Basics and Intermediates ONLY No more BLS 911 ambulances?

[AMESEMT]

I have seen both dual paramedic services, and an EMT/Paramedic service. When I did my field time for my medic, I was with the service that had an EMT and a paramedic on a truck. From what I experienced that is the best I have seen. You arrive on scene and the EMT does what the medic wants (i.e. vitals, hook them up to the EKG, prepare IV bag, etc.) while the medic determines what is going on and the appropriate treatment. The EMT is operating in their scope of practice without wasting skills (like with a dual medic truck, will explain in a minute) and the medic has someone there to help them. This gives the patient immediate ALS care, and the EMT experience. With the dual medic truck it seemed like the one who was driving at the time was basically a glorified EMT. Yea, they helped the other medic (i.e. starting IV's, preparing medications, etc.) but the one attending did the vast majority of the ALS skills. The plus side is the one attending had someone to help them when the c%&p hit the fan.

People complain about wasting a ALS truck on a BS call, but sometimes those BS calls do need ALS care. Someone mentioned a broken ankle earlier, and how a BLS truck could handle it. Yea, they could but how comfortable would that patient be going down the road when it is bumpy? If there were a medic on the truck they could start a line and give morphine or fentanyl or some other analgesic to help make the patient comfortable. While doing my ride time for medic we did our fair share of BS calls but each call presents a new challenge and sometimes does end up being a good call. Another person brought up the point that sometimes what the patient presents with may be considered BS but turns out to be something quite serious. I am all for having an EMT/Paramedic truck.

Just my 2 cents worth.

[spenac]

I have seen both dual paramedic services, and an EMT/Paramedic service. When I did my field time for my medic, I was with the service that had an EMT and a paramedic on a truck. From what I experienced that is the best I have seen. You arrive on scene and the EMT does what the medic wants (i.e. vitals, hook them up to the EKG, prepare IV bag, etc.) while the medic determines what is going on and the appropriate treatment. The EMT is operating in their scope of practice without wasting skills (like with a dual medic truck, will explain in a minute) and the medic has someone there to help them. This gives the patient immediate ALS care, and the EMT experience. With the dual medic truck it seemed like the one who was driving at the time was basically a glorified EMT. Yea, they helped the other medic (i.e. starting IV's, preparing medications, etc.) but the one attending did the vast majority of the ALS skills. The plus side is the one attending had someone to help them when the c%&p hit the fan.

People complain about wasting a ALS truck on a BS call, but sometimes those BS calls do need ALS care. Someone mentioned a broken ankle earlier, and how a BLS truck could handle it. Yea, they could but how comfortable would that patient be going down the road when it is bumpy? If there were a medic on the truck they could start a line and give morphine or fentanyl or some other analgesic to help make the patient comfortable. While doing my ride time for medic we did our fair share of BS calls but each call presents a new challenge and sometimes does end up being a good call. Another person brought up the point that sometimes what the patient presents with may be considered BS but turns out to be something quite serious. I am all for having an EMT/Paramedic truck.

Just my 2 cents worth.

At least having 1 paramedic on every ambulance is a must to make sure patients have the best chance of the supposed BS that is really life threatening being caught. It would even be better if all ambulances had 2 paramedics. That would allow 2 supposedly equally educated individuals to help one another and in difficult cases, even bounce ideas off each other.

[jbanagas]

Well take Los Angeles County FD, they run dual paramedic squads and use a private BLS ambulance for transport, if the call does not require ALS they simply hand it over to the BLS crew, and if the call requires ALS treatment they jump in with the BLS ambulance crew and transport. Great system dual paramedics if it's not broken why fix it?

[JPINFV]

Wow, someone actually think that So Cal style EMS is a good system? :shock: To think, I've always viewed LA and OC EMS setup to be a good example on how not to design an EMS system.

[Dustdevil]

Well take Los Angeles County FD, they run dual paramedic squads and use a private BLS ambulance for transport, if the call does not require ALS they simply hand it over to the BLS crew, and if the call requires ALS treatment they jump in with the BLS ambulance crew and transport. Great system dual paramedics if it's not broken why fix it?

ROFL! Not broken? Been there lately?

LA County isn't so much "broken" as it is simply a FAILURE to thrive. They're stuck exactly where they were in 1972, without the slightest hint of progress. Their "paramedics" (using the term very loosely) are still doing the same 13 weeks of monkey training they were doing three decades ago. Zero progress. That's worse than broken. To break it, they would actually have to change something over thirty-six years.

[Kiwiology]

Their "paramedics" (using the term very loosely) are still doing the same 13 weeks of monkey training they were doing three decades ago....

How the hell can you get your Paramedic in thirteen weeks? The shortest program I've ever seen was for the Dallas Fire Rescue medics and that was six months of 5 days a week, 7 or 8 hours a day.

I wonder if Brackett and Early are still running it ..... :roll:

[Dustdevil]

How the hell can you get your Paramedic in thirteen weeks?

It's really a very simple formula. Instead of educating people for competent professional practice, you just train them to pass the test. Of course, you could train someone to pass the test in half that time, but remember, they're dealing with lowest-common-denominator firemonkey wannabes there, so it takes a little longer. At least Dallas is using real firefighters, and not just wannabes.

[toutdoors]

As a new medic, I like the dual medic rig. Makes me feel a little more comfortable knowing that if I want to bounce something off of someone, I can turn to my more experienced partner and discuss it, instead of calling med control, and maybe sound unsure of myself, or dumb; thereby earning myself a bad rep with the ER staff. I feel pretty comfortable tending to my patients, yet still have a small tingle of nervousness in me as I ride in, just going over everything, what is going on, what am I doing, what is the result, are they still breathing, yada yada yada. The system I work for is a little different, we are mostly medic/medic. There are only three EMT-I's on the staff, and hopefully in 4 months one of them will be a medic after her testing.

I worked the streets as an I, (I-85), and learned alot! The only reason for that was because most of the medics I worked with would take the time to answer questions after the run was over. Did this experience help in medic class? A little bit, but it would have been smarter for me to get my medic a year or two after my basic or I, and not wait as long as I did; oh well, hindsight.

In regards to EMD; it is only as good as the info the caller gives, period. No offense to any dispatchers out there, I know I read a post from one of ya, but seriously, if the caller does not answer the questions with the right words, then all is for not. An excellent example is to ask someone if they are having chest pain. They will say "no" Then ask if they are having any discomfort or pressure, and they will say yes. To me, if you say yes to any of these three questions, I am gonna start to think along the lines of cardiac event, and start down that road, and dig deeper. To the patient, chest pressure is not a heart attack, because it isn't really "killing" them pain, it is just simple pressure. (Hope this makes some sense, I am getting tired)

As far as the toothache scenario mentioned way back in the first part of this post, it strikes a scenario that my first responder instructor shared with us. She was an EMT who responded to a person C/O a toothache. The family had called, and a middle aged man in his 50's was having a tooth ache. He declined transport, they did all the right things as far as initial V/S and talked to him, got a signed refusal and left. About 2-3 hours later, they were called back for an unconscious party, and coded him. He died. He had a heart attack (autopsy results) and his only complaint was a toothache. Does this mean that I am gonna hook up every tooth ache to the monitor? I highly doubt it, but it has stuck with me for over 15 years on what a unique scenario that was.

I believe that a paramedic should be availble on every rig in perfect world. In our service, we go so far as to start moving towards an incident if it sounds as though it may need a second rig when we hear dispatch information. We don't go emergent, we just kind of cruise over in the general direction, while still being available to cover a call in our primary district if it comes in. In this manner, we are able to get at least two medics on scene rather quickly if the initial rig has a newer medic on board. Our shift supervisor, and field training officer will also respond to some calls if they feel that it may be a rather complex call if the medic responding is still a little new and working with one of the EMT-I's. I know it sounds a little like a cop out, but I really do think that this system is working, and working pretty good. Of course there are days we could use one or two more rigs on the street, but then again there are more days where we are just "comfortably busy enough" to have enough to do, but not up to our necks in backed up paperwork.

I think I am rambling now, so I will just say that at least one medic per rig would be a beautiful step in the right direction.

[spenac]

As a new medic, I like the dual medic rig. Makes me feel a little more comfortable knowing that if I want to bounce something off of someone, I can turn to my more experienced partner and discuss it, instead of calling med control, and maybe sound unsure of myself, or dumb; thereby earning myself a bad rep with the ER staff.

This even applys if both medics are experienced. No matter how long you do something there will be times it would be nice to confer with someone else to see what would be best course of treatment.

[WolfmanHarris]

Well take Los Angeles County FD, they run dual paramedic squads and use a private BLS ambulance for transport, if the call does not require ALS they simply hand it over to the BLS crew, and if the call requires ALS treatment they jump in with the BLS ambulance crew and transport. Great system dual paramedics if it's not broken why fix it?

What is the saying about knowing enough to know how much you don't know? I'm afraid you don't even know that much my friend.

It's natural to not want to look at the system you work and find significant problems. It's natural to look at the hard working, decent folks within your department and not want to admit that despite the commitment and hard work that your department is not providing the best care possible for your community. It's even harder to look at the work you put into your training and admit that while you worked your hardest and learned your stuff, that despite your best efforts, your education was deficient and failed you and your efforts. These are incredibly hard things to face but there's an important distinction to be made. No one is saying that you as individual providers are not doing the best you can within your system; we're saying that as a system there are problems that should not be ignored. If you can see within yourself to separate these concepts and not take them personally, than you can look past your backyard and see the areas where your system can learn, improve and provide the service I'm sure you would agree your community deserves.

I don't know a tonne about your department and a quick look on its website told me very little. Therefore I will only address one thing that you have mentioned and that is relevant to this discussion. Crewing.

In terms of general crew requirements, I would argue that a single ALS provider should be on every unit; at least until that hallowed day when we have one level of care. In Ontario, education is very much geared to, this is the first step towards ALS. We are taught to work with ALS (in terms of equipment familiarization and background information) and the tone of the instruction is that most of us will go onto ACP within a few years (backed up by stats that say 80% will go ACP; sorry no source). I plan on being ACP within 5 years of graduating max; 2 preferably.

It sounds like on staffing LA Co has a great start. Two ALS providers in a unit. Now go the rest of the way and lose the squad and enter the 21t century with the rest of the world. Treat and release is a great direction for EMS, but in the end transport medicine is still the cornerstone; a cornerstone you don't even touch.