Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 In a message dated 02-Mar-06 12:22:27 Central Standard Time, petsardlj@... writes: I have taken patients into the ER and was either asked by the RN or Physician why an intubation was not accomplished. I have set at the work station at the hospital to prepare my reports and actually overheard the comments made by the respiratory technicians as to how inadequate the paramedic was because they were unable to obtain an intubation in the field because it was easy to obtain in the trauma room. I try not to harrass my medics too much about that...I've been there in the mud and the blood, knee deep in water and trying to intubate literally over my head...and there have been times when a medic has managed to slide a tube in that I had trouble seeing for what ever reason... Control of chaos is the name of the game, and it's a lot easier to do when there is at least good light and dry footing! S. Krin, DO FAAFP Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Dudley -- If you'll pardon my cynicism, a lot of liability protections already exist. Is the problem *truly* liability -- or is it something different? -Wes In a message dated 3/2/2006 2:56:37 PM Central Standard Time, THEDUDMAN@... writes: Wes, That is one issue that I think the legislature should look at taking up...and everyone would agree to it...(well except you lawyer types...) and that is to take steps to protect facilities, physicians, and other practitioners from liability in settings where paramedics could get more/better intubation rotations...in the late 80's I was fortunate enough to get to intubate almost 20 patients in the OR setting and several more in the field...but now we are getting medics out of school who haven't even intubated a dog, cat or pig....let alone a human... This problem needs some serious attention... Dudley 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 [Non-text portions of this message have been removed] Yahoo! Groups Links [Non-text portions of this message have been removed] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 Dudley -- If you'll pardon my cynicism, a lot of liability protections already exist. Is the problem *truly* liability -- or is it something different? -Wes In a message dated 3/2/2006 2:56:37 PM Central Standard Time, THEDUDMAN@... writes: Wes, That is one issue that I think the legislature should look at taking up...and everyone would agree to it...(well except you lawyer types...) and that is to take steps to protect facilities, physicians, and other practitioners from liability in settings where paramedics could get more/better intubation rotations...in the late 80's I was fortunate enough to get to intubate almost 20 patients in the OR setting and several more in the field...but now we are getting medics out of school who haven't even intubated a dog, cat or pig....let alone a human... This problem needs some serious attention... Dudley 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 [Non-text portions of this message have been removed] Yahoo! Groups Links [Non-text portions of this message have been removed] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 The problem might have something to do with the Anesthesiologist shopping at the same Wal-Mart as Dr. B. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 The problem might have something to do with the Anesthesiologist shopping at the same Wal-Mart as Dr. B. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 I doubt it is truly liability but a fear of perceived liability....that and a lack of hospital/EMS relationships...potentially. Dudley 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 [Non-text portions of this message have been removed] Yahoo! Groups Links [Non-text portions of this message have been removed] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 I doubt it is truly liability but a fear of perceived liability....that and a lack of hospital/EMS relationships...potentially. Dudley 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 [Non-text portions of this message have been removed] Yahoo! Groups Links [Non-text portions of this message have been removed] Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 ‹utopia› Would it not be better to develop those relationships rather than force them legislatively? ‹/utopia› When I worked at a certain hospital, the ER residents often deferred to the gas-passing residents, because they " needed the tubes " - now the increased usage of alternative devices (ie. LMA's) in surgery has made it even harder to find intubation opportunities for the baby medic. Facilities often hide behind liability as a way to protect the procedures for the baby docs. They will also use reimbursement complications as a reason to deny access. Answer? I don't know. But its definitely something we as a profession need to work on, alongside our doctor colleagues. Oh, and the lawyers too. I didn't wanna leave Wes out. R ___ Sent with SnapperMail www.snappermail.com ..... Original Message ....... >I doubt it is truly liability but a fear of perceived liability....that and a lack of hospital/EMS relationships...potentially. > >Dudley > > Re: Too many paramedics? > > >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. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 ‹utopia› Would it not be better to develop those relationships rather than force them legislatively? ‹/utopia› When I worked at a certain hospital, the ER residents often deferred to the gas-passing residents, because they " needed the tubes " - now the increased usage of alternative devices (ie. LMA's) in surgery has made it even harder to find intubation opportunities for the baby medic. Facilities often hide behind liability as a way to protect the procedures for the baby docs. They will also use reimbursement complications as a reason to deny access. Answer? I don't know. But its definitely something we as a profession need to work on, alongside our doctor colleagues. Oh, and the lawyers too. I didn't wanna leave Wes out. R ___ Sent with SnapperMail www.snappermail.com ..... Original Message ....... >I doubt it is truly liability but a fear of perceived liability....that and a lack of hospital/EMS relationships...potentially. > >Dudley > > Re: Too many paramedics? > > >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. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 2, 2006 Report Share Posted March 2, 2006 I agree there are many that do not perform well in the field. I worked a side job for a transfer service for about a year and while on this job had very few transfers were anything was needed besides gather demographics and vitals and to monitor the Pt. during transport. I gained some knowledge on pumps, vents ect. that was valuable and learned much from reading Pt. histories and such. But I work for a pretty busy 911 service that routinely runs significant calls trauma/medical. I feel that if you work only transfer you will not get much experience in performing Pt. skills at least that was my experience. crazywoowooz wrote: 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 Quote Link to comment Share on other sites More sharing options...
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