Re: Too many paramedics?

[Guest guest]

Wes, I cannot answer your last question because I do not have any data to

prove or disprove your question. I can answer the first three

1.Hard to say, if the paramedics are not getting the skill usage in the

field to keep up their skills, then out-of-field training should be used to

help offset this.

2. I do not think so. EMT's and EMT-I cannot do the job a paramedic can. A

paramedic can do their job.

3. Refer to the above answer.

[Guest guest]

Wes, I cannot answer your last question because I do not have any data to

prove or disprove your question. I can answer the first three

1.Hard to say, if the paramedics are not getting the skill usage in the

field to keep up their skills, then out-of-field training should be used to

help offset this.

2. I do not think so. EMT's and EMT-I cannot do the job a paramedic can. A

paramedic can do their job.

3. Refer to the above answer.

[Guest guest]

Seems to me that this is more of a training issue. Regardless of how many

paramedics you have you still cannot pick and chose your calls. By that I

mean you cannot make a patient need a chest decompression when the call was

for fallen out of bed. I don't think anyone routinely practices to the full

national scope on a routine basis regardless of call volume.

1. Is your skills are degradating you probably need to do some CE time or

refresher on those skills not used often. example: We don't run a lot of

pediatric calls but today a attended a PALS course. Helps you brush up on

the stuff you don't used (thank God) on a daily basis.

2. Reducing the number of medics just so the ones you have left can 'play'

more seems counterproductive to whatever area you are servicing.

3. see 2

4. Note much into empirical evidence but I would go out on a limb and say

whenever advanced airway is required immediately, that is a skill you need

when you need it.

Just my 2 cents on this matter

Quinten

EMT-LP/Firefighter

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from having

too many paramedics competing for a finite number of ALS interventions, even

in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

2) Is reducing the number of paramedics a way to address this issue?

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

4) On which call types does ALS intervention make a difference? Is there

empirical evidence/proof?

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm just

curious to see what the collective consciousness of EMS is regarding this

issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

Seems to me that this is more of a training issue. Regardless of how many

paramedics you have you still cannot pick and chose your calls. By that I

mean you cannot make a patient need a chest decompression when the call was

for fallen out of bed. I don't think anyone routinely practices to the full

national scope on a routine basis regardless of call volume.

1. Is your skills are degradating you probably need to do some CE time or

refresher on those skills not used often. example: We don't run a lot of

pediatric calls but today a attended a PALS course. Helps you brush up on

the stuff you don't used (thank God) on a daily basis.

2. Reducing the number of medics just so the ones you have left can 'play'

more seems counterproductive to whatever area you are servicing.

3. see 2

4. Note much into empirical evidence but I would go out on a limb and say

whenever advanced airway is required immediately, that is a skill you need

when you need it.

Just my 2 cents on this matter

Quinten

EMT-LP/Firefighter

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from having

too many paramedics competing for a finite number of ALS interventions, even

in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

2) Is reducing the number of paramedics a way to address this issue?

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

4) On which call types does ALS intervention make a difference? Is there

empirical evidence/proof?

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm just

curious to see what the collective consciousness of EMS is regarding this

issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

Seems to me that this is more of a training issue. Regardless of how many

paramedics you have you still cannot pick and chose your calls. By that I

mean you cannot make a patient need a chest decompression when the call was

for fallen out of bed. I don't think anyone routinely practices to the full

national scope on a routine basis regardless of call volume.

1. Is your skills are degradating you probably need to do some CE time or

refresher on those skills not used often. example: We don't run a lot of

pediatric calls but today a attended a PALS course. Helps you brush up on

the stuff you don't used (thank God) on a daily basis.

2. Reducing the number of medics just so the ones you have left can 'play'

more seems counterproductive to whatever area you are servicing.

3. see 2

4. Note much into empirical evidence but I would go out on a limb and say

whenever advanced airway is required immediately, that is a skill you need

when you need it.

Just my 2 cents on this matter

Quinten

EMT-LP/Firefighter

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from having

too many paramedics competing for a finite number of ALS interventions, even

in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

2) Is reducing the number of paramedics a way to address this issue?

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

4) On which call types does ALS intervention make a difference? Is there

empirical evidence/proof?

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm just

curious to see what the collective consciousness of EMS is regarding this

issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

I am not sure if it is limited.

I have yet to see where there is not just one but several Paramedics that want

to use their skills. Even if it is a far stretch to have to use them.

In a large volume service skills are more easily acquired and retained than in

the rural settings.

In a large volume service there are more opportunities to use your advanced

skills.

I believe reduction of Paramedics is not the cure. It would be a devastation

to rural America.

I do also believe that for low volume services skill practice should be more

of a mandate. It is true the saying " If you don't use it you loose it. "

ALS intervention makes a difference in possibly 20 to 30% of all calls. It is

what we train for. We train for the worst so we will hopefully be able to

handle the least.

ALS skills are of a greater necessity on medical, especially the difficulty

breathing calls. The major trauma calls are also a better chance for use of the

advanced skills.

My humble opinion.

ExLngHrn@... wrote:

I've been discussing the topic of skills degradation off-list with a paramedic

who believes that some skills degradation that comes from having too many

paramedics competing for a finite number of ALS interventions, even in a busy

urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of paramedics

with a limited number of ALS interventional opportunities?

2) Is reducing the number of paramedics a way to address this issue?

3) If reducing the number of paramedics was to happen, what additional skills

might an EMT-B need to possess?

4) On which call types does ALS intervention make a difference? Is there

empirical evidence/proof?

There's something that seems counterintuitive about reducing the availability of

ALS to the general public, but I may well be wrong. I'm just curious to see what

the collective consciousness of EMS is regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from

having too many paramedics competing for a finite number of ALS

interventions, even in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

[] I suppose there is some truth to the saying " use it or lose

it " , but there are other ways to retain your skill level. Of course this

will require effort on the medic's part. To participate in our system,

the Medical Director requires a certain number of advanced procedures to

be performed in a six month period. This may be accomplished by direct

patient care, in a clinical setting or by formal skills assessment in a

classroom. While I agree that direct patient care may be the preferred

method, the other options can work well also. To just sit on your ass

and wait for the real deal should not be the limit.

2) Is reducing the number of paramedics a way to address this issue?

[] Reduce supply, increase demand, and you will see the work load

of many Paramedics increase. I can sit and think up many reasons why

reducing the number of medics is wrong, but instead I will just express

my opinion - No this is not the answer.

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

[] The only thing you changed is the name. You move a skill from

one level to the other and you still have the initial argument - not

enough interventions.

4) On which call types does ALS intervention make a difference? Is

there empirical evidence/proof?

[]We get back to the research thing here. In my experience we make

a great deal of difference with some patients, with others we do not. I

do think we give the ill or injured patient a greater chance of

improvement by

being able to intubate, defibrillate, administer meds, pace, decompress,

crich and all the other things we do. Is this evidence, no! Just one

medic,s observation. After 28 years treating patients, I think we do

better for a patients today than we did in my first year.

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm

just curious to see what the collective consciousness of EMS is

regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from

having too many paramedics competing for a finite number of ALS

interventions, even in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

[] I suppose there is some truth to the saying " use it or lose

it " , but there are other ways to retain your skill level. Of course this

will require effort on the medic's part. To participate in our system,

the Medical Director requires a certain number of advanced procedures to

be performed in a six month period. This may be accomplished by direct

patient care, in a clinical setting or by formal skills assessment in a

classroom. While I agree that direct patient care may be the preferred

method, the other options can work well also. To just sit on your ass

and wait for the real deal should not be the limit.

2) Is reducing the number of paramedics a way to address this issue?

[] Reduce supply, increase demand, and you will see the work load

of many Paramedics increase. I can sit and think up many reasons why

reducing the number of medics is wrong, but instead I will just express

my opinion - No this is not the answer.

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

[] The only thing you changed is the name. You move a skill from

one level to the other and you still have the initial argument - not

enough interventions.

4) On which call types does ALS intervention make a difference? Is

there empirical evidence/proof?

[]We get back to the research thing here. In my experience we make

a great deal of difference with some patients, with others we do not. I

do think we give the ill or injured patient a greater chance of

improvement by

being able to intubate, defibrillate, administer meds, pace, decompress,

crich and all the other things we do. Is this evidence, no! Just one

medic,s observation. After 28 years treating patients, I think we do

better for a patients today than we did in my first year.

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm

just curious to see what the collective consciousness of EMS is

regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

The service I work for has a Paramedic on every truck (and in my opinion) as it

should be.

wrote:

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from

having too many paramedics competing for a finite number of ALS

interventions, even in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

[] I suppose there is some truth to the saying " use it or lose

it " , but there are other ways to retain your skill level. Of course this

will require effort on the medic's part. To participate in our system,

the Medical Director requires a certain number of advanced procedures to

be performed in a six month period. This may be accomplished by direct

patient care, in a clinical setting or by formal skills assessment in a

classroom. While I agree that direct patient care may be the preferred

method, the other options can work well also. To just sit on your ass

and wait for the real deal should not be the limit.

2) Is reducing the number of paramedics a way to address this issue?

[] Reduce supply, increase demand, and you will see the work load

of many Paramedics increase. I can sit and think up many reasons why

reducing the number of medics is wrong, but instead I will just express

my opinion - No this is not the answer.

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

[] The only thing you changed is the name. You move a skill from

one level to the other and you still have the initial argument - not

enough interventions.

4) On which call types does ALS intervention make a difference? Is

there empirical evidence/proof?

[]We get back to the research thing here. In my experience we make

a great deal of difference with some patients, with others we do not. I

do think we give the ill or injured patient a greater chance of

improvement by

being able to intubate, defibrillate, administer meds, pace, decompress,

crich and all the other things we do. Is this evidence, no! Just one

medic,s observation. After 28 years treating patients, I think we do

better for a patients today than we did in my first year.

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm

just curious to see what the collective consciousness of EMS is

regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

The service I work for has a Paramedic on every truck (and in my opinion) as it

should be.

wrote:

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from

having too many paramedics competing for a finite number of ALS

interventions, even in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

[] I suppose there is some truth to the saying " use it or lose

it " , but there are other ways to retain your skill level. Of course this

will require effort on the medic's part. To participate in our system,

the Medical Director requires a certain number of advanced procedures to

be performed in a six month period. This may be accomplished by direct

patient care, in a clinical setting or by formal skills assessment in a

classroom. While I agree that direct patient care may be the preferred

method, the other options can work well also. To just sit on your ass

and wait for the real deal should not be the limit.

2) Is reducing the number of paramedics a way to address this issue?

[] Reduce supply, increase demand, and you will see the work load

of many Paramedics increase. I can sit and think up many reasons why

reducing the number of medics is wrong, but instead I will just express

my opinion - No this is not the answer.

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

[] The only thing you changed is the name. You move a skill from

one level to the other and you still have the initial argument - not

enough interventions.

4) On which call types does ALS intervention make a difference? Is

there empirical evidence/proof?

[]We get back to the research thing here. In my experience we make

a great deal of difference with some patients, with others we do not. I

do think we give the ill or injured patient a greater chance of

improvement by

being able to intubate, defibrillate, administer meds, pace, decompress,

crich and all the other things we do. Is this evidence, no! Just one

medic,s observation. After 28 years treating patients, I think we do

better for a patients today than we did in my first year.

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm

just curious to see what the collective consciousness of EMS is

regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

The service I work for has a Paramedic on every truck (and in my opinion) as it

should be.

wrote:

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from

having too many paramedics competing for a finite number of ALS

interventions, even in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

[] I suppose there is some truth to the saying " use it or lose

it " , but there are other ways to retain your skill level. Of course this

will require effort on the medic's part. To participate in our system,

the Medical Director requires a certain number of advanced procedures to

be performed in a six month period. This may be accomplished by direct

patient care, in a clinical setting or by formal skills assessment in a

classroom. While I agree that direct patient care may be the preferred

method, the other options can work well also. To just sit on your ass

and wait for the real deal should not be the limit.

2) Is reducing the number of paramedics a way to address this issue?

[] Reduce supply, increase demand, and you will see the work load

of many Paramedics increase. I can sit and think up many reasons why

reducing the number of medics is wrong, but instead I will just express

my opinion - No this is not the answer.

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

[] The only thing you changed is the name. You move a skill from

one level to the other and you still have the initial argument - not

enough interventions.

4) On which call types does ALS intervention make a difference? Is

there empirical evidence/proof?

[]We get back to the research thing here. In my experience we make

a great deal of difference with some patients, with others we do not. I

do think we give the ill or injured patient a greater chance of

improvement by

being able to intubate, defibrillate, administer meds, pace, decompress,

crich and all the other things we do. Is this evidence, no! Just one

medic,s observation. After 28 years treating patients, I think we do

better for a patients today than we did in my first year.

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm

just curious to see what the collective consciousness of EMS is

regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

If a paramedic can not keep up with his/her skills then what's the sense

in having one? A service will have a paramedic that only holds the patch

for TDH reasons, but skills wise, they suck. I've come across many

paramedics that shouldn't hold a patch at all...

-- Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from

having too many paramedics competing for a finite number of ALS

interventions, even in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

[] I suppose there is some truth to the saying " use it or lose

it " , but there are other ways to retain your skill level. Of course this

will require effort on the medic's part. To participate in our system,

the Medical Director requires a certain number of advanced procedures to

be performed in a six month period. This may be accomplished by direct

patient care, in a clinical setting or by formal skills assessment in a

classroom. While I agree that direct patient care may be the preferred

method, the other options can work well also. To just sit on your ass

and wait for the real deal should not be the limit.

2) Is reducing the number of paramedics a way to address this issue?

[] Reduce supply, increase demand, and you will see the work load

of many Paramedics increase. I can sit and think up many reasons why

reducing the number of medics is wrong, but instead I will just express

my opinion - No this is not the answer.

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

[] The only thing you changed is the name. You move a skill from

one level to the other and you still have the initial argument - not

enough interventions.

4) On which call types does ALS intervention make a difference? Is

there empirical evidence/proof?

[]We get back to the research thing here. In my experience we make

a great deal of difference with some patients, with others we do not. I

do think we give the ill or injured patient a greater chance of

improvement by

being able to intubate, defibrillate, administer meds, pace, decompress,

crich and all the other things we do. Is this evidence, no! Just one

medic,s observation. After 28 years treating patients, I think we do

better for a patients today than we did in my first year.

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm

just curious to see what the collective consciousness of EMS is

regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

Sounds like somebody Mr. Ogilvie should go back to school to further his

education to a Paramedic. At which time he too might see the need to try

and bring the skill level up in all areas of EMS. Which in turn might help

bring respect and up the professionalism that EMS deserves?

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from

having too many paramedics competing for a finite number of ALS

interventions, even in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

[] I suppose there is some truth to the saying " use it or lose

it " , but there are other ways to retain your skill level. Of course this

will require effort on the medic's part. To participate in our system,

the Medical Director requires a certain number of advanced procedures to

be performed in a six month period. This may be accomplished by direct

patient care, in a clinical setting or by formal skills assessment in a

classroom. While I agree that direct patient care may be the preferred

method, the other options can work well also. To just sit on your ass

and wait for the real deal should not be the limit.

2) Is reducing the number of paramedics a way to address this issue?

[] Reduce supply, increase demand, and you will see the work load

of many Paramedics increase. I can sit and think up many reasons why

reducing the number of medics is wrong, but instead I will just express

my opinion - No this is not the answer.

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

[] The only thing you changed is the name. You move a skill from

one level to the other and you still have the initial argument - not

enough interventions.

4) On which call types does ALS intervention make a difference? Is

there empirical evidence/proof?

[]We get back to the research thing here. In my experience we make

a great deal of difference with some patients, with others we do not. I

do think we give the ill or injured patient a greater chance of

improvement by

being able to intubate, defibrillate, administer meds, pace, decompress,

crich and all the other things we do. Is this evidence, no! Just one

medic,s observation. After 28 years treating patients, I think we do

better for a patients today than we did in my first year.

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm

just curious to see what the collective consciousness of EMS is

regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

Sounds like somebody Mr. Ogilvie should go back to school to further his

education to a Paramedic. At which time he too might see the need to try

and bring the skill level up in all areas of EMS. Which in turn might help

bring respect and up the professionalism that EMS deserves?

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from

having too many paramedics competing for a finite number of ALS

interventions, even in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

[] I suppose there is some truth to the saying " use it or lose

it " , but there are other ways to retain your skill level. Of course this

will require effort on the medic's part. To participate in our system,

the Medical Director requires a certain number of advanced procedures to

be performed in a six month period. This may be accomplished by direct

patient care, in a clinical setting or by formal skills assessment in a

classroom. While I agree that direct patient care may be the preferred

method, the other options can work well also. To just sit on your ass

and wait for the real deal should not be the limit.

2) Is reducing the number of paramedics a way to address this issue?

[] Reduce supply, increase demand, and you will see the work load

of many Paramedics increase. I can sit and think up many reasons why

reducing the number of medics is wrong, but instead I will just express

my opinion - No this is not the answer.

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

[] The only thing you changed is the name. You move a skill from

one level to the other and you still have the initial argument - not

enough interventions.

4) On which call types does ALS intervention make a difference? Is

there empirical evidence/proof?

[]We get back to the research thing here. In my experience we make

a great deal of difference with some patients, with others we do not. I

do think we give the ill or injured patient a greater chance of

improvement by

being able to intubate, defibrillate, administer meds, pace, decompress,

crich and all the other things we do. Is this evidence, no! Just one

medic,s observation. After 28 years treating patients, I think we do

better for a patients today than we did in my first year.

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm

just curious to see what the collective consciousness of EMS is

regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

Sounds like somebody Mr. Ogilvie should go back to school to further his

education to a Paramedic. At which time he too might see the need to try

and bring the skill level up in all areas of EMS. Which in turn might help

bring respect and up the professionalism that EMS deserves?

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from

having too many paramedics competing for a finite number of ALS

interventions, even in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

[] I suppose there is some truth to the saying " use it or lose

it " , but there are other ways to retain your skill level. Of course this

will require effort on the medic's part. To participate in our system,

the Medical Director requires a certain number of advanced procedures to

be performed in a six month period. This may be accomplished by direct

patient care, in a clinical setting or by formal skills assessment in a

classroom. While I agree that direct patient care may be the preferred

method, the other options can work well also. To just sit on your ass

and wait for the real deal should not be the limit.

2) Is reducing the number of paramedics a way to address this issue?

[] Reduce supply, increase demand, and you will see the work load

of many Paramedics increase. I can sit and think up many reasons why

reducing the number of medics is wrong, but instead I will just express

my opinion - No this is not the answer.

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

[] The only thing you changed is the name. You move a skill from

one level to the other and you still have the initial argument - not

enough interventions.

4) On which call types does ALS intervention make a difference? Is

there empirical evidence/proof?

[]We get back to the research thing here. In my experience we make

a great deal of difference with some patients, with others we do not. I

do think we give the ill or injured patient a greater chance of

improvement by

being able to intubate, defibrillate, administer meds, pace, decompress,

crich and all the other things we do. Is this evidence, no! Just one

medic,s observation. After 28 years treating patients, I think we do

better for a patients today than we did in my first year.

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm

just curious to see what the collective consciousness of EMS is

regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

Michele --

I'm actually probably attending paramedic school in May. My goal was to try to

address some of the straw man arguments that some use to limit the role and

scope of practice for paramedics.

Methinks the real concern expounded by some (NOT ALL, of course) physicians

about skills degradation and such for paramedics stems as much from turf

protection as it does from patient advocacy. After all, if some of these same

doctors were actually concerned about EMS students gaining competence in airway

management, you'd see these doctors advocating for more opportunities for EMT-P

students to intubate during their clinicals. However, I'd be willing to guess

that some of these same doctors railing against paramedics' perceived skills

degradation are the same ones hiding behind the " liabilty " excuse and not

letting paramedic students intubate during their OR rotation.

Unfortunately, we have too few allies and advocates in the medical community.

If you go back and read most of my posts, you'll find that I favor an expanded,

not contracted, role for EMS.

-Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

Too many paramedics?

I've been discussing the topic of skills degradation off-list with a

paramedic who believes that some skills degradation that comes from

having too many paramedics competing for a finite number of ALS

interventions, even in a busy urban system.

My question for all of you is four-fold:

1) Is skills degradation caused (even in part) by a large number of

paramedics with a limited number of ALS interventional opportunities?

[] I suppose there is some truth to the saying " use it or lose

it " , but there are other ways to retain your skill level. Of course this

will require effort on the medic's part. To participate in our system,

the Medical Director requires a certain number of advanced procedures to

be performed in a six month period. This may be accomplished by direct

patient care, in a clinical setting or by formal skills assessment in a

classroom. While I agree that direct patient care may be the preferred

method, the other options can work well also. To just sit on your ass

and wait for the real deal should not be the limit.

2) Is reducing the number of paramedics a way to address this issue?

[] Reduce supply, increase demand, and you will see the work load

of many Paramedics increase. I can sit and think up many reasons why

reducing the number of medics is wrong, but instead I will just express

my opinion - No this is not the answer.

3) If reducing the number of paramedics was to happen, what additional

skills might an EMT-B need to possess?

[] The only thing you changed is the name. You move a skill from

one level to the other and you still have the initial argument - not

enough interventions.

4) On which call types does ALS intervention make a difference? Is

there empirical evidence/proof?

[]We get back to the research thing here. In my experience we make

a great deal of difference with some patients, with others we do not. I

do think we give the ill or injured patient a greater chance of

improvement by

being able to intubate, defibrillate, administer meds, pace, decompress,

crich and all the other things we do. Is this evidence, no! Just one

medic,s observation. After 28 years treating patients, I think we do

better for a patients today than we did in my first year.

There's something that seems counterintuitive about reducing the

availability of ALS to the general public, but I may well be wrong. I'm

just curious to see what the collective consciousness of EMS is

regarding this issue.

Best regards,

Wes Ogilvie, MPA, JD, EMT-B

Austin, Texas

[Guest guest]

>>> Methinks the real concern expounded by some (NOT ALL, of course)

physicians about skills degradation and such for paramedics stems as

much from turf protection as it does from patient advocacy. <<<

Wes,

I suppose there are some who would like to see intubation go away

because of turf protection, but my guess is they are in the minority.

I think most are genuinely concerned with the risk to the patient when

the intubator is not likely to gain significant experience in the

field especially given the paucity of evidence to suggest any

significant benefit.

There are safer ways to manage an airway than with an tracheal tube.

Perhaps some physicians are just beginning to see the light.

Kenny Navarro

UT Southwestern Medical Center

[Guest guest]

I definitely agree that the standard of care is and should continue to be

ventilation, rather than intubation.

Many healthcare providers (not just EMS providers) are lacking in airway

management skills.

However, it's the height of absurdity (not to mention disingenous) for some

physicians to carp about paramedics not mastering intubation, then hiding behind

the ol' liabilty insurance excuse when they explain why they won't let paramedic

students practice intubation skills in their ER and OR rotations. Equally

disturbing are the EMS systems that allow minimally competent medics to practice

merely to have the vacancy filled.

Of course, this brings up one of my longstanding theories about EMS management.

My theory is that EMS managers pick one of the following four excuses when they

don't want to do something or allow it to be done:

1) We can't because our insurance won't let us.

2) Our attorneys say we can't do that.

3) HIPPA won't let us do that.

4) We can't due that because of " homeland security. "

-Wes Ogilvie, MPA, JD, EMT-B

Attorney at Law/Emergency Medical Technician

Austin, Texas

*Special disclaimer -- my ire is not typically directed at any particular EMS

system, educational program, or physician. If it is directed at a specific

entity, I'll clearly state such.*

Re: Too many paramedics?

>>> Methinks the real concern expounded by some (NOT ALL, of course)

physicians about skills degradation and such for paramedics stems as

much from turf protection as it does from patient advocacy. <<<

Wes,

I suppose there are some who would like to see intubation go away

because of turf protection, but my guess is they are in the minority.

I think most are genuinely concerned with the risk to the patient when

the intubator is not likely to gain significant experience in the

field especially given the paucity of evidence to suggest any

significant benefit.

There are safer ways to manage an airway than with an tracheal tube.

Perhaps some physicians are just beginning to see the light.

Kenny Navarro

UT Southwestern Medical Center

[Guest guest]

I definitely agree that the standard of care is and should continue to be

ventilation, rather than intubation.

Many healthcare providers (not just EMS providers) are lacking in airway

management skills.

However, it's the height of absurdity (not to mention disingenous) for some

physicians to carp about paramedics not mastering intubation, then hiding behind

the ol' liabilty insurance excuse when they explain why they won't let paramedic

students practice intubation skills in their ER and OR rotations. Equally

disturbing are the EMS systems that allow minimally competent medics to practice

merely to have the vacancy filled.

Of course, this brings up one of my longstanding theories about EMS management.

My theory is that EMS managers pick one of the following four excuses when they

don't want to do something or allow it to be done:

1) We can't because our insurance won't let us.

2) Our attorneys say we can't do that.

3) HIPPA won't let us do that.

4) We can't due that because of " homeland security. "

-Wes Ogilvie, MPA, JD, EMT-B

Attorney at Law/Emergency Medical Technician

Austin, Texas

*Special disclaimer -- my ire is not typically directed at any particular EMS

system, educational program, or physician. If it is directed at a specific

entity, I'll clearly state such.*

Re: Too many paramedics?

>>> Methinks the real concern expounded by some (NOT ALL, of course)

physicians about skills degradation and such for paramedics stems as

much from turf protection as it does from patient advocacy. <<<

Wes,

I suppose there are some who would like to see intubation go away

because of turf protection, but my guess is they are in the minority.

I think most are genuinely concerned with the risk to the patient when

the intubator is not likely to gain significant experience in the

field especially given the paucity of evidence to suggest any

significant benefit.

There are safer ways to manage an airway than with an tracheal tube.

Perhaps some physicians are just beginning to see the light.

Kenny Navarro

UT Southwestern Medical Center

[Guest guest]

I used to worry a lot about malpractice suits and defensive medicine. I

found myself doing absurd things simply to make the chart look good in case

I was sued (which I never was). I learned that it is best to act solely in

the patient's best interest. Damn the attorneys, HIPAA, the federal

government and all others. When I was at and White I got in trouble

with the health plan for referring a patient with a complicated problem to

one of the leading specialists in the nation (who was not on the S & W Health

Plan). We I was confronted, the bean counters wanted blood, but the

physicians who run and White agreed that putting the patient first was

the most defensible position.

Unlike the law, medicine does not have the same level of checks and balances

and perhaps it should. There was a time when nobody questioned a physician's

decision and that was wrong. Physicians are human--but usually the most

knowledgeable members of the health care team.

EMS needs to be based upon the prevailing science. And, when science is

scant, the best expert conjecture. Changing from dogma to science is

painful. The changes in CISM and MAST upset a few who were big believers in

the practice or the device. The issues of helicopter transport and such

bring out great emotion because the jobs are pretty good and unique.

Paramedics not being able to intubate in the future brings up emotions. Wes

is right there are physicians who make decisions not based on science. I do

not know their motives. Science can adversely affect any of us if it does

not support what we have come to do. I would be hurt financially if

paramedics went away since the majority of my income is derived from book

royalties.

We physicians bitch about the lawyers (and Wes and Gene know that my jokes

are simply those). But, the lawyers play an important role because in

medicine when we are reluctant to regulate ourselves and people have to have

recourse. EMS providers and administrators have looked through the smoke at

certain things (CISM, MAST, reflex spinal immobilization) and said, " OK. The

science is overwhelming. Let's not do that. " Likewise, some practices are

growing despite the lack of prevailing science (helicopters, AutoPulses).

So, if we don't act on the science, the attorneys come in as they should.

The post I made yesterday from the journal TRIAL is a perfect example. The

author of the article in a step by step fashion (you have to simplify things

for trial lawyers) states the problem and defines how to file the cases.

Like it or not. That is the American system. That, my friends, is the

ultimate regulatory authority. A big lawsuit that is based on: pilot error,

singe-engine aircraft, lack of IFR capability, lack of dual pilots,

transport of non-critical patients will forever change the playing field.

Once the attorneys are involved, people pay attention because it threatens

the universal theme in capitalistic business--profit. Wouldn't it be better

to make the helicopter safety changes voluntarily? But, instead you get

finger pointing--public versus private, profit versus non-profit, rural

versus urban. Such arguments are merely delaying tactics from the

inevitable. Likewise, an increase in ground ambulance accidents might change

the practice of using lights and sirens or limiting responses to the

parameters of a " black box " .

But, it works both ways. There is a paramedic in Nebraska who makes her

living as an expert witness against EMS and police on restraint issues. She

is no longer a certified paramedic and only a high-school graduate, but has

done a great deal of damage. Several of us physicians have been finally

countering her claims by correctly explaining to the courts and the juries

what the science " really says " and not how the high school graduate

interprets it. We have used the science to keep several EMTs and paramedics

out of jail--much less being penalized financially.

So, science is what we need. It may be painful and yet it can be

beneficial. The best thing, it is objective when properly applied. Carl

Sagan said it best when he said, " In science there are no experts. "

Re: Too many paramedics?

>>> Methinks the real concern expounded by some (NOT ALL, of course)

physicians about skills degradation and such for paramedics stems as

much from turf protection as it does from patient advocacy. <<<

Wes,

I suppose there are some who would like to see intubation go away

because of turf protection, but my guess is they are in the minority.

I think most are genuinely concerned with the risk to the patient when

the intubator is not likely to gain significant experience in the

field especially given the paucity of evidence to suggest any

significant benefit.

There are safer ways to manage an airway than with an tracheal tube.

Perhaps some physicians are just beginning to see the light.

Kenny Navarro

UT Southwestern Medical Center

[Guest guest]

I used to worry a lot about malpractice suits and defensive medicine. I

found myself doing absurd things simply to make the chart look good in case

I was sued (which I never was). I learned that it is best to act solely in

the patient's best interest. Damn the attorneys, HIPAA, the federal

government and all others. When I was at and White I got in trouble

with the health plan for referring a patient with a complicated problem to

one of the leading specialists in the nation (who was not on the S & W Health

Plan). We I was confronted, the bean counters wanted blood, but the

physicians who run and White agreed that putting the patient first was

the most defensible position.

Unlike the law, medicine does not have the same level of checks and balances

and perhaps it should. There was a time when nobody questioned a physician's

decision and that was wrong. Physicians are human--but usually the most

knowledgeable members of the health care team.

EMS needs to be based upon the prevailing science. And, when science is

scant, the best expert conjecture. Changing from dogma to science is

painful. The changes in CISM and MAST upset a few who were big believers in

the practice or the device. The issues of helicopter transport and such

bring out great emotion because the jobs are pretty good and unique.

Paramedics not being able to intubate in the future brings up emotions. Wes

is right there are physicians who make decisions not based on science. I do

not know their motives. Science can adversely affect any of us if it does

not support what we have come to do. I would be hurt financially if

paramedics went away since the majority of my income is derived from book

royalties.

We physicians bitch about the lawyers (and Wes and Gene know that my jokes

are simply those). But, the lawyers play an important role because in

medicine when we are reluctant to regulate ourselves and people have to have

recourse. EMS providers and administrators have looked through the smoke at

certain things (CISM, MAST, reflex spinal immobilization) and said, " OK. The

science is overwhelming. Let's not do that. " Likewise, some practices are

growing despite the lack of prevailing science (helicopters, AutoPulses).

So, if we don't act on the science, the attorneys come in as they should.

The post I made yesterday from the journal TRIAL is a perfect example. The

author of the article in a step by step fashion (you have to simplify things

for trial lawyers) states the problem and defines how to file the cases.

Like it or not. That is the American system. That, my friends, is the

ultimate regulatory authority. A big lawsuit that is based on: pilot error,

singe-engine aircraft, lack of IFR capability, lack of dual pilots,

transport of non-critical patients will forever change the playing field.

Once the attorneys are involved, people pay attention because it threatens

the universal theme in capitalistic business--profit. Wouldn't it be better

to make the helicopter safety changes voluntarily? But, instead you get

finger pointing--public versus private, profit versus non-profit, rural

versus urban. Such arguments are merely delaying tactics from the

inevitable. Likewise, an increase in ground ambulance accidents might change

the practice of using lights and sirens or limiting responses to the

parameters of a " black box " .

But, it works both ways. There is a paramedic in Nebraska who makes her

living as an expert witness against EMS and police on restraint issues. She

is no longer a certified paramedic and only a high-school graduate, but has

done a great deal of damage. Several of us physicians have been finally

countering her claims by correctly explaining to the courts and the juries

what the science " really says " and not how the high school graduate

interprets it. We have used the science to keep several EMTs and paramedics

out of jail--much less being penalized financially.

So, science is what we need. It may be painful and yet it can be

beneficial. The best thing, it is objective when properly applied. Carl

Sagan said it best when he said, " In science there are no experts. "

Re: Too many paramedics?

>>> Methinks the real concern expounded by some (NOT ALL, of course)

physicians about skills degradation and such for paramedics stems as

much from turf protection as it does from patient advocacy. <<<

Wes,

I suppose there are some who would like to see intubation go away

because of turf protection, but my guess is they are in the minority.

I think most are genuinely concerned with the risk to the patient when

the intubator is not likely to gain significant experience in the

field especially given the paucity of evidence to suggest any

significant benefit.

There are safer ways to manage an airway than with an tracheal tube.

Perhaps some physicians are just beginning to see the light.

Kenny Navarro

UT Southwestern Medical Center

[Guest guest]

If Kinky wins, I propose that he nominate Dr. Bledsoe to be his special advisor

for EMS and hopefully, the first chairman of the Texas EMS Commission.

-Wes Ogilvie

Austin, Texas

Re: Too many paramedics?

>>> Methinks the real concern expounded by some (NOT ALL, of course)

physicians about skills degradation and such for paramedics stems as

much from turf protection as it does from patient advocacy. <<<

Wes,

I suppose there are some who would like to see intubation go away

because of turf protection, but my guess is they are in the minority.

I think most are genuinely concerned with the risk to the patient when

the intubator is not likely to gain significant experience in the

field especially given the paucity of evidence to suggest any

significant benefit.

There are safer ways to manage an airway than with an tracheal tube.

Perhaps some physicians are just beginning to see the light.

Kenny Navarro

UT Southwestern Medical Center

[Guest guest]

If Kinky wins, I propose that he nominate Dr. Bledsoe to be his special advisor

for EMS and hopefully, the first chairman of the Texas EMS Commission.

-Wes Ogilvie

Austin, Texas

Re: Too many paramedics?

>>> Methinks the real concern expounded by some (NOT ALL, of course)

physicians about skills degradation and such for paramedics stems as

much from turf protection as it does from patient advocacy. <<<

Wes,

I suppose there are some who would like to see intubation go away

because of turf protection, but my guess is they are in the minority.

I think most are genuinely concerned with the risk to the patient when

the intubator is not likely to gain significant experience in the

field especially given the paucity of evidence to suggest any

significant benefit.

There are safer ways to manage an airway than with an tracheal tube.

Perhaps some physicians are just beginning to see the light.

Kenny Navarro

UT Southwestern Medical Center

[Guest guest]

If Kinky wins, I propose that he nominate Dr. Bledsoe to be his special advisor

for EMS and hopefully, the first chairman of the Texas EMS Commission.

-Wes Ogilvie

Austin, Texas

Re: Too many paramedics?

>>> Methinks the real concern expounded by some (NOT ALL, of course)

physicians about skills degradation and such for paramedics stems as

much from turf protection as it does from patient advocacy. <<<

Wes,

I suppose there are some who would like to see intubation go away

because of turf protection, but my guess is they are in the minority.

I think most are genuinely concerned with the risk to the patient when

the intubator is not likely to gain significant experience in the

field especially given the paucity of evidence to suggest any

significant benefit.

There are safer ways to manage an airway than with an tracheal tube.

Perhaps some physicians are just beginning to see the light.

Kenny Navarro

UT Southwestern Medical Center

[Guest guest]

I believe that not holding the particular paramedics actually accountable for

failure to properly ventilate their patients is the way to fix the problem.

There is not an EMT-Basic,EMT-Intermediate or Paramedic practicing that should

not use their training and knowledge to properly ventilate a patient. If that

means you ventilate by BVM because for some reason an intubation is not

attainable (for whatever the reason) it should be done.

I believe the problem occurs because some are so concerned with either a

feeling of inadequacy or have a genuine lack of skill that the patient is put

into jeopardy.

We are trained to use different methods to ventilate our patients. If

advanced techniques are not available (again for whatever the reason) basic

ventilation techniques with suction when and if needed will do. The studies and

outcomes from those studies I have seen tend to emphasize more with the fact the

patient was put into jeopardy because of the total absence of ventilation due to

inadequate intubation skills rather than because of the absence of the advance

ventilation technique itself. In other words " The EMS personnel did not

recognize the inadequacy of their ventilation and did not abandon the advanced

attempt and correct the situation with basic ventilation procedures. "

Using our " common sense " is also a skill we need to be proficient in.

ExLngHrn@... wrote:

I definitely agree that the standard of care is and should continue to be

ventilation, rather than intubation.

Many healthcare providers (not just EMS providers) are lacking in airway

management skills.

However, it's the height of absurdity (not to mention disingenous) for some

physicians to carp about paramedics not mastering intubation, then hiding behind

the ol' liabilty insurance excuse when they explain why they won't let paramedic

students practice intubation skills in their ER and OR rotations. Equally

disturbing are the EMS systems that allow minimally competent medics to practice

merely to have the vacancy filled.

Of course, this brings up one of my longstanding theories about EMS management.

My theory is that EMS managers pick one of the following four excuses when they

don't want to do something or allow it to be done:

1) We can't because our insurance won't let us.

2) Our attorneys say we can't do that.

3) HIPPA won't let us do that.

4) We can't due that because of " homeland security. "

-Wes Ogilvie, MPA, JD, EMT-B

Attorney at Law/Emergency Medical Technician

Austin, Texas

*Special disclaimer -- my ire is not typically directed at any particular EMS

system, educational program, or physician. If it is directed at a specific

entity, I'll clearly state such.*

Re: Too many paramedics?

>>> Methinks the real concern expounded by some (NOT ALL, of course)

physicians about skills degradation and such for paramedics stems as

much from turf protection as it does from patient advocacy. <<<

Wes,

I suppose there are some who would like to see intubation go away

because of turf protection, but my guess is they are in the minority.

I think most are genuinely concerned with the risk to the patient when

the intubator is not likely to gain significant experience in the

field especially given the paucity of evidence to suggest any

significant benefit.

There are safer ways to manage an airway than with an tracheal tube.

Perhaps some physicians are just beginning to see the light.

Kenny Navarro

UT Southwestern Medical Center