daedalus

"BLS has better patient outcomes than ALS" "You may think your a cool paramedic with all those fancy skills but remember OPALS..." I hear this and variations of this on multiple EMS forums a the time. The same people that say these things all the time like to also push the idea that BLS is solely in the domain of the EMT, and ALS is solely the domain of the paramedic. Somehow in their mind, the fact that limited scene time in severe trauma is better than stay and play equates that EMTs are the gold standard for patient care in the prehospital setting. These people also like to point out that ambu bag ventilation with a "BLS" airway may be better than intubation in some patients. True. However these same people seem to interpret that as EMTs are better for these patients than paramedics. Who is better at BVM ventilation: An EMT who bagged a mannequin a few times in class and MAYBE once during the ER observation, or, the paramedic who was an EMT and than spent time with an anesthesiologist in the OR learning the right way to hold a mask before they even touched the laryngoscope? It was in the OR that I learned that a BVM is not a BLS tool, but a medical device that required expert training to use properly. Can you get expert training in a EMT tech school that has no access to experts in airway management? It blows my mind that certain things are considered basic and advanced when they are not. They are just medical care.

Gottcha!! Just read it and replied in the original thread.

Actually, the federal government extends no protection for equal opportunity for employment to LGBT people. However, most corporations are socially far ahead of the government on this one and you will find that most employers have a policy forbidding discriminative hiring practices based on a potential employee's sexual orientation. It is a matter of opinion on weather these polices are followed or not by EMS and Fire hiring managers and it is very difficult to prove that you were a victim of discrimination in a hiring process. As for dealing with partners that are of the LGBT crowd, you are still entitled to your rights to a comfortable workplace. If your partner is having phone sex while you are in the rig trying to sleep on a night shift, you have every right to be angry regardless if your partner is gay or straight. That being said, you should give all your partners the respect they deserve and if you are uncomfortable around gay people, perhaps the medical profession is not for you.

What?? Why even start a thread like this?

The only person in this thread I see knocking down the EMT's role in patient care is you. While I may not think that EMTs are educated enough to do a job such as independent care of emergency patients, I think of myself as an advocate for EMTs and want us as a profession to grow to the level of competence though education needed to take on this role. You want respect as a medical professional yet you readily admit you don't know what exam findings mean, and you see nothing wrong with this as long as you can pass that information on. Thats embarrassing and is really a testament to the sad state of prehospital provider education in this country. There is no use in communicating exam findings that you do not understand to some one who does. The clinician taking over care of your patient will be able to do their own exam and understand what they are doing. You run a risk of incorrectly interpreting a finding because of poor technique or no understanding of pathophysiology. For example, while in my clinical time on the ED, I had a hypotensive patient where the labs came back with a low hemoglobin and hematocrit. I thought wow this guy must be bleeding somewhere, and when the internal medicine team came from downstairs to admit the patient I told them my theory, for which I was promptly put in my place after the attending immediately dismissed the anemia due to the patients severe renal disease. I had totally forgotten about the kidneys role in regulating hematopoiesis. To be honest, your rant sounds like that of someone who does not understand the need for education and you are displaying the very type of behavior you are condemning. When it comes to patient care, egos need to be checked at the door. While there is no room for paramedics who think they are too good to run calls, there is also no room for disgruntled EMTs who think they don't need any more education in medical science.

Most of the med students that are being placed into preceptorships while still in first year are at med schools with a primary care emphasis and these students are usually placed with family medicine physicians. They typically have already completed gross anatomy or are in the middle of it in school. They are also in the middle of whole classes dedicated the the physical exam called something like "physical diagnosis" (which the hours they spend in this lab class in a 2 months probably well exceed the EMT 120 hours) Like the whole point of this thread, first year med students do not go into a room and work up their own patient and do what they want, they do what their preceptor tells them too. I, nor anyone else, is arguing against allowing EMT students to palpate an abdomen. I am arguing against an EMT student deciding to launch into an exam on his own accord, without the permission of the preceptor (which you will realize if you re read the original post in this thread). They just do not have the education to decide for themselves what is indicated or not. Comparing a medical student with four years of biological science intensive undergraduate education, with a 120 hour first aid class student is really the extreme end of apples to oranges.

I have had the huge pleasure of attending a few lectures and watching some operative cases with a neuro-interventional surgeon who is using pioneering new procedures to remove clots with catheter based techniques while the patient is having an acute CVA. Smartest guy I know. Anyways, I routinely see him using Cardene (Ca channel blocker) to keep the pressures artificially low in stroke patients. He and his team are real advocates of head of the bed at 30 degrees and keeping the pressures low. No fluids unless otherwise indicated. Ill have to ask him about this.

You think that someone with maybe only a month done of EMT class (my class put us through our ride alongs at about 1/4-1/2 the way through the semester), should be preforming an assessment of an emergency patient on their own accord? I don't. By observing, I mean soaking in information like a sponge and helping out where asked. An EMT student should be expected to be able to take a blood pressure or put a patient on oxygen, but both only after being asked by the paramedic on scene. They should not be palpating an abdomen without asking, when this may not even be indicated. In some patients, the pain may be so severe that they will barley tolerate the initial exam of their abdomen by the paramedic, and do not need to be prodded again by the EMT student who does not even have knowledge of anatomy and physiology. ( You can argue all you want that some people may have taken an A&P class prior to EMT class, but it simply is not required so we will always be looked at by the lowest standards).

Good to know. Thanks for the new info. I think we both understand what eachother is saying.

Robbins Pathologic Basis of Disease defines that an aneurysm is a localized abnormal dilation, while a dissecting aneurysm is created once the tunica intima is breached. (pg 526-8). I

I agree with you in theory, however the american EMT student is poorly educated* and the (only) one or two ride alongs they do are often in the middle of the 4 month program, so they are not even ready to do the few basic skills that they are taught. *Individuals should not get offended. EMTs as a whole under educated. That includes me.

To those stating that you can poke an abdomen without fear of rupturing an AAA, and referring articles to cite this, you may want to review some pathology of aortic aneurysm. Many people have asymptomatic AAAs that may require surgical repair in the future, but are for the present, stable. It seems reasonable based on the posted citations that abdominal exams may be preformed without fear in these patients, when it is justified. However, in a patient with a dissecting AAA (different ballgame), I find it unreasonable to preform unnecessary palpation of the abdomen for teaching purposes. -daed

I'm sorry, but you do not let a student jab at a patients abdomen who has a c/c of abd pain, and than proceed to tediously press again and again on the patient's belly to show proper technique. If you want to teach the procedure, that can be done on a patient who is not in pain, or another classmate. And while I find the cited article interesting, it is not enough to convince me to abandon my practice of palpating an abdomen with a suspected dissecting AAA as little as possible, and I sure will not be letting a student do so.

You bet. I am almost done with paramedic school, and while I am working at my EMT job I still ask my paramedic permission before doing certain things. As a EMT ride along student, your primary responsibility is just to observe. You may be asked to assist with vital signs or other simple procedures within your scope of practice, but other than that, you should not start conducting your own examination of a patient or starting to do something on your own without being asked. My two cents, anyways.

Standard part of a physical exam of a patient with a c/c of abdominal pain. Inspect, auscultate, palpate, percuss. Although, a ride along should have asked before he/she preformed patient care in your ambulance.