lee357

I happen to work for a non emergent transport company. I have also worked for a 911 agency that paired Paramedics/Basics then went to Paramedic/Intermediate due to the fact that the state expanded the Intermediate scope to include 12-leads and expanded the drugs an Intermediate can administer. I have also been a GM of a 911 volunteer transporting agency. Enough of the bio. I put these thoughts to the readers of this thread. Should EMS be doing non emergency transports or should we just be doing the emergency ones alone? Well it would seem to me; that is not the question we should debate. First, Emergency Medical Services, services is the key term to frame my response to this question. From the service point of view we should do both. This is why I said "we should not be debating the question". I would like to reframe the question like this If we take both emergent and non emergent transports, how should each be handled? You see my point. It should not be if we should do them, because the public in general has already answered that question and the task has already been given to us to do. So now that we have been assigned the task, the question should be how to do them. I have many opinions on the how, none of them worth telling here to the readers of this thread. Instead I would only like to pose a few questions as to how you the reader think we should handle them. Should paramedics be taking granny home, or transferring a multi-system trauma that has already been in the hospital for four months a thousand miles to a local hospital closer to their home for the rest of their hospital stay? The last sentence was just one example of what we are talking about. I do not want to degrade into what if the sky fell down thinking. Or should a Basic take this call? in either case should it be done in a wheel chair van or an ambulance? Will both pt. benefit one way or the other? Can both pt be transported the same way, in a wheel chair for example? Second the word Medical in EMS. What is the definition to you the reader? Is it the same definition that a Doctor would apply? Or do you prefer to make your own definition? Is the definition of medical deferent for the Paramedic than it is for the Basic? The general public has their own definition of the word. I humbly submit that the public definition is "If there is something wrong with me it is a medical condition". If you agree that this is the general publics' definition then there is not much room for misinterpetation of the definition of the word Medical in EMS. After all it is (by the service point of view) the general public that assigned these tasks to us in the first place. Can you provide medical care in a wheelchair van? Or is a properly equipt (probably misspelled) ambulance the only vehicle that can provide medical care? Is the Paramedic the only level of EMT with the ability to provide medical care? Is the Basic the only level of EMT with the correct skill set to administer medical care? Just as a note of interest here, there have been studies done that suggest that removing ALS from transporting ambulances dramatically reduce the mortality/morbidity rate of Trauma victims, when the transport time is less than 15 min. to definitive care. Keep in mind that the first responding units in these studies were all Paramedic units and did initial als care on scene. According to the summary reports the reason the rates dramatically dropped was because the ALS units did not have time to stay a do all their skills and the BLS units could not do any more than the ALS units so the on scene to hospital times were reduced by more than 30% over prior study times. These studies, for me, confirm only one thing both ALS and BLS have unique skill sets that can not function efficiently without each other. So in just one EMT's opinion all the debate over who is valuable and is one better than the other is time wasted and with that time the loss of knowledge that could someday save my life. But I digress, sorry for that, now I waste your time. Third now we come to the most over used word in EMS. The word Emergency, and how to define it. Is it defined the same among all medical providers? Does the definition change throughout a medical providers career? Is the situation that was a emergency as a rookie the same after 16 yrs on the job? These question are not dependant on whether you are a Paramedic or a Basic because the emergency situation that you both faced as a rookie where the same the only difference was what you could do to resolve the situation, but it scared the s!!t out of both of you. In the same manner after awhile on the job the same situation arose and it really was not that big of an emergency to you this time. I humbly propose that the general public's definition is more likely closer to the definition we all had when we were rookies. After all most of the pt we transport think that any thing that is happening to them is important and should be addressed as an emergency. If not they would not have called us, and yes there are those that call just for a ride or just because they are lonely and need someone to talk to, although I think the last mentioned group are not abusers of the system, but I concede that would depend on your definition of medical. The general public's voice the government has agreed with them and has mandated that we transport all that call and that the ER treat all that come in wether by us or by foot. In conclusion, If you accept my humble view of the question posed at the very beginning of this thread and the definitions that I believe to be very close to the publics; that we serve. Then the debate is futile and we should just get on to figuring out how to treat the pt (that is the system). This duality is at the core of modern EMS. It is as much our doing as it is the system, as a whole EMTs both Paramedic and Basic have since the very start done much with little and to those who do more is given.

Are they relevant? DO they serve a purpose in the system? Most definitely they do. Why, the short and sweet answer is framed in a statement: go to school and spend 18 months and approx. $20,000 then go to a true rural setting and try to find a job that pays well enough (or at all) to pay off your college loans. Until a paragod can drug or assess an answer to that they need to shut up and realize that short of in the population centers (where it seems to be the only place that this is an issue) the rest of the country does just fine with bls transporting agencies backed up by als units. Now for the nuts and bolts (thats country talk for the proof) The main premise for the emt basic is to arrive on scene and provide basic life support. And for those who think they are educated that means Air goes in and out blood goes round and round. People, at this level of care it is not rocket science. So how does the basic achieve this simplest of goals? They do it by assessment of the PT. There are those of you that are going to get all riled up by this statement, but please read on before you reply (ya right, I to have read the post and replies in here). Is this the same assessment that the paramedics do? should it be? Obvious answer no, but is it? The purpose of the bls assessment is two fold, first determine if air is going in and out and if blood is going around and around, second to determine if this PT needs or, and more importantly, is going to need a higher level of care than the basic can provide. Oh my!! there is the value of the emt basic. Now back to is it the same assessment is the answer obviously no? Well yes and no. Answer this question and you will see what I mean: can a paramedic be a paramedic without being a basic? So how unimportant can the role of a basic be. Are the levels of als bls care different? apple and oranges. Some of the post I have read in this thread seem to be discussing bls as partners new people in the industry I hate to be the person who brings the bad news but it is only like that in the cities and suburbs. most of you don't seem to remember that basics are also stand alone care givers in the same chain as the paramedics. So if your reasoning about basics not being relevant or then every argument you use to justify that position can realistically be said by a doctor or PA about the position of paramedic. As I said it only serves to divide a profession. Now to tell you where my point of view comes from. I write this at 2:45 in the morning sitting in the front of my medic unit thinking back to my years as a lead EMT basic on a bls transporting ambulance in a location that the closest hospital was 45 min away code 3 and could be as much as 4 hrs away code 3 then as an intermediate for another Ils transporting agency and now in this dam paramedic unit in the big city. To conclude the basics role in the system is not the role of the paramedic so to try to compare them to justify why one should be considered irrelevant is ignorant.

No we still transport even if wew know that it is unlikely that they will pay because the tax code allows the company to write off 60% of the uncollected money. The resulting un payed bill can still get me fired but we do still transport the person. I would like to get a new job but I am still in the paramedic program and it is hard to find a job as a intermediate with only five years as a lead emt for a intermediate level transport agency. most places want paramedic

To respond to the ? does my service get paid if the pt or the pt insurance doesn't pay answer no. That is another thing the company keeps track of and can cost us our jobs and that is our collection rate. Lets say we get paged to a homeless person with difficulty breathing, not going to get paid on this one right. Well that goes right on our collection rate stats. My job hangs on several different factors that have nothing to do with pt care. I have only been with this company for a short time and I came from a city owned ambulance company that rated you only on pt care and encouraged you to treat and release and it was ok to refuse transport to some one with no medical need, we were taught that we were the gate keepers of our over stretched ER and with that came the responsibility to make sure that the one that did not need emergency care did not compromise the one that did need it. What I have seen of the private sector ambulance so far seems to me that they are selling a product and that product is transport to the hospital regardless if one needs it or not. At the company I work for now we are judged on transport times the shorter the better, collection rates, dry run percentages, and if are charts are written so it can be billed. If you can see pt care in those standards let me know because I need something to justify my job so I can sleep at night

I work for a private service and the policy is if you call we hall. The company keeps track of dry runs and the only thing they look at in the dry runs is if we transported (non dry run) or not (dry run). The company will fire us if our dry run rate gets higher than 25%. Included in the dry runs are things like cancellations by fire, refusals, utl's, no medical need, or any of the varied reasons a pt. may not be transported. So I would have to say that in the system that I work in the person would most likely be transported no matter what the reason they called for.

I RECENTLY FINISHED THE INTERMEDIATE PROGRAM IN OREGON UNDER THE NEW STATE SCOPE OF PRACTICE YOU ARE TO DIAGNOSE AND TREAT ACCORDINGLY. THIS TRAINING WAS BACKED UP BY A VISIT TO THE CLASS BY THE STATE OFFICIAL IN CHARGE OF THE EMS SCOPE AND I QUOTE " SHOULD YOU BE GIVING DIAGNOSES TO YOUR PT. YOU HAD BETTER BECAUSE YOU NEED TO CHOSE A TREATMENT PLAN AND EXPLAIN IT TO THE PT." NOW TO QUANTIFY THIS POSITION: THIS SCOPE OF PRACTICE IS BRAND NEW AND THE LOCAL PROTOCOLS HAVEN'T EVEN BEEN WRITTEN YET. I WAS IN THE PILOT CLASS AND I THINK THE STATE DIDN'T EVEN KNOW JUST HOW IT WOULD END UP. THAT WAS ALMOST SIX MONTHS AGO AND THE ER DOCS ARE STILL ASKING FOR OUR DIAGNOSIS. MAKE OF IT WHAT YOU WILL. AND THE LOCAL PROTOCOLS ARE STILL NOT DONE JUST YET. EMS YA GOTTA LOVE IT ;-)

it seems to be fine for the "standard pt." but what about the 300 pound pt. or the 6'5" pt. and not needing the c-collar is just a foolish. and my agency has one and it is very difficult to log roll onto. the management bought it without consulting us. most of our medics don't use it at all we use the lsb mainly for the afore mentioned log roll