Shishkabob
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Prehospital command hierarchy, fitting it in with the regular medical community
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ZootownMedic
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Where have you been Linuss! I have been holding off the whole world of Paramedic naysers. Could use a little backup from someone with far more expertise and experience than me...............not that its a war but the arguments have been pretty direct and there are some people on this forum with VERY low opinions of Paramedicine
JPINFV
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Opinion on the current state or opinion on where EMS should be?
ZootownMedic
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Hey brotha, as I told you before I agree with alot of what you said. There are alot of bad EMS providers out there, our educational standards in much of the country could do with vast improvement, and our young profession could use a transfusion of some new higher standards. With that being the case there are still far more good Paramedics out there than bad ones and to say that a few bad apples in our profession ruin it for all of us but that in other professions that isn't the case is hypocritical. You aren't in EMS anymore JP...I get it. Your on your way to be a Doc, thats great, seriously. But if I was bleedign on the street I'd want a Paramedic to roll up and not a nurse, or a doctor, or a RT. Pretty much sums up my whole point all along. In a pre-hospital setting, when emergency medicine is the need, Paramedics get it done because thats what they do. Alot of people hate because our education isn't as much as others but we still get a great amount of freedom and responsiblity. Its understandable....just say it like it is
ZootownMedic
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And if I could tell you the story of what my grandma went through several weeks ago in her last 3 weeks of life in the hospital it would make your heart sink. Horror stories from a AZ hospital where my 78 year old grandpa watched nurses and doctors and everyone in between treat the woman he loved for 60 years like complete crap as she wasted away. Does that mean I think all doctors and nurses are crappy? Of course not. But those ones were and that's all it means......
But at least every RN on this planet has had a traditional anatomy class, that cant be said for the majority of EMS providers.
ZootownMedic
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That is slowly changing.....Again, EMS is a young profession. They are working on nationally recognizing certifications and when that happens things will start getting where they need to be. Its hard when every state controls education standards because there is nothing across the board. Paramedics here in Colorado Springs are great, our Medical Directors and ER Docs have great confidence in us. Medics here can RSI & ET Intubate, Surgical and Needle Cric, push around 60 drugs etc all on standing orders. I know in some parts of the country you have to call for a Dope Drip. Thats the problem, some places have this and some have that. In due time it will get better. Sucks for the good ones in the meantime.......
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JPINFV
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Oh, I won't say that individuals in other health care providers don't provide bad care, and I don't have issue with the fact that EMS is no different (I'm one of many that thinks that the punishment for the recent incident in Tennessee was excessive). My issues is more of what I see as the systemic issues holding EMS back, not necessarily the action of any one individual.
ZootownMedic
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Again, I agree with you. There is a definite need for change and I think that nationally recognizing and standardizing minimun standards across the board can start getting us on the right track. In the meantime I just plan to learn as much as I can and be the best that I can be. I never plan to stop learning. I take the fact that people call us on their worst day very seriously and treat every patient as if they were a family member. Hopefully things will start to turn around in all aspects of healthcare.
JPINFV
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My current career plans includes EM, subspecialized in EMS. In the words of MacArthur, I will return.
Depends on the physician, but in general, I agree that the vast majority of physicians, including many emergency medical physicians aren't suited for prehospital care (lack of specific training, lack of specific experience).
The problem with the freedom is that that freedom isn't everywhere, and the question for many of us, especially if we don't live near the high powered systems, is how much do you want to bet on getting hired at one of the high powered systems. Places like Wake County are unfortunately the exception, not the rule.
ZootownMedic
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On a side note they just changed(our will soon) the EMS provider levels. The new levels are Emergency Medical Responder(formerly First Responder), EMT(Formerly EMT-B), Advanced EMT(former EMT-I) and Paramedic(Formerly EMT-Paramedic. While the name changes don't neccessarily mean crap the certification levels have changed. The getting rid of the EMT in front of Paramedic shows that Paramedicine is much more about being clinicians rather than Technicians. Also, the new Advanced EMT level is supposedly much less advanced than the former EMT-I level. From what I understand usually Advanced EMT just means that they can start IV's and have more advanced cardiac skills. In the end, this is a small change but its moving in the right direction.
Have the minimum didactic and clinical hours increased?
Otherwise the name change doesn't mean much, other than to trick people into thinking its a significant change.
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ZootownMedic
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On another note, kinda of sad and by no means indicative of ER physicians I have a story that happened several weeks ago. A guy I knew who was one of my best friends' friends was riding shotgun in a pick-up being driven by his drunk friend that did a 100mph french kiss with a streetlight pole.
Dude I know hit the windshield breaking his neck instantly, and in turn jerking his torso so violently that he severed both his liver and spleen. My buddy from Paramedic school was first on scene(as the EMT on a ALS/BLS bus). He said as they were spinaling the guy a great ER doc that was driving by pulled up. The doc took patient care and they transported. Instead of letting the Paramedic who was familiar with pre-hospital care intubate the doc tried....and failed. Wanna know what she said? "WHY THE HELL DOESN'T THIS COT OR MY CHAIR(she was sitting in the airway/jump seat) GO DOWN?!"....to make matters worse the poor guy had a tension nuemo the size of a beach ball but when the Paramedic suggested a decompression she said it was unneccesary because the vitals were stable...(78/30 BP)...????
In the end this is just a point that you can be the GREATEST ER Doc in the world(I heard this ER Doc was a great ER Doc) but if your out of your element it doesn't mean much. They called the guy 20 minutes after arrival at the hospital. Probably would have died no matter what but you never know if he'd have gotten more timely and appropriate care.
ZootownMedic
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Not sure to be honest.....
JPINFV
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To be fair, there's a difference between the docs who regularly engage in prehospital emergency care, and those who don't.
ZootownMedic
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Haha. Yeah since they know where everything on the ambulance is......but hey its your life
Exactly. To blanket make the statement that a paramedic is always better than a physician in the field is extremely shortsighted is the point I was making.
usafmedic45
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