Using Ultrasound on the ambulance - Yes No Maybe?

[VentMedic]

No, it is not working.

Unfortunately I see the Paramedic heading down the same path so many "techs" before them have.

The LVN (and CRTT) were probably some of the most "skilled" health care workers of the hospitals. LVNs could do every "skill" an RN could do plus do basic radiology and US at one time. The same with the CRTTs (Respiratory Techs) of the early years. Many were "educated" on the job and had a multitude of "skills". Some even picked up a college class or two besides the "tech training" just like the LVN. Now these 1 year "techs" have started to vanish. The CRTT is no more and had to become a 2 year college graduate, but the same skills and many more came with that education. The LVN is out of the ED and ICUs as well as off many med-surg floors. The RN has discovered what opportunities the 2 year degree could bring as a foundation for many specialties including CCT and Flight along with hundreds of other employment opportunities. Their "skills" are now almost limitless in some states including doing whatever "skill" the Paramedic has. RTs have also managed to achieve an open-ended scope of practice in may states that can give them whatever "skills" their medical director wants. However, for credibility and reimbursement is such areas as US, one may have to be Registered in that field. But skills such as intubation and various line placement are fair game if they already fall within your scope of practice and are recognized by the various agencies for reimbursement by your education and credentials.

Do I believe the Paramedic will vanish? No. Do I believe they with ever get the recognition, like the LVN, worthy of their skills? No. Medicine has become competitive. When RTs, RNs, PTs and SLTs have their representatives go before some legislative body for reimbursement money, these professionals are competing with each other on services that overlap. Usually the one with the most education wins as they can show both "skills" and formal education that is universally accepted. RTs have had to petition for a new category for a bill concerning reimbursement in home care by making a Bachelors the minimum for that area. You wouldn't believe have many had already planned for that day including myself although its not homecare that I am particularly interested in.

It doesn't hurt to understand how education and legislation had been the motive for change with other professions.

You also don't know when stricter standards will come out of some profession's legislation as Radiology, RT and Nursing have already set higher standards for who can do some of their procedures. Even phlebotomists are now establishing a national standard which now since CLIA and JCAHO approve of this higher standards, it affects Paramedics who work in the ED or who draw blood specimens on the ambulance. US also closed the loop hole for certification by other professionals that now must meet stricter requirements. RT closed its loop hole for RNs touching some ventilators in Florida. Yet, the Paramedic exam can still be challenged by RNs and other healthcare professionals because we have not defined our standards well enough to prevent it.

Since JCAHO does the leg work for Medicare, it would be interesting to see an accrediting entity similar to them involve in ambulance standards of care.

Yes, there are extremely accountable and highly trained EMS companies out there that are more than qualified to take on any new skill and challenge. But, as a whole, the industry will still be only as strong as the weakest link. Again, it is found within the education systems and that also includes the minimally qualified instructors.

[Mediclcems]

Another diagnostic tool is always nice to have. However the cost is definitely a big factor, especially to a large EMS service with 30 or more rigs to outfit. The other big problem I can foresee is the delay in transport. I do not think sitting on scene for an extra 10 or 20 minutes to do an ultrasound is in my patients best interest unless transport time is extensive.

[spenac]

Vent I agree we need to get organized and educated. But at this time I have to continue my education as I can get it. Hopefully I will have my education complete so when and if ever we do get it elevated I am at or above the new requirements. But as time goes if it continues as is I will probably have to leave this profession I love doing.

I have to say it is sad to have really no choices in EMS except to get education piece by piece. It is a big reason we are not respected or paid. Sadly some in EMS want to keep it this way.

But a bigger group are the citys and fire departments trying to find ways to save money while providing services. They realize if we ever are required to meet higher standards they will be out more money. They fight tooth and nail to keep the minimum standards so they save money.

[VentMedic]

The "save money" logic is the part I don't think some in EMS understand.

In many areas, CA and FL which I know, still have very reasonable community college tuition. A 2 year degree in EMS can still be obtained for about $5000. Yet, most would rather spend $12 - $15,000 on a 700 hour or 6 month Medic Mill.

The reimbursement will make the investment worthy in the long run for companies.

RT started "preferring" the 2 year degree graduate almost 20 years before it became mandatory. Much of this was done through peer pressure and working in a close environment to other educated professionals to see where they were being left behind by accepting the 1 year wonders as a "standard".

More RNs are getting their BSN degrees because they have looked around and saw what other professions are requiring as entry level. It is a b*&%$ to realize that while your profession had once ruled, it was now the least educated at the multidisciplinary meetings.

Continuing your own education is excellent but remember; piece milling bits of education in technology may not achieve the results you want. Technology advances too quickly and before you know it, like the computer, you have yesterday's model and are already way behind without the funds to upgrade. Education in the sciences to enhance one's knowledge to prepare for the changes will take one into the future.

[Ridryder 911]

Not trying to stray from the subject but it goes with any piece of equipment, skill, pay etc. I personally feel part of the problem that we rarely adress here on this forum is the lack of education and understanding of health care administration performed by EMS Directors and Administrators.

I feel at least 90% of them have not a clue about the health care industry. Especially those in public service departments such as Fire, Third Party, etc.. Again, what would we expect our industry to be like if our leaders are not educated to perform do their job? I can assure you that most Fire Service Programs have no areas of Medicare, capitation, reimbursement issues. I doubt that most cover health care statistics. Again, what do we really expect the profession to be, when many of the "leaders" are in the wrong business.

So many make the mistake assuming, John Doe was a great medic or supervisor, surely he will make a great EMS administrator.. and what will occur? .... Does one even really have to be in EMS to be a good EMS administrator? This is debatable, in which I see both sides.

My point or emphasis is this. Until we have qualified leaders such as educators instead of instructors, health care administrators instead of Directors, our system will never change. What can we expect from a half-ass system.. half-ass results.. thus causing people never to take this profession seriously. Why should they? Why should Medicare, Aetna, Blue-Cross and the rest of the payers want to reimburse a fancy taxi-cab? Again, I don't wish ill to any EMS, but if & whenever Medicare cleans house with fraud & refusal to pay, demands more bang for the money; we will never see a change. But until then, we are going to see a slow hemorrhage of EMS.

In regards to time delay for U/S; it is very fast device to use. Much more faster than hooking up a cardiac monitor or having that green EMT to attempt to start an IV. Would it not make sense to determine if the patient should go to a hospital with vascular capabilities? Or for one to have to wait... call u/s ..then make arrangements for transport and acceptance? Again, the same lame excuses I first heard of not wanting to by-pass ER's based upon severity, wanting to go the nearest one in lieu of the most appropriate.

R/r 911