change one thing...

[Veneficus]

If you could change one thing about your actual practice, what would it be?

 

[abckidsmom]

I would like to be able to recommend urgent care or the like and provide transportation (of some kind or another) there. It would still be less expensive for the Medicaid "ER cures all" crowd than transporting to the ER.

 

[phideux]

Take the hospital choice away from patient choice to the paramedics decision of closest appropriate facility. We have quite a few regulars who abuse the patient choice of hospital rule we have and use us as a Taxi on a regular basis, wasting fuel and taking units out of service when needed elsewhere.

 

[DesertMedic66]

Get away from the "if the patient wants to go to the hospital by ambulance then we take them".

If you hit your nose and it bleeds for 5 mins then stops, more then likely you do not need an ambulance.

If your 8 year old daughter throws up only one time at 1am, then more then likely she does not need an ambulance.

If you stubbed your toe at 2am, more then likely you don't need an ambulance.

 

[Aprz]

3-leads for EMTs.

 

[Handsome Robb]

3-leads for EMTs.

no.

 

[Aprz]

EMTs have that mentality of SKILLS, SKILLS, SKILLS, and ironically lack in both skills and education. I would love to see EMTs be able to check blood glucose level, pulse oximetry, 3-leads, IV, and be able to administer a limited amount of drugs. Obviously I would also like to see a lot more training along with that. We really drop the ball when it comes to being emergency medical technicians.

 

[Vetitas86]

Personally, I'd like to see more education and training requirements to begin with.

 

[abckidsmom]

EMTs have that mentality of SKILLS, SKILLS, SKILLS, and ironically lack in both skills and education. I would love to see EMTs be able to check blood glucose level, pulse oximetry, 3-leads, IV, and be able to administer a limited amount of drugs. Obviously I would also like to see a lot more training along with that. We really drop the ball when it comes to being emergency medical technicians.

You would like to see EMTs become medics?

I think that providers who desire to help patients more than they do as EMT-Bs should go to medic school.

 

[DrankTheKoolaid]

To be able to do away with protocol sets. Simply have the NREMT Paramedic meds in protocol and to be able to decide based on the individual patient what is best.

 

[Aprz]

You would like to see EMTs become medics?

I think that providers who desire to help patients more than they do as EMT-Bs should go to medic school.

Something like that. I don't think all the skills they teach to paramedics should be the minimum though. Didn't we have a discussion about how having a paramedic on every ambulance or dual paramedic isn't good because their skills begin to decline/studied showed it? And that's why some of us felt that systems outside of the States had right was improving the minimum so that they could take care of most emergencies while a certain few who had more training/skills would only go to calls that required that more training/skills so they wouldn't lose it?

It's ridiculous that our scope of practice (where I live) is to roll the patient on their side, slap on a non rebreather, and transport to the nearest facility (not most appropriate) lights and sirens or wait for ALS.

I would love to be a paramedic, but for where I live, that's unreasonable. We are extremely over saturated with paramedics, some even without EMT experience (not saying that experiences hurts, helps, or makes no difference), others working as EMTs for interfacility (even though they may have experience as paramedics in our out of the state), because we are that over saturated. My area is very pro experience too. It's expensive to go to a private school (around $9k) and difficult to get into a community college because it's cheaper (around $3k) and most believe it produces better paramedics.

 

[SoCal911]

Allow us some sort of authority to deny transport... We need repercussions for our frequent flyers that call 3 times a day or more and then treat us like we owe it to them. Especially the ones that later call our supervisors and complain about our moral - cuz I'm totally going to be excited that I'm about to spend more time doing paperwork then you're actually going to spend in the ER.

 

[Vetitas86]

Something like that. I don't think all the skills they teach to paramedics should be the minimum though. Didn't we have a discussion about how having a paramedic on every ambulance or dual paramedic isn't good because their skills begin to decline/studied showed it? And that's why some of us felt that systems outside of the States had right was improving the minimum so that they could take care of most emergencies while a certain few who had more training/skills would only go to calls that required that more training/skills so they wouldn't lose it?

It's ridiculous that our scope of practice (where I live) is to roll the patient on their side, slap on a non rebreather, and transport to the nearest facility (not most appropriate) lights and sirens or wait for ALS.

I would love to be a paramedic, but for where I live, that's unreasonable. We are extremely over saturated with paramedics, some even without EMT experience (not saying that experiences hurts, helps, or makes no difference), others working as EMTs for interfacility (even though they may have experience as paramedics in our out of the state), because we are that over saturated. My area is very pro experience too. It's expensive to go to a private school (around $9k) and difficult to get into a community college because it's cheaper (around $3k) and most believe it produces better paramedics.

This is why I think education should be at a higher level. I'd rather have a medic with declining skills than an B with declining skills, ya know?

Also a big reason the CE methods need to change.

 

[DrParasite]

cuz I'm totally going to be excited that I'm about to spend more time doing paperwork then you're actually going to spend in the ER.

oddly, enough, I transported a patient with a broken nose to the ER when I was in upstate NY. They were discharged by the ER doc before I finished my run sheet.

If I could change one thing, it would be the staffing levels for EMS agencies nationwide. I would put on enough EMS units where we didn't need the FD to act as a first responder during routine times. Every EMS system would have enough units to never stack calls, and rely on mutual aid only in the rarest of times when all hell is breaking loose.

that way, we could get the FD out of EMS, run our own system, with it's own career path. We would also need to be funded by taxes like the other public safety systems, to allow us to have the proper staffing levels (which would solve other issues).

But that's just my dream of how EMS will become before I retire

 

[Aprz]

This is why I think education should be at a higher level. I'd rather have a medic with declining skills than an B with declining skills, ya know?

Also a big reason the CE methods need to change.

I think you need to clarify on this.

 

[Vetitas86]

As far as CE?

I think CE should focus more on advancing skills and knowledge rather than mostly working as a refresher. That's pretty much what it comes down to. As a student, I'm not terribly sure exactly how CE works, so take my opinion with a grain of salt. I've just heard refreshers, especially last minute ones, are all some EMTs and medics do.

I think it should be a continuous process, not so much an oh sh*t one.

As far as having medics skills decline on ambulance work when they're not constantly being challenged (there have been studies, but again. Grain of salt), I'd still rather have someone there who does have the advanced training.

Say a medic and an EMT vs a 2 EMT rig. You'd still have someone who's had that advanced training, even if the skills did decline.

Also my reasoning beinind higher education requirements and continuous CE. Keep the flow of learning going, and you should, in theory, have higher standards to work with.

This is also good from a pay standpoint (theoretically). Make it more difficult and more involved, and it should equal at least somewhat better pay. Make it incentive and education based and it should be a win-win.

 

[Tigger]

As far as CE?

I think CE should focus more on advancing skills and knowledge rather than mostly working as a refresher. That's pretty much what it comes down to. As a student, I'm not terribly sure exactly how CE works, so take my opinion with a grain of salt. I've just heard refreshers, especially last minute ones, are all some EMTs and medics do.

I think it should be a continuous process, not so much an oh sh*t one.

As far as having medics skills decline on ambulance work when they're not constantly being challenged (there have been studies, but again. Grain of salt), I'd still rather have someone there who does have the advanced training.

Say a medic and an EMT vs a 2 EMT rig. You'd still have someone who's had that advanced training, even if the skills did decline.

Also my reasoning beinind higher education requirements and continuous CE. Keep the flow of learning going, and you should, in theory, have higher standards to work with.

This is also good from a pay standpoint (theoretically). Make it more difficult and more involved, and it should equal at least somewhat better pay. Make it incentive and education based and it should be a win-win.

Most places and the National Registry require both a refresher and elective. continuing education hours. They serve two different purposes, hence you must do both.

 

[MS Medic]

that way, we could get the FD out of EMS, run our own system, with it's own career path. We would also need to be funded by taxes like the other public safety systems, to allow us to have the proper staffing levels (which would solve other issues).

But that's just my dream of how EMS will become before I retire

The unfortunate reality is that most other non fire public services have budget and staffing issues as well because they don't have the EMS piggy bank to steal from. I do agree that fire ought to get out of EMS because we get the crumbs of Care/Caid/Insurance and here they come stealing part of outs to pay for equipment that usually does not see the light of day other than training exercises

 

[Vetitas86]

Fire should get out of EMS. It's two different career fields. Granted, they should work together in some cases. But broadly speaking, no.

EMS while technically public safety, is a medical specialty, as is nursing.

 

[Tigger]

If I could change one thing about my practice, I would be a medic. It sucks not being able to mange someone's illness or injury to their and my expectations.