Guest guest Posted November 15, 2003 Report Share Posted November 15, 2003 Just starting to review some of the preliminary data from the famed OPALS (Ontario Prehospital Advanced Life Support) study and the findings are much as I suspected they would be. ALS seems to significantly improve outcome in respiratory distress and chest pain and ACS, but not cardiac arrest. Now, if somebody will take this information to the idiot doctor in Vermont who refuses ALS to be provided in his system (and his system has half of the paramedics in Vermont), we can get on about our rat killing. Mortality rates were reduced from 5.1% to 2.8% with ALS when compared to BLS only. More reading and pondering required. BEB E. Bledsoe, DO, FACEP Midlothian, Texas (http://www.bryanbledsoe.com) Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2003 Report Share Posted November 15, 2003 I didn't know there was anyone left that didn't advecate pre- hospital ALS care. > Just starting to review some of the preliminary data from the famed OPALS > (Ontario Prehospital Advanced Life Support) study and the findings are much > as I suspected they would be. ALS seems to significantly improve outcome in > respiratory distress and chest pain and ACS, but not cardiac arrest. Now, if > somebody will take this information to the idiot doctor in Vermont who > refuses ALS to be provided in his system (and his system has half of the > paramedics in Vermont), we can get on about our rat killing. > > > > Mortality rates were reduced from 5.1% to 2.8% with ALS when compared to BLS > only. > > > > More reading and pondering required. > > > > BEB > > > > E. Bledsoe, DO, FACEP > > Midlothian, Texas > > (http://www.bryanbledsoe.com) > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2003 Report Share Posted November 15, 2003 RI got a good look from the media when the nightclub fire happened. That was when I first learned that Rhode Island has a lower level of EMS than almost anywhere else in the US. But on the positive side, their State Police Troops wear really silly uniforms and talk in really obnoxious accents when they're on COPS. If they pulled me over I'd probably get shot because I wouldn't be able to understand a single thing they were screaming at me at the top of their lungs. Or because I would say, " I speak English. What language do you speak? " GG Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2003 Report Share Posted November 15, 2003 Bledsoe (Notebook) wrote: > > if somebody will take this information to the idiot doctor in Vermont who > refuses ALS to be provided in his system (and his system has half of the > paramedics in Vermont), we can get on about our rat killing. I give up; why would those medics continue to work there? Are there so few jobs in Vermont, or does that system just pay tremendously well? Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2003 Report Share Posted November 15, 2003 Mostly volunteer systems up there, I believe. At least, that's what I've been told. Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2003 Report Share Posted November 15, 2003 >I didn't know there was anyone left that didn't advecate pre- >hospital ALS care. > Just look at almost the entire state of Rhode Island. Jim< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2003 Report Share Posted November 15, 2003 ALS is the Standard of Care in Rhode Island. The only thing about RI is that they do not utilize Paramedics appropriately. They have a program called EMT-Cardiac. An EMT-Cardiac can do all of the skills and administer many of the meds normally at the ALS level across the country. And, there are a good number of Paramedics in service across the State. What was your reasoning for bringing RI into this anyway? Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2003 Report Share Posted November 15, 2003 >ALS is the Standard of Care in Rhode Island. The only thing about RI is >that they do not utilize Paramedics appropriately. They have a program >called EMT-Cardiac. An EMT-Cardiac can do all of the skills and administer >many of the meds normally at the ALS level across the country. And, there >are a good number of Paramedics in service across the State. > > >What was your reasoning for bringing RI into this anyway? Because the state is backwards in there use of Paramedics and not many medics are used outside the Providence area. EMT-Cardiac is FAR from a replacement for paramedics, they are a robot with the skills but limited knowledge. Any systems in RI with pre-hospital RSI protocols or aggressive standing orders? Jim< Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 15, 2003 Report Share Posted November 15, 2003 , Just to give you some background, I obtained my RI EMT-Ambulance license in 1996, EMT-Cardiac in 1998, and EMT-Paramedic in 2000. And, I agree with you in that the Cardiac curriculum is a far cry from Paramedic. This is something that I've been trying to change for a few years. Unfortunately, it is a difficulty now that I find myself in Central Texas. But, my argument was in the fact that the EMT-Cardiac standards are, in fact, ALS (though, mother-may-I). Also, most active Paramedics are found OUTSIDE of the Providence Metro area (Bristol, Cumberland, Warwick, South Kingstown, Hope Valley, Exeter, and Westerly), and this is the main problem. Most EMS is run by career fire service in RI. The issue is the cost of providing EMS training ($1500 vs. $10,000 for tuition alone). And, those that primarily want to be firefighters obtain their EMT-B license just to qualify to apply. They fear that if they have a higher license, they will be forced onto a Rescue (Ambulance). Unfortunately, the focus is not patient care. It is only a thinly-veiled attempt to keep costs down. This is widely known. As for me, I left RI to obtain a job as a Paramedic where I didn't have to be a firefighter (and still make a decent wage). This is typical of many Paramedics that obtained initial licensure in RI (many work in MA. others leave the region. and, still, others continue to make $10/hr). That being said, a 76 y.o. female c/o shortness of breath secondary to CHF will get O2 @ 15 L NRB, IV NS KVO, ASA PO chewed 300-600mg, NTG 0.4 SL x 3, MSO4 2-10mg IV, furosemide 40-240mg IV, dopamine if required to sustain BP whether being treated by a Paramedic or a Cardiac. Unfortunately, an IWMI w/ right-sided involvement will get nitrates without thought to significant lowering of BP, and MI with bradycardia will get atropine when treated by an EMT-Cardiac (without regard to BP, LOC, etc.). And, I'm speaking generally. Anecdotally speaking, you go to Paramedic school to find out why you've been killing patients as an EMT-Cardiac. So, I will tell you that I do disagree with the EMT-Cardiac program. But, the EMS Standard of Care in RI is, indeed, ALS (skill-wise. not education-wise). I hope that shed some light for you. Where are from? Mike Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 16, 2003 Report Share Posted November 16, 2003 Hey. I resemble that remark! A bit of a side note: The girl that designed the RISP summer uniform was my paramedic programs salutatorian (Can you guess who the valedictorian was? Okay, so that's not worth a trip to Ladonia, but I can give out a trip to South County). Mike Quote Link to comment Share on other sites More sharing options...
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