Wierd call. Can you create a scenario that justifies it?

[chbare]

I'm not arguing about the inadequacy of EMS education in the United States; however, I'm not keen on quantifying it with a single number when significant variation exists.

[Kiwiology]

[The] cynical part of me knows from prior experience with virtually any healthcare provider is that everyone seems to think they know better than the medics, and that they have the right to tell them what to do, being that EMS is apparently at the bottom of the medical food chain.

'zilla

You raise a very interesting point and for a moment let me take a little bit of a spin on it

To say (rhetorically) "I know better" is a bit arrogant and/or rude but sometimes you need to be forcefully suggestive to somebody e.g. lets get going to hospital now, this patient is crook, stop snuffing around with that blood pressure or whatever ... let me put another spin on it

I've seen Physicians who are just down right awful, they've put patient with chest pain on one litre of oxygen and then gone to hide in the corner or they get snarky when you elicit from the black women with an IUD, who smokes, who has had two kids previously, who has had multiple sexual partners that she has diffuse abdominal rigidity and pain which makes you think it's an ectopic pregnancy, or they tell you that you couldn't possibly know it's DKA without doing biochemistries for anion gap, pH. glucose, pOsm and testing for ketonuria despite their blood sugar is 30mmol/l (like 600mg/dl) they are polydipsic, polyuric and they stink of ketones.

Many have an attitude of "you're not a doctor so how can you know XYZ or you don't need to ask all these questions just take the patient to the hospital or whatever".

If you're making a total snafu of the situation and somebody picks up on it then there's nothing wrong with telling the other person, again you don't have to be rude but as I said sometimes you need to be forcefully suggestive in the best interest of the patient.

While the attitude of "I know better" seems to be rife in the medical world it's particularly bad amongst EMS I've noticed; that somehow the limited education given somehow justifies a big ego.

And you're clearly an American Physician, you haven't cottoned on to the idea that the House Surgeon is at the bottom of the medical food chain

(in most commonwealth nations/ outside the US/Canada you must do one or two years post-graduation of general hospital experience before applying for specialist training)

[DFIB]

Our course is 290 didactic hours. For certification students will now have to have 40 hours of service a month for a year, including 50 radio hours and 80 hospital hours. The deficiency is that many of the existing proctors are EMT-B’s as well and probably not as prepared as the students.

[chbare]

Is this in the United States? That is a pretty meaty EMT curriculum compared to many in the United States. Not that I am complaining however. I'd live to discuss your curriculum if possible assuming it is based on the NSC. A couple of other EMS educators and I and pushing for significant changes to our EMT, AEMT and paramedic curriculum.

[jonas salk]

I find this unusual; many times we've taken the family member with us to hospital; it's just something normal here; in fact it's a breach of the patients legal rights not to allow this (unless they endanger the crew) and I think its unethical even if wasn't part of the law.

I'd say about 75% of the time I'd have no issues with taking family with us, however I often do suggest that it's better for the family to take their personal vehicle (if they have one) as it gives them better options to get home.

I was also thinking about this story as I was driving into work last night, one thing that struck me was that crew and the hospital stated that the weather was particularly bad, yet they opted to leave this woman at the side of the road during blizzard like conditions?

[Kiwiology]

I'd say about 75% of the time I'd have no issues with taking family with us, however I often do suggest that it's better for the family to take their personal vehicle (if they have one) as it gives them better options to get home.

Good point

[DFIB]

Is this in the United States? That is a pretty meaty EMT curriculum compared to many in the United States. Not that I am complaining however. I'd live to discuss your curriculum if possible assuming it is based on the NSC. A couple of other EMS educators and I and pushing for significant changes to our EMT, AEMT and paramedic curriculum.

It is in Mexico. I teach as a volunteer for the Red Cross. I will e-mail you our curriculum. The practice hours are different now because changes were just implemented this year. Before there was no certification test so the course was "beefy" to make up for it. There is also a nationwide deficiency among instructors. Many of them have only been EMT's for a short time and teach out of the sheer need for instructors. As with most volunteer services the best and the brightest will eventually move on. We have a saying that "volunteers are not always the best, simply available."

Changes implemented this year will include certification testing and an extended third ride period.

Edited February 8, 2012 by DFIB

[island emt]

Actually , the course my wife taught last semester ended up at 185 hrs plus clinicals and ride times which brought the total time to around 240 hrs.

We added in 2 8 hr Saturdays for hands on exercises such as applying a KED in a vehicle and used several different scenario based "calls" to get the students comfortable with what they had learned.

Yes they all knew how to properly apply a KED while the Pt was sitting in a chair, now put them in a tiny car and make the adjustments to put it into practical knowledge. The current course practicum has lots of new requirements  that require additional hrs to get through.

[jonas salk]

Still 240 hours is not even close to being adequate; that's just a first aid course.

[DartmouthDave]

Hello, The patient's wife is a NP with critical care expereince. Here is a better article:

http://thechronicleh...-ns-man-s-death

Personally, leaving the wife on the highway and returning to the ski hill was odd.A very sad case.Cheers

Edited February 9, 2012 by DartmouthDave