Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 On Saturday, April 3, 2010 10:34, " " aggiesrwe03@...> said: > That is too broad just because the patch on their shoulder says they > are EMT does not mean they are ignorant... First, let me make it absolutely clear to anyone who has not been following closely that I have never used the term " ignorant " , because, as we see right here, it is too often misunderstood. Second, and I hate to play the English teacher card here, but you are wrong. A lack of knowledge is the very definition of ignorance. But remember, you used the word, not me. Perhaps you meant to refer to stupidity, and not ignorance. However, I would never be caught confusing the two terms. But I will certainly say that no, no patch makes you stupid, or even smart for that matter. > Sorry Rob but paramedics > don't really know more because the chapter in their book was a little > longer and had bigger words, sure they may have a few more tricks but > that does not make them that much more " educated. " Not sure I understand the basis of this contention. If someone undergoes two years of education and doesn't come out knowing more than the guy who didn't, I'd be really surprised if they passed even the NR exam. > Now you can > misquote me all you want because of that but when it all comes down to > it this field as it stands this min. is still a tech job that requires > little more than a diploma, people " learn " what it takes to pass the > NR test then get in the field where the real " education " starts. What > I mean by that is alot of ems programs teach thier students to pass > that test not to be medics that is learned at the service level, we > may be working to change that but it hasn't happened yet. Red on your > shoulder does not make you a fixall, it means you passed a test, and I > think too many people forget when it comes down to it, it is about > putting the patient in the truck and going to the hospital if you > don't do that then nothing you do in the field is really all that > helpful. Well said! I don't disagree with any of that. It is a disgrace to a forty year old vocation that we still cater to the lowest common denominator, and settle for the status quo instead of progressing into the realm of a real profession. I share your disgust with the system as it currently exists. I simply believe that we should improve it rather than live with it. And until that is done, we need to utilise what we have in the way that best benefits our patients, not our egos. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 To take your " every patient needs to be evaluated by a Paramedic " concept to other areas, that would mean that every patient wanting to see a doctor should not be evaluated by a primary care physician (in office, ER, or elsewhere) but instead should be " evaluated " by a collegium of " higher-qualified " specialists because the PCP is too dumb to know whether or not the patient needs a specialist.  By that definition, the only people " allowed " to do triage at a scene (MCI or not) would be the lofty god-like Paramedics who could then decide whether a particular case could be " dumped " on a lower patch.  Sorry, can't agree with you. Subject: Re: Progressive services? To: texasems-l Date: Saturday, April 3, 2010, 10:42 AM  On Saturday, April 3, 2010 08:48, " Alyssa Woods " said: > But just like in the sense of > supplies, sometimes you can do more with less. A good basic knows how > to do that. > > Sorry this is so long, and sorry if it's a complete left turn. Absolutely no need to apologise for a very well thought out and relevant post! The issues I have are: 1. Why are we comparing good EMTs to poor Paramedics? If your Paramedics suck, wouldn't a better solution be (if you're not going to replace them) to augment them with more medics? If you had a bad surgeon, would you rather him be backed up by a good nurse, or another surgeon? And if your medics are that poorly trained, what makes you think your EMTs are really any better? I just don't see the wisdom in trying to get by with the minimum that you can " sometimes " do with. 2. Yes, not every patient needs a Paramedic for treatment. However, EMTs are not qualified to competently determine which patient is which. Consequently, every patient needs to be evaluated by a Paramedic. If that medic determines that a patient can be dumped (for lack of a better word, since that's exactly what it is) on an EMT, so be it. It's his licence. But at least the patient was properly evaluated before that dumping. We've all seen how incompetent the telephone triage system is at making these decisions without seeing the patient. As with every single issue confronting EMS today, the answer is education. Better education will assure that fewer of your medics need to be " saved " by an EMT or anyone else. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 To take your " every patient needs to be evaluated by a Paramedic " concept to other areas, that would mean that every patient wanting to see a doctor should not be evaluated by a primary care physician (in office, ER, or elsewhere) but instead should be " evaluated " by a collegium of " higher-qualified " specialists because the PCP is too dumb to know whether or not the patient needs a specialist.  By that definition, the only people " allowed " to do triage at a scene (MCI or not) would be the lofty god-like Paramedics who could then decide whether a particular case could be " dumped " on a lower patch.  Sorry, can't agree with you. Subject: Re: Progressive services? To: texasems-l Date: Saturday, April 3, 2010, 10:42 AM  On Saturday, April 3, 2010 08:48, " Alyssa Woods " said: > But just like in the sense of > supplies, sometimes you can do more with less. A good basic knows how > to do that. > > Sorry this is so long, and sorry if it's a complete left turn. Absolutely no need to apologise for a very well thought out and relevant post! The issues I have are: 1. Why are we comparing good EMTs to poor Paramedics? If your Paramedics suck, wouldn't a better solution be (if you're not going to replace them) to augment them with more medics? If you had a bad surgeon, would you rather him be backed up by a good nurse, or another surgeon? And if your medics are that poorly trained, what makes you think your EMTs are really any better? I just don't see the wisdom in trying to get by with the minimum that you can " sometimes " do with. 2. Yes, not every patient needs a Paramedic for treatment. However, EMTs are not qualified to competently determine which patient is which. Consequently, every patient needs to be evaluated by a Paramedic. If that medic determines that a patient can be dumped (for lack of a better word, since that's exactly what it is) on an EMT, so be it. It's his licence. But at least the patient was properly evaluated before that dumping. We've all seen how incompetent the telephone triage system is at making these decisions without seeing the patient. As with every single issue confronting EMS today, the answer is education. Better education will assure that fewer of your medics need to be " saved " by an EMT or anyone else. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 To take your " every patient needs to be evaluated by a Paramedic " concept to other areas, that would mean that every patient wanting to see a doctor should not be evaluated by a primary care physician (in office, ER, or elsewhere) but instead should be " evaluated " by a collegium of " higher-qualified " specialists because the PCP is too dumb to know whether or not the patient needs a specialist.  By that definition, the only people " allowed " to do triage at a scene (MCI or not) would be the lofty god-like Paramedics who could then decide whether a particular case could be " dumped " on a lower patch.  Sorry, can't agree with you. Subject: Re: Progressive services? To: texasems-l Date: Saturday, April 3, 2010, 10:42 AM  On Saturday, April 3, 2010 08:48, " Alyssa Woods " said: > But just like in the sense of > supplies, sometimes you can do more with less. A good basic knows how > to do that. > > Sorry this is so long, and sorry if it's a complete left turn. Absolutely no need to apologise for a very well thought out and relevant post! The issues I have are: 1. Why are we comparing good EMTs to poor Paramedics? If your Paramedics suck, wouldn't a better solution be (if you're not going to replace them) to augment them with more medics? If you had a bad surgeon, would you rather him be backed up by a good nurse, or another surgeon? And if your medics are that poorly trained, what makes you think your EMTs are really any better? I just don't see the wisdom in trying to get by with the minimum that you can " sometimes " do with. 2. Yes, not every patient needs a Paramedic for treatment. However, EMTs are not qualified to competently determine which patient is which. Consequently, every patient needs to be evaluated by a Paramedic. If that medic determines that a patient can be dumped (for lack of a better word, since that's exactly what it is) on an EMT, so be it. It's his licence. But at least the patient was properly evaluated before that dumping. We've all seen how incompetent the telephone triage system is at making these decisions without seeing the patient. As with every single issue confronting EMS today, the answer is education. Better education will assure that fewer of your medics need to be " saved " by an EMT or anyone else. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 On Saturday, April 3, 2010 11:14, " STEVE BOWMAN " swbowman@...> said: > To take your " every patient needs to be evaluated by a Paramedic " concept to other > areas, that would mean that every patient wanting to see a doctor should not be > evaluated by a primary care physician (in office, ER, or elsewhere) but instead > should be " evaluated " by a collegium of " higher-qualified " specialists because the > PCP is too dumb to know whether or not the patient needs a specialist. Not really a valid analogy. As I tried to make absolutely clear earlier, we're discussing EMS here, not other professions. I could make your analogy more relevant, but it would still be comparing apples to oranges, so I'll leave it as is and try to keep the discussion focused. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 On Saturday, April 3, 2010 11:14, " STEVE BOWMAN " swbowman@...> said: > To take your " every patient needs to be evaluated by a Paramedic " concept to other > areas, that would mean that every patient wanting to see a doctor should not be > evaluated by a primary care physician (in office, ER, or elsewhere) but instead > should be " evaluated " by a collegium of " higher-qualified " specialists because the > PCP is too dumb to know whether or not the patient needs a specialist. Not really a valid analogy. As I tried to make absolutely clear earlier, we're discussing EMS here, not other professions. I could make your analogy more relevant, but it would still be comparing apples to oranges, so I'll leave it as is and try to keep the discussion focused. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 On Saturday, April 3, 2010 11:14, " STEVE BOWMAN " swbowman@...> said: > To take your " every patient needs to be evaluated by a Paramedic " concept to other > areas, that would mean that every patient wanting to see a doctor should not be > evaluated by a primary care physician (in office, ER, or elsewhere) but instead > should be " evaluated " by a collegium of " higher-qualified " specialists because the > PCP is too dumb to know whether or not the patient needs a specialist. Not really a valid analogy. As I tried to make absolutely clear earlier, we're discussing EMS here, not other professions. I could make your analogy more relevant, but it would still be comparing apples to oranges, so I'll leave it as is and try to keep the discussion focused. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 Sorry Rob, what I meant was -Chris Sorry for the spelling and punctuation this was typed on tge tiny keyboard on my iPhone On Apr 3, 2010, at 11:12, " rob.davis@... " rob.davis@... > wrote: > On Saturday, April 3, 2010 10:34, " " > aggiesrwe03@...> said: > >> That is too broad just because the patch on their shoulder says they >> are EMT does not mean they are ignorant... > > First, let me make it absolutely clear to anyone who has not been > following closely that I have never used the term " ignorant " , > because, as we see right here, it is too often misunderstood. > > Second, and I hate to play the English teacher card here, but you > are wrong. A lack of knowledge is the very definition of > ignorance. But remember, you used the word, not me. Perhaps you > meant to refer to stupidity, and not ignorance. However, I would > never be caught confusing the two terms. But I will certainly say > that no, no patch makes you stupid, or even smart for that matter. > >> Sorry Rob but paramedics >> don't really know more because the chapter in their book was a little >> longer and had bigger words, sure they may have a few more tricks but >> that does not make them that much more " educated. " > > Not sure I understand the basis of this contention. If someone > undergoes two years of education and doesn't come out knowing more > than the guy who didn't, I'd be really surprised if they passed even > the NR exam. > >> Now you can >> misquote me all you want because of that but when it all comes down >> to >> it this field as it stands this min. is still a tech job that >> requires >> little more than a diploma, people " learn " what it takes to pass the >> NR test then get in the field where the real " education " starts. What >> I mean by that is alot of ems programs teach thier students to pass >> that test not to be medics that is learned at the service level, we >> may be working to change that but it hasn't happened yet. Red on >> your >> shoulder does not make you a fixall, it means you passed a test, >> and I >> think too many people forget when it comes down to it, it is about >> putting the patient in the truck and going to the hospital if you >> don't do that then nothing you do in the field is really all that >> helpful. > > Well said! I don't disagree with any of that. It is a disgrace to > a forty year old vocation that we still cater to the lowest common > denominator, and settle for the status quo instead of progressing > into the realm of a real profession. I share your disgust with the > system as it currently exists. I simply believe that we should > improve it rather than live with it. And until that is done, we > need to utilise what we have in the way that best benefits our > patients, not our egos. > > Rob > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 Sorry Rob, what I meant was -Chris Sorry for the spelling and punctuation this was typed on tge tiny keyboard on my iPhone On Apr 3, 2010, at 11:12, " rob.davis@... " rob.davis@... > wrote: > On Saturday, April 3, 2010 10:34, " " > aggiesrwe03@...> said: > >> That is too broad just because the patch on their shoulder says they >> are EMT does not mean they are ignorant... > > First, let me make it absolutely clear to anyone who has not been > following closely that I have never used the term " ignorant " , > because, as we see right here, it is too often misunderstood. > > Second, and I hate to play the English teacher card here, but you > are wrong. A lack of knowledge is the very definition of > ignorance. But remember, you used the word, not me. Perhaps you > meant to refer to stupidity, and not ignorance. However, I would > never be caught confusing the two terms. But I will certainly say > that no, no patch makes you stupid, or even smart for that matter. > >> Sorry Rob but paramedics >> don't really know more because the chapter in their book was a little >> longer and had bigger words, sure they may have a few more tricks but >> that does not make them that much more " educated. " > > Not sure I understand the basis of this contention. If someone > undergoes two years of education and doesn't come out knowing more > than the guy who didn't, I'd be really surprised if they passed even > the NR exam. > >> Now you can >> misquote me all you want because of that but when it all comes down >> to >> it this field as it stands this min. is still a tech job that >> requires >> little more than a diploma, people " learn " what it takes to pass the >> NR test then get in the field where the real " education " starts. What >> I mean by that is alot of ems programs teach thier students to pass >> that test not to be medics that is learned at the service level, we >> may be working to change that but it hasn't happened yet. Red on >> your >> shoulder does not make you a fixall, it means you passed a test, >> and I >> think too many people forget when it comes down to it, it is about >> putting the patient in the truck and going to the hospital if you >> don't do that then nothing you do in the field is really all that >> helpful. > > Well said! I don't disagree with any of that. It is a disgrace to > a forty year old vocation that we still cater to the lowest common > denominator, and settle for the status quo instead of progressing > into the realm of a real profession. I share your disgust with the > system as it currently exists. I simply believe that we should > improve it rather than live with it. And until that is done, we > need to utilise what we have in the way that best benefits our > patients, not our egos. > > Rob > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 Sorry Rob, what I meant was -Chris Sorry for the spelling and punctuation this was typed on tge tiny keyboard on my iPhone On Apr 3, 2010, at 11:12, " rob.davis@... " rob.davis@... > wrote: > On Saturday, April 3, 2010 10:34, " " > aggiesrwe03@...> said: > >> That is too broad just because the patch on their shoulder says they >> are EMT does not mean they are ignorant... > > First, let me make it absolutely clear to anyone who has not been > following closely that I have never used the term " ignorant " , > because, as we see right here, it is too often misunderstood. > > Second, and I hate to play the English teacher card here, but you > are wrong. A lack of knowledge is the very definition of > ignorance. But remember, you used the word, not me. Perhaps you > meant to refer to stupidity, and not ignorance. However, I would > never be caught confusing the two terms. But I will certainly say > that no, no patch makes you stupid, or even smart for that matter. > >> Sorry Rob but paramedics >> don't really know more because the chapter in their book was a little >> longer and had bigger words, sure they may have a few more tricks but >> that does not make them that much more " educated. " > > Not sure I understand the basis of this contention. If someone > undergoes two years of education and doesn't come out knowing more > than the guy who didn't, I'd be really surprised if they passed even > the NR exam. > >> Now you can >> misquote me all you want because of that but when it all comes down >> to >> it this field as it stands this min. is still a tech job that >> requires >> little more than a diploma, people " learn " what it takes to pass the >> NR test then get in the field where the real " education " starts. What >> I mean by that is alot of ems programs teach thier students to pass >> that test not to be medics that is learned at the service level, we >> may be working to change that but it hasn't happened yet. Red on >> your >> shoulder does not make you a fixall, it means you passed a test, >> and I >> think too many people forget when it comes down to it, it is about >> putting the patient in the truck and going to the hospital if you >> don't do that then nothing you do in the field is really all that >> helpful. > > Well said! I don't disagree with any of that. It is a disgrace to > a forty year old vocation that we still cater to the lowest common > denominator, and settle for the status quo instead of progressing > into the realm of a real profession. I share your disgust with the > system as it currently exists. I simply believe that we should > improve it rather than live with it. And until that is done, we > need to utilise what we have in the way that best benefits our > patients, not our egos. > > Rob > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 Sorry Rob, what I meant was that just because someone is an EMT does not mean they don't have the same knowledge or education it means they have not taken the same test, to elaborate there are plenty of people (nurses, former medics, even a doc or two) that are EMT that are perfectly capable of evaluating BLS vs. ALS so when it comes down to it, it is a matter of the individual and not the skill level as a whole. So in that context the term ignorance was used correctly I was not saying you called anyone ignorant. It's funny we seem to agree while at the same time disagree. -Chris Sorry for the spelling and punctuation this was typed on tge tiny keyboard on my iPhone On Apr 3, 2010, at 11:12, " rob.davis@... " rob.davis@... > wrote: > On Saturday, April 3, 2010 10:34, " " > aggiesrwe03@...> said: > >> That is too broad just because the patch on their shoulder says they >> are EMT does not mean they are ignorant... > > First, let me make it absolutely clear to anyone who has not been > following closely that I have never used the term " ignorant " , > because, as we see right here, it is too often misunderstood. > > Second, and I hate to play the English teacher card here, but you > are wrong. A lack of knowledge is the very definition of > ignorance. But remember, you used the word, not me. Perhaps you > meant to refer to stupidity, and not ignorance. However, I would > never be caught confusing the two terms. But I will certainly say > that no, no patch makes you stupid, or even smart for that matter. > >> Sorry Rob but paramedics >> don't really know more because the chapter in their book was a little >> longer and had bigger words, sure they may have a few more tricks but >> that does not make them that much more " educated. " > > Not sure I understand the basis of this contention. If someone > undergoes two years of education and doesn't come out knowing more > than the guy who didn't, I'd be really surprised if they passed even > the NR exam. > >> Now you can >> misquote me all you want because of that but when it all comes down >> to >> it this field as it stands this min. is still a tech job that >> requires >> little more than a diploma, people " learn " what it takes to pass the >> NR test then get in the field where the real " education " starts. What >> I mean by that is alot of ems programs teach thier students to pass >> that test not to be medics that is learned at the service level, we >> may be working to change that but it hasn't happened yet. Red on >> your >> shoulder does not make you a fixall, it means you passed a test, >> and I >> think too many people forget when it comes down to it, it is about >> putting the patient in the truck and going to the hospital if you >> don't do that then nothing you do in the field is really all that >> helpful. > > Well said! I don't disagree with any of that. It is a disgrace to > a forty year old vocation that we still cater to the lowest common > denominator, and settle for the status quo instead of progressing > into the realm of a real profession. I share your disgust with the > system as it currently exists. I simply believe that we should > improve it rather than live with it. And until that is done, we > need to utilise what we have in the way that best benefits our > patients, not our egos. > > Rob > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 Sorry Rob, what I meant was that just because someone is an EMT does not mean they don't have the same knowledge or education it means they have not taken the same test, to elaborate there are plenty of people (nurses, former medics, even a doc or two) that are EMT that are perfectly capable of evaluating BLS vs. ALS so when it comes down to it, it is a matter of the individual and not the skill level as a whole. So in that context the term ignorance was used correctly I was not saying you called anyone ignorant. It's funny we seem to agree while at the same time disagree. -Chris Sorry for the spelling and punctuation this was typed on tge tiny keyboard on my iPhone On Apr 3, 2010, at 11:12, " rob.davis@... " rob.davis@... > wrote: > On Saturday, April 3, 2010 10:34, " " > aggiesrwe03@...> said: > >> That is too broad just because the patch on their shoulder says they >> are EMT does not mean they are ignorant... > > First, let me make it absolutely clear to anyone who has not been > following closely that I have never used the term " ignorant " , > because, as we see right here, it is too often misunderstood. > > Second, and I hate to play the English teacher card here, but you > are wrong. A lack of knowledge is the very definition of > ignorance. But remember, you used the word, not me. Perhaps you > meant to refer to stupidity, and not ignorance. However, I would > never be caught confusing the two terms. But I will certainly say > that no, no patch makes you stupid, or even smart for that matter. > >> Sorry Rob but paramedics >> don't really know more because the chapter in their book was a little >> longer and had bigger words, sure they may have a few more tricks but >> that does not make them that much more " educated. " > > Not sure I understand the basis of this contention. If someone > undergoes two years of education and doesn't come out knowing more > than the guy who didn't, I'd be really surprised if they passed even > the NR exam. > >> Now you can >> misquote me all you want because of that but when it all comes down >> to >> it this field as it stands this min. is still a tech job that >> requires >> little more than a diploma, people " learn " what it takes to pass the >> NR test then get in the field where the real " education " starts. What >> I mean by that is alot of ems programs teach thier students to pass >> that test not to be medics that is learned at the service level, we >> may be working to change that but it hasn't happened yet. Red on >> your >> shoulder does not make you a fixall, it means you passed a test, >> and I >> think too many people forget when it comes down to it, it is about >> putting the patient in the truck and going to the hospital if you >> don't do that then nothing you do in the field is really all that >> helpful. > > Well said! I don't disagree with any of that. It is a disgrace to > a forty year old vocation that we still cater to the lowest common > denominator, and settle for the status quo instead of progressing > into the realm of a real profession. I share your disgust with the > system as it currently exists. I simply believe that we should > improve it rather than live with it. And until that is done, we > need to utilise what we have in the way that best benefits our > patients, not our egos. > > Rob > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 Sorry Rob, what I meant was that just because someone is an EMT does not mean they don't have the same knowledge or education it means they have not taken the same test, to elaborate there are plenty of people (nurses, former medics, even a doc or two) that are EMT that are perfectly capable of evaluating BLS vs. ALS so when it comes down to it, it is a matter of the individual and not the skill level as a whole. So in that context the term ignorance was used correctly I was not saying you called anyone ignorant. It's funny we seem to agree while at the same time disagree. -Chris Sorry for the spelling and punctuation this was typed on tge tiny keyboard on my iPhone On Apr 3, 2010, at 11:12, " rob.davis@... " rob.davis@... > wrote: > On Saturday, April 3, 2010 10:34, " " > aggiesrwe03@...> said: > >> That is too broad just because the patch on their shoulder says they >> are EMT does not mean they are ignorant... > > First, let me make it absolutely clear to anyone who has not been > following closely that I have never used the term " ignorant " , > because, as we see right here, it is too often misunderstood. > > Second, and I hate to play the English teacher card here, but you > are wrong. A lack of knowledge is the very definition of > ignorance. But remember, you used the word, not me. Perhaps you > meant to refer to stupidity, and not ignorance. However, I would > never be caught confusing the two terms. But I will certainly say > that no, no patch makes you stupid, or even smart for that matter. > >> Sorry Rob but paramedics >> don't really know more because the chapter in their book was a little >> longer and had bigger words, sure they may have a few more tricks but >> that does not make them that much more " educated. " > > Not sure I understand the basis of this contention. If someone > undergoes two years of education and doesn't come out knowing more > than the guy who didn't, I'd be really surprised if they passed even > the NR exam. > >> Now you can >> misquote me all you want because of that but when it all comes down >> to >> it this field as it stands this min. is still a tech job that >> requires >> little more than a diploma, people " learn " what it takes to pass the >> NR test then get in the field where the real " education " starts. What >> I mean by that is alot of ems programs teach thier students to pass >> that test not to be medics that is learned at the service level, we >> may be working to change that but it hasn't happened yet. Red on >> your >> shoulder does not make you a fixall, it means you passed a test, >> and I >> think too many people forget when it comes down to it, it is about >> putting the patient in the truck and going to the hospital if you >> don't do that then nothing you do in the field is really all that >> helpful. > > Well said! I don't disagree with any of that. It is a disgrace to > a forty year old vocation that we still cater to the lowest common > denominator, and settle for the status quo instead of progressing > into the realm of a real profession. I share your disgust with the > system as it currently exists. I simply believe that we should > improve it rather than live with it. And until that is done, we > need to utilise what we have in the way that best benefits our > patients, not our egos. > > Rob > > > > ------------------------------------ > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 You met Saffer at EMStock, right? He works for Boston EMS, where they run a tiered response BLS/ALS system. The bulk of their transports are done by BLS units. Not every call even gets a paramedic evaluation, although the EMTs are free to call for an ALS assist. For example, in Boston, stroke is a BLS emergency. Now, their EMTs use glucometers and administer nebs, as I recall, but otherwise they're just EMT-Basics (or the MA equivalent). When the medics do a transport, you can be assured they are doing an ALS skill - hence, very little skill rust out, since they divide those skills among a much smaller cadre of medics. And since the EMTs do a lot of the transports, what they get are very experienced EMTs. And paramedic in Boston is a promotional position. They never hire medics from outside. All of theirs were EMTs on a BLS unit for some time before a paramedic opening was available. They have a SCA survival rate well over 30%, first time ETI attempt success rate in the high 90s, and are better at recognizing STEMIs than the docs they hand off the patients to. They do therapeutic hypothermia, CPAP, RSI, etc. All this makes me sound like I'm a Boston EMS fanboy, but I'm not. I'm sure they have their flaws, as all systems do. But they *do* manage to score very well on the same metrics that other " premier " systems are judged on, yet they manage to do it still utilizing a level of provider whose skills and knowledge you disparage. How is that? Here's my theory: All EMT training programs are not created equal. I'm sure you've seen the products of some bad ones, as have I. But regardless of the quality of the training program, a major factor in quality is the experience they gain on the street. If you give them adequate supervision, solid CQI and the freedom to work, you wind up with strong ones, like in Boston. And they go on to become strong medics who understand, from long experience, the importance of BLS. If, on the other hand, you think little enough of their ability and knowledge that you relegate them to the role of pack mule and IV pole -as you seem to - that's what you get; an EMT that never learns to think on a higher level than a pack mule. Do they do a better job than systems that double stack medics on a truck, or send medics to every call? Maybe not, but they certainly do a better job than *some* of those major systems - like the Volusia County system I referenced in an earlier reply, for example. When it comes to ALS providers, more is not necessarily better. It's just... more ALS providers. > > On Saturday, April 3, 2010 08:23, " Grayson " Grayson902@... > > said: > > > Define " best " systems, and provide proof of your assertion. > > " Best " is defined by my personal observations and opinion of what is > ideal. The proof is in my opinion, nothing else. Feel free to disprove it. > > > I know of at least one premier EMS systems that uses EMT-Basics for the > > majority of their calls. > > Now, define " premier " and provide proof of your assertion, as well as > the relevancy of the term " premier " . > > Rob > > -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 You met Saffer at EMStock, right? He works for Boston EMS, where they run a tiered response BLS/ALS system. The bulk of their transports are done by BLS units. Not every call even gets a paramedic evaluation, although the EMTs are free to call for an ALS assist. For example, in Boston, stroke is a BLS emergency. Now, their EMTs use glucometers and administer nebs, as I recall, but otherwise they're just EMT-Basics (or the MA equivalent). When the medics do a transport, you can be assured they are doing an ALS skill - hence, very little skill rust out, since they divide those skills among a much smaller cadre of medics. And since the EMTs do a lot of the transports, what they get are very experienced EMTs. And paramedic in Boston is a promotional position. They never hire medics from outside. All of theirs were EMTs on a BLS unit for some time before a paramedic opening was available. They have a SCA survival rate well over 30%, first time ETI attempt success rate in the high 90s, and are better at recognizing STEMIs than the docs they hand off the patients to. They do therapeutic hypothermia, CPAP, RSI, etc. All this makes me sound like I'm a Boston EMS fanboy, but I'm not. I'm sure they have their flaws, as all systems do. But they *do* manage to score very well on the same metrics that other " premier " systems are judged on, yet they manage to do it still utilizing a level of provider whose skills and knowledge you disparage. How is that? Here's my theory: All EMT training programs are not created equal. I'm sure you've seen the products of some bad ones, as have I. But regardless of the quality of the training program, a major factor in quality is the experience they gain on the street. If you give them adequate supervision, solid CQI and the freedom to work, you wind up with strong ones, like in Boston. And they go on to become strong medics who understand, from long experience, the importance of BLS. If, on the other hand, you think little enough of their ability and knowledge that you relegate them to the role of pack mule and IV pole -as you seem to - that's what you get; an EMT that never learns to think on a higher level than a pack mule. Do they do a better job than systems that double stack medics on a truck, or send medics to every call? Maybe not, but they certainly do a better job than *some* of those major systems - like the Volusia County system I referenced in an earlier reply, for example. When it comes to ALS providers, more is not necessarily better. It's just... more ALS providers. > > On Saturday, April 3, 2010 08:23, " Grayson " Grayson902@... > > said: > > > Define " best " systems, and provide proof of your assertion. > > " Best " is defined by my personal observations and opinion of what is > ideal. The proof is in my opinion, nothing else. Feel free to disprove it. > > > I know of at least one premier EMS systems that uses EMT-Basics for the > > majority of their calls. > > Now, define " premier " and provide proof of your assertion, as well as > the relevancy of the term " premier " . > > Rob > > -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 You met Saffer at EMStock, right? He works for Boston EMS, where they run a tiered response BLS/ALS system. The bulk of their transports are done by BLS units. Not every call even gets a paramedic evaluation, although the EMTs are free to call for an ALS assist. For example, in Boston, stroke is a BLS emergency. Now, their EMTs use glucometers and administer nebs, as I recall, but otherwise they're just EMT-Basics (or the MA equivalent). When the medics do a transport, you can be assured they are doing an ALS skill - hence, very little skill rust out, since they divide those skills among a much smaller cadre of medics. And since the EMTs do a lot of the transports, what they get are very experienced EMTs. And paramedic in Boston is a promotional position. They never hire medics from outside. All of theirs were EMTs on a BLS unit for some time before a paramedic opening was available. They have a SCA survival rate well over 30%, first time ETI attempt success rate in the high 90s, and are better at recognizing STEMIs than the docs they hand off the patients to. They do therapeutic hypothermia, CPAP, RSI, etc. All this makes me sound like I'm a Boston EMS fanboy, but I'm not. I'm sure they have their flaws, as all systems do. But they *do* manage to score very well on the same metrics that other " premier " systems are judged on, yet they manage to do it still utilizing a level of provider whose skills and knowledge you disparage. How is that? Here's my theory: All EMT training programs are not created equal. I'm sure you've seen the products of some bad ones, as have I. But regardless of the quality of the training program, a major factor in quality is the experience they gain on the street. If you give them adequate supervision, solid CQI and the freedom to work, you wind up with strong ones, like in Boston. And they go on to become strong medics who understand, from long experience, the importance of BLS. If, on the other hand, you think little enough of their ability and knowledge that you relegate them to the role of pack mule and IV pole -as you seem to - that's what you get; an EMT that never learns to think on a higher level than a pack mule. Do they do a better job than systems that double stack medics on a truck, or send medics to every call? Maybe not, but they certainly do a better job than *some* of those major systems - like the Volusia County system I referenced in an earlier reply, for example. When it comes to ALS providers, more is not necessarily better. It's just... more ALS providers. > > On Saturday, April 3, 2010 08:23, " Grayson " Grayson902@... > > said: > > > Define " best " systems, and provide proof of your assertion. > > " Best " is defined by my personal observations and opinion of what is > ideal. The proof is in my opinion, nothing else. Feel free to disprove it. > > > I know of at least one premier EMS systems that uses EMT-Basics for the > > majority of their calls. > > Now, define " premier " and provide proof of your assertion, as well as > the relevancy of the term " premier " . > > Rob > > -- Grayson, CCEMT-P www.kellygrayson.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 Actually, it is NOT irrelevant. Your contention is that EVERYTHING should be done by the most " qualified " and highly-certified (i.e. by a paramedic). I was pointing out that elsewhere that is not the case - and should not be in EMS either.  The above is true in other professions than in the medical field as well. Competent practitioners evaluate what needs to be done and determine whether it is in their capabilities and permitted scope of practice, and if it isn't they refer it to a specialist or more highly credentialed practitioner. If it IS within the capabilities and scope of the " basic " practitioner, they perform as required and keep the " higher " level individual available for when his/her expertise actually is needed.    Subject: Re: Progressive services? To: texasems-l Date: Saturday, April 3, 2010, 11:23 AM  On Saturday, April 3, 2010 11:14, " STEVE BOWMAN " said: > To take your " every patient needs to be evaluated by a Paramedic " concept to other > areas, that would mean that every patient wanting to see a doctor should not be > evaluated by a primary care physician (in office, ER, or elsewhere) but instead > should be " evaluated " by a collegium of " higher-qualified " specialists because the > PCP is too dumb to know whether or not the patient needs a specialist. Not really a valid analogy. As I tried to make absolutely clear earlier, we're discussing EMS here, not other professions. I could make your analogy more relevant, but it would still be comparing apples to oranges, so I'll leave it as is and try to keep the discussion focused. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 Actually, it is NOT irrelevant. Your contention is that EVERYTHING should be done by the most " qualified " and highly-certified (i.e. by a paramedic). I was pointing out that elsewhere that is not the case - and should not be in EMS either.  The above is true in other professions than in the medical field as well. Competent practitioners evaluate what needs to be done and determine whether it is in their capabilities and permitted scope of practice, and if it isn't they refer it to a specialist or more highly credentialed practitioner. If it IS within the capabilities and scope of the " basic " practitioner, they perform as required and keep the " higher " level individual available for when his/her expertise actually is needed.    Subject: Re: Progressive services? To: texasems-l Date: Saturday, April 3, 2010, 11:23 AM  On Saturday, April 3, 2010 11:14, " STEVE BOWMAN " said: > To take your " every patient needs to be evaluated by a Paramedic " concept to other > areas, that would mean that every patient wanting to see a doctor should not be > evaluated by a primary care physician (in office, ER, or elsewhere) but instead > should be " evaluated " by a collegium of " higher-qualified " specialists because the > PCP is too dumb to know whether or not the patient needs a specialist. Not really a valid analogy. As I tried to make absolutely clear earlier, we're discussing EMS here, not other professions. I could make your analogy more relevant, but it would still be comparing apples to oranges, so I'll leave it as is and try to keep the discussion focused. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 Actually, it is NOT irrelevant. Your contention is that EVERYTHING should be done by the most " qualified " and highly-certified (i.e. by a paramedic). I was pointing out that elsewhere that is not the case - and should not be in EMS either.  The above is true in other professions than in the medical field as well. Competent practitioners evaluate what needs to be done and determine whether it is in their capabilities and permitted scope of practice, and if it isn't they refer it to a specialist or more highly credentialed practitioner. If it IS within the capabilities and scope of the " basic " practitioner, they perform as required and keep the " higher " level individual available for when his/her expertise actually is needed.    Subject: Re: Progressive services? To: texasems-l Date: Saturday, April 3, 2010, 11:23 AM  On Saturday, April 3, 2010 11:14, " STEVE BOWMAN " said: > To take your " every patient needs to be evaluated by a Paramedic " concept to other > areas, that would mean that every patient wanting to see a doctor should not be > evaluated by a primary care physician (in office, ER, or elsewhere) but instead > should be " evaluated " by a collegium of " higher-qualified " specialists because the > PCP is too dumb to know whether or not the patient needs a specialist. Not really a valid analogy. As I tried to make absolutely clear earlier, we're discussing EMS here, not other professions. I could make your analogy more relevant, but it would still be comparing apples to oranges, so I'll leave it as is and try to keep the discussion focused. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 On Saturday, April 3, 2010 12:22, " Grayson " Grayson902@...> said: > Here's my theory: All EMT training programs are not created equal. I'm > sure you've seen the products of some bad ones, as have I. But > regardless of the quality of the training program, a major factor in > quality is the experience they gain on the street. If you give them > adequate supervision, solid CQI and the freedom to work, you wind up > with strong ones, like in Boston. And they go on to become strong medics > who understand, from long experience, the importance of BLS. Now, just imagine how much more they would get from that experience if they had two more years of educational foundation behind them before hand. Are you suggesting that it would hurt them instead of helping them? Does Boston do well? Apparently so. But that shouldn't stop anyone from doing better. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 On Saturday, April 3, 2010 12:22, " Grayson " Grayson902@...> said: > Here's my theory: All EMT training programs are not created equal. I'm > sure you've seen the products of some bad ones, as have I. But > regardless of the quality of the training program, a major factor in > quality is the experience they gain on the street. If you give them > adequate supervision, solid CQI and the freedom to work, you wind up > with strong ones, like in Boston. And they go on to become strong medics > who understand, from long experience, the importance of BLS. Now, just imagine how much more they would get from that experience if they had two more years of educational foundation behind them before hand. Are you suggesting that it would hurt them instead of helping them? Does Boston do well? Apparently so. But that shouldn't stop anyone from doing better. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 On Saturday, April 3, 2010 12:22, " Grayson " Grayson902@...> said: > Here's my theory: All EMT training programs are not created equal. I'm > sure you've seen the products of some bad ones, as have I. But > regardless of the quality of the training program, a major factor in > quality is the experience they gain on the street. If you give them > adequate supervision, solid CQI and the freedom to work, you wind up > with strong ones, like in Boston. And they go on to become strong medics > who understand, from long experience, the importance of BLS. Now, just imagine how much more they would get from that experience if they had two more years of educational foundation behind them before hand. Are you suggesting that it would hurt them instead of helping them? Does Boston do well? Apparently so. But that shouldn't stop anyone from doing better. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 On Saturday, April 3, 2010 12:27, " STEVE BOWMAN " swbowman@...> said: > Actually, it is NOT irrelevant. Your contention is that EVERYTHING should be > done by the most " qualified " and highly-certified (i.e. by a paramedic). I > was pointing out that elsewhere that is not the case - and should not be in > EMS either. It is indeed irrelevant, because you are misquoting me. I never suggested that " everything " should be done by the most highly-certified provider. I merely suggested that all patients should receive an evaluation by an ALS provider for the decision to be made whether they are an ALS or BLS patient. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 On Saturday, April 3, 2010 12:27, " STEVE BOWMAN " swbowman@...> said: > Actually, it is NOT irrelevant. Your contention is that EVERYTHING should be > done by the most " qualified " and highly-certified (i.e. by a paramedic). I > was pointing out that elsewhere that is not the case - and should not be in > EMS either. It is indeed irrelevant, because you are misquoting me. I never suggested that " everything " should be done by the most highly-certified provider. I merely suggested that all patients should receive an evaluation by an ALS provider for the decision to be made whether they are an ALS or BLS patient. Rob Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 3, 2010 Report Share Posted April 3, 2010 On Saturday, April 3, 2010 12:27, " STEVE BOWMAN " swbowman@...> said: > Actually, it is NOT irrelevant. Your contention is that EVERYTHING should be > done by the most " qualified " and highly-certified (i.e. by a paramedic). I > was pointing out that elsewhere that is not the case - and should not be in > EMS either. It is indeed irrelevant, because you are misquoting me. I never suggested that " everything " should be done by the most highly-certified provider. I merely suggested that all patients should receive an evaluation by an ALS provider for the decision to be made whether they are an ALS or BLS patient. Rob Quote Link to comment Share on other sites More sharing options...
Recommended Posts
Join the conversation
You are posting as a guest. If you have an account, sign in now to post with your account.
Note: Your post will require moderator approval before it will be visible.