how to fix EMS

[Veneficus]

I figured it out reading the most recent active threads.

Eliminate medical control.

Think about it.

All treatments would be defined by a scope of practice and performed at the discretion of the provider.

Which would make that provider soley and officially responsible for care.

Those that are too inept to function without a protocol book would be weeded out sooner or later.

Providers would have to seek out more advanced education in order to figure out what they were doing. No more "just following orders."

Nobody to call and ask permission for things that are known to be needed.

No more inept providers calling and disrupting the ED asking for permission to follow standing orders.

The more I think about it, the more I like it.

 

[Anjel]

I figured it out reading the most recent active threads.

Providers would have to seek out more advanced education in order to figure out what they were doing. No more "just following orders."

^^ This for sure. Basic training is a joke. And Paramedic is a crash course as well. I think a Bachelors degree should be the absolute minimum. You need one to run a company why not to care for another human being.

And whether people wanna admit it. While that patient is in the back of your ambulance you are in control of their life. What happens to them and their well being.

But we will trust a 18yr old dumb :censored: that went through 15 weeks of advanced first aid to get grandma where she needs to go and get her there alive. Yes I am a basic and I will be the first to admit I don't know much. lol But I know my protocols, and I know what the 15 weeks taught me. And that's good enough for my state. I am learning a lot more...but not from class. More on my own research.

ANDDD that's the end of my rant lol

 

[46Young]

Sounds good, but how will these depts feel about liability? They might go back to BLS in response. I don't believe that there's anything saying that the gov't is mandated to provide ALS txp.

 

[Anjel]

Sounds good, but how will these depts feel about liability? They might go back to BLS in response. I don't believe that there's anything saying that the gov't is mandated to provide ALS txp.

In my county all 911 calls have to be answered by an ALS crew with 2 medics.

I think that is gov't mandated. county gov't anyway.

 

[46Young]

In my county all 911 calls have to be answered by an ALS crew with 2 medics.

I think that is gov't mandated. county gov't anyway.

Is that something that was voted on, but can be repealed if they want? ALS is only 40 years old or so; I'm sure your county has existed for longer than that. Someone had to propose that mandate, and get it voted on. I'm sure they would reconsider the measure if $$$ were at stake.

Alternatively, are you referring to a contract that a private 911 EMS provider has with the county, or is your county 100% municipal EMS?

My county says ALS calls must have two medics onscene, but that doesn't always happen, either.

 

[FrostbiteMedic]

In reference to how to fix EMS, there is one big, recurrent theme: education. Yup, I said it again....
Call me weird, but I really don't know what it is like to be limited to a "normal" bls ambulance, as TN has EMT-IV (i/85) as the lowest level of EMT licensure (excluding first responder, and a few fire departments that run in-house EMT-B, but neither licensure will get you employed in TN). You may have noticed that here recently I have been on sort of an education kick. Why is this? Because over the past few months I have realized just how woefully behind many of us (to include myself) are in our education. Part of the reason I came to this is due to physical issues (which I will not go into at this time) that made me wish I had decided to pursue more education sooner. It is the one thing that barring neurological injury/disorder that can never be taken away from you.

 

[MrBrown]

You mean like how Australia, New Zealand, South Africa, the UK, all of Europe and parts of Canada have no "medical control" whatsoever?

 

[JJR512]

Nothing is getting fixed by what was proposed here because the proposal completely fails to address the cost of implementation. Oh sure, it's nice to sit back and say more education is the solution to any problem. In a dream world, I'd agree. But this is the real world. Who is going to pay for the "Bachelors degree should be the absolute minimum"? The people who want to be EMS providers, the companies that want to hire them, the communities that want to use them, or the government (grants)? There are a lot of problems in EMS. Simply saying "we need providers to be more educated" not only doesn't solve all of them, it also creates new problems or makes other existing ones worse.

 

[reaper]

Sounds good, but how will these depts feel about liability? They might go back to BLS in response. I don't believe that there's anything saying that the gov't is mandated to provide ALS txp.

Actually yes in FL. It is state mandate that all counties have ALS services. Now some of your poor counties may only have two ALS units for the whole county, but at least they have them. Some are mix of Medic units and EMT units. But every pt gets assessed by a medic, then may be handed off to an EMT for transport.

 

[FrostbiteMedic]

Nothing is getting fixed by what was proposed here because the proposal completely fails to address the cost of implementation. Oh sure, it's nice to sit back and say more education is the solution to any problem. In a dream world, I'd agree. But this is the real world. Who is going to pay for the "Bachelors degree should be the absolute minimum"? The people who want to be EMS providers, the companies that want to hire them, the communities that want to use them, or the government (grants)? There are a lot of problems in EMS. Simply saying "we need providers to be more educated" not only doesn't solve all of them, it also creates new problems or makes other existing ones worse.

As for the first bolded area, how did I imply that an Bachelor's was to be the minimum? I just said that we need to get more education. The government has already attempted to solve problems elsewhere by chunking money at them, hoping they'll go away, but it does not seem to be working. And continuing along that line, how does it create/worsen problems? Having more education only benefits, and never hurts.....

 

[46Young]

Actually yes in FL. It is state mandate that all counties have ALS services. Now some of your poor counties may only have two ALS units for the whole county, but at least they have them. Some are mix of Medic units and EMT units. But every pt gets assessed by a medic, then may be handed off to an EMT for transport.

No kidding. I'm also curious if any systems exist where an ambulance is not guaranteed if you call 911.

 

[Veneficus]

Nothing is getting fixed by what was proposed here because the proposal completely fails to address the cost of implementation. Oh sure, it's nice to sit back and say more education is the solution to any problem. In a dream world, I'd agree. But this is the real world. Who is going to pay for the "Bachelors degree should be the absolute minimum"? The people who want to be EMS providers, the companies that want to hire them, the communities that want to use them, or the government (grants)? There are a lot of problems in EMS. Simply saying "we need providers to be more educated" not only doesn't solve all of them, it also creates new problems or makes other existing ones worse.

Actually, it seemed a rather inexpensive idea when I thought of it.

I didn't even suggest mandating education.

I did suggest that if they were held personally accountable for thier decisions, individuals might seek out further education on their own.

The rest of it is basically cutting costs.

 

[rescue99]

Nothing is getting fixed by what was proposed here because the proposal completely fails to address the cost of implementation. Oh sure, it's nice to sit back and say more education is the solution to any problem. In a dream world, I'd agree. But this is the real world. Who is going to pay for the "Bachelors degree should be the absolute minimum"? The people who want to be EMS providers, the companies that want to hire them, the communities that want to use them, or the government (grants)? There are a lot of problems in EMS. Simply saying "we need providers to be more educated" not only doesn't solve all of them, it also creates new problems or makes other existing ones worse.

Wow....someone who actully gets it! It takes time to sort all of these details out. Clicking our heels and saying, "make it so", is the note on the napkin, not the marketable product.

 

[Veneficus]

I wouldn't be opposed to hear how education actually makes things in EMS worse?

 

[usalsfyre]

Wow....someone who actully gets it! It takes time to sort all of these details out. Clicking our heels and saying, "make it so", is the note on the napkin, not the marketable product.

Except no one has even attempted to "sort out the details" in the 10 years I've been around. National Scope of Practice came out with the thought of establishing uniform levels, and it was derided because (gasp!) we might have to go back to school. It was watered down to the point of being basically the same thing we have now. We've had enough time. It's time to stop making excuses and DO SOMETHING.

The excuses are pushing me closer and closer to leaving the field entirely.

 

[MrBrown]

No kidding. I'm also curious if any systems exist where an ambulance is not guaranteed if you call 911.

Right here, every day if you call up for something like a tooth ache, a sprained ankle or "my woogie hurts".

 

[HappyParamedicRN]

In my state we are ahead of the game, as our only med conrol option is Heparin for STEMI... Everything else is standing order!


Happy

 

[ffemt8978]

No kidding. I'm also curious if any systems exist where an ambulance is not guaranteed if you call 911.

There's an area that covers a couple hundred square miles not too far from here that has no fire or EMS coverage because they don't want to pay for it (via taxes, etc...). There's about 15 homes in that area so there are some out there.

I'm not sure if an ambulance would respond if they were called to a home in that area (same for fire).

 

[Aidey]

In my state we are ahead of the game, as our only med conrol option is Heparin for STEMI... Everything else is standing order!


Happy

That only makes you ahead of the game if your standing orders are good.

 

[the_negro_puppy]

Although i'm just regurgitating what Brown has been saying- Aus, NZ England etc are all examples of this. We have no medical control and generally an education level of diploma or degree.

I guess the problem is that the US EMS is largely privatised with different companies having different drugs, guidelines, skills etc. Here as with the UK and NZ, Ambulance services are state or region run and funded.

This means that the services can afford to educate, train and employ people.

I am doing the Diploma method, where I work full-time for 2.5 years, complete papers and study in my own time, have assessments (CME's + exams) and skill training every 6 months and receive mentoring.

The other method is attend university, obtain a bachelors degree (3-4 years) and apply for employment.

Both the degree and diploma method both allow practice as paramedic witht he same skills.