Perfect EMS

[Thunderchild145]

My service uses the "partnered" system Dust was talking about with a Paramedic partnered with a Basic. I think it works well because most (note: most) of our basics are capable and know what needs to be done. They really help the paramedics. Here in Arkansas I'm pretty sure that the emergency ambulances all have to have a paramedic on them, but we also have many first responder squads in the area that are staffed by MFRs and EMT-Bs. Usually they get there before the paramedic. I can appreciate an extra hand when it's offered.

The other thing about my area is that EMT-Bs are a dime a dozen, but paramedics are gold here because there aren't many of them.

[zippyRN]

Treat and Release....which in turn requires paramedics to make a patient diagnosis. For complicated cases this can only be achieved through a variety of tests including blood work and radiology.

in which case you won't treat and release

but what about

the known type 1 diabetic who hypos and comes round with some glucose gel or a shot of glucagon, has someone with them, means to get some complex carbs on board and a ride home ...

the 'whipcash' neck pains at low speed RTCs...

the ottawa negative ankle injury ... or even an ottawa positive ankle injury where there is someone to run them up to the minor injuries unit for the X ray ...

the none life or limb threatening wound that needs formal closure in the next few hours but there is no reason why thwy can't go to a minor injuries unit under their own steam

the 'difficulty breathing' cat A who is nothign more than a case of man flu ...

all stuff that could be treated and released at scene by a decently educated tech never mind a Higher Education prepared paramedic

In prehospital medical treatment, this is not an option as these tests 1) require expensive medical equipment not available on an ambulance 2) take a great deal of time, 3) are interpreted by doctors. However, there are a number of non emergent cases seen in the hospital which could be treated in the field. Before giving paramedics the ability to rule out conditions and release patients after an examination, they must receive higher education. They must have the ability to rule out underlying symptoms and illness. Similar to a physicians assistant, they would still be required to confer with a doctor/medical control.

or like Emergency Care Practitioners and Nurse Practitioners in UK Minor Injuries Units and Emergency Depts. act as a autonomous health professional act within theoir own professional scope of practice and discharge / refer / admit as approrpaite

By removing non emergent cases from the ER, and giving paramedics the ability to treat, release, and refer patients to primary care providers, hospitals ER's and the EMS system will be relieved of the burden that non emergent care puts on the facilities (use of healthcare resources and healthcare costs). The available funds produced can be used for continuing education of personnel and upgrading of facilities.

Without an ability to pay, healthcare costs skyrocket. For every uninsured patient who enters the ER experiencing a non emergent condition, which could have been treated and released by a qualified paramedic, costs the general public several thousand dollars in tax resources. This cost is budgeted into EMS systems and hospitals. Hospitals are required to examine all patients, regardless of ability to pay (EMTALA). But if the examination and treatment paramedics provide could fulfill the EMTALA law, millions of $$$ would be saved. This money has countless uses. Including being able to morph prehospital treatment into advanced levels of care through medical technology research to put efficient laboratory and radiology equipment on all purpose rescue ambulances.

or just sticking to using expensive tests where they will affect the treatment of the patient - hence hte reason for the various imaging rules because of the huge burden of unneccessary 'medicolegal' Imaging with the assocated X ray exposure this brings happening o nthe left of the pond ... ditto for haematoloy and clinical biochemistry

[zippyRN]

What would be the purpose in having a doctor on an ambulance? They are highly skilled and educated but they also know a lot more than they need to (e.g. there is not need to interpret an x-ray in the field right now). There's also EMT-Bs in the US who I would consider no more than ambulance drivers and maybe sometimes give them the credit of being medical technicians. So where do we draw the line? It's hard to say for sure but obviously somewhere in the middle. I think a good start is a four year degree with a large focus on patho to ever be able to call yourself a Paramedic and respond to my family's call for help.

doctors in prehospital care

safe and effective critical care medicine and surgery when you need it on the streets it;s there - look at the UK model of provision particularly LondonHEMS (ground units as well as air) , WMCARE , ATACC , SJMRWY plus the air ambis that fly with flight physicians ...

EMT-Bs = really first aiders with extended skills - same quantity of training in the Uk would have you viewed as a first aider with extended skills and perhpas you'd be allowed to use a first response vehicle on a large event where there was lots on site Ambulanc,e Paramedic, Nursing and Doc backup ...

Higher education for parmedics -absolutely!

[Timmy]

While were on the subject of training and EMT's. This is what the aussie EMT-B course is:

Is there much difference? EMT in Australia is mainly for workplace first aid and event coverage.

Anatomy and Physiology

Primary Assessments (Basic Life Support)

Patient Assessment and History Taking

Documentation of Records & Reports

Scene Size Up - Kinematics

Airway

Hypoxia

Bag Valve Mask Resuscitators

Manually Triggered Ventilators

Oropharyngeal Airways

Suction Equipment

Airway - Advanced Laryngeal Mask Airway

Cardiovascular Emergencies

Respiratory Emergencies

Cardiac Defibrillation

Automated External Defibrillation)

Diabetes and Altered Mental States

Poisoning and Overdoses

Shock and Haemorrhage

Moving and Lifting Patients

Environmental Exposure

Soft Tissue Injuries

Chest Injuries

Pharmacology

Inhaled Analgesia (Entonox/Penthrane)

Medication Administration (Injection Procedures)

Head and Spinal Injuries

Musculoskeletal Injuries.

Patient Transport and Immobilisation Cervical Immobilisation

Kendrick Extrication Device

Stretchers & Spinal Boards

Introduction to Triage

Holistic Assessments

Advanced Airway Management

IV Fluid Therapy

Wound Closure

Medical First Aid - Marine

Non Emergency Patient Transport

[BEorP]

Advanced airway management and IV therapy?

[JPINFV]

Timmy, the list isn't nearly as important as the depth that it's covered in. We probably went over some basic IV thearapy and did a little intro into advance airways in my EMT-B class. It doesn't mean that we can use them or anything.

[Timmy]

Airway Management covers intubations.

I.V, were taught how to put a line in and then up them up on I.V Saline.

As I said this any sort of EMT course is only for workplace first aid and event coverage. They don’t ride on ambulances.

[BEorP]

Airway Management covers intubations.

I.V, were taught how to put a line in and then up them up on I.V Saline.

As I said this any sort of EMT course is only for workplace first aid and event coverage. They don’t ride on ambulances.

Are you saying that EMT-Bs in Australia are trained in intubation or know what it is?

[jw-c152]

Timmy, in your list you stated "Airway - Advanced Laryngeal Mask Airway"

Then you went on to say EMTs intubate.

LMA and ET Intubation couldn't be much further from the opposite ends of airway management. The LMA (or plastic vagina as it is known as here - for it's shape!!! Heads out of the gutter...) isn't used very much in the pre-hospital setting (offhand I can only think of 2 services (PCP [bLS]) in Ontario that use this device. I used to work for one of them, and used the LMA a handful of times on VSA patients. I'd say it was better than an OPA but not nearly as reliable as an ETT.

That said, I could see an EMT-B being trained in using an LMA... but if an EMT-B is intubating patients then that's quite scary.

[uncle_salty]

Oh dusty just likes to go the extremes of both levels of training. By his indication all basics are first-aid providers fresh out of a two-weeker, all the while he and his ultra-hip paramedic friends have attended years of advanced scientific didactic lecture at the university level. So understand this: The real truth is that the gap isn't quite as wide as he may lead you to believe. The vast majority of basic programs in the U.S. well exceed the minimum DOT requirements. Most basic courses are 5-month (one semester) programs in which classes are attended 2-4 days a week usually in a community college setting. Add a couple or so semsters of mostly skills/meds training and maybe a A&P class and you've got the typical paramedic. There are exceptions to the rule on both ends of EMS, therein lies the two-week EMT bootcamp - but not without consideration of Illinois' brand spankin' new two-month paramedic course, so do not be deceived into believing the excepetions have become the rule. His apprecation of the cost is spot on, and the reason the basic classes stay full is because that is foundation of all paramedicine in this country, being a mandatory prerequisite to more advanced programs.

Now that the playing field is just a little more level, discuss.