The Golden Hour - is it a real a principal for EMS?

[JPINFV]

^

ABC, Ambulate Before Carry, right?

[aussiephil]

Why do we need a time frame? Shouldnt ems be flexible or do we blindly assume that the information supplied to us by dispatch is always right & treat blindly what is there?

I'd wager this is not the common practice in Australia, and I'm relatively certain it isn't in the U.S. This is definitely a step in the right direction, but everyone has a different set of circumstances to deal with.

My point is that we need to re educate people right across EMS that in many cases we do have time on our side. We need to make right decisions regarding patient care & what will be best for the long term outcome of the patient. Not work on the 3 P's - Pick em up, Pack em in & Piss em off.

The main problem that ems comes across & the lowest common denominator is the emt/medic who wants to think that they can provide more than pre hospital primary care. We are not' date=' & should never think we are medical practitioners. We are pre hospital care providers & as such treat problems symptomatically. [/quote']

How, exactly, are we not medical practitioners? EMS is a very specific MEDICAL field. It is significantly different from any other MEDICAL endeavor, but it is still medicine. Even, as you describe, treating symptomatically is much the same as physicians will do. Sure, MD/DO's have more education, and tools at their disposal, but they are still treating symptoms, right?

AZCEP, we perform a service that is pre hospital medicine. It is protocol/guideline driven. We have limitied diagnostic tools & much of our Provisional Diagnosis is supposition, not coming from diagnostic tools, & yes in the initial instance they will continue to treat a patient symptomatically, until they have the ability to confirm the persons illness through the appropriate diagnostic testing & then amend their treatment accordingly. Do you consider yourself to be as educated & medically knowledgable as a doctor, specifically an ER specialist & will they continue the treatment you have instigated without doing their own assessment first?

We need education to make our assessments of the patients conditions & to make our provisional diagnosis & in many cases we are correct' date=' this doesn't put us on par with a Doctor.[/quote']

.

Then where do we start? It has to have a starting point & pre hospital medicine, along with all medicine needs to have its education of things like traume, Acute Coronary Syndrone & many others treatments based on Evidence Based Practice. To put your head in the sand & say

Until we can achieve the backing of those that put this system in place to begin with--namely physicians--we will never be able to break from the mantra. Just as there are so many ridiculous mnemonics, or sayings, that are used on a daily basis that need to be expunged from having ever being uttered to a student of EMS. The providers in the field have to agree that the old standby's just don't have a place any longer. Everything from A-B-C's to "treat the patient not the monitor", will continue to be mentioned and taught, evidence or not

we are condoning the old ways that will not allow us to move forward. We need to challenge our medical directors, those on protocol committees etc to change, but we need to do it with evidence. We need to prove they are teaching the wrong thing & start the change now.

This is a generational problem, but until we allow each person to take ownership, the same crap will be sprouted in 100 years from now with no change.

[aussiephil]

Why do we need a time frame? Shouldn't ems be flexible or do we blindly assume that the information supplied to us by dispatch is always right & treat blindly what is there?

I'd wager this is not the common practice in Australia, and Iamb relatively certain it isn't in the UA.S. This is definitely a step in the right direction, but everyone has a different set of circumstances to deal with.

My point is that we need to re educate people right across EMS that in many cases we do have time on our side. We need to make right decisions regarding patient care & what will be best for the long term outcome of the patient. Not work on the 3 P's - Pick em up, Pack em in & Piss em off.

The main problem that ems comes across & the lowest common denominator is the emt/medic who wants to think that they can provide more than pre hospital primary care. We are not' date=' & should never think we are medical practitioners. We are pre hospital care providers & as such treat problems symptomatically. [/quote']

How, exactly, are we not medical practitioners? EMS is a very specific MEDICAL field. It is significantly different from any other MEDICAL endeavor, but it is still medicine. Even, as you describe, treating symptomatically is much the same as physicians will do. Sure, MD/DO's have more education, and tools at their disposal, but they are still treating symptoms, right?

AZCEP, we perform a service that is pre hospital medicine. It is protocol/guideline driven. We have limited diagnostic tools & much of our Provisional Diagnosis is supposition, not coming from diagnostic tools, & yes in the initial instance they will continue to treat a patient symptomatically, until they have the ability to confirm the persons illness through the appropriate diagnostic testing & then amend their treatment accordingly. Do you consider yourself to be as educated & medically knowledgable as a doctor, specifically an ER specialist & will they continue the treatment you have instigated without doing their own assessment first?

We need education to make our assessments of the patients conditions & to make our provisional diagnosis & in many cases we are correct' date=' this doesn't put us on par with a Doctor.[/quote']

.

Then where do we start? It has to have a starting point & pre hospital medicine, along with all medicine needs to have its education of things like trauma, Acute Coronary syndrome & many others treatments based on Evidence Based Practice. To put your head in the sand & say

Until we can achieve the backing of those that put this system in place to begin with--namely physicians--we will never be able to break from the mantra. Just as there are so many ridiculous mnemonics, or sayings, that are used on a daily basis that need to be expunged from having ever being uttered to a student of EMS. The providers in the field have to agree that the old standby's just don't have a place any longer. Everything from A-B-C's to "treat the patient not the monitor", will continue to be mentioned and taught, evidence or not

we are condoning the old ways that will not allow us to move forward. We need to challenge our medical directors, those on protocol committees etc to change, but we need to do it with evidence. We need to prove they are teaching the wrong thing & start the change now.

This is a generational problem, but until we allow each person to take ownership, the same crap will be sprouted in 100 years from now with no change.

[AZCEP]

I'm not suggesting that we do need a "time frame". Merely that the system that is in place has bought into the supposition that we do. Until we can break from the tradition, it will continue to be taught with little evidence that it is beneficial.

I'd wager this is not the common practice in Australia, and Iamb relatively certain it isn't in the UA.S. This is definitely a step in the right direction, but everyone has a different set of circumstances to deal with.

My point is that we need to re educate people right across EMS that in many cases we do have time on our side. We need to make right decisions regarding patient care & what will be best for the long term outcome of the patient.