Re: Too many paramedics?

[Guest guest]

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

[Guest guest]

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]

[Guest guest]

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]

[Guest guest]

The problem might have something to do with the Anesthesiologist shopping at the

same Wal-Mart as Dr. B.

[Guest guest]

The problem might have something to do with the Anesthesiologist shopping at the

same Wal-Mart as Dr. B.

[Guest guest]

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]

[Guest guest]

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]

[Guest guest]

‹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.

>

[Guest guest]

‹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.

>

[Guest guest]

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