Appropriate use of ALS providers.

[PRPGfirerescuetech]

Do we all need to be Paramedics? How many is too few? Too many? Where is the balance?

[AZCEP]

Really depends on the type of system you are dealing with.

The more rural, or distant from a receiving facility, the greater the need for ALS providers. Unfortunately, these places don't usually have the finances to support paramedics. The closer to a facility, the less paramedics are truly needed, but the urban centers can afford the level easier.

Interesting conundrum you've hit on here. 8)

[Asysin2leads]

If I had my way, every person in the United States of America and the world would have access to 24/7 coverage of ambulances staffed by two paramedics. The arguement against this is that very few calls require ALS intervention. My answer to that is that while that may be true, patients do not lay along the lines of ALS or BLS. Patients are patients and should be treated by appropriately trained and educated providers. Not only that, but I believe there are some calls that are traditionally thought of as needing only BLS could benefit from ALS. My best example of this is a non-critical extremity injury. Just because having your leg broken in a few places won't kill you, doesn't mean you won't benefit from some ALS pain management.

In an ideal world, the people on the ambulance would be well trained and educated professional specialists in their field, able to recognize and treat life threatening illness and injury, as well as being able to handle non-critical patients with appropriate management. A good paramedic should be able to switch roles and perform what ever task is necessary to aide the patient.

[Dustdevil]

Ever person employed on an EMS providing unit should be a degreed paramedic.

I really don't care what training ambulance drivers do or do not have. It has nothing to do with EMS.

[SARgal]

I was just wondering this same thing ... should we all be paramedic certified, eliminating MFRs, Basics? I'm still in Basic school and am learning, more than anything, how little I will be certified to do to help someone.

We're a very rural paid volly service. The nearest hosp with ALS service is at least 20 minutes out; the nearest trauma hosp is 45 min away. Usually, when we end up calling ALS, it's off to the larger/trauma hosp as well. Doesn't it just make sense that we are ALS providers?

Yeah, financing is a HUGE issue.

Population (year 2000): 614

Median resident age: 45.1 years

Median household income: $24,545 (year 2000)

Median house value: $33,400 (year 2000)

We can barely keep the darn school running. But personally, *I* live here by choice, and I am willing to pay more in taxes to live here, to support better emergency care and better education. I say raise the taxes and let those that don't like it leave.

Most here don't ask my views on these issues... They'd rather to bury their heads in the sand and wait for the day the township magically recovers and becomes a great place to live.

Whoops, uh... what was the topic again?

Do we really need Basics, should we all be paramedics? So um, yeah, I've been mulling this over also. I'm leaning toward all paramedics.... I'm starting to think that if you decide to be a pre-hospital provider, you should be able to provide. Call me crazy.

[hfdff422]

It won't happen overnight, but all transporting providers do eventually need to be ALS. This is a fight we all need to take up. There is a place for EMT-B's, but that is as first responders only. The money will not appear overnight, but it can be found. That swimming pool in the school or that $200,000 restroom at the park can go a long way towards improving services. We just need to make the public realize what they are spending their money on and what they could have instead.

[Dustdevil]

Excellent! Plus 5 for making that point in a much shorter, more succinct post than I would have.

The really sad thing is how many people in EMS lack the imagination or foresight to figure that very simple fact out.

[everyminutesucks.com]

No disrespect to Medics but where do you draw the line?? With those arguments would it not be better then to have nothing by MD's respond to calls? They are far more educated than medics. Or how about nurses? That is a much closer step up but they do have far more education as well... If we can find the money for 2 medics then why not 2 docs. or 2 nurses? It has also been shown that bls providers have higher save rates on severe trauma calls because the spend less time trying to diagnose the pt and are much more likely to load and go.

Again I am just trying to play devils advocate here. I don't think the answer is to just dump more money into a system that is already floundering as it is. (the healthcare system) It is increasingly difficult for hospitals and ambulance services to get reimbursement as it is. And while I want the best for my family and myself as well, I can not justify an increase in costs like that for pain meds or a lot of other things.

I hope I didn't ruffle to many feathers.

[BushyFromOz]

No disrespect to Medics but where do you draw the line?? With those arguments would it not be better then to have nothing by MD's respond to calls? They are far more educated than medics. Or how about nurses? That is a much closer step up but they do have far more education as well... If we can find the money for 2 medics then why not 2 docs. or 2 nurses? It has also been shown that bls providers have higher save rates on severe trauma calls because the spend less time trying to diagnose the pt and are much more likely to load and go.

Do you not feel that pe-hospital care is a specialist field?

The BLS have more save rates on trauma is a pretty simplistic analysis of whatever data your using..could it be that ALS only gets the patienst where BLS goes "Hmmmmbit to messed up for us, better they handle it?" whats the variabls here?

Any service that sets a standard and its met, they should then continually do systems and input v output analysis and decide if A) The standrd needs to be raised again or The way the standard is met needs augmentation.

No one should say "we are happy with where we are so we are not going to change anything", if its not evolving its dying

Anyone who argues against raising the standards of the minimum level of education and training is against quality care.

[BushyFromOz]

Holy Crap! I just realised why they made us do organisational theory! :shock: