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Inter-facility transports


brentoli

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What are two medics going to do? One of them still has to drive, and the other is not going to tube, obtain access, place pads, and do CPR, and ventilate at the same time. In fact, even if they pull over and the driver gets in back, one of them is still stuck doing CPR and the other is stuck doing all the procedures that aren't, more than likely, going to change the outcome anyway. You're never going to prove in a million years that two medics doing that are going to have a better patient outcome than two Basics who decide to make tracks for the ER while the tech does CPR by himself.

So treatment for cardiac arrest secondary to hyperkalemia isn't something medics can do better than EMTs? Weird.

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methinks someone thinks that EMT's are just as valuable as medics in all situations. hmmmmm All you have to do is get haul ass and get them to a hospital.

I believe that advanced skills and treatments trump basic skills any day according to CBEMT

But I would like to see CBEMT justify why he said that EMT's were just as valuable in a code as medics. I'm curious as to if I missed something.

i am sure that if I ever code I'd like 2 emt's to rush me to the hospital and leave the medics behind, but then again, that's just me. ha ha

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What are two medics going to do? One of them still has to drive, and the other is not going to tube, obtain access, place pads, and do CPR, and ventilate at the same time. In fact, even if they pull over and the driver gets in back, one of them is still stuck doing CPR and the other is stuck doing all the procedures that aren't, more than likely, going to change the outcome anyway. You're never going to prove in a million years that two medics doing that are going to have a better patient outcome than two Basics who decide to make tracks for the ER while the tech does CPR by himself.

1. You're assuming that a cardiac arrest should be a load and go situation in all cases.

2. At least with 2 paramedics you can switch off doing compressions.

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People- it's A CARDIAC @#$%ING ARREST- what do you THINK the outcome's going to be? Throw a doctor who happens by in there too while we're making up stories about two medics switching off compressions in the back of the truck..... while they go nowhere. Doesn't matter.

1. You're assuming that a cardiac arrest should be a load and go situation in all cases.

When you're already moving at the moment of code it is!

Not one of you can prove anymore successful outcome to two medics coding a patient by themselves when it occurs during a routine or any other transport any more than I can prove two Basics could successfully complete an IABP transport. How bout we leave it at that.

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CBEMT - step away from the KoolAid and take a breather.

hmmmm cbemt, let's see

Cardiac arrest secondary to foreign body airway obstruction - advanced airway using magill forceps to remove the foreign body - hmmm can an emt use magills and remove the FB?

Cardiac arrest in the back of the unit - one round of epi and a good shock and I've had patient's have a ROSC.

Remember CB witnessed arrests have a much more favorable outcome than ones that are not witnessed.

The arrest that akroeze pointed out - medics can reverse that situation but then again, two emt's must be better.

There are things that basics cannot do in the back of an ambulance and I guess that we will have to disagree on this one. If you aren't a medic why don't you wait to pass this type of judgement until you are.

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If you have a competent partner and you are a competent medic, all you need when you leave the scene with a code is a first responder or EMT to help with the code. Set your drugs out on the actionary or within reach and do your job. As a medic, you should not be above doing chest compressions and drugs only have to be pushed every two minutes. Efficiency is the key and basic skills are a must.

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I happen to work for a non emergent transport company. I have also worked for a 911 agency that paired Paramedics/Basics then went to Paramedic/Intermediate due to the fact that the state expanded the Intermediate scope to include 12-leads and expanded the drugs an Intermediate can administer. I have also been a GM of a 911 volunteer transporting agency. Enough of the bio. I put these thoughts to the readers of this thread.

Should EMS be doing non emergency transports or should we just be doing the emergency ones alone? Well it would seem to me; that is not the question we should debate.

First, Emergency Medical Services, services is the key term to frame my response to this question. From the service point of view we should do both. This is why I said "we should not be debating the question". I would like to reframe the question like this If we take both emergent and non emergent transports, how should each be handled? You see my point. It should not be if we should do them, because the public in general has already answered that question and the task has already been given to us to do. So now that we have been assigned the task, the question should be how to do them. I have many opinions on the how, none of them worth telling here to the readers of this thread. Instead I would only like to pose a few questions as to how you the reader think we should handle them. Should paramedics be taking granny home, or transferring a multi-system trauma that has already been in the hospital for four months a thousand miles to a local hospital closer to their home for the rest of their hospital stay? The last sentence was just one example of what we are talking about. I do not want to degrade into what if the sky fell down thinking. Or should a Basic take this call? in either case should it be done in a wheel chair van or an ambulance? Will both pt. benefit one way or the other? Can both pt be transported the same way, in a wheel chair for example?

Second the word Medical in EMS. What is the definition to you the reader? Is it the same definition that a Doctor would apply? Or do you prefer to make your own definition? Is the definition of medical deferent for the Paramedic than it is for the Basic? The general public has their own definition of the word. I humbly submit that the public definition is "If there is something wrong with me it is a medical condition". If you agree that this is the general publics' definition then there is not much room for misinterpetation of the definition of the word Medical in EMS. After all it is (by the service point of view) the general public that assigned these tasks to us in the first place. Can you provide medical care in a wheelchair van? Or is a properly equipt (probably misspelled) ambulance the only vehicle that can provide medical care? Is the Paramedic the only level of EMT with the ability to provide medical care? Is the Basic the only level of EMT with the correct skill set to administer medical care? Just as a note of interest here, there have been studies done that suggest that removing ALS from transporting ambulances dramatically reduce the mortality/morbidity rate of Trauma victims, when the transport time is less than 15 min. to definitive care. Keep in mind that the first responding units in these studies were all Paramedic units and did initial als care on scene. According to the summary reports the reason the rates dramatically dropped was because the ALS units did not have time to stay a do all their skills and the BLS units could not do any more than the ALS units so the on scene to hospital times were reduced by more than 30% over prior study times. These studies, for me, confirm only one thing both ALS and BLS have unique skill sets that can not function efficiently without each other. So in just one EMT's opinion all the debate over who is valuable and is one better than the other is time wasted and with that time the loss of knowledge that could someday save my life. But I digress, sorry for that, now I waste your time.

Third now we come to the most over used word in EMS. The word Emergency, and how to define it. Is it defined the same among all medical providers? Does the definition change throughout a medical providers career? Is the situation that was a emergency as a rookie the same after 16 yrs on the job? These question are not dependant on whether you are a Paramedic or a Basic because the emergency situation that you both faced as a rookie where the same the only difference was what you could do to resolve the situation, but it scared the s!!t out of both of you. In the same manner after awhile on the job the same situation arose and it really was not that big of an emergency to you this time. I humbly propose that the general public's definition is more likely closer to the definition we all had when we were rookies. After all most of the pt we transport think that any thing that is happening to them is important and should be addressed as an emergency. If not they would not have called us, and yes there are those that call just for a ride or just because they are lonely and need someone to talk to, although I think the last mentioned group are not abusers of the system, but I concede that would depend on your definition of medical. The general public's voice the government has agreed with them and has mandated that we transport all that call and that the ER treat all that come in wether by us or by foot.

In conclusion, If you accept my humble view of the question posed at the very beginning of this thread and the definitions that I believe to be very close to the publics; that we serve. Then the debate is futile and we should just get on to figuring out how to treat the pt (that is the system). This duality is at the core of modern EMS. It is as much our doing as it is the system, as a whole EMTs both Paramedic and Basic have since the very start done much with little and to those who do more is given.

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The only people who need to back off the kool-aide are the ones who think anybody on an ambulance can fix everything.

FBAO arrest? Sure, if you're not monitoring your patient I suppose they could pull out a ham sandwich and start going to town.

hmmm can an emt use magills and remove the FB?

Here they can, yeah. I never had the extra cert when I was a Basic, but lots of people do.

Hyperkalemic? Absolutely, run that 12-lead with no pulse, let me know how it turns out. Or are we not just drawing labs now, but running the tests too?

One epi and a shock? Sure, I'll buy that, but let me guess- you already had an IV?

Just as a note of interest here, there have been studies done that suggest that removing ALS from transporting ambulances dramatically reduce the mortality/morbidity rate of Trauma victims, when the transport time is less than 15 min. to definitive care.

I'd love to see you back that one up, because surely you've read the LA study where the gangbangers brought in by private auto (Homeboy Ambulance Service) had better outcomes than those brought in by an ALS system? I'm not sure how many hospitals there are in LA, but I'm sure there's not many areas more than 15 minutes from one of them.

All of you have lovely anecdotes and what-if scenarios. All I'm doing is asking you to prove an outcome-based benefit for two medics over two basics in a cardiac arrest during a non-emergency transfer.

As I thought, the "Paramedics Fix Everything" attitude wasn't far behind.

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New to this posting thing, however as an ER Nurse and Medic both active. I run on a MICU and 911 service. My Micu Trips I need a second medic no doubt or I am setting my EMTB up for failure or risk of being out of scope, the non acute als/bls trips that we do locally to keep up the revenue to support our Micu could go either way. It will always depend on the EMTB vs Medic you are judging. There is no don't I know EMTB's that could run circles around some of our medics, but truth is they don't have the happy little piece of paper that allows them to play with the cool stuff. Our perception is our reality and we can all sit here and pretend for what if's and worse case scenarios, but when a jury of 12 peers is judging you and your actions as long as you can say you did everything in your power and acted to the best of your obligations does it really matter what the initials are of the person next to you? Are you really going to perform better because you have an equal next to you, or the fact that you have two medics in the back both searching for a line and you realize thats its been 3 min since the patients last been ventilated because nobody is performing BLS skills? I have seen both and great outcomes both ways. Several of our rural squads bringing patients in through my ER doors are often BLS and yeah its a hell of a lot of work for us when they come in, but they have had AED access (mandatory in my State for all squads), intubated and usually decent CPR so I can honestly say in my neck of the woods it depends more on the crews themselves and their effort then what initials they have behind there name. And on the flip side I have some real lazy double Medic crews that hate to be bothered for the 5am dead guy and we are lucky to see an oral airway in place. So again I close with our perception is our reality.

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