Re: Progressive services?

[Guest guest]

" As you note, all of the standards that we have traditionally held up

as measures of quality are rapidly falling into Dr. Bledsoe's myth

bin. We now know that cardiac arrest saves is a bogus standard. Less

and less of the care we provide is showing to make any difference in

survival numbers. And now it is starting to appear that even response

times are a dubious measure. "

I can't help but argue, but if this is proving to be true why stress

more ALS teatment, if it's not making that much of an impact let's

focus more on a BLS level of care and get people to the hospital.

Don't get me wrong I'm not saying furthering your education is bad in

fact it's the most important thing we do to better ourselves, but as

mentioned before I see way too many people sit on scene to get an IV

or pull over during transport to induce and intubate, is this really

better than getting people to a physician, surgeon, etc?!?! Sure

those skills are interesting and dare I say fun (for lack of better

term)but the first thing I was taught in paramedic class was that

performing a skill just because you can is poor pt. managment. After

perfection with " how " to do these skills schools and agencies really

need to focus on " when " to do them!!

-Chris

Sorry for the spelling and punctuation this was typed on tge tiny

keyboard on my iPhone

On Apr 7, 2010, at 9:03, " rob.davis@... "

rob.davis@...

> wrote:

> As you note, all of the standards that we have traditionally held up

> as measures of quality are rapidly falling into Dr. Bledsoe's myth

> bin. We now know that cardiac arrest saves is a bogus standard.

> Less and less of the care we provide is showing to make any

> difference in survival numbers. And now it is starting to appear

> that even response times are a dubious measure.

[Guest guest]

" As you note, all of the standards that we have traditionally held up

as measures of quality are rapidly falling into Dr. Bledsoe's myth

bin. We now know that cardiac arrest saves is a bogus standard. Less

and less of the care we provide is showing to make any difference in

survival numbers. And now it is starting to appear that even response

times are a dubious measure. "

I can't help but argue, but if this is proving to be true why stress

more ALS teatment, if it's not making that much of an impact let's

focus more on a BLS level of care and get people to the hospital.

Don't get me wrong I'm not saying furthering your education is bad in

fact it's the most important thing we do to better ourselves, but as

mentioned before I see way too many people sit on scene to get an IV

or pull over during transport to induce and intubate, is this really

better than getting people to a physician, surgeon, etc?!?! Sure

those skills are interesting and dare I say fun (for lack of better

term)but the first thing I was taught in paramedic class was that

performing a skill just because you can is poor pt. managment. After

perfection with " how " to do these skills schools and agencies really

need to focus on " when " to do them!!

-Chris

Sorry for the spelling and punctuation this was typed on tge tiny

keyboard on my iPhone

On Apr 7, 2010, at 9:03, " rob.davis@... "

rob.davis@...

> wrote:

> As you note, all of the standards that we have traditionally held up

> as measures of quality are rapidly falling into Dr. Bledsoe's myth

> bin. We now know that cardiac arrest saves is a bogus standard.

> Less and less of the care we provide is showing to make any

> difference in survival numbers. And now it is starting to appear

> that even response times are a dubious measure.

[Guest guest]

On Wednesday, April 7, 2010 09:41, " " aggiesrwe03@...> said:

> I can't help but argue, but if this is proving to be true why stress

> more ALS teatment, if it's not making that much of an impact let's

> focus more on a BLS level of care and get people to the hospital.

> Don't get me wrong I'm not saying furthering your education is bad in

> fact it's the most important thing we do to better ourselves, but as

> mentioned before I see way too many people sit on scene to get an IV

> or pull over during transport to induce and intubate, is this really

> better than getting people to a physician, surgeon, etc?!?! Sure

> those skills are interesting and dare I say fun (for lack of better

> term)but the first thing I was taught in paramedic class was that

> performing a skill just because you can is poor pt. managment. After

> perfection with " how " to do these skills schools and agencies really

> need to focus on " when " to do them!!

No argument from me, Chris. I couldn't agree more. I definitely do not

advocate doing things simply because we can. As you mention, it can often stand

in the way of expeditious transportation and a delay of definitive care. That's

cookbook medicine, which I am the sworn enemy of.

No, I don't think that ALS care is a cure-all, or that everyone needs ALS

intervention. In fact, I recognise that only a small percentage of our patients

actually benefit from such intervention. However, I still maintain that EVERY

patient benefits from an advanced assessment. I'm talking about an assessment

by someone not just trained to take signs and symptoms, but EDUCATED to

critically interpret them to form a differential diagnosis, which is what is

necessary in order to determine if the patient needs ALS intervention or not.

An EMT-B simply cannot do that. And yes, living in the Dallas area, I am well

aware that a lot of paramedics cannot either. We won't get into the reasons for

that. But the more education you have, the better your assessment skills will

be. And the more practice you get at assessment, the better your skills will be

to. Both of those factors suggest that paramedics making all of your patient

assessments is then the " best practice " .

Rob

[Guest guest]

On Wednesday, April 7, 2010 09:41, " " aggiesrwe03@...> said:

> I can't help but argue, but if this is proving to be true why stress

> more ALS teatment, if it's not making that much of an impact let's

> focus more on a BLS level of care and get people to the hospital.

> Don't get me wrong I'm not saying furthering your education is bad in

> fact it's the most important thing we do to better ourselves, but as

> mentioned before I see way too many people sit on scene to get an IV

> or pull over during transport to induce and intubate, is this really

> better than getting people to a physician, surgeon, etc?!?! Sure

> those skills are interesting and dare I say fun (for lack of better

> term)but the first thing I was taught in paramedic class was that

> performing a skill just because you can is poor pt. managment. After

> perfection with " how " to do these skills schools and agencies really

> need to focus on " when " to do them!!

No argument from me, Chris. I couldn't agree more. I definitely do not

advocate doing things simply because we can. As you mention, it can often stand

in the way of expeditious transportation and a delay of definitive care. That's

cookbook medicine, which I am the sworn enemy of.

No, I don't think that ALS care is a cure-all, or that everyone needs ALS

intervention. In fact, I recognise that only a small percentage of our patients

actually benefit from such intervention. However, I still maintain that EVERY

patient benefits from an advanced assessment. I'm talking about an assessment

by someone not just trained to take signs and symptoms, but EDUCATED to

critically interpret them to form a differential diagnosis, which is what is

necessary in order to determine if the patient needs ALS intervention or not.

An EMT-B simply cannot do that. And yes, living in the Dallas area, I am well

aware that a lot of paramedics cannot either. We won't get into the reasons for

that. But the more education you have, the better your assessment skills will

be. And the more practice you get at assessment, the better your skills will be

to. Both of those factors suggest that paramedics making all of your patient

assessments is then the " best practice " .

Rob

[Guest guest]

On Wednesday, April 7, 2010 09:41, " " aggiesrwe03@...> said:

> I can't help but argue, but if this is proving to be true why stress

> more ALS teatment, if it's not making that much of an impact let's

> focus more on a BLS level of care and get people to the hospital.

> Don't get me wrong I'm not saying furthering your education is bad in

> fact it's the most important thing we do to better ourselves, but as

> mentioned before I see way too many people sit on scene to get an IV

> or pull over during transport to induce and intubate, is this really

> better than getting people to a physician, surgeon, etc?!?! Sure

> those skills are interesting and dare I say fun (for lack of better

> term)but the first thing I was taught in paramedic class was that

> performing a skill just because you can is poor pt. managment. After

> perfection with " how " to do these skills schools and agencies really

> need to focus on " when " to do them!!

No argument from me, Chris. I couldn't agree more. I definitely do not

advocate doing things simply because we can. As you mention, it can often stand

in the way of expeditious transportation and a delay of definitive care. That's

cookbook medicine, which I am the sworn enemy of.

No, I don't think that ALS care is a cure-all, or that everyone needs ALS

intervention. In fact, I recognise that only a small percentage of our patients

actually benefit from such intervention. However, I still maintain that EVERY

patient benefits from an advanced assessment. I'm talking about an assessment

by someone not just trained to take signs and symptoms, but EDUCATED to

critically interpret them to form a differential diagnosis, which is what is

necessary in order to determine if the patient needs ALS intervention or not.

An EMT-B simply cannot do that. And yes, living in the Dallas area, I am well

aware that a lot of paramedics cannot either. We won't get into the reasons for

that. But the more education you have, the better your assessment skills will

be. And the more practice you get at assessment, the better your skills will be

to. Both of those factors suggest that paramedics making all of your patient

assessments is then the " best practice " .

Rob