Basics and Intermediates ONLY No more BLS 911 ambulances?

[DwayneEMTP]

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.

What study(ies) are being referenced here. My apologies if I missed the reference before.

Who would allow, or take seriously such a poorly designed study?

Can you show us a reference (other than the Docs hearsay) for the fact that they allow one system, out of the whole study, to compile their data differently? I'm curious how this is allowed, when it obviously invalidates the entire study...

Perhaps I got lost somewhere...

Dwayne

[flight-lp]

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

For starters...........It's where Boston got their numbers. Do a search for Utstein criteria studies and you will find what you seek..................

[kelfr25]

The system that I work in has an interesting setup. Until recently we have always had at least a Basic and Paramedic on each truck. Anything less is just a transfer truck, and can only run ILS transfers. We have trucks with an Intermediate and a Paramedic, and we have several different levels of Paramedics. We have Secondary Paramedics, which can perform all their medic skills, but cannot ride the call in or write the chart. These people just haven't passed their interview with the medical director or haven't gone through their extra phase of training. This level is slowly being phased out. We have Lead Secondary Paramedics, that have their own truck, and can do all the skills and write the chart, but they have more restricted protocols, and a limited scene time. They have to call for orders for certain things, then we have Primary Paramedics, that have the least restricted protocols. In our system, which has been suffering from staffing problems as of late (ok... it's an ongoing thing, but the city just noticed), it is ridiculous to have two primaries on a truck together when they could be split up and create an extra truck on the street, which is what happens all the time. It takes an act of congress to get a double primary truck kept together.

Also, I've been partners with several paramedics that like having a basic. they say that we notice things that they would otherwise forget, because we see things from a basic standpoint. Lets put in an OPA and bag, then worry about the tube, etc. CPR is always nice. They say (and I've seen since I'm in school) that it's easy to get involved in the ALS stuff and forget about the BLS stuff, like O2.

Thats how I see it.

[EMT007]

Why is it that all of you who advocate a solely paramedic-based EMS system because of the vast amount of education/training (i.e. 3 months of classroom and 6 months of internship) :roll: that a paramedic receives aren't offering to give up your jobs if it meant thatwe could have emergency medicine-trained nurses or physicians on every rig???

After all, its all about the "education" isn't it?

[BushyFromOz]

After all, its all about the "education" isn't it?

nice attempt at sniping there mate, but all the education in the world is irrelevent if it is not applicable to the environment in which it is being utilised, ergo your smart ass comment is null and void :?

Further, back that up with paramedic education of 3 months is not education at all, and the vast majority of medics will agree with that.

[p3medic]

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]

Why is it that all of you who advocate a solely paramedic-based EMS system because of the vast amount of education/training (i.e. 3 months of classroom and 6 months of internship) :roll: that a paramedic receives aren't offering to give up your jobs if it meant thatwe could have emergency medicine-trained nurses or physicians on every rig???

After all, its all about the "education" isn't it?

Yes, it was a nice attempt at early morning humor, however as Bushy stated, your illogical analogy is irrelevent.

Listen to your own belief, an English grammar class would do you well.

[p3medic]

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).

Did someone reject your application? :roll:

[CBEMT]

P3 did you try to type something of your own in your last post? I'm sitting here trying to figure out if it's just my computer showing me only what you quoted. I figured if you quoted it you'd have something to say about it.

[CBEMT]

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

You guys are always bitching that paramedics aren't educated enough.

So why should a major metropolitan city let any moron off the street with a medic ticket practice ALS on their citizens?

I guess the education argument only applies to Basics when a medic wants a job, huh?