Do we diagnose, rule in/out, or just load and go.

[crotchitymedic1986]

That's all well and fine, Vent. And none of it is going to make me tell my chain-smoking asthma patient who has no air conditioner for the summertime that because I gave her an albuterol treatment as she requested, she now has to go to the hospital whether she like it or not in spite of her desire to refuse without prompting, adequate mentation, normal vital signs, and no evidence of hypoxia.

You just put a bandaid on the problem. IF aerosol treatments solved the problem, the inhaler the patient used 7 times before she called 911 would have stopped her symptoms. Pt should be transported.

[CBEMT]

You just put a bandaid on the problem. IF aerosol treatments solved the problem, the inhaler the patient used 7 times before she called 911 would have stopped her symptoms. Pt should be transported.

No shit, Sherlock. And Are you going to apply physical restraints and carry her to the ambulance in order to accomplish that? Because I'll be out on the sidewalk speed-dialing the Department of Health.

[freethinker]

Googling it basically finds what Britain calls a "superparamedic." This person works under the authority of a physician, and still has a primary goal and cognitive process of assessment. Field EMS, again, requires a different approach than hospital or clinic practice by necessity of circumstances. This is true even in continental Europe where "everybody sees a doctor."

A PA or nurse practitioner can preliminarily "diagnose" strep throat or other infection, and in many underserved settings may even set up a private practice. However, such a "diagnosis" must still be approved by a bona-fide physician.

A smarter allied health provider, who might even know the differential process were the diagnostic tests available, is still just that, a smart allied health professional- not a doctor.

[scott33]

Googling it basically finds what Britain calls a "superparamedic." This person works under the authority of a physician.

No they don't.

They are autonimous practitioners in their own right, employed by the NHS. No such thing as medical control in the UK. They are required to carry their own controlled substances (as are all UK paramedics) which they are lawfully allowed to obtain, independantly, from a pharmacy. This can be stored in their own homes / vehicles if they wish.

Usually a loaners job in the responder vehicle, they can request ambulance backup for transport, treat and release, or order follow up work / lab tests off their own back. They can even "admit" patients to specialist units if needed, all without the need to "ask mummy".

This is just one example of where US EMS should be.

[freethinker]

Judging by the information on them, they are similar in some ways to a PA or NP in the US. Except Europe does not have PAs and NPs, and the US versions are not geared for the prehospital environment. Emergency practitioners can work outside the EMS framework, such as in clinics, and in some cases order diagnostic tests. Maybe we need to have PAs or NPs riding on our ambulances. Certainly having the smartest provider possible benefits patients in all settings, limited or controlled. Oh, woops, they wouldn't need us anymore then. That would really suck. Maybe we should all go to medical school.

[WolfmanHarris]

You have to ask yourself then are you in this for the medicine and patient care or for the job? Either is fine, but just be clear on your motivation. If you want to keep your job secure above all else, than by all means resist change that might push EMS into a realm that's uncomfortable for you. You may also find the IAFF a useful resource for tactics. There's nothing wrong with self-interest.

If you're interested in the patient care, than recognize that we've got a lot of growing to do in EMS in terms of education and our delivery models. If that means integrating PA's, NP's or other advance practice providers into EMS to help pull us away from "you call, we haul" than welcome that. Yes this might mean that we as Paramedics find ourselves in a system that we might not instantly recognize, but that's not necessairly a bad thing. Yes Basics and other BLS providers (myself included) might find themselve on their way out of EMS long-term, but that doesn't mean you can't increase your education.

Realistically we're all interested in both to varying degrees.

As far as Physicians on Ambulances, look up SAMU in France. Physicians are a big part of EMS over there, though that is changing. Traditionally BLS is provided by FD and hospitals have SAMU units that have a physician on board and handled ALS. Unfortunately a shortage of Physicians has resulted in them training RN's to take over ALS pre-hospital roles.

[VentMedic]

That's all well and fine, Vent. And none of it is going to make me tell my chain-smoking asthma patient who has no air conditioner for the summertime that because I gave her an albuterol treatment as she requested, she now has to go to the hospital whether she like it or not in spite of her desire to refuse without prompting, adequate mentation, normal vital signs, and no evidence of hypoxia.

How do you know she's not hypoxic? Your pulse oximeter tell you that? Did you get a CO2 or CO level? Normal vital signs for her or just by a textbook? Was the call for difficulty breathing or shortness of breath?

If her living conditions are as you described, the first thing I would do is remove her from an irritating environment to an air conditioned ambulance. Once in the back of the truck, you will have the advantage and she might even enjoy the AC. Giving a nebulizer in a hot and smoky house is of no benefit. The only thing accomplished is maybe raising her PaO2 momentarily with the O2 running the neb giving her a "good feeling".

You are also letting her known history dictate the treatment. Just because she has a hx of asthma does not mean it is the asthma causing her breathing problems. If she has a long smoking hx or any pulmonary hx, she may have a much more serious condition forming that should be diagnosed at a hospital.

It is too bad that some EMS companies do not link themselves with social welfare agencies to get repeat patients assistance instead of just bitching about them.

[scott33]

Judging by the information on them, they are similar in some ways to a PA or NP in the US. Except Europe does not have PAs and NPs

Sorry, don't think I am picking on you here as I am not. But PAs and NPs do exist in Europe (UK), just not to the same extent as far as numbers go.

[CBEMT]

I'm surprised you can see us mere mortals from the saddle of that horse, Vent.

I did the best I could with what I had- a patient who wanted some albuterol and a little attention, and who refused to be transported or even leave the damn house under any circumstances. No matter what zebra medical condition I tried to scare her into the truck with.

[VentMedic]

I did the best I could with what I had- a patient who wanted some albuterol and a little attention, and who refused to be transported or even leave the damn house under any circumstances. No matter what zebra medical condition I tried to scare her into the truck with.

I guess it is a good thing you don't carry other meds as an EMT that patients ask for.

Next time try using the patient's air compressor and see if she feels fine afterwards. Some patients just want the O2 fix and not the albuterol.