EMT-B/BLS care is there a point??

[JPINFV]

Trauma? So what?

Your point is? To be fair, any prehospital care might not decrease mortality rates of trauma patients either.

http://www.ncbi.nlm.nih.gov/pubmed/8611068

 

[Free-B-EMT]

The point is, and by the way it's not my point but the study's, is that it doesn't really seem to make a difference to the patient's outcome whether you are ALS or BLS in the long run. If we take it one step further, according to your link, all we need for the best patient care is a car.

 

[VentMedic]

The point is, and by the way it's not my point but the study's, is that it doesn't really seem to make a difference to the patient's outcome whether you are ALS or BLS in the long run. If we take it one step further, according to your link, all we need for the best patient care is a car.

The other point that was also made in that study was the provider to have enough education to determine whether ALS or BLS intervention was needed. It was not intended to mean ALS or BLS service or provider. The study does not promote BLS services over ALS services, just the type of procedures done for the trauma patient. You can not base the EMS system on some trauma calls when it is the providers education and training that should be deciding the level of care needed. An ALS provider can always reduce the amount of ALS procedures they do. A BLS provider can not step up to ALS procedures as needed.

http://www.cmaj.ca/cgi/content/full/178/9/1141

We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.

The relative effectiveness of community-based advanced life-support programs for major trauma patients has not been clearly established, and there have been calls for larger and more rigorously designed studies.

 

[JPINFV]

Apparently it doesn't make a difference if your a private citizen or an EMT-Basic either. The simple fact is that there is very little that an ambulance can provide to most trauma patients outside of a ride anyways. On the other hand, what exactly can a basic do for a CHF patient suffering from pulmonary edema besides oxygen?

Oh, by the way, you are making an argument and using the study as support for that argument. Otherwise you wouldn't be posting it.

 

[BossyCow]

what exactly can a basic do for a CHF patient suffering from pulmonary edema besides oxygen?

I'm thinking that having a basic provide oxygen is better than just a car ride. Sure its not going to be as good as ALS. I don't think anyone is going to say that ALS is not going to do more for a patient than BLS. But the point I repeatedly try to make is that in many areas, BLS is all they can afford or support. Statements like BLS is just a car-ride, are not accurate.

That said, I'm going to go to my meeting, where I'm going to hear the sad news that I have just lost access to another ALS provider for my district. Tell me again about how ALS is the future! Nice to know its so wonderful, now if I could just have it available to me!!!!!

 

[Ridryder911]

There seems to be quite a few people with very strong and varying opinions on this subject. There was an independent study carried out in Canada over a 3 year period that addressed the patient's survivability when treated ALS vs. BLS in a prehospital setting. Try googleing OPALS Major Trauma Study to read the results. A lot of people may be surprised. You can also take the link below to see a full write up.

http://www.cmaj.ca/cgi/content/full/178/9/1141

Everyone like to refer to Canada's OPAL study, that found to be heavily flawed. Although there were some good points, but over all really not informative and unrealistic. For example the primary recommendation was to correct measures was to have BLS within 4-8 minutes on every response.. Yeah, that will happen!..

This is why it is hardly used or recognized anymore...

R/r 911

 

[Ridryder911]

This is really becoming humorous. Lower levels attempt to justify their existence, at the job they have. Now, describing how "advanced" does not do this or that.. again, take a deep breath and figure out there is no such thing as advanced life support; only patient care. Now, state that "there is no good in patient care".. doesn't sound right huh? ...

No one is saying Basics should be done away with.. rather their job description and usage should be changed. What is amazing is everyone agrees that the educational level is piss poor but then they refuse to agree that should changed from those to that deliver primary care? This makes no sense.. Shooting out of both sides of the mouth.

Why would EMT's be threatened to be a MFR? I ask what advantages does running the so called "BLS" calls have for you? Why would anyone be defending a position of this? Is it the best for the patient or... just for you?

I agree the Paramedic training is so inconsistent it is horrible, but appears to be much better than what I continue to read about the Basic courses that are being taught. For example one day of scenarios and usage of a stretcher & your qualified for what? ... Do you really even realize what points you are attempting to make?

I ask if most felt that their education was adequate or difficult. or was it easy and not to hard or even a joke, read the numbers. Sorry, I have a problem that if one believes a 6'th grade level text is hard and as well if it is so easy, then apparently the material was not detailed enough.

So let's propose this... a change in the material. Make the Basic Level at least 650 clock hours long with at least 150 clinical hours. All agree it was too short, not enough material, so increase it. Now .. what would be the problem? ...

Bossy, your situation is not unique. All levels of EMS are closing due to poor funding. Even metro areas. What is going to have to change is the perception of EMS being not being a luxury that it is an essential service. Amazing, communities will have F.D.'s with haz-mat, thermal imaging, etc.. all nice but in comparison the EMS will run 75% more responses. No, it does not make sense...

R/r 911

 

[Lyss]

RidRyder... you make a hell of a lot of sense. Want to come be my boss? Mine is senseless.

 

[BossyCow]

Rid, well, my fears were justified. I just left a meeting where I found out that I will only have ALS available from 8am to 8pm. After that time, a medic will be toned out from his/her home, go to the station to pick up a rig, then proceed to my critical pt. By that time, I will be pulling into the hospital parking lot with an ALS pt in a BLS rig.

As to a name change, I could give a rat's patootie what lable they hang on my uniform. I just wish the discussion could take place without adjectives such as 'worthless', 'pointless' and 'ignorant' being applied to what I do. As long as the discussion takes place in that tone, nothing is going to be resolved and we will never work together to improve the whole of EMS. It shows a lack of professionalism on both sides when the issues can't be addressed without acrimony and insults.

I too wish that EMS could be seen as essential service and funded as such. I believe it has to happen federally, because too many local districts, agencies and businesses have other agendas. My husband's ALS agency just doubled their response area and added around 40-60 additional calls per month without any increase in staff, pay or equipment. The ripple effect of this move was to eliminate ALS support availablity to the unicorporated areas of the county because it took those 40-60 calls per month away from a local private ambulance company. The city saves money, and the only cost is to the health and safety of my critical pts. But how can I compare that to the resume of the local city mangler(manager) who will show his future employers how he cut the budget to the city he used to work at?

So, I'm working on my SAFER grant, working on a multiple scenario solution for my little rural fire district, preparing to face my board of commissioners who will in no way implement the movement of our agency into ALS and are forbidden by charter to authorize any charge for services.

And oh yeah.. meetings, meetings, meetings..... where suits attending will discuss the impact, the financial repercussions, the liability issues, the required language changes to protocols, SOPs and district responsiblities.. and none of them will ever have to face the family of a critical pt. at 2am and tell them that we're going to do the best we can. Knowing full well, that it will not be enough.

 

[JPINFV]

Rid, well, my fears were justified. I just left a meeting where I found out that I will only have ALS available from 8am to 8pm. After that time, a medic will be toned out from his/her home, go to the station to pick up a rig, then proceed to my critical pt. By that time, I will be pulling into the hospital parking lot with an ALS pt in a BLS rig.

I know it's a tad off topic, but if they're running an on-call type service, why not just have the on-call medic take a fly car home?

 

[Ridryder911]

Bossy's predicament is an unusual & not unusual one. Her location is unique so the chances of becoming more advanced will always be hard. There is no right answer. AS well, her predicament in shortage of funding, employees, is not unusual from any EMS.

As the costs of fuel increases, we will see shifts in operations to save money. This as well will ripple from those that live outside areas where employees no longer want to commute, and the operating costs to prohibit raises to offset costs. A viscous circle called recession.

I wish I had the answer for you Bossy, but if I did , I doubt I be here on a forum. As I would be a much wealthier man not saving lives but business such as EMS, hospitals, etc.. Unfortunately, those much smarter & wiser too are at a dilemma. Many EMS are having to consolidate with other EMS services making districts or chance being placed into a Fire Service that only really wants them to be able keep the FTE they have. Both can have drastic measures.

Until the public sees that we are an integral part of a healthcare system, nothing will change. Next to requiring education, marketing is one of the poorest areas we failed at. Unlike Fire Services projection of being hero's, we never have promoted ourselves enough and now it has bit us and we are paying for it.

R/r 911

 

[mycrofft]

The missing ingredient is personal excellence.

Example: we pull up on a scene where the driver of the car t-boned by a van is trapped by the firewall being curled up around his left foot by the lateral impact. (Yeah, that hard). I'm a former firefighter with rescue school, other firefighters on scene are extrication oriented, they're revving up the Jaws and the K-12 saw but don't see how they can be of use short of cutting the front off this early Sixties tank of a station wagon. My senior partner, an EMT-A with a tour in Nam with the Rangers, finishes splinting the driver's broken arm (while I moved his DOA wife out the other side), looks at the floorboard, opens his Buck knife, cuts the carpet and, voila, out comes the miraculously uninjured foot and, with it, our victim. He was excellent, we were not, despite our creds and experience; he was the better man.
Give me an experienced EMT-B who is good, versus a green and arrogant anything else, anyday.
(Ask me about the podiatrist at the accident scene sometime).

 

[JPINFV]

(Ask me about the podiatrist at the accident scene sometime).

Regardless, it doesn't matter. A podiatrist telling a medic what to do unless it involves feet would be like a paramedic telling a radiologist how to read a CT scan.

 

[GeekMedic]

Ok, just so I can understand the issue with EMT-Bs, Don`t they have to be under medical control with in their agency?, What about the registration process? Do the EMT-Bs have to do continuing education to keep thier certification?
If there are such disreputable companies out there, why aren't they getting blacklisted, or put out of business by the state regulatory body?
If you have state colleges, they should be pushing for increased training standards, registration standards, and a more relevant scope of practice.

I profess ignorance of the american system, please educate me.

 

[CFRBryan347768]

Their is no point what so ever to this thread any more, nothing more productive will come from this both sides have argued their point, and yet no happy median occured. And to the new members please read the previous pages before posting so you can atleast understand what the entire discussion was about, yes ALL 14 pages.

 

[Ridryder911]

Example: we pull up on a scene where the driver of the car t-boned by a van is trapped by the firewall being curled up around his left foot by the lateral impact. (Yeah, that hard). I'm a former firefighter with rescue school, other firefighters on scene are extrication oriented, they're revving up the Jaws and the K-12 saw but don't see how they can be of use short of cutting the front off this early Sixties tank of a station wagon. My senior partner, an EMT-A with a tour in Nam with the Rangers, finishes splinting the driver's broken arm (while I moved his DOA wife out the other side), looks at the floorboard, opens his Buck knife, cuts the carpet and, voila, out comes the miraculously uninjured foot and, with it, our victim. He was excellent, we were not, despite our creds and experience; he was the better man.
Give me an experienced EMT-B who is good, versus a green and arrogant anything else, anyday.
(Ask me about the podiatrist at the accident scene sometime).

That is not in regard to any level, that is using common sense or as known now as "Critical Thinking Skills" to be able to think and rationalize outside and prioritize things more than just what was taught.

CFRBryan is right, now people are posting just to post. Still nothing has been proven that as I described until EMT's has more education then they are still in comparison like a nurses aide. Until Paramedic education level increases nothing is going to change, Don't expect to get professional recognition and pay until you meet professional standards.

R/r 911

 

[Jeremy89]

With that being said, I move for forum closure. Do I hear a second?

 

[mycrofft]

Seconded.

---------------

 

[mycrofft]

Deep breath, not an argument, an anecdote.

Regardless, it doesn't matter. A podiatrist telling a medic what to do unless it involves feet would be like a paramedic telling a radiologist how to read a CT scan.

We were sent to a two car accident out in the sticks, fire dept was ther but no business, guy identifies himself as a doctor, says the girl in the red Mustang just bumped her head so he had her lie down in the back seat, then he drives off. She has a goose-egg on her forehead then says her posterior neck hurts. Instead of easing her out of the front seat , we had to weasle her out of the back seat of a 66
Mustang. We heard the next day she had a cervical sprain, and he was a podiatrist.
Had to cut the Tony Lama boots off the other driver. He was crying, and it wasn't his ankle causing it.

 

[Tincanfireman]

Interesting thread with many good, valid points. Now for my .02. For the record, I'm an EMT-I 85, working full time at a fire department and part time with a 911 county EMS provider, putting me in EMS purgatory in this state. I can start lines, but little else above a basic level. That said, I think -I's get a bit more respect for the simple reason that we have taken the initiative to increase our skill set, even if ever so slightly. -B is just that, a basic level to get you started, not the final destination for someone interested in EMS as a profession. I still think the hours spent in Intermediate class were well spent, because it gave me a new mindset regarding EMS. it opened my eyes to the possibilities of care beyond Basic, and it gave me a new curiousity about human physiology, anatomy, and the effects of injury and illness on the body. Will I ever advance to Medic? Probably not, as I love my job in the fire department and cannot juggle the two for the amount of classroom and clinical time that medic would require. I agree completely with Rid's often stated position that -B's need to understand that they must advance in their skills (and certifications) to grow in our chosen field, and also that Basic should be much more than a few dozen hours in a classroom. We need to recognize that without the building blocks of A&P, medical terminology, biology and chemistry, Basic EMT will forever be considered little more than a good first aid course. Even in the fire service, recruit class involves building construction, fire science and behavior, a smattering of physics, and other topics totally unrelated to applying 2/1 mixtures of hydrogen and oxygen to rapidly carbonizing cellulose. Anyone who is content to stand in the yard with a hoseline in their hands will have a career in the fire service that can be measures in weeks, if not days. Accept your Basic patch with the understanding that it comes with an inherent challenge to learn and grow, and not to stagnate at the lowest level possible. To my brethren and sisters in the fire service; I'm certainly not tossing darts at you, we have a different role as firefighters first, and medical professionals second. However, if you desire even a part time position in EMS, I would hope that you take the time to advance beyond the -B level. I did, and it has paid off in ways I never imagined.