whit72 Posted June 20, 2006 Author Share Posted June 20, 2006 Rid wrote: one should be actively involved in changing local and state regulations and protocols. Either your part of the solution or part of the problem... and not being active or promoting change is part of the problem. So I should be fighting to remove this from the protocol? I agree.... actually my barber appears to have a better understanding of pathophysiology than most basics. As well, I would probably trust him more than some basics I have recently seen. At least he does not profess to be "medically trained" and is aware of his limitations. I know your are busy in all your endeavors, maybe one of them should be working towards a more competent EMT training program. AS you stated if you "Either your part of the solution or part of the problem... and not being active or promoting change is part of the problem. Regardless of your beliefs EMT's are actually out there doing calls. There are probably a couple sitting in a truck close to where one of your loved ones lives. God for bid if the tones go off, what then............... Link to comment Share on other sites More sharing options...
ERDoc Posted June 20, 2006 Share Posted June 20, 2006 I agree with all of the above posts as they are stated......more specifically the ones which echo the $$'s issue (as an excuse, not as it being 'right'), and need for increased understanding, education, and assessment abilities on the part of BLS before being able to undertake advaced skills, and or med administration.. I also find it remarkable that noone has commented on the 'short duration' of this med, and the fact that there are many providers who would administer this medication and then take a refusal from the pt only to have the pt, not take appropriate measure to prevent a 'relapse' event of hypoglycemia. Not long ago this was a problem in this area, and it ended with the 'medics' in mass needing to call for med con before accepting or taking a pt refusal, form a diabetic who got this med, and or D50. There were a few instances where pts had 'reflex' hypoglycemia and an MI, a few even 'died'. There were also some similar incidents involving basics and cardiacs in RI as well. Sad but true.... This is just one example of why I am, and continue to be apprehensive about expanded BLS Scope without the appropriate further education.... Out here, ACE844 This is an issue that really grinds my beans. I really bothers me when field crews give D50 for a hypoglycemic while in the house and then wait for the pt to come around and then call for an RMA. Don't give the D50 in the house, wait till you are in the ambulance. The few minutes that it takes to get the pt out of the house. The pt will need to be observed for a while and I just don't trust family members to do it. If they are hypoglycemic due to sulfonylurea use they will need to be admitted for observation at least overnight. Please do your friendly medical control doc a favor and don't give the D50 until you are in the ambulance (unless you can do the RMA without him/her). I will now step off of my soapbox Link to comment Share on other sites More sharing options...
Ace844 Posted June 20, 2006 Share Posted June 20, 2006 This is an issue that really grinds my beans. I really bothers me when field crews give D50 for a hypoglycemic while in the house and then wait for the pt to come around and then call for an RMA. Don't give the D50 in the house, wait till you are in the ambulance. The few minutes that it takes to get the pt out of the house. The pt will need to be observed for a while and I just don't trust family members to do it. If they are hypoglycemic due to sulfonylurea use they will need to be admitted for observation at least overnight. Please do your friendly medical control doc a favor and don't give the D50 until you are in the ambulance (unless you can do the RMA without him/her). I will now step off of my soapbox "ERdoc," Well said, and I will also include the fact that there are other pathphys. d/o's which act to alter BS levels with diabetics which require eval and lab work up by an MD/facility. The fact that there are significant numbers of my colleagues not even able to recognize this at the paramedic level. This further supports the 'fact,' that BLS providers who don't even recieve a smidgen of that education, yet, still after a short 'how to lecture' get to give this med to pts, and potentially cause them harm!!!...... :banghead: It is also concerning that this 'practice' is broadly accepted... :banghead:..But I digress... out here, ACE844 Link to comment Share on other sites More sharing options...
Dustdevil Posted June 20, 2006 Share Posted June 20, 2006 Regardless of your beliefs EMT's are actually out there doing calls. There are probably a couple sitting in a truck close to where one of your loved ones lives. God for bid if the tones go off, what then............... Maybe where you're from. Not me. No EMT's in EMS here. Although I suspect you probably consider carrying grandma to dialysis for Joe Bob's Ambulance and Wrecker Service to be "EMS." I don't. I would not live in a community that did not provide full-time professional paramedics. I care more about my life and my family than I do promoting wanker jobs for unemployable illiterates. Link to comment Share on other sites More sharing options...
ERDoc Posted June 20, 2006 Share Posted June 20, 2006 Maybe where you're from. Not me. No EMT's in EMS here. Although I suspect you probably consider carrying grandma to dialysis for Joe Bob's Ambulance and Wrecker Service to be "EMS." I don't. I would not live in a community that did not provide full-time professional paramedics. I care more about my life and my family than I do promoting wanker jobs for unemployable illiterates. Dust, do you feel it is a waste of resources using an ALS unit to transport an ankle injury or a wrist injury? Why not keep the ALS units for the ALS calls and let the EMTs transport the pts that don't need the higher level of care? How about in rural areas where there may not be medics? To play devil's advocate, would it not be better to have an EMT, who can contact medical control and be overseen by an MD/DO, give IM glucagon to someone with hypoglycemic seizures with a long transport time than it would for that pt to be seizing for 30-45 minutes? I agree that every area should be covered by ALS, but we have to be realistic and accept that utilization of resources dictates that this is not always possible. Link to comment Share on other sites More sharing options...
Ace844 Posted June 20, 2006 Share Posted June 20, 2006 Dust, do you feel it is a waste of resources using an ALS unit to transport an ankle injury or a wrist injury? Why not keep the ALS units for the ALS calls and let the EMTs transport the pts that don't need the higher level of care? How about in rural areas where there may not be medics? To play devil's advocate, would it not be better to have an EMT, who can contact medical control and be overseen by an MD/DO, give IM glucagon to someone with hypoglycemic seizures with a long transport time than it would for that pt to be seizing for 30-45 minutes? I agree that every area should be covered by ALS, but we have to be realistic and accept that utilization of resources dictates that this is not always possible. "Hello Everyone," Here are some references for those who would like soem point of refrence for what we've said in the past in relation to this topic as well... http://www.emtcity.com/phpBB2/viewtopic.php?t=2893 http://www.emtcity.com/phpBB2/viewtopic.php?t=541 http://www.emtcity.com/phpBB2/viewtopic.php?t=2431 http://www.emtcity.com/phpBB2/viewtopic.php?t=810 http://www.emtcity.com/phpBB2/viewtopic.php?t=723 http://www.emtcity.com/phpBB2/viewtopic.php?t=1183 Hope this helps, ACE844 Link to comment Share on other sites More sharing options...
Dustdevil Posted June 20, 2006 Share Posted June 20, 2006 Dust, do you feel it is a waste of resources using an ALS unit to transport an ankle injury or a wrist injury? No. Do you feel it is a waste of resources using a physician to evaluate every patient that presents to the ED instead of just letting the admissions clerk decide who gets seen by who? Link to comment Share on other sites More sharing options...
ERDoc Posted June 20, 2006 Share Posted June 20, 2006 No. Do you feel it is a waste of resources using a physician to evaluate every patient that presents to the ED instead of just letting the admissions clerk decide who gets seen by who? I'm all for it, lessens my workload. My point is that there is really nothing a medic is going to do for a simple injury or someone with a cold that an EMT can't do. Why not keep the additional education for those that need it (MI, CHF, etc). Link to comment Share on other sites More sharing options...
Dustdevil Posted June 20, 2006 Share Posted June 20, 2006 I'm all for it, lessens my workload. My point is that there is really nothing a medic is going to do for a simple injury or someone with a cold that an EMT can't do. Why not keep the additional education for those that need it (MI, CHF, etc). For the same reason that all ER patients need to be evaluated by a physician. Because you simply do not know what level of care a patient needs until they are competently evaluated by an adequately educated medical professional. You don't diagnose by phone in the ER. Dispatchers shouldn't be diagnosing by phone either. A medic needs to evaluate every patient. If that patient does not need advanced care, fine. But he ALWAYS needs advanced evaluation. Link to comment Share on other sites More sharing options...
JPINFV Posted June 20, 2006 Share Posted June 20, 2006 Isn't there a growing trend in EM where the fast track (minor patients) is covered by midlevel (NP or PA) providers, and in these cases, the patient is normally not seen by an EMP? Link to comment Share on other sites More sharing options...
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