Finally ! Someone who cares about BLS and EMT's

[medichopeful]

[I know... I used this line earlier, but no one likes answering this]

Would you accept going to the emergency room and having an ER tech examine, treat, and discharge you regardless of what your complaint was?

Hell no!

We go to the E.D. to get highly advanced, highly educated care as soon as possible, which an ER Tech cannot give.

But EMS should be different, because for many patients their emergencies can wait for more advanced care. h34r:

 

[VentMedic]

It is interesting that in Soviet/Russian medical literature it is widely recognized that pain is a major contributing factor of shock and one of the most important things in preventing and treating shock after trauma is pain management. In American literature I couldn't find much info about this. Can anybody explain what are the effects of pain on development of shock in case of major trauma?

Many, many, many articles and I didn't even have to use my medical search engines. JCAHO now also has several measurements in place to see how a hospital is dealing with the pain of a patient.

Just type in Pain Trauma Mortality or Morbidity.

http://www.google.com/search?hl=en&source=hp&q=trauma+pain+management+morbidity&aq=f&oq=&aqi=

 

[Sasha]

Hell no!

We go to the E.D. to get highly advanced, highly educated care as soon as possible, which an ER Tech cannot give.

But EMS should be different, because for many patients their emergencies can wait for more advanced care. h34r:

Why should they have to wait? Would you want to wait 30 minutes for pain management?

 

[Aidey]

Well, we often receive treatment from a practitioner other than a pahysician so I'd have to say the situation can dictate the course.

That is after you have been triaged though, and your complaint has been assessed. Hospitals (and some clinics) have triage protocol that dictates who sees who and how fast and you can easily be transferred to to a MD (in a lot EDs) if they determine you need more advanced care.

Granted in some smaller and more rural places the highest level of care at the medical facility may be a PA, or NP, especially at off times. They always have ways to transfer you to high care if they determine you need it though.

Assuming all pts are ok with BLS is coming at it backwards in my opinion. The pt usually hasn't been assessed by anyone with any medical knowledge. Dispatch kind of acts as a triage, but it doesn't replace it since we all know how accurate dispatches can be.

Hell no!

We go to the E.D. to get highly advanced, highly educated care as soon as possible, which an ER Tech cannot give.

But EMS should be different, because for many patients their emergencies can wait for more advanced care. h34r:

How do you know until the pt has actually been assessed? Yes, there are patients that would be ok without ALS care, but that should only be determined after the pt has been assessed. At least in a hospital the pt sees a triage nurse who determines if they can wait or not.

 

[medichopeful]

Why should they have to wait? Would you want to wait 30 minutes for pain management?

I don't think it came across this way, but I was trying to be sarcastic. If you go back and read my earlier post(s) in this thread, you'll see that we agree on this subject and that we're on the same page

 

[medichopeful]

How do you know until the pt has actually been assessed? Yes, there are patients that would be ok without ALS care, but that should only be determined after the pt has been assessed. At least in a hospital the pt sees a triage nurse who determines if they can wait or not.

Like I said to Sasha, you and me are on the same page. I was trying to be sarcastic, but it didn't translate well.

 

[Sasha]

I don't think it came across this way, but I was trying to be sarcastic. If you go back and read my earlier post(s) in this thread, you'll see that we agree on this subject and that we're on the same page

Sorry I'm sick and loopy from cold meds :[

 

[medichopeful]

Sorry I'm sick and loopy from cold meds :[

Not your fault. I wasn't very clear.

I hope you feel better soon :sad:

 

[eynonqrs]

I have some more to add here.

1) There are EMT's that are good out there. The problem is that there is less and less of them becuase of poor teaching. I had to prove my skills and do extensive ride along time as a volunteer and on a paid service before I was let go on my own in the back of the rig. They just don't do that anymore.

2) We do still need quailty EMT's. Rural areas or areas that can not afford paramedic services that rely on paid BLS or volunteers need good EMT's to provide care. There is one county above mine that the only ALS service that covers the entire county is hospital based chase unit with 2 medics. All BLS services are volunteer and serve rural areas where transport times can be in excess of 30 min to a hospital or 30+ min before ALS can get there.

3) It would be nice if all towns could afford paid services, but in the state of the economy towns and counties are cutting public services so that leaves it up to volunteers and private services to provide care for the public.

4) It is a slap in the face to say that EMT's are not fit for IFT's. IFT's are good way to do pt assessments.

5) There is also a way to help in pain managment on a BLS level, it is called making the pt comfortable. I can't tell you how many times I have used an air splint for ankle and wrist fx's. You are stabalizing the fx and you making a shock absorber. Also there is called taking and calming down the pt.

6) I have been blessed to work with paramedics that were in the field for 20+ years. I had learned alot from them, because they took the time to help us out. If paramedics would stop thinking EMT's are so stuipd and nuture them you can help everyone out in the end.

 

[So. IL Medic]

All nursing students (in many states) can become CNAs. I have not seen any change in the legislation in the states where that is mandatory to become an RN.

In this part of the state, all the nursing programs now require completion of and work experience as a CNA. It's not a government thing but a school specific policy...probably why it was sucessfully implemented.

Is that why they are called "assistants"? Aren't CNAs "assistants" also? Is that like a BLS RN?

Let's see...when I drop off a pt for a direct admit, CNAs take the vitals, transfer the O2, etc. while the RN heads straight for my pump and the med drip....sounds like a Basic to me!

 

[JPINFV]

4) It is a slap in the face to say that EMT's are not fit for IFT's. IFT's are good way to do pt assessments.

Good for the EMT-B isn't necessarily good for the patient. Saying that EMT-Bs aren't fit for IFTs isn't any more of a slap in the face as saying a painter isn't fit to make sculptures. The simple fact is that there isn't much in the way of training or education on the chronic conditions that make up the bread and butter work of IFT transports while a lot of the interventions taught to EMT-Bs are essentially useless. Imagine how much less complaining about dialysis transports if, for example, the childbirth module was moved from teaching about labor and assisting with birth (you aren't going to be helping a 70 y/o female deliver a baby) and instead focused on renal anatomy, physiology, and pathophysiology? Take extrication training (KED, etc) and move it to issues and pitfalls of transporting patients following hip replacement?

It isn't that EMT-Bs are too stupid for IFTs. It's that the emphasis in EMT-B course doesn't match up with the demands of IFT work.

5) There is also a way to help in pain managment on a BLS level, it is called making the pt comfortable. I can't tell you how many times I have used an air splint for ankle and wrist fx's. You are stabalizing the fx and you making a shock absorber. Also there is called taking and calming down the pt.

...and what about the numerous patients who aren't going to see a large enough (like down to 1 or 2 out of 10) reduction in pain based on splinting and ice?

 

[Aidey]

I have some more to add here.

4) It is a slap in the face to say that EMT's are not fit for IFT's. IFT's are good way to do pt assessments.

5) There is also a way to help in pain management on a BLS level, it is called making the pt comfortable. I can't tell you how many times I have used an air splint for ankle and wrist fx's. You are stabilizing the fx and you making a shock absorber. Also there is called taking and calming down the pt.

6) I have been blessed to work with paramedics that were in the field for 20+ years. I had learned a lot from them, because they took the time to help us out. If paramedics would stop thinking EMT's are so stupid and nurture them you can help everyone out in the end.

4. EMTs are not fit for all IFTs. Just because it is an IFT most certainly does not mean that it's perfectly fine for an EMT to take that patient. Yes, my EMT partner does take most of the IFTs, but that is only after we have both received report and we are both comfortable with him taking the patient. We've shown up at IFTs before that were dispatched as BLS transfers and the patients condition when we arrive is nothing close to what was dispatched.

I've run into transferring facilities that don't understand the difference between BLS and ALS, and it isn't listed the CMS PCS, so they don't realize the pt with the IV actually needs ALS and not BLS (per my state). Sometimes the person calling for the transfer is not the person with the pt, and they only have limited info and don't know how bad the patient is. The patients condition can also change between the call and when we get there.

Sometimes I even end up taking BLS patients, not because I don't want my partner taking the patient, but because it is what is best for the patient. For example if the RN tells us the patient does better with females, or in one case I spoke the patients primary language and my partner didn't

5. Those are all things Paramedic's can, and should be doing too. Do you really feel like that is the most care a patient in pain needs during transport?

6. I would hazard a guess that the majority of us do not think all EMTs are stupid. Undereducated, yes and so are Paramedics. But undereducated doesn't equal stupid.

 

[MrBrown]

You guys are driving me totally bonkers!!!!!!!!!

A PATIENT IS NOT A "BLS" PATIENT OR AN "ALS" PATIENT, THEY ARE ALL PATIENTS

.... and as such deserve an acceptable standard of care, skill and knowledge. A tech-cert-gone-horribly-wrong couple hundred hour cookbook wonder with a Plano box full of drugs is not an acceptable level of care, knowledge and skill, for that matter neither is an oxygen tank and a toaster from a 120 hour course!.

Would you argue an ED nurse does not need the same level of education as they currenty have (2 or 4 year degree) as they are unable to do "skills" that a Paramedic can, they just have to ask the doctor so all we need to teach them is how to physically perform the skill and a quick introduction on why?

Until you stop categorising your patients as "advanced" or "basic" then you will still find need for a 120 hour toaster wonder.

We still have a "tiered" level of response here; differnece is our system is very progressive and has good scopes of practice; at our "basic" level we have 8 medications (including 3 analgesics).

Let's say I'm at my friends place and I get hit by a car; I can choose either a basic EMT with two semesters of college A&P and one each of pharmacology, patho, English, research and ethics or a Tech school wonder Paramedic with his Plano full of drugs.

I will choose the Paramedic any day of the week and twice today because he has really good drugs like fentanyl and morphine to control my pain!

I am not trying to turn this into a skills pissing match because we could quickly increase the EMT scope of practice and no real education would be required.

 

[VentMedic]

In this part of the state, all the nursing programs now require completion of and work experience as a CNA. It's not a government thing but a school specific policy...probably why it was sucessfully implemented.

Can you PM me the schools? Our nursing educators would love to know what is happening in other colleges.

Some schools do like the nursing student to take the CNA test after their first semester but they are already accepted into the program and actually working as one is not required.

Let's see...when I drop off a pt for a direct admit, CNAs take the vitals, transfer the O2, etc. while the RN heads straight for my pump and the med drip....sounds like a Basic to me!

All medical professionals with licenses get the "basics". That should NOT be confused with BLS and ALS. The "basics" will be applied by all professionals on critically ill patients. An "assistant" assists a professional with their level of training regardless of how ill or not the patient is. If the CNA is there to "assist" the RN, that RN will not say this is a "BLS" or "ALS" patient so there is no "Basic". It is medicine and providing patient care without trying to label a patient according to provider.

 

[rescue99]

Medics manning triage has been a common practice for the last 12 or so years nearly everywhere here. All triage is ALS no matter which license is sitting there! If we'd bill for the level of care needed, not for the highest level on scene, I'd be a much happier tax payer ^_^

Can't wait until the day Medics replace most RN's in the ER. It's been talked about for many years and of course, techs have already replaced a protion of them. Won't that stir up some burned beans from the bottom of the pot?

 

[VentMedic]

If we'd bill for the level of care needed, not for the highest level on scene, I'd be a much happier tax payer ^_^

So your community should not be entitled to ALS EMS?

Also, for individual billing, have you not heard about how ambulance services are charged? BLS, ALS1, ALS2, SCT?

Understand how EMS, billing, reimbursement and your tax laws work. Don't take away ALS EMS from your community because you just want EMTs or feel you pay too much in taxes. Also look at your itemized tax bill and see all the charges there. You might be enlightened.

Can't wait until the day Medics replace most RN's in the ER. It's been talked about for many years and of course, techs have already replaced a protion of them. Won't that stir up some burned beans from the bottom of the pot?

We've also talked about increasing the education of the paramedic for many years and that hasn't happened either.

In your hospital you mean they have increased patient to RN ratios to make budget? They have not "replaced" the RNs with techs in saying the techs are now equal to RNs. You really should understand the difference before flapping your fingers on a keyboard. Nor are Paramedics now RNs and given an RN license. I seriously doubt if their scope has expanded very much to even begin to do what an RN can do. However, the Paramedic might be okay in some limited roles in a little ED or a larger one that has a section for the simpler cases. But again, that is NOT to be confused with the ALS vs BLS crap that EMS uses.

At least one thing California and NJ have done right is enforcing a decent nurse/patient ratio.

The LVN who has much more education and APPROPRIATE training than the 700 hour medic mill Paramedic was told to advance or get out. It would seriously be a shame for any hospital to reduce their standard of patient care to just "techs". As well, when the Paramedic is working in the ED, it puts more stress on the RN who now has to supervise them and be held accountable for any screwups. When the Paramedic believes their 700 hours of training exceeds that of an ED RN who not only has at least 2 years of "basic" RN education but also specialty training for the ED, mistakes will be made. There is also nothing in the Paramedic curriculum that prepares them for the type of assessments that need to be done for long term (longer than 15 minutes) of care.

What a sad, sad day if medicine resorts back to those with less than 1 year of education/training for the patients. That really is a very horrible statement about health care in the U.S. When this happens we might as well eliminate the Paramedic and just have all 110 hour EMTs on the ambulances. Too bad patients in the U.S. don't deserve anything more when it comes to health care.

 

[Sasha]

4) It is a slap in the face to say that EMT's are not fit for IFT's. IFT's are good way to do pt assessments.

As an EMT I worked IFT for a year, and have been doing it as a medic for a couple months. I can comfortably say that the only thing an EMT should do at the IFT level is nursing home discharges, and even then I think a CNA or MA or LPN would be more suited for the job.

5) There is also a way to help in pain managment on a BLS level, it is called making the pt comfortable. I can't tell you how many times I have used an air splint for ankle and wrist fx's. You are stabalizing the fx and you making a shock absorber. Also there is called taking and calming down the pt.

Yes. I'm a big fan of trying ice packs for pain before jumping into pain meds. However, the difference is when that doesn't work I have the ability to give them pain meds, a BLS ambulance does not. I don't care how good you are at talking, talking does not make the pain go away. And once again, the patient should not suffer because of an EMT's inflated sense of self importance.

If paramedics would stop thinking EMT's are so stuipd and nuture them you can help everyone out in the end.

I agree not every EMT is stupid, but that doesn't mean that they are equipped to deal with emergencies. At the end of the day the EMT with a bachelor's degree in biology or that EMT in med school is still just an EMT and is limited by the their very small scope for what they can do for a patient.

 

[zmedic]

The basic truth is that IFT pays the bills and is how most private companies stay afloat. So financially it makes a lot more sense to have EMTs running transfters between 911 calls.

Also I can't believe that people think most IFTs need a medic. When I was on the truck most of the IFTs we were doing were "80 yo man who is normally in a wheel chair needs to get to his doctor's appointment and back." Most of these patients medically stable, but for some reason they don't have the mobility to physically walk out and get in a cab.

Sure there are the sicker people who are on lines, pressors etc. But most an EMT can handle. And if the stable patient who is going to the doctor suddenly codes, I'd much rather have an EMT in the back than an LPN whose code experience is "go call the doctor."

 

[Scottpre]

I think fractures should be ALS. It's not about the ER not wanting to start IVs. It's about the fact that giving pain meds in the field for fractures is really one of the few cases where EMS can make people feel a lot better on the way to the hospital.

I worked a scene Dec 5 at the UW vs California game at Husky Stadium (Seattle, WA) where a guy had clearly dislocated his shoulder, but maybe had fractured his collar bone, too. I decide he needs better evaluation in the privacy/comfort of a first-aid room, so we wheel-chair him up to one. I also ask paramedics to evaluate him.

One paramedic checks his right side CMS, confirms it's present (which our BLS team had already done) and then looks at me like "Why does this guy need us?". I had tried to explain my reasoning:

1- PT needed more thorough exam.
2- Given level of pain and guarding, likley more than just a simple dislocation of the R shoulder.
3- Transport would likely be needed.

Fortunately, the paramedic's partner thought a little more examintation was in order and sure enough, the PT looks like he may have fratured his R clavicle as well. No pain meds were offered. PT gets transported BLS (AMR) to the ED (ANY transport call, BLS or ALS, must goe through paramedics at Husky stadium, EMT B-'s can't order transport directly).

Sometimes I feel like ALS doesn't want to bothered with the "routine stuff" untill it's late in the call, when the PT could have been given pain meds much earlier.

 

[Sasha]

And if the stable patient who is going to the doctor suddenly codes, I'd much rather have an EMT in the back than an LPN whose code experience is "go call the doctor."

i'd much rather have a paramedic.

However, if I were bedconfined and being moved from bed to stretcher I'd much rather have a CNA or MA, who'se education greatly revolves around moving and positioning patients than an EMT who'se ticked off he's not on an emergency call.