Basics and Intermediates ONLY No more BLS 911 ambulances?

[spenac]

Flight-lp this statement " Their "we only transport true ALS calls" mentality has bit them in the ass before........." is exactly why all 911 ambulances should be staffed at paramedic levels. You make a mistake conditions change enroute to the hospital and you fix it. Or better yet your fellow paramedic partner steps up catchs your mistake, no problem.

Again we should be doing whats best for the patient not us. And yes that at time includes saying no to a patient, just like a good parent does with their child.

[Asysin2leads]

I think I've suggested this before, but here it goes again...

If I had my druthers, the system would be set up like this...

Level 1: Transport technician/First Responder.

Our current EMT-B level. People could still do the 120 hours of training and get a transport job, and any professional firefighter that responds to medical or trauma calls should have at least this level of training. It should not be used as a stand alone certification for any 911 service.

Level 2: EMT/Paramedic Assistant.

In services that cannot afford to run a dual medic truck, the second person should at least be at the level of EMT-Intermediate. The EMT-I will shut up and follow direction.

Level 3: Paramedic

Every unit that transports 911 patients should have at least one of these.

Level 4: Paramedic ummmm.... plus?

I hope someday the option is explored for paramedics who have worn out their knees and or backs to be able to build on their education, training, and experience and move into a primary care or long distance critical transport function, or something. I think one of the many things that hold EMS back is that we are generally equivalent to a workhorse, once we break a leg our only option is to be taken out to a field and shot.

[Dustdevil]

I think I've suggested this before, but here it goes again...

If I had my druthers, the system would be set up like this...

As I believe I said the previous time you ran this up the flagpole, I like it. I like everything about it. I think it is a reasonable, yet safe compromise between those who want a Bachelors Degree entry level and those who think things are just fine the way they are.

I like the idea of doing what so many states have already done, and make our current EMT level of training the standard for all First Responders. In that context, it remains useful. As a member of an emergency ambulance crew, it is useless.

I like allowing a limited entry into field practise before completion of a full paramedic degree curriculum. And I agree that their skillset (not to be confused with their education) would be similar to that of the current EMT-I. I would put this one stipulation on it: It would not be a stand-alone course. It would be a level only attained by completing more than half of a formal paramedic degree programme, including all prerequisite support courses, and passing a comprehensive examination at that point. Continued student status would be a requirement for continued eligibility. Dropping out of paramedic school would result in loss of practice privileges. It is not a licence or certification. It is just like a Junior or Senior nursing student being allowed to work as a "Nurse Tech" while finishing their final semesters. This MUST NOT become a stopping level for lazy people who think they are "good enough."

[spenac]

Holy crap I got a complement on a statement. What do I do now? :wink: Thanks

[CBEMT]

Yeah, I know, people like to trash Seattle and Boston because they're tiered.

On the other hand, both have SCA save rates over 40%.

What's yours?

[spenac]

Yeah, I know, people like to trash Seattle and Boston because they're tiered.

On the other hand, both have SCA save rates over 40%.

What's yours?

IMHO those studies are flawed. Ours are much less as I suspect truthfully theirs are. Of course I don't count it unless they leave the hospital with a high quality of life.

[vs-eh?]

IMHO those studies are flawed. Ours are much less as I suspect truthfully theirs are. Of course I don't count it unless they leave the hospital with a high quality of life.

I recently had my fall CME which included (amoung other things) one of our physicians commenting on the ROC study and our involvement in it. Seattle (Medic 1 or whatever), along with us and several other North American systems are involved in this study. One of the sections of the study involves the ROSC outcome amoung systems and specifically with the shock "early" or "late" study monitors.

The physician told us the reason why Seattle's numbers are so high. It is because they only include those in the study who INITIALLY PRESENTED in a SHOCKABLE RHYTHM. All other systems involved base it on the TOTAL NUMBER of cardiac arrests involved REGARDLESS of the initial rhythm. Obviously, that is going to play with the numbers. From a "survivability" standpoint alone, a patient who initially presents in a shockable rhythm (regardless of first provider contact) will likely be "fresher" with a much greater likelihood of a ROSC.

Obviously stacking the deck in your favour by eliminating PEA/asystolic cardiac arrest patients, who generally will have a significantly reduced likelihood of a ROSC (all things being equal).

Carrying on with the topic, people will know my opinion. Take a page (yet again) from Ontario's book of standards of prehospital education for BLS providers. There is your minimum folks. EMT-B and I education by comparison is a joke, and would not be allowed on an ambulance here.

[flight-lp]

http://www.aemj.org/cgi/content/abstract/8/5/431

http://www.wakegov.com/NR/rdonlyres/B03101...diac_arrest.pdf

http://www.wakegov.com/NR/rdonlyres/469BF7..._arrest2006.pdf

Actually Boston's numbers from 2006 was 34% on the ONE model they actually made it on..........................

Those numbers are nice and all, but they fail to look at the overall big picture. The numbers are only inclusive of cardiac arrests that meet the Utstein Criteria, which in Boston's case was a little more than 9% of all cardiac arrests (593 / 6512). So their 34% (King County's 40%, or 30% depending on which model you are looking at.......) is off of a total 9% of cardiac arrests. Therefore , the TRUE survivability is around 3%, neurologically intact, discharged from hospital. Far from the pretty numbers that they toot their own horns with..........................

With the implementation of the ITD, an induced hypothermia protocol, direct cath lab access, the use of the Lucas device, rapid deployment of and high availability of AED's, and an outstanding community education program, our numbers are averaging around 17% for ALL cardiac arrests. Our ROSC average is 80%+. But I digress......................

The tiered system isn't all that. And sorry, any system that will not allow a Paramedic to act as one and makes them be an EMT-B for a year, makes them reside in the city and then pays them horrible wages, is absolute crap (Boston EMS in case you are still confused).

[flight-lp]

Sorry VS I was typing as you posted...............Similar info posted............

[vs-eh?]

With the implementation of the ITD, an induced hypothermia protocol, direct cath lab access, the use a the Lucas device, rapid deployment of and high availability of AED's, and an outstanding community education program, our numbers are averaging around 17% for ALL cardiac arrests. Our ROSC average is 80%+. But I digress......................

Ya, we just got re-introduced to the ITD when I did the CME. We were first shown it about a year ago (at least). I don't know what the hold up was, I don't even ask anymore.