he or she lives in a rural environment? Again..lame excuses! Guess what, the physician had to go to school for the whole entire program.. why can't you?

I'd like to have a scope that spells out minimum levels, and be able to provide services, after serious discussion and education, that are needed in specific areas.

Actually it does; the basic, advanced and Paramedic. It is shame there is that many levels. Amazing, I am sure there is a nursing home, health clinic, even maybe a public mobile center that visits your community.... and guess what, they had to have an education before going there. Only in EMS do we excuse persons not to have formal education and training. Wow, we actually excuse ourselves to be ignorant!

If my community has several brittle diabetics and anaphylactic emergencies, if my medical control physician allows the training and the treatment, and if my EMTs are educated and trained in assessment of diabetic emergencies and anaphylaxis, IV administration, SQ injections, and D50 administration, I want them to be able to provide that definitive treatment in my community without a National Scope of Practice that denies this ability.

This is just one example. Albuterol neb treatments, Nitro and aspirin administration in cardiac events, and epi SQ administration are others. We have several anaphylactic events each year. Why are we spending hundreds of dollars for epi-pens when our EMTs can easily be trained to properly administer the proper dose for a much lower cost? Each of our ambulances carry two adult epi-pens and two child epi-pens. This is more than $200 in costs. One vial of Epi, a syringe, alcohol prep pads, etc. for an Epi-kit would cost less than $15. The gain is more than the $185. The gain is measured in better educated EMTs and a community that receives the needed treatment. I don't care whether you call them EMT-Specialists. EMT-Intermediates, EMT-IV, EMT-SQ, EMT-Advanced, EMT-II, low level medic, or any other label. I just want my friends and neighbors to get the needed life-saving treatments.

Well, if you have that many diabetics, anaphylactic reactions (which I do doubt, since it is a rare occurrence) then a community could justify higher educated medics. If you respond on one or two a week, then you could justify the offset on charge to employ them.

With a minimum transport time of over two hours to the nearest hospital, some of these treatments are necessary not just desired. There are even times when our patients cannot be transported due to weather, such as fog (like this morning), blowing snow or freezing rain. We don't need a National Scope of Practice that denies our patients needed treatments. As long as my EMTs are trained, educated, and have received clinical, I need them to be able to provide these treatments. I might be the person having the heart attack one day.

True you are correct, it should not had to come down to such. Unfortunately communities like yours has made it that way! Everyone deserves a chance to be treated appropriately by educated personal with clinical knowledge and skills. Again, since you are attempting to be a health provider, then one has to do like all other health providers and go to school, perform clinicals to obtain exposure and experience, then maintain levels of competency. NO MATTER WHERE YOU LIVE... Yes, I personally live in a rural area.

This small, very rural, community cannot afford paid paramedics. It just isn't going to happen here.

With an attitude like that .... nope. How much has your town investigated in rural health grants, or discussed with other governmental medical facilities such as Indian Health Services or many other agencies... what I thought.

I have managed communities with less than 800 people with a Paramedic on each truck, and no it was not a wealthy community. So YES it can be done.. then again, if the community chooses not to have them .. so be it. They should not have the choice of choosing in between or half assing it or making excuses.

Fortunately, professional EMS is finally getting tired of the whiners and excuse makers. Hopefully, they will lobby too and make sure that professional standards are endorsed and patients actually receive care that have at least met some standards.

R/r 911

[katbemeEMT-B]

The first thing I want to ask, why the hell is EMS governed by the NHTSA? Would it not make sense for EMS to be governed by the medical community, (ie, AMA)? Maybe this is the first change that needs to take place. I would imagine that if the AMA governed EMS, our education standards would increase dramatically, which is a positive. I could also see TRUE national standards and protocols being set forth with little variance. Maybe this would also give EMS the ability to assess a patient on scene and determine if the need to transport is really there. It would also put us in the professional category versus "taxi driver".

Increasing the education at each level of EMS is also a necessity. I used to think that I knew it all after my training to be an EMT-B. After doing the job for awhile, I have realized how much I don't know. This has pushed me to further my education and become a medic. My objective is to give my patients the best possible care I can, I can't do that as a Basic. Even if the scope of practice isn't increased for a basic, the extra education could concentrate on those things that are already done (ie, assessment). Proper assessment is the key to proper care and 120hrs of training in which maybe 5hrs were spent on assessment is not enough to make you a competent provider. Stronger continuing ed. would also come with this. No more of this stupid monkey training that seems to be the norm, especially in BLS services. I work for both a career ALS service and paid volunteer BLS service. When comparing the CE offered, there is no comparison. The BLS service offers the same 10 CE every year and pays for one conference per year. The ALS service, which is hospital based, offers several CE every month, many of which are tied into the hospital employees, (ie, ED nurses, RT, and even Ed docs). Hospital care providers are encouraged to attend CE aimed specifically for EMS also. This is how it should be done.

If we want to be viewed as medical professionals, than we have to be associated with a professional medical organization, not a highway organization. Maybe instead of trying to rejuvenate the standards and protocols, the NHTSA should relinquish their control of EMS and turn it over to the medical community.

[medic5740]

Thank you, Dust Devil, for turning this into a personal vendetta of negativity.

You do not know me, my experience level, my background, or my motives.

I am a licensed paramedic and paramedic instructor. I am a volunteer paramedic in my community. I am also an ACLS instructor, PEPP instructor, PALS instructor, ITLS instructor, and, of course, a BLS instructor, but this discussion isn't about me.

I am not, and never have been, a country bumpkin, and neither are my EMTs.

Every treatment that I have discussed, which the exception of the SQ injections, are already part of the state protocols and available to all county medical control physicians to adopt. All of these treatments were determined by a state organization named the Emergency Medical Coordinating Committee, which is composed of emergency physicians, paramedics, and instructors.

Every one of my EMT-Specialists is trained and educated in acid base balance and fluid resuscitation or they would not be starting IVs. They also have the clinical experience to provide this level of care.

My whole point here has been that the education should be IMPROVED for these kinds of programs, but, more importantly, we do not need a National Scope of Practice or a national curriculum that would deny our state or our county medical control physicians the opportunity to make these changes.

Some of us would call these changes improvements.

[Dustdevil]

I am a licensed paramedic and paramedic instructor. I am a volunteer paramedic in my community. I am also an ACLS instructor, PEPP instructor, PALS instructor, ITLS instructor, and, of course, a BLS instructor, but this discussion isn't about me.

I don't want it to be about you. I'm sure you're a fine human being. But your grasp of the serious gravity of the practice of medicine is far less than intellgent. This is exactly why I tell n00bs that they must choose their school so very carefully. You never know who is teaching those things.

My whole point here has been that the education should be IMPROVED for these kinds of programs, but, more importantly, we do not need a National Scope of Practice or a national curriculum that would deny our state or our county medical control physicians the opportunity to make these changes.

Some of us would call these changes improvements.

How is reducing the education needed to provide advanced medical care an "improvement?" We have already reduced the 9 years of education necessary to practise medicine down to a technical training course of less than 1000 hours, and you still think that is unreasonable? That's insane. How about answering some of the questions I raised so we can better understand why your idea is such a good one?