EMT's Performing Selected ALS?

[BEorP]

No, Asysin2leads, I can assure you no one who isn't a medic is playing around with Lopressor, its a new medication (to our agency) that our Paramedic's can use. To answer your question about supervision, protocol states that the EMT can start IV's under the Medic's supervision. Like for instance the Cardiac arrest we had today. I started 2 18 G IV's one in each AC for med and fluid acsess while my Medic was intubating.

Was there a problem controlling the airway with BLS? If not, then why did you not just control the airway with BLS while you let the EMT-P obtain IV access?

Maybe the answer is because you can, but would the pt outcome have been any different if you took the airway and let the EMT-P perform ALS?

[Asysin2leads]

In response to Nifty's post, I'm gonna delve into a little economic theory, the knowledge of which seems to be severely lacking in EMS as a whole. Okay, so we here in the rank of paramedic are, and while it may be debatable, pretty much skilled labor. We have a skill which is economically viable. Therefore, as skilled laborers, we like to get a reasonable amount for the use of our skills. Our interests lie in getting the highest pay for our skill, increased demand of our skill means increased wages.

Management, on the other hand, who recieves money from billing, but then pays out a portion of that to salaries, wants to pay the least amount out while getting the most amount of labor, which generates the revenue. Many, many, many a labor dispute has been over increased duties without an increase in salaries. Go ahead, go ask a carpenter on a construction site if he wouldn't mind emptying the garbage bins at the end of the day. He's liable to hit you with his hammer. However, compensate him to empty the garbage bins, and you'll have much more luck.

EMS I believe is fairly unique in that we have a workforce which kicks down the door to take on as much responsibility and tasks as possible with out being compensated for such. I'm an EMT. Give me the IV's, Give me the LMA, give me Hazmat training and counter terrorism training and have me patrol the streets on my off time, hell, you don't even have to pay me! I'll do it for free!!! I

Trust me when I say this attitude has a real effect on the wages of EMS providers. If you went to my college website, you'd see that the AAS program for paramedic is 60 credits and the AAS program for nursing is 65 credits. Not too much difference in terms of educational requirements. Now, I will plead ignorance to the extent of an AAS nursing program or the demands of the job of nursing versus being a paramedic. That's not what I'm debating. What I saying is that given the educational requirements, the fact that at top salary, with overtime, I'll be making around $65,000 (gross), vs. something like $80,000 or higher for a nurse of similar education and experience, is absurd. There are a lot of factors as to the salary differential, but fact that you rarely see nurses volunteering to show up at your house and treat you for free has a lot to do with it.

There are areas in this country that are economically depressed enough that cannot afford professional emergency services. I say in these areas EMT-I's or advanced EMT's are better than nothing, but other than that, the only people that advanced EMT's benefit are the people who actually get paid the money from the insurance companies. Don't be a tool of the bourgeois elite. Unite with your fellow workers. Dosvedanya, comrades.

[ERDoc]

Was there a problem controlling the airway with BLS? If not, then why did you not just control the airway with BLS while you let the EMT-P obtain IV access?

Maybe the answer is because you can, but would the pt outcome have been any different if you took the airway and let the EMT-P perform ALS?

Probably because in the secondary ABC's of ACLS, securing the airway comes before IV access.

[ERDoc]

In response to Nifty's post, I'm gonna delve into a little economic theory, the knowledge of which seems to be severely lacking in EMS as a whole. Okay, so we here in the rank of paramedic are, and while it may be debatable, pretty much skilled labor. We have a skill which is economically viable. Therefore, as skilled laborers, we like to get a reasonable amount for the use of our skills. Our interests lie in getting the highest pay for our skill, increased demand of our skill means increased wages.

Management, on the other hand, who recieves money from billing, but then pays out a portion of that to salaries, wants to pay the least amount out while getting the most amount of labor, which generates the revenue. Many, many, many a labor dispute has been over increased duties without an increase in salaries. Go ahead, go ask a carpenter on a construction site if he wouldn't mind emptying the garbage bins at the end of the day. He's liable to hit you with his hammer. However, compensate him to empty the garbage bins, and you'll have much more luck.

EMS I believe is fairly unique in that we have a workforce which kicks down the door to take on as much responsibility and tasks as possible with out being compensated for such. I'm an EMT. Give me the IV's, Give me the LMA, give me Hazmat training and counter terrorism training and have me patrol the streets on my off time, hell, you don't even have to pay me! I'll do it for free!!! I

Trust me when I say this attitude has a real effect on the wages of EMS providers. If you went to my college website, you'd see that the AAS program for paramedic is 60 credits and the AAS program for nursing is 65 credits. Not too much difference in terms of educational requirements. Now, I will plead ignorance to the extent of an AAS nursing program or the demands of the job of nursing versus being a paramedic. That's not what I'm debating. What I saying is that given the educational requirements, the fact that at top salary, with overtime, I'll be making around $65,000 (gross), vs. something like $80,000 or higher for a nurse of similar education and experience, is absurd. There are a lot of factors as to the salary differential, but fact that you rarely see nurses volunteering to show up at your house and treat you for free has a lot to do with it.

There are areas in this country that are economically depressed enough that cannot afford professional emergency services. I say in these areas EMT-I's or advanced EMT's are better than nothing, but other than that, the only people that advanced EMT's benefit are the people who actually get paid the money from the insurance companies. Don't be a tool of the bourgeois elite. Unite with your fellow workers. Dosvedanya, comrades.

Asys, great post, but I have to call you on it. Not very many nurses make $80,000, especially with an AAS. From what I have been told, the AAS nurses are finding it harded and harder to find jobs because most places want BSNs. Most of the BSNs that I have known make between 40 and 60K per year with overtime. I hope some of the nurses on here will correct me if I am wrong.

[BEorP]

Probably because in the secondary ABC's of ACLS, securing the airway comes before IV access.

From the other thread I now gather that there were issues (i.e. vomiting) that created the need for advanced airway management in this case.

But in general, I was under the impression that in the ACLS secondary "A" could be secured by BLS measures as long as they are sufficient. I'm not an ALS provider so I am not up on these things as much as most of you so please enlighten me.

[ERDoc]

From the other thread I now gather that there were issues (i.e. vomiting) that created the need for advanced airway management in this case.

But in general, I was under the impression that in the ACLS secondary "A" could be secured by BLS measures as long as they are sufficient. I'm not an ALS provider so I am not up on these things as much as most of you so please enlighten me.

There is no such thing as an airway secured with BLS measures. An airway is only secure when there is a tube below the vocal cords (ETT or true surgical airway). BLS measures are temporizing measures until a secure airway can be established.

[BEorP]

Opps... I guess I didn't mean "secured" but just "managed" but thanks for the explaination.

[Asysin2leads]

Asys, great post, but I have to call you on it. Not very many nurses make $80,000, especially with an AAS. From what I have been told, the AAS nurses are finding it harded and harder to find jobs because most places want BSNs. Most of the BSNs that I have known make between 40 and 60K per year with overtime. I hope some of the nurses on here will correct me if I am wrong.

ERDoc, I realize most nurses do not make the same amount nurses around my area do. However, I do have it on good authority that per diem nurses are making around $40 an hour straight time. 40 x 40 = 1600 x 52 = 83,200. Anyway, if your paramedics are making more than your AAS nurses in your area, then God bless. The bottom line is that I believe paramedics, as a whole, make far less than similarly trained positions, and part of its due to the depression caused by people willing to work for free. That's my line and I'm sticking to it.

[ERDoc]

ERDoc, I realize most nurses do not make the same amount nurses around my area do. However, I do have it on good authority that per diem nurses are making around $40 an hour straight time. 40 x 40 = 1600 x 52 = 83,200. Anyway, if your paramedics are making more than your AAS nurses in your area, then God bless. The bottom line is that I believe paramedics, as a whole, make far less than similarly trained positions, and part of its due to the depression caused by people willing to work for free. That's my line and I'm sticking to it.

Ahh, per diem yes. They make some great money (no benes). I was talking about full timers. I know the nurses out on the Island don't make that much. Full time makes less than $35/hr. I know a nursing supervisor from a dialysis unit in Queens who was making about $38/hr with 20+ years of experience.

[PRPGfirerescuetech]

Charge nurse for a dialysis unit?

Is it me, or is that 38/hr job sound just a bit too simple...i mean really...