mycrofft
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Hear hear
-ADVANCING PARAMEDIC's SCOPE OF PRACTICE-
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Zodiac
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Nurses didn't get where they are today by resisting any and all attempts to raise education standards. I agree that education needs to come before expanding the SOP. I've come across paramedics who could barely even write coherent sentences, let alone explain the most basic of pathophysiology (one of my preceptors during clinicals was about as helpful as an chocolate teapot when it came to answering simple questions) so I can't see giving them more toys to play with with they don't fully understand the ones they have.
Did you happen to drive a yellow Merc too?
You know Northland will probably be the first to get Ceftriaxone outside of WFA, Brown never did really support prehospital antibiotics but the Kapiti Coast/Wainouiamata is quite isolated when you think about it so it makes sense they got it.
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mycrofft
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Nurses got to where they are for a number of reasons.
1. Being predomionantly female, and victims of rampant sexism for generations, the civil rights movement helped. Also, the dawning of labor organization in medical settings.
2. Nurses with education and permission are cheaper than MD's in attendance of hospital pt's.
3. As nurses started getting degrees, they started getting into positions of influence. Since "nursing schools" had always been separate (used to be quasi-nunneries as late as the 1970's and early 1980's), they developed their own hierarchy, our most persuasive, intelligent and ambitious members started looking up from climbing upon each other's shoulders for advantage and started making requirements for nursing education the law (as did hospitals tired of getting nurses who were only good at wearing the little cap, doing laundry, and standing up when the MD walked in).
Where does a paramedic with a Master's degree (in what?) fit into American EMS? Maybe an author or as an administrator, but no executive positions exist affecting care and profesisonal standards, at least not where they actually can do something.
1. Being predomionantly female, and victims of rampant sexism for generations, the civil rights movement helped. Also, the dawning of labor organization in medical settings.
2. Nurses with education and permission are cheaper than MD's in attendance of hospital pt's.
3. As nurses started getting degrees, they started getting into positions of influence. Since "nursing schools" had always been separate (used to be quasi-nunneries as late as the 1970's and early 1980's), they developed their own hierarchy, our most persuasive, intelligent and ambitious members started looking up from climbing upon each other's shoulders for advantage and started making requirements for nursing education the law (as did hospitals tired of getting nurses who were only good at wearing the little cap, doing laundry, and standing up when the MD walked in).
Where does a paramedic with a Master's degree (in what?) fit into American EMS? Maybe an author or as an administrator, but no executive positions exist affecting care and profesisonal standards, at least not where they actually can do something.
I think it just needs time. It's always easy to see the negative, and see why things won't work. I think over a long enough period enough motivated people eventually end up dragging the entire system forwards, even if they have to fight against the stasis holding it back.
Maybe.
But I think that much of the issue here is QI and equipment related. If provider's don't have capnography, secondary devices, bougies, etc. there's going to be a higher rate of misadventure.
If we can't measure PETCO2, we're probably going to hyperventilate a lot of patients.
If we don't identify paramedics who choose to intubate in inappropriate situations, or have repeated failures, then we're doomed.
Perhaps the answer is to decrease the amount of people intubating. But I think it may also be to provide better training, equipment, oversight and QI.
Maybe. Most real problems are fixed with electricity. But there's plenty of services doing treat-and-release with adenosine for repeat SVT patients. This seems beneficial.
Don't see why you'd take it away. I haven't seen studies showing that paramedics are administering thrombolysis inappropriately. I've worked in a system doing thrombolysis / ER bypass to PCI, I felt it worked great, the cardiologists loved it, the ER docs thought it was a great idea.
I'd suggest if anything we should be setting up regional infrastructure so that paramedics in rural regions can get on-line consultation with cardiology, fax ecgs and either begin with thrombolysis or expedite transfer to a PCI-capable facility via rotary wing with adjunctive therapy.
Maybe. It's potentially life-saving, but rarely used, with a lot of associated risks.
If we're talking chest tubes, yes, they're probably not necessary. If we talking needle thoracotomy, then I'd disagree. This is lifesaving, if rarely used.
usafmedic45
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I think we need to focus more on educating people to correctly perform the skills they currently have in the appropriate circumstances before we start trying to advocate for expanded scopes as a general practice.
BTW, field thoracotomy? Seriously? It's never a problem opening the chest, it's the matter of dealing with what you might find once you get in there that's a problem (note: the inside of a chest is not as neat, tidy and easy to get around in as anatomy textbooks and dissection would make one believe). Not to mention issues with skill retention from infrequent use of that particular "option".
usafmedic45
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USAFMedic45's Rule #1 of Protocol Development: "If they can't spell the procedure, they probably should not be allowed to perform it."
USAFMedic45's Rule #1 of Treatment Decision Making: "Don't just do something, stand there!"
I probably should go back and put all of the rules I have thought up into one list and post it.
mycrofft
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And he did
http://www.emtlife.com/showthread.php?t=23783
Look at it this way. "You" (the generic "you", not anyone in particular, put down your typing fingers and lower your disatolics, mates
) might or might not be the next Johnny, Roy, or Trapper John, but following the bell curve overall for the wave of people you may send amongst an unsuspecting population dictates that about 3/4 will be anytthing from slightly better than mediocre to downright lethal in their talent with any given procedure. Then, add (or subtract) the retention and experience factors. Might as well hand out pistols to people entering a mall because someday there might be a holdup.
(I DID NOT introduce "right to carry", don't go there...).
http://www.emtlife.com/showthread.php?t=23783
Look at it this way. "You" (the generic "you", not anyone in particular, put down your typing fingers and lower your disatolics, mates
) might or might not be the next Johnny, Roy, or Trapper John, but following the bell curve overall for the wave of people you may send amongst an unsuspecting population dictates that about 3/4 will be anytthing from slightly better than mediocre to downright lethal in their talent with any given procedure. Then, add (or subtract) the retention and experience factors. Might as well hand out pistols to people entering a mall because someday there might be a holdup.(I DID NOT introduce "right to carry", don't go there...).
usafmedic45
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Always protocols for the person at a service you trust least, not the best and brightest.
Dangit I was tired and wasn't paying attention when I typed that! (Facepalm for my own fail)
But, the above is very true.
mycrofft
Still crazy but elsewhere
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ANother Murphy's Law of EMS
While the lowest denominator EMT in your service will make lots of mistakes, it takes a really brilliant one to make that one timeless, epic leap into the abyss.
While the lowest denominator EMT in your service will make lots of mistakes, it takes a really brilliant one to make that one timeless, epic leap into the abyss.
Blessed187
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Blessed187
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medicRob
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Once upon a time one of the tasks for nurses was to bring a coal from home to add to the fire and keep the fire up. Nurses had NO INPUT whatsoever. You simply did not question a doc. You were not considered a true part of the team with regard to having input. We only recently phased out diploma RN programs (for all I know, there could still be a few). ADN was created to help with a projected shortage in nursing, and remained popular, although the powers that be would prefer that the minimum educational level for RN be BSN. The very first thing you learn in your intro to professional nursing class (keep in mind the term "Professional Nurse" refers to BSN, an ADN is considered a technical nurse) about the models of nursing, and the roles that we play in healthcare delivery. Only recently have we truly began embracing evidence-based roles in nursing and taking the reigns of autonomy (Through graduate nursing research in education and practice).
EMS is just a baby when compared to the other nursing professions. Professional developments and reaching the hallmarks of a profession take time, and more importantly effort. We still have our problems and arguments in nursing, don't think that we are perfect by any means.
For instance you have the BSNers who say that ADN programs should end. You have a certain group who say that a doctorate of nursing should be the minimum for nurse practitioner. Some that say DNP is total BS, while others say DSN is redundant when compared alongside PhD Nursing.
We argue just as much as EMS does.
mycrofft
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Don't hear this sort of stuff among docs. MD that is.
Other than maybe Osteopath versus MD.
Nurses need to hold the reins to the money and certification, and be able to withold their services on the grounds of professional and patient safety, workplace conditions, or pay/benefits. We are so used to throwing one another under the bus and bickering over every little thing (even to the point of changing countries to do so) that I do not see nursing as a profession ever gaining the sort of clout MD's have. As for paramedics, not even close.
Other than maybe Osteopath versus MD.
Nurses need to hold the reins to the money and certification, and be able to withold their services on the grounds of professional and patient safety, workplace conditions, or pay/benefits. We are so used to throwing one another under the bus and bickering over every little thing (even to the point of changing countries to do so) that I do not see nursing as a profession ever gaining the sort of clout MD's have. As for paramedics, not even close.
medicRob
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Right. I think to non-nurse EMS providers, they have this idea that we, as a profession (Nursing) is perfect and have absolutely no problems whatsoever. Perhaps this is where some of the hostility comes from.