Conflict on Dual Medic Units

[Medic26]

Oh, it will work for everybody. It just won't make everybody happy. And the reason we are getting nowhere is because too many people are worried about making everybody happy.

I never siad anything about keeping anyone happy.

You could be right about the stronger paramedic being a teacher and bringing the lesser provider along, however you are assuming that they will all teach and be patient, explaining things along the way.

Where I come from, our system has a few "paramedic" EMT's who couldn't cut the grade and now they are paid and operate at the EMT level. Yes they were given many chances to get help, remedy their profound weakness's and they have had to face the fact that not everyone is cut out to do the job.

[Richard B the EMT]

Dustdevil said:

The way I see it, dual medic trucks allow for STRONGER providers because a poor medic has somebody to LEARN from all the time, someone else to help them with their skills if needed, and someone to encourage them through their assessments until they improve.

Bravo, my man. Everybody knows different things, and two viewpoints bolstering each other, from different areas, can only help the patient care.

Think outside EMS. I play regular guitar, and my buddy plays bass guitar. Each alone is good, but together, we're awesome!

[Medic26]

That makes no sense whatsoever. Beat their chests to whom? Their paramedic partner? How does that work when your partner is your equal? How do you beat your chest and impress somebody who is no less qualified than yourself? The answer is, you don't. Take away the imbalance of power, and you take away the conflict. That's the whole point of this topic.

By this I mean that they think everyone should be a paramedic....because thats what they are. Some get that "P" after the "EMT" and forget where they came from, that most of them too started as a basic and earned there keep just like most everyone else. Learning how to be a good EMT and doing basic skills before advancing to the ALS level. Building upon a basic working knowledge of how things need to be done before they are in charge and taking in an overwhelming responsability.

Do you really think that the person driving the ambulance and lifting the wheels on the stretcher should be a paramedic? Its just not feasible for the whole system, many places have a multi-teared system and it works well, other places not so well. Do you really think from a financial standpoint as a executive director of a large EMS organization you could afford to pay people who spend several years obtaining a degree to run dual medic trucks in rural america where call volumes are only 100 calls per year?

Now, while I do think that "basics" have their place in the 911 system I do realize that there is a need for elevated education across the board. For example, an EMT would be given a more thorough understanding of why they are doing something instead of the standard........because the protocol says too!!

[Paradude]

You know, the whole " Remembering where you came from.." thing is very misleading. I came from my mom and dad. I became a medical prefessional when I became a Paramedic. All time before then that I spent in EMS as an EMT, I was preparing for that. The problem is that EMT's tend to stay where they are at, in order to make money without bettering themselves. I have EMT partners. One is a Paramedic student, and the other is a full-time firefighter who works on the rescue truck, and is wanting to work a second job as an EMT to make him better at this. (and to build a new deck). I have said many times that I have a problem with someone who is satisfied being less than what they need to be.

-Paradude-

[Ridryder 911]

There we go again! You know I would had at least thought at a Paramedic level, one would understand there is not really a BLS or ALS treatment! There is treatment as a continuum, with no separation. Medical schools and even nursing schools do not teach .. BLS then afterwards ALS. Even in medical textbooks; BLS is regarded as making sure patient has adequate ABC's ... including intubation, IV's etc.. Only in EMS do we have to separate such due to the fragmentation of levels.

We all are quite aware that dual Paramedics would provide the best care for our patient. Period! Unfortunately, this is where the difference between our profession and other health care providers separate. Other medical professions have not diluted their programs and instituted alternate levels to provide lower care! Hmm.... can we see some of our problems?

Are we really that patient orientated to jeopardize care to anyone but at the Paramedic level? Can we truthfully say we always have the best interest of the patient in mind? Apparently not! Look at other health professions, that have progressed upwards... and then sadly look at ours. How embarrassing! Where others have met challenges and rallied to increase their profession ... we much rather dilute our profession, our patient care and ourselves... all for ego's !

Again, compare any other medical profession. Look at what they have done within their practice. They have stood firm on education levels, (actually increasing) where we have coward down and used any excuse from geography, payment, to shortages instead of correcting the problem. Oh, we much rather take any other route than to stick it through and fight for patient care. Which leads me to the question, if you are for anything but the best for your patient, "how good of a Paramedic are you?" Sure, you might be adequate in skills, knowledge, but as in the profession as a whole why would you allow anyone less to perform treatment?

What is a shame most medics really do NOT care about patient care! Seriously, EMS is over 40 years old and there are still places that cannot even deliver the type of care Johnny & Roy provided thirty two years ago! How shameful! We have allowed a continuation of piss poor care and lack of concern to our citizens and patients!

Again, if you are not part of the solution, then you are part of the problem.. like it or not! R/r 911

[Medic26]

Paramedics beating their chest....refer to the two posts above. :roll: It sounds like you are talking down about BLS providers, not being good enough. Maybe this is not your intention.

So to boil it all down you guys would rather the "entry level" EMS position to be a paramedic? You have assumed that I am against this theory........it would be great but its just not feasible. Nobody has disputed that fact that a dual medic unit would be able to provide the best care.

Rid stated - "Other medical professions have not diluted their programs and instituted alternate levels to provide lower care!"

If this is true, there would only be "nurses". But the case is there are RN's, LPN's, NP's, Etc. and to break it down further RN's can obtain a certificate, associates, bachelor or masters degree. Which part of this training do you regard as the "gold standard"?

[Medic26]

Rid stated - "What is a shame most medics really do NOT care about patient care!"

If this were true many of them would not be practicing today. I think the shame is that we cannot agree we all have different views.

Excuse me for the next 48 hours as I will be participating in a conference to further my knowledge. I will resume my banter with you after I am done.

[Ridryder 911]

Have fun at the conference!

Now, in regards to multiple level of nurses, as per say you have to understand LPN's, CNA, etc work directly under the supervision of the RN.. period.

In the hospital setting the LPN/LVN's are not approved enough to even perform the initial assessment, or even triage (even Paramedics are not approved to do so in a ER) . Again, they have to be under the direct supervision or monitoring of the RN, never the only nurse seen.

Actually, there has been a wave of changes called "total nursing care" ever heard of it ? This is where there the only nurses are RN, check local hospitals and you might be surprised the only label of a nurse is the RN. Other assistants are called patient care representatives (PCR) or tech.'s. JCAHO does not endorse LPN in any critical care areas. Many hospitals have now removed their status and label, replacing it with a technician or PCR with advanced level label. Many PCR or tech.'s maybe actually RN students, since some states allow them to obtain their LPN license after their first year of nursing education.

I know of many hospitals that have totally removed and discharged all LPN's and only allowed RN's to be the only nurse. Again, PCR ( nurse tech) and PCR II (sometimes LPN's) are allowed to perform certain procedures, but are not called nurses, and only perform these tasks assigned by the RN.

I lecture at both LPN and RN schools. Majority of the LPN's in my area no longer practice in a hospital setting rather nursing homes and offices and clinics.

So back to the thread and to answer... yes the only acceptable entry level for acute and intensive care such ICU, CCU, ER is now the RN.

You see, we have policed our area, and did not allow the normal excuses as in EMS to get in our way, even in the rural areas... and now it is time we do the same in EMS.

R/r 911

[firefighter523]

Rid, do me a favor, stay in the ER, every nurse that I have had contact with, would look at me like I have 3 heads if I asked them to dart a chest, or place a needle in someone's throat, or even intubate. Nurses have no clue, and never will understand what we do as medics out in the field. Never, have I ran into the problem of a nurse questioning my rx's in the field. They are always too scared to ask, because they are usually CLUELESS!!!! You might be the exception, but I am sure you were a paramedic first.

[AnthonyM83]

Honesty, I haven't been following the topic, because it's long and I've been busy, but I do intend to read through it for the info.

What do you think of this situation:

One of our recent EMT trainees said he had previously gone through medic school, but failed in his internship. He attributes it to not having been an EMT beforehand. I asked him specifically howso.

He said he just wasn't comfortable on-scenes or interacting with patients and it was to much figuring out how to do that AND practicing his ALS skills for the first time in the field. He gave the example of a lady hyperventilating and he wanted to start bagging her. He had never seen a patient breathing like that. He said if he had worked jut a few months as an EMT, recognizing her breathing as not an immediate threat requiring ventilations, he wouldn't have gotten so nervous.

A common counter to that would be that you'll learn that stuff along with your training, but being comfortable on-scene takes some time. Speaking to several people at my ambulance company, it seems 3 months is often a breakthrough point. I think 6months and a year are also....(though for me the best breakthrough point was taking the paramedic prep class...you're a lot more confident on scene when you actually know what's going on to some degree).

What do you guys think about preventing the above situations from occurring? I mean best answer would probably be a restructuring of the paramedic school programs and having concurrent ride-alongs during class, but what about within our current system.