Would you do it?

[Sasha]

AMI's we may not have advanced meds but we carry ASA and nitro, which would be medics first line.

First line, but not the entire treatment. Do you know the whys and hows, and why nots?

What other drugs do you carry? ALS has a big drug box for many different medical problems. EMS is NOT all about chest pain.

 

[medic417]

You're assuming that there would be a job created/available if there weren't volunteers, and assuming that there would be funding for it, and assuming the community wants full-time professional coverage. Mighty big assumptions there.

So far every community I have seen where all the volunteers quit has gone paid and this is in a poverty stricken area. As soon as the local blue hairs (old women) start screaming about things politicians change priority's and money is found.

Secret is you don't walk away quietly. You post letters explaining why you can no longer volunteer, you emphasize the importance of having professional EMS including listing how it will be better, you emphasize the danger the community faces if left uncovered or relying on the mutual aid that may get withdrawn if there is no service at all in the the area, etc, etc. It really is not hard.

 

[ffemt8978]

I used to say ignorance was blessed.. but this borders upon stupidity. Please tell me about the aspiration pneumonia patient that died because you were unable to intubate and secure their airway, or the life threatening AMI that was increasing infarct size or the patient with pain and you could not administer an analgesic. Now, what exactly will you a ..."God send".. going to do for that premi birth? Are you preventing those brain cells from dying due to hypoglycemia? I wonder how your community would feel if they knew they could provide almost the same care with a Boy Scout first aid course? God send? Yes, first aid is essential but please, please don't disguise yourself as medical providers.

Better quit patting yourself on the back before you need to call a Paramedic to administer pain med.'s..

Yes, you and I do mean you are one of the downfalls of prehospital care! It is the ignorant providers as such. Did you rally in support of increasing the level of care or rendezvous with an ALS? Or are you part of the whining, crying of how hard EMS courses have become? Did you participate in studies of possibly funding a real EMS? ..............I didn't think so..
No, it is exactly people like you who like to blow their own horn instead of progressing onward. The same people that are protesting increased education and accreditation because it will be "too tough" on the caring citizens.

I do thank you though. You are exactly the reason there is such an opinion of why EMS should be primarily professional and only per ALS personnel. You demonstrated the exact reason why we still have a crappy EMS system within the U.S. borders.

I ask you this; how does it feel to deliver inefficient care more than Johnny & Roy did nearly 40 years ago? .. God send? .. I think not; deterimental? Possibly.

R/r 911

And let me ask you this? What about the communities that refuse to support/fund an all paid-professional ALS system? We can educate all we want, but it is ultimately the community we serve that has the final say in what level of care they want present. If they say no to ALS, then what? No EMS coverage at all?

Our county seat had a city FD that was running an all paid-professional ALS ambulance. About three years ago, they disbanded the entire unit because the community refused to fund it to necessary levels. They now contract with a neighboring fire district to provide their ambulance service. Wait times for an ALS ambulance can be as high as 30 minutes now because this neighboring district is the only ambulance provider for 4 communities, and is the contracted ALS intercept provider for another 7 communities.

 

[ffemt8978]

So far every community I have seen where all the volunteers quit has gone paid and this is in a poverty stricken area. As soon as the local blue hairs (old women) start screaming about things politicians change priority's and money is found.

Secret is you don't walk away quietly. You post letters explaining why you can no longer volunteer, you emphasize the importance of having professional EMS including listing how it will be better, you emphasize the danger the community faces if left uncovered or relying on the mutual aid that may get withdrawn if there is no service at all in the the area, etc, etc. It really is not hard.

See my response above where I quoted Rid. The fire department in question did this, and it was a year long campaign for them to keep the EMS squad. Ultimately, the voters voted their pocket book because contracting out was cheaper than keeping it in house.

 

[medic417]

See my response above where I quoted Rid. The fire department in question did this, and it was a year long campaign for them to keep the EMS squad. Ultimately, the voters voted their pocket book because contracting out was cheaper than keeping it in house.

Well the citizens made their choice let them live with it. But a little time and a few deaths waiting will get a change to take place. Sad that people have to die but that is what some require. If they are willing to accept this risk let them.

 

[Sasha]

Sad that people have to die but that is what some require. If they are willing to accept this risk let them.

This is something I have a problem with.

If we are in EMS for the patients, putting the patients first, are we really going to let people DIE to get what we want? Sounds kind of like spoiled children with hurt feelings, only you're playing with real people's lives.

I agree there's a need for paid, professional EMS. But I, personally, have a problem with sacrificing people's lives to get it.

 

[EMTWintz]

I am glad to see this but why don't your community deserve ALS first before an BLS unit? Why should even those exist except in the very remote areas?

R/ r911

We get there in a matter of min. our response time is 3min or less, where as it takes ALS 10-15min. And in some areas up to 30min.

 

[EMTWintz]

First line, but not the entire treatment. Do you know the whys and hows, and why nots?

What other drugs do you carry? ALS has a big drug box for many different medical problems. EMS is NOT all about chest pain.

Well we def. dont get all the meds in the handy dandy drug box, but since you asked we get epi pen, neb tx's, ASA, nitro. For which all of us know the indications/contraindications and the fact that we have no problem calling med control before giving if we are unsure

 

[AJ Hidell]

I agree there's a need for paid, professional EMS. But I, personally, have a problem with sacrificing people's lives to get it.

They're sacrificing their own lives if they ignore the problem until it's too late. That burden is on them, not us. It's the law of the jungle. At some point, baby birds get kicked out of the nest and they either fly or die. Occasionally some die. I feel more compassion for the baby bird than people who are too stupid to protect themselves when they know the consequences.

I have yet to see a community that refused to provide some arrangement for EMS when the vollies dried up. What I also have never seen is a volly squad work in earnest to eliminate their own organization in order to establish professional EMS in the community. Instead, I see them fight it tooth and nail in order to save their little good ol' boys club.

And any system allowing non-paramedics to administer nitro is a system that sucks.

 

[Veneficus]

Well the citizens made their choice let them live with it. But a little time and a few deaths waiting will get a change to take place. Sad that people have to die but that is what some require. If they are willing to accept this risk let them.

Has there ever been a time that fire, EMS, or LE was not based on a management by disaster principle?

It is always after a death or serious event communities give any thought to funding these agencies appropriately.

 

[medic417]

This is something I have a problem with.

If we are in EMS for the patients, putting the patients first, are we really going to let people DIE to get what we want? Sounds kind of like spoiled children with hurt feelings, only you're playing with real people's lives.

I agree there's a need for paid, professional EMS. But I, personally, have a problem with sacrificing people's lives to get it.

It is wrong for them to ask me to do work for free. Doctors let people die all the time because they can not get the money to fund the surgerys and treatments they need to prolong life. Sorry that is harsh reality. But in all honesty his community decided they did not need EMS so they choose to risk death who am I to try and stop it beyond trying to get them to change their minds. If I am on duty I will be there but these people decided not to let them be on duty so they get sick and die its on them not EMS.

This is not spoiled children this is people expecting lots for nothing. I will not run as a volunteer but if they collapse next to me I would do chest compressions until the ambulance that they felt was safe to wait on gets there and pronounces them dead. They made their bed let them die in it.

 

[medic417]

Has there ever been a time that fire, EMS, or LE was not based on a management by disaster principle?

It is always after a death or serious event communities give any thought to funding these agencies appropriately.

Exactly after 9/11 money was free flowing for a year or two. After someone important dies when ambulances are not available it becomes an issue and things improve for year or two. Then people look and go wow those guys sleep in the parking lot a lot how about we cut funding because they do nothing but drive, eat and sleep.

 

[Sasha]

Well we def. dont get all the meds in the handy dandy drug box, but since you asked we get epi pen, neb tx's, ASA, nitro. For which all of us know the indications/contraindications and the fact that we have no problem calling med control before giving if we are unsure

But do you know the whys and hows to how it works?

 

[EMTWintz]

But do you know the whys and hows to how it works?

Nitro, when given to a pt with s/s of chest pain believed to be cardiac in nature will dilate the blood vessels in the body resulting in more blood staying in the veins and less blood coming back to heart which means the heart doesnt have to work as hard. Also drops the blood pressure, and ALS sometimes uses it to bring down dangerously high b/p's. Nitro dosage: .4mgs up to 3times pre-hosp.
Contraindications: Do not give if pt's systolic is close to 100. If b/p falls below but pt in trendelenberg; pt has head injury; pt is infant or child; pt has taken max dosage; pt has taken ED meds

 

[EMTinNEPA]

This is something I have a problem with.

If we are in EMS for the patients, putting the patients first, are we really going to let people DIE to get what we want? Sounds kind of like spoiled children with hurt feelings, only you're playing with real people's lives.

I agree there's a need for paid, professional EMS. But I, personally, have a problem with sacrificing people's lives to get it.

Unfortunately, that isn't our call to make. John Q. Public doesn't know anything about the lack of volunteers, the difference between EMTs and paramedics, the number of emergent calls a service runs daily, etc.

Lots of communities think that a volunteer ambulance will be enough. If the town refuses to fund an ALS service, the ALS service has three choices that I can think of: 1) Go private, buy a lot more trucks, hire a lot more EMTs, and do a lot more IFTs, 2) Pick up a lot more territory to up their call volume, or 3) Call it a day.

I hate to sound like the folks on here that I argue with on a regular basis, but public education is the key. John Q. Public needs to know more about how the EMS system works (or doesn't work) and what kind of wait times the community may be subjecting itself to by telling the paid service to take a hike because it will make their wallets fatter. What can we do about it?

Volunteer paramedics? As far as I know, no such thing. Correct me if I'm wrong, but I believe you have to actually be on the clock at a professional ALS service to perform any ALS interventions because those interventions are an extension of your medical director's license to practice medicine. Does John Q. Public know this?

 

[EMTinNEPA]

Contraindications: Do not give if pt's systolic is close to 100. If b/p falls below but pt in trendelenberg; pt has head injury; pt is infant or child; pt has taken max dosage; pt has taken ED meds

Do you know why nitro is contraindicated in these situations?

 

[enjoynz]

And any system allowing non-paramedics to administer nitro is a system that sucks.

That is a very big statement to make!
In fact there would be a very large percentage of EMS services in the world, that allow nitro to be given at an EMT-B skill level.
You telling us that EMS Clinical Directors throughout the world,
(who have years of experience and training in Field medicine that make that Clinical procedures) don't know what they are doing?

Come on!!!!!

Enjoynz

 

[EMTWintz]

Do you know why nitro is contraindicated in these situations?

You do not give nitro to pt with low bp, one word SHOCK. Do not give to pt with head injuries because risk of bleeding out (?). Its a no brainer why you don't give to infants and children. You just dont do it. If pt has taken ED meds their bp is probably already low and why lower it to the point of shock?

 

[Ridryder911]

Well we def. dont get all the meds in the handy dandy drug box, but since you asked we get epi pen, neb tx's, ASA, nitro. For which all of us know the indications/contraindications and the fact that we have no problem calling med control before giving if we are unsure

You do realize administering NTG without a knowing if the patient is having a right sided AMI could be fatal? Administering nebulizers to CHF instead of asthmatics can actually cause the patient more problems? There is a major difference between anaphylactic shock and a reaction.. right?

Sorry, just because you have a box with some medications the patient might have on hand or already been prescribed does not make the difference, when in fact maybe harmful. Yet, again usually many do not understand this as they do not know medicine.

R/r 911

 

[EMTWintz]

You do realize administering NTG without a knowing if the patient is having a right sided AMI could be fatal? Administering nebulizers to CHF instead of asthmatics can actually cause the patient more problems? There is a major difference between anaphylactic shock and a reaction.. right?

Sorry, just because you have a box with some medications the patient might have on hand or already been prescribed does not make the difference, when in fact maybe harmful. Yet, again usually many do not understand this as they do not know medicine.

R/r 911

and that is why we have taken the class and used our own research abilities to find out more about the meds we have been given. Again we are taking it upon our selves to increase our knowledge for the wellbeing of our pt's and community.