Too Old To Work, Too Young To Retire has a nice post on EMS 2.0, but from a slightly different perspective - EMS 2.0, Again - Or "Ten Tools that Basic EMTs Need".
Before you start reading and get all kinds of upset about these things needing ALS, stop and think. For one thing TOTWTYTR has thought about this before writing it. He is one of the clearest thinking people in EMS, even when he does disagree with me about EMS. I do not disagree with him about anything on this list. Go read his explanations, nice short explanations, and learn.
These are for Basic EMTs.
10. CPAP. 9. Epi Pens. 8. Narcan. 7. Aspirin. 6. Glucometer. 5. Albuterol nebulizers. 4. A better airway than the OPA or NPA. 3. AEDs. 2. Mad CPR skills.
1. Better assessment skills.
This is not a Letterman List. These are all serious suggestions.
The assessment skills are important before being able to implement some of the others, but why do we not demand excellence in assessment already?
I know.
I know.
The NR (National Registry of EMTs) says that they know what is good enough.
The NR pretends that the NR's incompetent very very structured assessment of an EMT's assessment of an actor is valid.
Yes, the patient is unstable. Trust me. . . . Really. I can tell from here. Yes. Even with my eyes closed. No. I'm not peeking. There is no judgment involved. Not even a little bit.
If the NR does not know how to assess EMT skills, how would the NR possibly recognize the two most important parts of a real competent assessment?
Thoroughness. You cannot assess properly, if you miss what is wrong. This is not to suggest that there is anything wrong with a focused assessment.
Flexibility. This is essential, unless you believe that all patients will present as NR scenario actors do.
The OCD (Obsessive Compulsive Disorder) at NR is at the point where they should probably be involuntarily committed. They are a danger to others.
The most important word in the English language is Why? This word is stricken from the NR vocabulary formulary. Why? Because Why? has too much potential for independent thought and that most evil of evils - Critical Judgment.
Maybe if we just put a bunch of Ativan in the drinking water at NR HQ.
Now before you go back and look at the picture at the top of the post. Do you want an assessment that meets NR standards, which are unethically low, or do you want a real assessment by a real EMT? A real EMT is someone who has been properly trained in assessment, not in performing an OCD ritual that is no different from learning the steps to a witchdoctor's medicine dance.
OK. Look at the picture.
A lack of critical judgement means that almost everyone on that plane is dead. NR does not like critical judgment. NR likes dead.
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7 Comments:
You seem to be writing this from a defensive standpoint. Is there really anyone who thinks this isn't a good list? Perhaps I am presuming too much.
Buckman,
You seem to be writing this from a defensive standpoint. Is there really anyone who thinks this isn't a good list? Perhaps I am presuming too much.
Maybe I am not as familiar with the Pennsylvania scope of practice for Basic EMTs as I should be. There are plenty of people who think this is not a good list.
10. CPAP.
This was only added to the ALS protocols in PA in the last few years.
9. Epi Pens.
I believe that is a separate add-on certification for EMTs in PA.
8. Narcan.
Not in PA. Not this decade. Maybe not even in the next decade.
7. Aspirin.
One of my protocol committee accomplishments was to get ASA moved from requiring a medical command order to a standing order. So, BLS? Not any time soon? I don't know.
6. Glucometer.
The concern is that the rural agencies will not change destination because of this, so it is a waste of money, and there is a shortage of resources.
5. Albuterol nebulizers.
Since we do not even include lung sounds in the Basic EMT curriculum, probably not any time soon, either.
4. A better airway than the OPA or NPA.
With all of the airway research done in PA, I wish we were more progressive, but nobody is demanding that medical directors actually provide competent oversight. The attitude is - Call a medic. This will be that paramedic's tube for the year, if he gets it.
3. AEDs.
We do that. We are so cutting edge.
2. Mad CPR skills.
The CPR skills I see, well, they make me mad.
1. Better assessment skills.
I would be much happier if the just medics consistently had good assessment skills.
There are some great Basic EMTs. There are some great medics.
As Kelly stated, and I quoted in the previous post -
But for the most part, those medics are as good as they are in spite of their EMS education and not because of it, and it's not those superior medics that we should use as measure of the effectiveness of EMS education. They are, by definition, outliers.
There is a lot that needs to change.
Meatloaf sang that 2 Out of 3 Ain't Bad. So what is 2 out of 10?
Should we count on providers from Outlier Medical Services showing up? Is that a reasonable expectation where you are?
Yes. I did write this from a defensive standpoint. Does anybody find things different in their state?
In KY we already carry Epi and AED's. Some services write in protocols for ASA and Glucometers. My problem is with the services that give their Basics a tube of glucose but not a glucometer.
And I remember that when I worked in IN, the state gave protocols for a King Airway. That was useful but I never got to use one.
In short, I think it boils down to the state and how many lives they want to save by EMS, and the service you work for and how much money they want to spend...
"My problem is with the services that give their Basics a tube of glucose but not a glucometer"
Yeah, I worked at an agency that did this. I refused to administer glucose. Nearly got written up for my troubles too.
In my old system in NC, Basics can administer Epipens, use a glucometer and an AED. It's the agencies choice between combitube and King Airway, though most are migrating to the King. We can assist patients with administering their own aspirin, only if they are taking it under doctor's orders.
We can also administer albuterol, but I can't say I know anyone who actually listens to lung sounds before using it. Sadly, I can't say I know any basics who know what to listen for.
Here in OR it's sub-q epi, no albuterol - but we have CPAP. Of course, I have no idea how to use CPAP - but it's in my protocols. Good stuff, right RM? :)
wow, I guess my area's more "progressive" than I thought. In my area, the EMT's(non transport only, all transport is ALS) all can do at least 6 of the 10 consistently. I mean honestly. ALS just got CPAP in the last few years, and they're actually looking at adding duonebs to the BLS treatments and there has been some talk of even adding narcan. I guess I only have one issue with this list. I think someone might see it as a good idea, which it is, but implement only pieces and parts, like #8 without #1. I'm just afraid of the medic attitude of "I can give them narcan and ruin their high" that is too rampant to be transferred to the EMT that will only have to deal with them until transport. Otherwise I agree, let's start with 1, make sure we can ALL assess beyond our wildest dreams then move forward. But I guess I should wait for quality hands on medical direction nationwide before that will happen
Medic7603,
I'd contend that if all transport is ALS, then your system is hardly progressive. Only about 25% of transports require ALS. Which means that 75% of the time the medic is transporting a patient that doesn't require ALS skills. If your system uses Basic/medic staffing and you drive while the Basic guy is in the back, it's even worse.
EMS 2.0 is about examining every thing we do in EMS with an eye to maximizing resources and improving patient care.
In most cases, less is more.
TOTWTYTR,
I agree with you actually, I just wasn't clear I think. I don't think my system is progressive, rather just more progressive than even I thought. Some people label me a pessimist, I prefer realist or pragmatist as fits the situation, but we delve into semantics. Anyway I fully agree that that percentage that ALS is truly needed is fairly low and that it is overused. However, I think you'll have a hard time selling that to ambulance company owners as well as a portion of the general public as they've been sold on the idea of paramedics being what they "need" and "deserve". Not to mention the amount of money they can charge if it's all ALS versus a mix. Sometimes I'm just not as clear as I mean to be. Hope this clears it up.
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