The Debate

[Guest guest]

The role of the paramedic has been in a state of flux ever since Gage and

Desoto first took to the streets those many years ago. Hospital based

paramedics as well as EMT's and often wasted as the bedpan and sheet changers,

cleanup staff, and gurney pushers in many areas where our skills could be far

more

better used. In this time of staffing shortages and such, with grossly

overworked doctors, nurses, etc., could a bit more training yield personnel

better

equipped to take up the slack, without the constant worry of " whose job am I

taking away? " or rather, " that EMT's trying to take my job? "

I work in a semi-rural setting where long transport times and critical

patients are far more prolific than big-city medics like to admit, and most of

my experience has been picked up in the field. In addition, I have spent many

years in the ER, being used as a tech, assisting and watching the physician's

ply their trade, an apprenticeship if you will. More than once I and my

fellows have had to keep a code 99 running until the physician arrived. We are

the

eyes, ears, and hands of the physician in the ambulance, then why not in the

ER?

If there were enough nurses to make every SCT, that would be one thing.

If there were enough PA's to take up the slack in the ER's, that would be

another.

I for one would be happy to get that extra training to take on more

responsibilities so that I may broaden my scope of practice. The problem then

becomes

who will support my family while I am in training.

Naturally I know that I am unable to replace a physician, I have no where

near the education for that. Yet I believe that paramedics could be used to

assist the Doctors and the hospital staff as more than linen changers and IV

starters.

This " debate " concerns us all, and we need to get involved.

McKneely, Paramedic

Clay County, Texas

[Guest guest]

The role of the paramedic has been in a state of flux ever since Gage and

Desoto first took to the streets those many years ago. Hospital based

paramedics as well as EMT's and often wasted as the bedpan and sheet changers,

cleanup staff, and gurney pushers in many areas where our skills could be far

more

better used. In this time of staffing shortages and such, with grossly

overworked doctors, nurses, etc., could a bit more training yield personnel

better

equipped to take up the slack, without the constant worry of " whose job am I

taking away? " or rather, " that EMT's trying to take my job? "

I work in a semi-rural setting where long transport times and critical

patients are far more prolific than big-city medics like to admit, and most of

my experience has been picked up in the field. In addition, I have spent many

years in the ER, being used as a tech, assisting and watching the physician's

ply their trade, an apprenticeship if you will. More than once I and my

fellows have had to keep a code 99 running until the physician arrived. We are

the

eyes, ears, and hands of the physician in the ambulance, then why not in the

ER?

If there were enough nurses to make every SCT, that would be one thing.

If there were enough PA's to take up the slack in the ER's, that would be

another.

I for one would be happy to get that extra training to take on more

responsibilities so that I may broaden my scope of practice. The problem then

becomes

who will support my family while I am in training.

Naturally I know that I am unable to replace a physician, I have no where

near the education for that. Yet I believe that paramedics could be used to

assist the Doctors and the hospital staff as more than linen changers and IV

starters.

This " debate " concerns us all, and we need to get involved.

McKneely, Paramedic

Clay County, Texas

[Guest guest]

The role of the paramedic has been in a state of flux ever since Gage and

Desoto first took to the streets those many years ago. Hospital based

paramedics as well as EMT's and often wasted as the bedpan and sheet changers,

cleanup staff, and gurney pushers in many areas where our skills could be far

more

better used. In this time of staffing shortages and such, with grossly

overworked doctors, nurses, etc., could a bit more training yield personnel

better

equipped to take up the slack, without the constant worry of " whose job am I

taking away? " or rather, " that EMT's trying to take my job? "

I work in a semi-rural setting where long transport times and critical

patients are far more prolific than big-city medics like to admit, and most of

my experience has been picked up in the field. In addition, I have spent many

years in the ER, being used as a tech, assisting and watching the physician's

ply their trade, an apprenticeship if you will. More than once I and my

fellows have had to keep a code 99 running until the physician arrived. We are

the

eyes, ears, and hands of the physician in the ambulance, then why not in the

ER?

If there were enough nurses to make every SCT, that would be one thing.

If there were enough PA's to take up the slack in the ER's, that would be

another.

I for one would be happy to get that extra training to take on more

responsibilities so that I may broaden my scope of practice. The problem then

becomes

who will support my family while I am in training.

Naturally I know that I am unable to replace a physician, I have no where

near the education for that. Yet I believe that paramedics could be used to

assist the Doctors and the hospital staff as more than linen changers and IV

starters.

This " debate " concerns us all, and we need to get involved.

McKneely, Paramedic

Clay County, Texas

[Guest guest]

TDH has something on their website for EMT's working in ER's. It's something

of a guideline/scope of practice. Anyway, basically it states that the EMT

reports directly to the doc and does what they tell them to do. Unfortunately,

we

most often end up as bed changers, etc., because the HOSPITAL mandates we

report directly to the nurse. Any idea from anyone as to why TDH's guideline is

not followed?

[Guest guest]

TDH has something on their website for EMT's working in ER's. It's something

of a guideline/scope of practice. Anyway, basically it states that the EMT

reports directly to the doc and does what they tell them to do. Unfortunately,

we

most often end up as bed changers, etc., because the HOSPITAL mandates we

report directly to the nurse. Any idea from anyone as to why TDH's guideline is

not followed?

[Guest guest]

TDH has something on their website for EMT's working in ER's. It's something

of a guideline/scope of practice. Anyway, basically it states that the EMT

reports directly to the doc and does what they tell them to do. Unfortunately,

we

most often end up as bed changers, etc., because the HOSPITAL mandates we

report directly to the nurse. Any idea from anyone as to why TDH's guideline is

not followed?

[Guest guest]

In a message dated 4/20/2004 12:49:39 PM Central Standard Time,

cllw602@... writes:

TDH has something on their website for EMT's working in ER's. It's something

of a guideline/scope of practice. Anyway, basically it states that the EMT

reports directly to the doc and does what they tell them to do.

Unfortunately, we

most often end up as bed changers, etc., because the HOSPITAL mandates we

report directly to the nurse. Any idea from anyone as to why TDH's guideline

is

not followed?

BOARD OF NURSING EXAMINERS. THE NURSING BOARD... WHAT EVER YOU WANT TO CALL

THE NURSING BOARD THEY RULE THE HOSPITALS.

If you want to work in the hospital and use your skills you must get the

hospital to go against the BNE. I have worked in the Hospital for 6 years. If

it

were not for my Anes. doc friends, I would not be using my skills. The BNE

sees paramedics as a threat, not a help to the nursing profession. If you are

not a nurse you will not be allowed to do advanced skills in the Hospital.

This is just from my humble experience and opinion.

Tom LeNeveu

Learning Paramedic

EMStock 2004 is just around the corner. Come join the fun and learn a little

while your at it.

[Guest guest]

In a message dated 4/20/2004 12:49:39 PM Central Standard Time,

cllw602@... writes:

TDH has something on their website for EMT's working in ER's. It's something

of a guideline/scope of practice. Anyway, basically it states that the EMT

reports directly to the doc and does what they tell them to do.

Unfortunately, we

most often end up as bed changers, etc., because the HOSPITAL mandates we

report directly to the nurse. Any idea from anyone as to why TDH's guideline

is

not followed?

BOARD OF NURSING EXAMINERS. THE NURSING BOARD... WHAT EVER YOU WANT TO CALL

THE NURSING BOARD THEY RULE THE HOSPITALS.

If you want to work in the hospital and use your skills you must get the

hospital to go against the BNE. I have worked in the Hospital for 6 years. If

it

were not for my Anes. doc friends, I would not be using my skills. The BNE

sees paramedics as a threat, not a help to the nursing profession. If you are

not a nurse you will not be allowed to do advanced skills in the Hospital.

This is just from my humble experience and opinion.

Tom LeNeveu

Learning Paramedic

EMStock 2004 is just around the corner. Come join the fun and learn a little

while your at it.

[Guest guest]

In a message dated 4/20/2004 12:49:39 PM Central Standard Time,

cllw602@... writes:

TDH has something on their website for EMT's working in ER's. It's something

of a guideline/scope of practice. Anyway, basically it states that the EMT

reports directly to the doc and does what they tell them to do.

Unfortunately, we

most often end up as bed changers, etc., because the HOSPITAL mandates we

report directly to the nurse. Any idea from anyone as to why TDH's guideline

is

not followed?

BOARD OF NURSING EXAMINERS. THE NURSING BOARD... WHAT EVER YOU WANT TO CALL

THE NURSING BOARD THEY RULE THE HOSPITALS.

If you want to work in the hospital and use your skills you must get the

hospital to go against the BNE. I have worked in the Hospital for 6 years. If

it

were not for my Anes. doc friends, I would not be using my skills. The BNE

sees paramedics as a threat, not a help to the nursing profession. If you are

not a nurse you will not be allowed to do advanced skills in the Hospital.

This is just from my humble experience and opinion.

Tom LeNeveu

Learning Paramedic

EMStock 2004 is just around the corner. Come join the fun and learn a little

while your at it.

[Guest guest]

In a message dated 4/20/2004 11:57:17 AM Central Standard Time,

mreed_911@... writes:

And you are?

That seems to be the gist of this discussion. A paramedic with limited

training and exposure to critical care medicine (not dealing with critical

patients, actual critical care medicine) will not be as effective as any

healthcare provider who has trained and worked in the critical care

setting. Currently, there are few, if any, paramedics who are active

parts of critical care teams that are making decisions with regards to

patient care for critical medicine patients. There are, by comparison,

far more nurses who actually specialize in critical care medicine and

function/train under the auspices of a critical care doc.

Good for them. They make a great resource in my ambulance. If riding with

me I would use them for their knowledge. I am still the responsible one in my

box.

What is being argued is that for those transfers of critical care

patients, having a nurse who is trained and skilled in the whole of

critical care medicine be in charge makes more sense than having a

paramedic, even a CC-EMTP, with significantly more limited training and

experience (much less everyday practice in actual critical care medicine)

be in charge.

No, it doesn't. When a charge nurse visits another facility, doesn't mean

they are still in charge. However they can and have been used as a resource to

help if or when needed. I as a paramedic have very limited knowledge. The

more I learn the more I realize I have so much more to learn. However, I have

resources to help through when something becomes confusing (Med Control, RN who

is riding with us) But I will answer for what happens on that box. As the

primary medic, It is my responsibility to get the patient from Point A to point

B without doing further harm.

In this aspects, if you replace " nurse " with any staff member

appropriately trained, and continuously practicing critical care medicine,

then the supposition seems to make sense.

If a doctor rides in my box, he will talk to my Med Control physician, and

then I will follow his guidelines.

No matter who is in my box, I am the responsible one. I will use my

resources and equipment and limited knowledge to the best of my ability. I will

do no

further harm to my patient. I will be a paramedic.

I am skilled, trained, and willing to go the extra mile to make someone's day

just a little better.

Tom LeNeveu

Learning Paramedic

EMStock 2004 is just around the corner. Come join the fun and learn a little

while your at it.

[Guest guest]

In a message dated 4/20/2004 11:57:17 AM Central Standard Time,

mreed_911@... writes:

And you are?

That seems to be the gist of this discussion. A paramedic with limited

training and exposure to critical care medicine (not dealing with critical

patients, actual critical care medicine) will not be as effective as any

healthcare provider who has trained and worked in the critical care

setting. Currently, there are few, if any, paramedics who are active

parts of critical care teams that are making decisions with regards to

patient care for critical medicine patients. There are, by comparison,

far more nurses who actually specialize in critical care medicine and

function/train under the auspices of a critical care doc.

Good for them. They make a great resource in my ambulance. If riding with

me I would use them for their knowledge. I am still the responsible one in my

box.

What is being argued is that for those transfers of critical care

patients, having a nurse who is trained and skilled in the whole of

critical care medicine be in charge makes more sense than having a

paramedic, even a CC-EMTP, with significantly more limited training and

experience (much less everyday practice in actual critical care medicine)

be in charge.

No, it doesn't. When a charge nurse visits another facility, doesn't mean

they are still in charge. However they can and have been used as a resource to

help if or when needed. I as a paramedic have very limited knowledge. The

more I learn the more I realize I have so much more to learn. However, I have

resources to help through when something becomes confusing (Med Control, RN who

is riding with us) But I will answer for what happens on that box. As the

primary medic, It is my responsibility to get the patient from Point A to point

B without doing further harm.

In this aspects, if you replace " nurse " with any staff member

appropriately trained, and continuously practicing critical care medicine,

then the supposition seems to make sense.

If a doctor rides in my box, he will talk to my Med Control physician, and

then I will follow his guidelines.

No matter who is in my box, I am the responsible one. I will use my

resources and equipment and limited knowledge to the best of my ability. I will

do no

further harm to my patient. I will be a paramedic.

I am skilled, trained, and willing to go the extra mile to make someone's day

just a little better.

Tom LeNeveu

Learning Paramedic

EMStock 2004 is just around the corner. Come join the fun and learn a little

while your at it.

[Guest guest]

In a message dated 4/20/2004 11:57:17 AM Central Standard Time,

mreed_911@... writes:

And you are?

That seems to be the gist of this discussion. A paramedic with limited

training and exposure to critical care medicine (not dealing with critical

patients, actual critical care medicine) will not be as effective as any

healthcare provider who has trained and worked in the critical care

setting. Currently, there are few, if any, paramedics who are active

parts of critical care teams that are making decisions with regards to

patient care for critical medicine patients. There are, by comparison,

far more nurses who actually specialize in critical care medicine and

function/train under the auspices of a critical care doc.

Good for them. They make a great resource in my ambulance. If riding with

me I would use them for their knowledge. I am still the responsible one in my

box.

What is being argued is that for those transfers of critical care

patients, having a nurse who is trained and skilled in the whole of

critical care medicine be in charge makes more sense than having a

paramedic, even a CC-EMTP, with significantly more limited training and

experience (much less everyday practice in actual critical care medicine)

be in charge.

No, it doesn't. When a charge nurse visits another facility, doesn't mean

they are still in charge. However they can and have been used as a resource to

help if or when needed. I as a paramedic have very limited knowledge. The

more I learn the more I realize I have so much more to learn. However, I have

resources to help through when something becomes confusing (Med Control, RN who

is riding with us) But I will answer for what happens on that box. As the

primary medic, It is my responsibility to get the patient from Point A to point

B without doing further harm.

In this aspects, if you replace " nurse " with any staff member

appropriately trained, and continuously practicing critical care medicine,

then the supposition seems to make sense.

If a doctor rides in my box, he will talk to my Med Control physician, and

then I will follow his guidelines.

No matter who is in my box, I am the responsible one. I will use my

resources and equipment and limited knowledge to the best of my ability. I will

do no

further harm to my patient. I will be a paramedic.

I am skilled, trained, and willing to go the extra mile to make someone's day

just a little better.

Tom LeNeveu

Learning Paramedic

EMStock 2004 is just around the corner. Come join the fun and learn a little

while your at it.

[Guest guest]

Doc,

As with anything else, If you aren't interested in the thread, delete

the message.

Keep it coming, I enjoy your thought provoking posts nearly as much

(just kidding), as I do your humor.

I find it interesting to know how the rest of the world views our

abilities, good insight.

W. Hatfield EMT-P

" Si hoc legere scis nimium eruditiones habes "

Mark your calendars now!!! EMStock 2004!!!

Booming Midlothian, Texas!!! May 21-23, 2004!!!

www.EMStock.com

From: Bledsoe

I just received an email asking me not to " trash the list " with

information

about the CCT debate on the NAEMSP list. I thought paramedics and others

on

these lists would find it of interest. I have taken the physician's

names

off the emails as I do not have their express permission to forward

(although I know them all and none will mind). If I am " trashing the

list "

let me know and I will cease and desist.

BEB

[Guest guest]

Doc,

As with anything else, If you aren't interested in the thread, delete

the message.

Keep it coming, I enjoy your thought provoking posts nearly as much

(just kidding), as I do your humor.

I find it interesting to know how the rest of the world views our

abilities, good insight.

W. Hatfield EMT-P

" Si hoc legere scis nimium eruditiones habes "

Mark your calendars now!!! EMStock 2004!!!

Booming Midlothian, Texas!!! May 21-23, 2004!!!

www.EMStock.com

From: Bledsoe

I just received an email asking me not to " trash the list " with

information

about the CCT debate on the NAEMSP list. I thought paramedics and others

on

these lists would find it of interest. I have taken the physician's

names

off the emails as I do not have their express permission to forward

(although I know them all and none will mind). If I am " trashing the

list "

let me know and I will cease and desist.

BEB

[Guest guest]

Doc,

As with anything else, If you aren't interested in the thread, delete

the message.

Keep it coming, I enjoy your thought provoking posts nearly as much

(just kidding), as I do your humor.

I find it interesting to know how the rest of the world views our

abilities, good insight.

W. Hatfield EMT-P

" Si hoc legere scis nimium eruditiones habes "

Mark your calendars now!!! EMStock 2004!!!

Booming Midlothian, Texas!!! May 21-23, 2004!!!

www.EMStock.com

From: Bledsoe

I just received an email asking me not to " trash the list " with

information

about the CCT debate on the NAEMSP list. I thought paramedics and others

on

these lists would find it of interest. I have taken the physician's

names

off the emails as I do not have their express permission to forward

(although I know them all and none will mind). If I am " trashing the

list "

let me know and I will cease and desist.

BEB

[Guest guest]

In our CCT course we require rotations through the cath lab, CCU, neuro ICU,

electrdiagnostics (doing nothing but taking and reading 12-leads), surgery,

and helicopter time (however, after my big helicopter article hits the press

any students anywhere remotely affiliated with me may not be allowed near a

helicopter), respiratory theray (nebs and vent management, blood gasses and

interpretation.

BEB

Bledsoe, DO, FACEP

Midlothian, TX

" Faith is believing what you know ain't so. "

Mark Twain

Following the Equator

Don't miss EMStock 2004!http://www.emstock.com

Re: The Debate

brian what about Introducing more critical care ICU or making a mandatory

ICU rotation every year per so many hours just to gain training and expense

[Guest guest]

In our CCT course we require rotations through the cath lab, CCU, neuro ICU,

electrdiagnostics (doing nothing but taking and reading 12-leads), surgery,

and helicopter time (however, after my big helicopter article hits the press

any students anywhere remotely affiliated with me may not be allowed near a

helicopter), respiratory theray (nebs and vent management, blood gasses and

interpretation.

BEB

Bledsoe, DO, FACEP

Midlothian, TX

" Faith is believing what you know ain't so. "

Mark Twain

Following the Equator

Don't miss EMStock 2004!http://www.emstock.com

Re: The Debate

brian what about Introducing more critical care ICU or making a mandatory

ICU rotation every year per so many hours just to gain training and expense

[Guest guest]

In our CCT course we require rotations through the cath lab, CCU, neuro ICU,

electrdiagnostics (doing nothing but taking and reading 12-leads), surgery,

and helicopter time (however, after my big helicopter article hits the press

any students anywhere remotely affiliated with me may not be allowed near a

helicopter), respiratory theray (nebs and vent management, blood gasses and

interpretation.

BEB

Bledsoe, DO, FACEP

Midlothian, TX

" Faith is believing what you know ain't so. "

Mark Twain

Following the Equator

Don't miss EMStock 2004!http://www.emstock.com

Re: The Debate

brian what about Introducing more critical care ICU or making a mandatory

ICU rotation every year per so many hours just to gain training and expense

[Guest guest]

These types of discussions are one reason WHY this list was created. Healthy

discussions over issues affecting the EMS industry DO affect every person on

this list and every EMS person NOT on this list. While I don't always agree

with you on the issues, Dr. B., I DO not think you should " cease and desist " .

Jane Hill

[Guest guest]

These types of discussions are one reason WHY this list was created. Healthy

discussions over issues affecting the EMS industry DO affect every person on

this list and every EMS person NOT on this list. While I don't always agree

with you on the issues, Dr. B., I DO not think you should " cease and desist " .

Jane Hill

[Guest guest]

These types of discussions are one reason WHY this list was created. Healthy

discussions over issues affecting the EMS industry DO affect every person on

this list and every EMS person NOT on this list. While I don't always agree

with you on the issues, Dr. B., I DO not think you should " cease and desist " .

Jane Hill

[Guest guest]

I met a guy once who I really made mad. He was introduced to me as a

PA that specialized in emergency medicine. I put out my hand to shake

his and replied, " oh so your a paramedic. " It was obviously only

funny to me.

This is how I have always viewed what being a paramedic 'should' be.

I've always hoped to see the day that I was not alone in this

vision. It has been an honor for me to help out my community as an

EMT first and as a paramedic. When a stranger didn't know what else

to do they called us - EMS.

We are a varied lot - working in all different areas: ECA's, EMT's,

intermediates, paramedics, rural, metropolitan, suburban, fire-based,

private service, third-city service, etc. But we fight amongst

ourselves too much. Debate is healthy as it helps our profession

grow. Fighting each other we are only trying to keep our individual

piece of the pie from changing. We need to focus on our collective

pieces as one larger piece in the healthcare and public safety pie.

What do the nurses have that we don't? Cohesion - They work together

for the profession.

'Should nurses be part of the critical care transport team?' 'Should

intermediate be the top level of EMS provider?' and a hundred other

questions WILL be answered. But will the be answered by us - EMS? I

hope so.

No question we do have one thing in common - we all want to be there

when that call for help comes. What an honor.

Thanks for letting me be part of this team,

White, L.P.

Assistant Professor

Emergency Medical Services

Tarrant County College

828 Harwood Road

Hurst, TX 76054-3299

.white@...

(cell)

(office)

> My initial question/suggestion has brought up many issue of the

same topic.

> Let me clarify some of my observations (definitions):

> As an organization of EMS physicians, we have a professional duty

and

> expertice to identify areas of improvement in patient care and

levels of

> training

> 1. Not all Paramedics are created equal. (CJ is a prime example)

There is

> a great disparity in training, certification, field experience,

supervision,

> and continuing education. My suggestion of a " shift " in

responsibilities,

> away from but not excluding basic field care and encouraging a

higher level

> of responsibility in (the voids) education, supervision,

and " higher " (for

> lack of a better word) patient care in the out-of-hospital

setting...like,

> CCT, and in-hospital patient care.

> In my opinion, a logical solution to this problem would be to

standardize,

> nationally, (even internationally) the training of a Paramedic.

This

> " standardization " can go either up or down.

> That is, either decide that the present level of " intermediate " is

the ideal

> pre-hospital training(30 yrs experience and study has proven this,

in my

> mind) and call that paramedicine. This would certainly translate

into cost

> saving, and increase the available pool of affordable medics

(another void

> in EMS in general), etc.. And rely on additional training or other

allied

> health providers to fill-in the gaps, etc.. Or agree that there is

a void(s)

> that could be best filled by a Paramedic with a degree (the

standard). A

> degree that can be used as a stepping stone into nursing, other

allied

> health careers, including medicine. Don't get me wrong, I do not

think that

> presently a newly graduated paramedic could fill this " new " role

without

> experience and further study. Also, field experience is a must and

should be

> included in the training before and after graduation, regardless.

I would

> venture to guess at least three years, in a specific setting, after

> graduation before extending into these " new " roles. Similar to

passing a

> residency. I guess I envision paramedics similar to PAs. and not

without

> close physician (dedicated EM physician) oversight. Further, there

is no

> question that there are specific field settings or " systems " where

> paramedics are still ideal for the patient care required.

>

>

> Bledsoe, DO, FACEP

>

>

>

>

[Guest guest]

I met a guy once who I really made mad. He was introduced to me as a

PA that specialized in emergency medicine. I put out my hand to shake

his and replied, " oh so your a paramedic. " It was obviously only

funny to me.

This is how I have always viewed what being a paramedic 'should' be.

I've always hoped to see the day that I was not alone in this

vision. It has been an honor for me to help out my community as an

EMT first and as a paramedic. When a stranger didn't know what else

to do they called us - EMS.

We are a varied lot - working in all different areas: ECA's, EMT's,

intermediates, paramedics, rural, metropolitan, suburban, fire-based,

private service, third-city service, etc. But we fight amongst

ourselves too much. Debate is healthy as it helps our profession

grow. Fighting each other we are only trying to keep our individual

piece of the pie from changing. We need to focus on our collective

pieces as one larger piece in the healthcare and public safety pie.

What do the nurses have that we don't? Cohesion - They work together

for the profession.

'Should nurses be part of the critical care transport team?' 'Should

intermediate be the top level of EMS provider?' and a hundred other

questions WILL be answered. But will the be answered by us - EMS? I

hope so.

No question we do have one thing in common - we all want to be there

when that call for help comes. What an honor.

Thanks for letting me be part of this team,

White, L.P.

Assistant Professor

Emergency Medical Services

Tarrant County College

828 Harwood Road

Hurst, TX 76054-3299

.white@...

(cell)

(office)

> My initial question/suggestion has brought up many issue of the

same topic.

> Let me clarify some of my observations (definitions):

> As an organization of EMS physicians, we have a professional duty

and

> expertice to identify areas of improvement in patient care and

levels of

> training

> 1. Not all Paramedics are created equal. (CJ is a prime example)

There is

> a great disparity in training, certification, field experience,

supervision,

> and continuing education. My suggestion of a " shift " in

responsibilities,

> away from but not excluding basic field care and encouraging a

higher level

> of responsibility in (the voids) education, supervision,

and " higher " (for

> lack of a better word) patient care in the out-of-hospital

setting...like,

> CCT, and in-hospital patient care.

> In my opinion, a logical solution to this problem would be to

standardize,

> nationally, (even internationally) the training of a Paramedic.

This

> " standardization " can go either up or down.

> That is, either decide that the present level of " intermediate " is

the ideal

> pre-hospital training(30 yrs experience and study has proven this,

in my

> mind) and call that paramedicine. This would certainly translate

into cost

> saving, and increase the available pool of affordable medics

(another void

> in EMS in general), etc.. And rely on additional training or other

allied

> health providers to fill-in the gaps, etc.. Or agree that there is

a void(s)

> that could be best filled by a Paramedic with a degree (the

standard). A

> degree that can be used as a stepping stone into nursing, other

allied

> health careers, including medicine. Don't get me wrong, I do not

think that

> presently a newly graduated paramedic could fill this " new " role

without

> experience and further study. Also, field experience is a must and

should be

> included in the training before and after graduation, regardless.

I would

> venture to guess at least three years, in a specific setting, after

> graduation before extending into these " new " roles. Similar to

passing a

> residency. I guess I envision paramedics similar to PAs. and not

without

> close physician (dedicated EM physician) oversight. Further, there

is no

> question that there are specific field settings or " systems " where

> paramedics are still ideal for the patient care required.

>

>

> Bledsoe, DO, FACEP

>

>

>

>

[Guest guest]

Truer words were never spoken. In EMS (and medicine), if you always put the

patient first, you will always be a professional.

Bledsoe, DO, FACEP

Midlothian, TX

" Faith is believing what you know ain't so. "

Mark Twain

Following the Equator

Don't miss EMStock 2004!http://www.emstock.com

Re: The Debate

It's not about the medic. It's not about the nurse. Or egos. Or

authority. Or turf battles. or money

IT'S ABOUT THE PATIENT!!!!!!

We forget mostly.

=Steve=

FireMedic1633@... wrote:

>In a message dated 4/20/2004 11:57:17 AM Central Standard Time,

>mreed_911@... writes:

>And you are?

>

>That seems to be the gist of this discussion. A paramedic with limited

>training and exposure to critical care medicine (not dealing with

>critical patients, actual critical care medicine) will not be as

>effective as any healthcare provider who has trained and worked in the

>critical care setting. Currently, there are few, if any, paramedics

>who are active parts of critical care teams that are making decisions

>with regards to patient care for critical medicine patients. There

>are, by comparison, far more nurses who actually specialize in critical

>care medicine and function/train under the auspices of a critical care doc.

>

>

>

>Good for them. They make a great resource in my ambulance. If riding

>with me I would use them for their knowledge. I am still the

>responsible one in my box.

>

>

>

>

>What is being argued is that for those transfers of critical care

>patients, having a nurse who is trained and skilled in the whole of

>critical care medicine be in charge makes more sense than having a

>paramedic, even a CC-EMTP, with significantly more limited training and

>experience (much less everyday practice in actual critical care

>medicine) be in charge.

>

>

>

>No, it doesn't. When a charge nurse visits another facility, doesn't

>mean they are still in charge. However they can and have been used as

>a resource to help if or when needed. I as a paramedic have very

>limited knowledge. The more I learn the more I realize I have so much

>more to learn. However, I have resources to help through when

>something becomes confusing (Med Control, RN who is riding with us) But

>I will answer for what happens on that box. As the primary medic, It

>is my responsibility to get the patient from Point A to point B without

doing further harm.

>

>

>

>

>In this aspects, if you replace " nurse " with any staff member

>appropriately trained, and continuously practicing critical care

>medicine, then the supposition seems to make sense.

>

>

>

>

>If a doctor rides in my box, he will talk to my Med Control physician,

>and then I will follow his guidelines.

>

>No matter who is in my box, I am the responsible one. I will use my

>resources and equipment and limited knowledge to the best of my

>ability. I will do no further harm to my patient. I will be a paramedic.

>

>I am skilled, trained, and willing to go the extra mile to make

>someone's day just a little better.

>

>

>Tom LeNeveu

>Learning Paramedic

>

>EMStock 2004 is just around the corner. Come join the fun and learn a

>little while your at it.

>

>

>

[Guest guest]

Truer words were never spoken. In EMS (and medicine), if you always put the

patient first, you will always be a professional.

Bledsoe, DO, FACEP

Midlothian, TX

" Faith is believing what you know ain't so. "

Mark Twain

Following the Equator

Don't miss EMStock 2004!http://www.emstock.com

Re: The Debate

It's not about the medic. It's not about the nurse. Or egos. Or

authority. Or turf battles. or money

IT'S ABOUT THE PATIENT!!!!!!

We forget mostly.

=Steve=

FireMedic1633@... wrote:

>In a message dated 4/20/2004 11:57:17 AM Central Standard Time,

>mreed_911@... writes:

>And you are?

>

>That seems to be the gist of this discussion. A paramedic with limited

>training and exposure to critical care medicine (not dealing with

>critical patients, actual critical care medicine) will not be as

>effective as any healthcare provider who has trained and worked in the

>critical care setting. Currently, there are few, if any, paramedics

>who are active parts of critical care teams that are making decisions

>with regards to patient care for critical medicine patients. There

>are, by comparison, far more nurses who actually specialize in critical

>care medicine and function/train under the auspices of a critical care doc.

>

>

>

>Good for them. They make a great resource in my ambulance. If riding

>with me I would use them for their knowledge. I am still the

>responsible one in my box.

>

>

>

>

>What is being argued is that for those transfers of critical care

>patients, having a nurse who is trained and skilled in the whole of

>critical care medicine be in charge makes more sense than having a

>paramedic, even a CC-EMTP, with significantly more limited training and

>experience (much less everyday practice in actual critical care

>medicine) be in charge.

>

>

>

>No, it doesn't. When a charge nurse visits another facility, doesn't

>mean they are still in charge. However they can and have been used as

>a resource to help if or when needed. I as a paramedic have very

>limited knowledge. The more I learn the more I realize I have so much

>more to learn. However, I have resources to help through when

>something becomes confusing (Med Control, RN who is riding with us) But

>I will answer for what happens on that box. As the primary medic, It

>is my responsibility to get the patient from Point A to point B without

doing further harm.

>

>

>

>

>In this aspects, if you replace " nurse " with any staff member

>appropriately trained, and continuously practicing critical care

>medicine, then the supposition seems to make sense.

>

>

>

>

>If a doctor rides in my box, he will talk to my Med Control physician,

>and then I will follow his guidelines.

>

>No matter who is in my box, I am the responsible one. I will use my

>resources and equipment and limited knowledge to the best of my

>ability. I will do no further harm to my patient. I will be a paramedic.

>

>I am skilled, trained, and willing to go the extra mile to make

>someone's day just a little better.

>

>

>Tom LeNeveu

>Learning Paramedic

>

>EMStock 2004 is just around the corner. Come join the fun and learn a

>little while your at it.

>

>

>