The practicality of EMT Basics as an emergecy responder

[NomadicMedic]

We are routinely requested by BLS for pain management. If they call, we'll go. However, I find it frustrating when they call us for pain management after they've moved granny from the floor, down two flights of stairs to the Ambulance and have gone en route to the hospital.

But, I'd rather they keep calling and act as patient advocates (as much as they can). I just educate them about early pain management and start the line.

 

[RocketMedic]

Ewwwwww.

???

 

[Bullets]

So after further investigation, ALS only carries morphine for chest pain protocol and has no standing orders for pain management. They would have to call medical control and get special permission. Basically I was told that pain isn't a life threat and thus not an ALS job.

Nice

 

[JPINFV]

So after further investigation, ALS only carries morphine for chest pain protocol and has no standing orders for pain management. They would have to call medical control and get special permission. Basically I was told that pain isn't a life threat and thus not an ALS job.

Nice

I hope whoever said that gets to sit in the emergency department with 10/10 pain because "pain is a med/surg issue, not an ED issue."

 

[RocketMedic]

I hope whoever said that gets to sit in the emergency department with 10/10 pain because "pain is a med/surg issue, not an ED issue."

Jersey. Poor, misserved Jersey.

 

[VFlutter]

Pain is just weakness leaving the body....so if we treat the pain aren't we keeping the weakness in? Or something like that

 

[EpiEMS]

So after further investigation, ALS only carries morphine for chest pain protocol and has no standing orders for pain management. They would have to call medical control and get special permission. Basically I was told that pain isn't a life threat and thus not an ALS job.

Nice

That's insane. What a silly way to design a system.

 

[jemt]

So after further investigation, ALS only carries morphine for chest pain protocol and has no standing orders for pain management. They would have to call medical control and get special permission. Basically I was told that pain isn't a life threat and thus not an ALS job.

Nice

Incorrect, pain management can be used on a variety of things, it just needs approval by med control. I've witnessed Morphine given in the field for abdominal pain by ALS.

 

[Bullets]

Incorrect, pain management can be used on a variety of things, it just needs approval by med control. I've witnessed Morphine given in the field for abdominal pain by ALS.

In NJ? The copy i have of the MICU protocols only allows for pain management in severe burn/traumas.

Obviously with medical control anything can be changed

 

[hogwiley]

I think the basic level should be Advanced EMT or EMT specialist, but since nobody has ran a specialist class anywhere in my state for at least 3years, Ive been stuck a basic for now.

At least until somebody volnteers to pay my bills along with my tuition for a year and a half while I go to Paramedic school, especially since Id have to relocate as there are no schools around me.

Anyway, why stop at eliminating EMT Basic, why not require an associates degree for Paramedic, and require the same science and math classes RN school does? How many Paramedics have passed college level anatomy and physiology? You probably have more EMT Basics that have since many Basics are also allied health care professionals who volunteer in EMS.

 

[DrParasite]

In NJ? The copy i have of the MICU protocols only allows for pain management in severe burn/traumas.

I find it very hard to believe that those doctors and allied healthcare providers would fail to add a pain management for medical pain or non-severe trauma...

oh wait, I have been in NJ for 15 years, that's pretty much what I have seen. You would think 10+ years of schooling and M.D. after your name would result in better protocols.

 

[hogwiley]

Im with a rural non transporting volunteer BLS first responder unit. Do you honestly think we could staff our agency with all Paramedics? So do away with EMT Basics and who replaces them in places like this?

Obviously no one would, so instead of having an EMT there in minutes, youll have an ALS rig with Paramedics first on scene 45 minutes later. Dont worry, im sure the Paramedics can make up that extra 40 minutes because they have an extra year of vocational ed(with no pre requisites).

Basing on what Ive personally observed over the past few years, in very few cases did ALS save a patient that would have died had it been BLS, and I cant think of seeing any calls where having two medics on scene instead of a medic and an EMT saved someones life. Im sure somewhere at some point it may have occured, but I havent seen it. Im sure having MDs on every rig would occasionally make a difference as well, but thats cost prohibitive, so you have to weigh the value with the cost.

Usually if the patient is in bad shape, its load em and go. As for pain management, does it really matter if you have two medics instead of one medic and a basic showing up in a rig?

Despite all the squawking about EMTs on here, the reason EMT Basic exists is probably because the people with MD by their name understand what saves patients is getting them to definitive care quickly, not whether the person driving the ambulance has an extra year of vocational ed.

 

[NYMedic828]

Im with a rural non transporting volunteer BLS first responder unit. Do you honestly think we could staff our agency with all Paramedics? So do away with EMT Basics and who replaces them in places like this?

Obviously no one would, so instead of having an EMT there in minutes, youll have an ALS rig with Paramedics first on scene 45 minutes later. Dont worry, im sure the Paramedics can make up that extra 40 minutes because they have an extra year of vocational ed(with no pre requisites).

1. Nurses. More abdundant and more educated than 9/10 paramedics.

2. A year of college level vocational training substantially different than three weeks of middle school level training.

Paramedic is at a subpar educational standard but an EMT class can be replaced with a week of employer provided training.

 

[Veneficus]

Im with a rural non transporting volunteer BLS first responder unit. Do you honestly think we could staff our agency with all Paramedics? So do away with EMT Basics and who replaces them in places like this?.

I think the issue is a bit more complex than this. In many countries, volunteer ambulance corps exist, and as a function of the state, medics are rotated through rural communities.

It doesn't take an EMT to drive somebody to the hospital. With the model of basic EMS first response, it means everyone goes to the hospital. Which is not a sustainable economic model.

I think it is important to seperate the fuctions of patient care and transport in EMS. A more advanced provider can decide if the patient needs to go to the hospital at all or a better place to refer them.

Obviously no one would, so instead of having an EMT there in minutes, youll have an ALS rig with Paramedics first on scene 45 minutes later. Dont worry, im sure the Paramedics can make up that extra 40 minutes because they have an extra year of vocational ed(with no pre requisites).

How many minutes more than 6? What good is a provider with only a handful of interventions that don't address most modern medical problems outside of the hospital?

As for an extra year of training, if you measure it in actual hours, an ALS provider has between 7 and 10x (depending on old or new curriculum respectfully) So the question must be reversed. Not what can an ALS provider add, but what can a BLS provider actually do?

Basing on what Ive personally observed over the past few years, in very few cases did ALS save a patient that would have died had it been BLS, and I cant think of seeing any calls where having two medics on scene instead of a medic and an EMT saved someones life. Im sure somewhere at some point it may have occured, but I havent seen it. Im sure having MDs on every rig would occasionally make a difference as well, but thats cost prohibitive, so you have to weigh the value with the cost.

Since the value of EMS in saving lives is so minimal, I am not surprised by your experience. Additionally, it has been identified in multiple studies that patients who call EMS overwhelmingly do not need life saving intervention but do need medical care. That makes a basic EMS service a very overpriced taxi.

As for having 2 medics, I agree most calls will not require 2 medics. During my time working as a medic, there were many more interpersonal issues on double medic trucks. There is also the problem of skill dilution. However, again, countries outside the US have managed to make it work. It is more of a question of system design than individual qualification.

Having an MD on the ambulance is only cost prohibitive because of the system of reimbursement. There is no data, but I am willing to bet that it costs less to have a physician who can treat/release/prescribe riding around than to initiate an emergency ambulance and the cost of an ED for majority who do need healthcare but do not need an ED.

Usually if the patient is in bad shape, its load em and go. As for pain management, does it really matter if you have two medics instead of one medic and a basic showing up in a rig?

If the patient is that bad and that far away from a hospital that actually can help and not the local doc in a box community hospital, then it isn't going to matter anyway. But again, if 5% of all EMS calls are non emergent, why are we staffing an expensive taxi in a system that costs more than it helps?

As for pain management, it is not a question of 1, 2, or 10 medics on the ambulance, it is a question of having somebody who is able to do it. 2 medics on an ambulance can control pain as well as 1. But 2 basics on an ambulance cannot.

Despite all the squawking about EMTs on here, the reason EMT Basic exists is probably because the people with MD by their name understand what saves patients is getting them to definitive care quickly, not whether the person driving the ambulance has an extra year of vocational ed.

That is an interesting tag line.

I believe that many MDs are just not interested in dealing with any part of the EMS system. I also believe that the reimburement model makes it impossible for MDs to alter the system design without changing the way it is funded, not because they approve of the system.

I think that effective stabilizing care can be borought to the patient. I think in many conditions, this immediate care may not save lives, but it is shown it reduces hospitalization length.

If having ALS providers saves every patient who used the 911 system 1 or 2 days in an ICU or inpatient ward, the cost savings will quickly be realized by the system.

"Saving lives" is a very poor measure of an EMS system. It reflects a time when we didn't know as much about disease as we do today. It reflects a time when we thought many illnesses were sudden in onset and unpredictable. Today, the value of EMS is to manage acute exacerbations of chronic medical conditions.

That sudden MI actually started as fatty streaks as a fetus. In a female, it was hormonally delayed. If a patient has their first "sudden" MI at 55, that means it was more than 55 years in the making with subclinical symptoms.

It is not like basics never had value, it is that as we learn more, the minimal service they provide becomes less and less valuable.

 

[TransportJockey]

Im with a rural non transporting volunteer BLS first responder unit. Do you honestly think we could staff our agency with all Paramedics? So do away with EMT Basics and who replaces them in places like this?

Obviously no one would, so instead of having an EMT there in minutes, youll have an ALS rig with Paramedics first on scene 45 minutes later. Dont worry, im sure the Paramedics can make up that extra 40 minutes because they have an extra year of vocational ed(with no pre requisites).

If it's like the county I run paid 911 in, they have to wait for the paid ILS or ALS unit to show up before they get any care anyways. The volly departments are lucky if they respond to 10% of the calls, and at this point we just automatically assume they don't exist until they mark en route. And even at that point we usually beat them to scene and cancel them.
I'm sorry, but if you can put a private 911 service in one of the poorest counties in one of the poorest states in the country (which we are!), there's no excuse to not have guaranteed 24/7 coverage.

 

[Veneficus]

correction

In my above post, that should read if 95% of calls are non-emergent.

In my multitasking fail, I didn't notice I didn't press hard enough on the 9 key.

 

[Tigger]

Despite all the squawking about EMTs on here, the reason EMT Basic exists is probably because the people with MD by their name understand what saves patients is getting them to definitive care quickly, not whether the person driving the ambulance has an extra year of vocational ed.

A successful EMS system cannot be based around the premise of saving lives but rather delivering the proper degree of healthcare to the population that it serves.

Just because the patient is not fixing to die in your ambulance doesn't mean that the patient is not sick. A sick patient needs treatment, a paramedic can offer that, a basic cannot. You cannot say that holding someone's hand is an acceptable alternative to Zofran, it's either you help the patient, or you do not.

 

[Asclepius911]

This blog brings me back when a nurse referred to us as "the taxi" or nurse that only cared for vitals and did not want to listen to the rest of the assessment/report. In Los Angeles County we are looked upon as ambulance drivers. It feels a bit degrading at times, similarly like a monkey that response to his name and at the same time can do some cool tricks. Lol

Now let's begin sarcasm with metaphors/simile. Let's look at the medical circus? sassy RNs are the mustached women, security are the strongest men, Drs are acrobats you see them at a distance flying around?

 

[hogwiley]

If it's like the county I run paid 911 in, they have to wait for the paid ILS or ALS unit to show up before they get any care anyways.

Well depends on what you mean by care, the faster you get them to a hospital, the faster they get definitive care. If you are substantially delaying their transport because you insist on having Paramedics take them, are you giving them better faster care?

The volly departments are lucky if they respond to 10% of the calls, and at this point we just automatically assume they don't exist until they mark en route. And even at that point we usually beat them to scene and cancel them.

So why is this volly department only responding to 10% of the calls? Is this all they are dispatched to, or all they respond to when dispatched? Either way something doesnt make sense. As for beating them to the scene, I can say that I personally have never seen that happen where Im at. Usually its a substantial wait before ALS gets there.

Imagine its winter and someone crashes their snowmobile into a tree on some remote logging trail. Would you want local EMTs who know the area well responding, or would you just prefer to wait out there in 5 degree weather while some non local Paramedics get lost repeatly while trying to get to you? Once they do get to you what are they gonna do prior to getting you into the ambulance? Pretty much the exact same thing we'd do. I know, Ive seen both sides of it doing ambulance clinicals with an ALS company and responding as an EMT and I didnt see anything done differently, except in the case where ALS handled it themselves the patients were suffering from hypothermia by the time they made it into the ambulance(almost the same thing on some car wrecks around here).

I'm sorry, but if you can put a private 911 service in one of the poorest counties in one of the poorest states in the country (which we are!), there's no excuse to not have guaranteed 24/7 coverage.

The poorest areas often get federal or state aid. Around here the poorest township has some of the best and most modern EMS equipment because they get federal aid and grants. Its the ones that arent as poor that have to pretty much fend for themselves because they dont qualify, and the public is usually less than enthusiastic about paying higher taxes for better EMS.

EMS is kind of a red headed step child when it comes to health care. People want the best hospitals staff and doctors, but EMS is generally an afterthought, especially in rural areas where people figure they are often better off just having someone drive them to the ER than waiting for an ambulance. I almost never see pediatric calls unless its something really bad because people just snatch the little ones up and drive rather than wait. Youd also be amazed at the condition of some of the patients that walk into the ED around here.

 

[TransportJockey]

Well depends on what you mean by care, the faster you get them to a hospital, the faster they get definitive care. If you are substantially delaying their transport because you insist on having Paramedics take them, are you giving them better faster care?

I mean any kind of care at all. All of my company's trucks run at least ILS level, most are ALS. We beat FD to a majority of the calls in the county, and a good amount in the three municipalities w/ combo depts.

So why is this volly department only responding to 10% of the calls? Is this all they are dispatched to, or all they respond to when dispatched? Either way something doesnt make sense. As for beating them to the scene, I can say that I personally have never seen that happen where Im at. Usually its a substantial wait before ALS gets there.

We have 9 Rescue districts, each a separate fire department loosely under the county Fire Marshall. 2 are Combo Departments w/ someone on the trucks 24/7. We have 1 district (9) that is literally responding to 10% of the medical calls dispatched in their district. And a good portion of the other 6 volly only districts w/ a rescue respond to maybe 25% of their medical calls during the day and maybe 40% at night. No one wants to be a volly, not that I blame them. Hell, the only reason I volly in another rural county (not where I live, since ABQ doesn't use vollys) is because they pay for classes for me. If they didn't offer that I wouldn't bother.

Imagine its winter and someone crashes their snowmobile into a tree on some remote logging trail. Would you want local EMTs who know the area well responding, or would you just prefer to wait out there in 5 degree weather while some non local Paramedics get lost repeatly while trying to get to you? Once they do get to you what are they gonna do prior to getting you into the ambulance? Pretty much the exact same thing we'd do. I know, Ive seen both sides of it doing ambulance clinicals with an ALS company and responding as an EMT and I didnt see anything done differently, except in the case where ALS handled it themselves the patients were suffering from hypothermia by the time they made it into the ambulance(almost the same thing on some car wrecks around here).

Not applicable here. Our units run this county from top to bottom, we know the county damn near the same as the vollies in their districts. If I am told a rough area of the county, I can find a way to get there PDQ.

The poorest areas often get federal or state aid. Around here the poorest township has some of the best and most modern EMS equipment because they get federal aid and grants. Its the ones that arent as poor that have to pretty much fend for themselves because they dont qualify, and the public is usually less than enthusiastic about paying higher taxes for better EMS.

Here in NM it seems the poorest areas still have issues getting equipment for EMS care. Fire apparatus is one thing, but Ambulances and supplies are still hard to come by. If by chance a volly unit beats me to scene and starts care and uses supplies, I am expected to restock them from my unit because their supply budget is nil.

EMS is kind of a red headed step child when it comes to health care. People want the best hospitals staff and doctors, but EMS is generally an afterthought, especially in rural areas where people figure they are often better off just having someone drive them to the ER than waiting for an ambulance. I almost never see pediatric calls unless its something really bad because people just snatch the little ones up and drive rather than wait. Youd also be amazed at the condition of some of the patients that walk into the ED around here.

No argument there. I've worked in an ER as a tech and seen some pretty F'ed up patients walk in. But because my county doesn't have a hospital at all, we intercept a lot with vehicles on the side of the road because they wanted to head to the hospital then realized that the patient was in a really bad way and needed medical care.