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

[JPINFV]

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.

[Just Plain Ruff]

JP I can't see the link but that had better not be the guy screaming about Britney for us to leave her alone. I just cringe when I see that.

[JPINFV]

It's the Tyra Banks/Next Top Model scene from a Family Guy episode.

http://youtube.com/watch?v=HntVxGqsHdM&amp...ted&search=

[medic5740]

I did not walk into the Emergency Medical Coordinating Committee meeting at the state level and demand that Basic EMTs and Intermediates be allowed to do these treatments. These treatments are defined in the protocols directly from the state and have been adopted by more than 23 counties in this state. I'm not sure where you can come off and opine that the decision made by the emergency physicians on the committee , the instructors, and the paramedics in twenty-three counties are completely wrong about this issue, but I really don't care if you do think they are all wrong, and that you are all right.

Your personal attacks do not change the facts that Basic EMTs in this state are granted permission and required by their protocols to provide these treatments. In Michigan, this is the Standard of Care. The albuterol neb treatments, the nitroglycerin, the aspirin, the epi-pen, and the D50 protocols are all post radio contact, unless a serious communications outage occurs. I can't change the protocols.

My point is that IF these protocols are going to exist in 23 counties in the State of Michigan, then we need to make certain that the prehospital providers are educated, trained, and have clinical experience to follow the protocols. Your opinion, and that is all that it is, an opinion, is that they shouldn't be allowed to provide the treatments at all. That opinion accomplishes nothing. They are allowed to do the treatments as written into the state protocols after medical control physician consent.

I will not continue to argue with you about whether these protocols should exist or not. They exist whether either of us agree with them or not. I happen to know from experience that they work and they work well in the rural area of my county, and I assume they also work in the other twenty-three counties too.

I'm betting that there are lots of other treatments that we provide that you wouldn't agree with either, as long as they fall under your definition of what only a paramedic should be able to do. My guess is that you were also against AEDs when they first came out, but now we have PAD with lives saved by people whose knowledge is zero and only are willing to follow instructions given by a machine.

Here is where we differ. You would lobby against the machine existing. I would lobby that since the machine exists, we better train the operators of the machine. I would argue that we better train them well and often.

[fiznat]

I think the reason you are getting the "all or nothing" impression is that medicine (and I use that word on purpose) is cumulative. Understanding of physiology, pathophysiology, and treatment must come in that order, and it is VERY difficult to take just one aspect and try to isolate it from the rest. That is why midlevels have had so much trouble, and require such supervision when they are practicing in their field. To administer a treatment requires not only knowledge of the mechanics of that drug, but also the physiology it acts on, the complications that may arise, and the signs+symptoms that make that treatment necessary. You cannot isolate a treatment from the wealth of knowledge that supports it's use. To offer a class on Epinephrine alone, or any other treatment, would require instruction on such a wide array of subjects that I think the class would be prohibitivly long. You can't respect this education, and then break it up into small pieces. It is one of those things where "the whole is greater than the sum of it's parts."

As far as administering Epi through syringe vs autoinjector, I dont see a problem with that as long as the administration remains within the same (EMT- scope. Drawing up a drug with a needle is just a mechanical task that can be taught to anybody, and there is no need to assume that EMTs are not capable of doing this. If you sought to expand the situations in which an EMT may decide to administer that medication, though, THEN I would have an issue.

[Richard B the EMT]

I think we should keep away from phrases like "country bumpkin". Those from farming areas have specific knowledge on their areas that a mountaineer wouldn't, and both have knowledge I lack, as a so called "City Boy". I admit this is generalized, but everyone knows something someone else doesn't, or wouldn't, know.

[Just Plain Ruff]

honestly, if it came from anyone other than Dust I'd be offended. I liken dust as the Neal Boortz of this site.

[Ridryder 911]

You are correct I was against AED when they first came out and the reason is still valid. It is not that it would definitely decrease needless deaths or be performed before I arrived, far from it. It was much that communities assumed that they would provide the same or equal care as having a Paramedic on board.

I watched in the mid 80's as hundreds of communities rallied together to purchase AED's and to send EMT's to EMT/D classes. From every bean and bar-b-que dinner in attempt to "save lives", Ironically, for about the same costs as the monitor then, would had paid for a person to attend Paramedic school. Now, we have AED's and no one to follow the course of ACLS. Yep, we again attempted to place a band-aid on an arterial bleed, quick-fix and half assed.

I realize your in a situation of teaching the state curriculum so be it. I am too, like any other licensed instructors, since many like to compare us to nursing the same as their instructors were at 30 years ago... the difference is they demanded better and they changed their profession. Where as the main point of my original post was we allow status quo. How many field medics are represented on your state board? Now, compare that with other medical professions.

As an educated Paramedic, you know and realize what is right and wrong. You also know short cuts in medicine will only lead to tragic events. Somewhere, someone will have to pay. You also know that an immediate fix never cures a long term problem, and rural EMS is a long term problem.

I am sure we will never convince many, because they refuse to see the "whole picture" again, seeing with blinders and refusing to ever develop or see alternatives to do the right thing, the first time. Again, compare us with any other medical profession and we are disgraceful. There are many reasons, but the main one is we are our worst enemies by being apathetic, and non-committal in promoting changes.

[Richard B the EMT]

I liken dust as the Neal Boortz of this site.

I plead ignorance. Who is Neal Boortz?

[Just Plain Ruff]

www.boortz.com He's a conservative talk show host out of Atlanta. He's pretty controversial and very very outspoken.