Guest guest Posted April 21, 2008 Report Share Posted April 21, 2008 Let me preface my comments by saying that my opinions are my own and do not reflect the position of any entity with which I am affiliated. Also, my comments are based on 24 years of prehospital experience as a field provider and educator. After reading your article today, I must admit that it appears that you researched your position well. However, you missed the mark with respect to the overarching issue. Paramedics are entrusted to perform many skills which, in the wrong (inexperienced) hands, can be dangerous. They also administer several medications that, in the wrong (inexperienced) hands, are much more dangerous than succinylcholine chloride. It is an unfortunate circumstance that the most critical (high liability) skills are performed on the smallest percentage of patients encountered by paramedics. The actual performance of a skill is a matter of practicing that skill under various conditions until the person develops the " muscle memory " to successfully complete the procedure; that has nothing to do with applying good judgement. That comes from quality experience assessing and treating patients in the clinical environment. Clinical judgement is acquired over time depending on several factors related to the quantity and quality of patient encounters. As you mentioned in your article, the standard to become a paramedic in Texas is lower than other non-healthcare professions; that is a big problem that I hope will be addressed in the future. At the same time, hospitals/physicians are reducing or eliminating access to certain clinical departments (like the OR where paramedics learn to intubate in a controlled environment and under the direct supervison by an expert) because these are high liability areas for them as well. Although it is not a substitute for the unpredictability of street medicine, hospitals (especially teaching hospitals) are an avenue where paramedics can obtain patient contacts under controlled circumstances to obtain additional experience. So how do we fix it? It would appear, according to your research, that neither regulation nor litigation are making a difference. So the answer may lie in quality education. Establishing partnerships between EMS agencies and hospitals in order to enhance the clinical experencies of EMTs and paramedics. It is the development and application of good clinical judgement that prevents the kind of scenario you have chosen to report. Respectfully, Tony Paramedic/Educator ________________________________________________________________________________\ ____ Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2008 Report Share Posted April 22, 2008 Excellent response, Tony!! Jane Dinsmore To: drobbins@...: texasems-l@...: afg1050@...: Mon, 21 Apr 2008 21:32:51 -0700Subject: RSI Article Let me preface my comments by saying that my opinions are my own and do not reflect the position of any entity with which I am affiliated. Also, my comments are based on 24 years of prehospital experience as a field provider and educator.After reading your article today, I must admit that it appears that you researched your position well. However, you missed the mark with respect to the overarching issue. Paramedics are entrusted to perform many skills which, in the wrong (inexperienced) hands, can be dangerous. They also administer several medications that, in the wrong (inexperienced) hands, are much more dangerous than succinylcholine chloride. It is an unfortunate circumstance that the most critical (high liability) skills are performed on the smallest percentage of patients encountered by paramedics. The actual performance of a skill is a matter of practicing that skill under various conditions until the person develops the " muscle memory " to successfully complete the procedure; that has nothing to do with applying good judgement. That comes from quality experience assessing and treating patients in the clinical environment. Clinical judgement is acquired over time depending onseveral factors related to the quantity and quality of patient encounters.As you mentioned in your article, the standard to become a paramedic in Texas is lower than other non-healthcare professions; that is a big problem that I hope will be addressed in the future. At the same time, hospitals/physicians are reducing or eliminating access to certain clinical departments (like the OR where paramedics learn to intubate in a controlled environment and under the direct supervison by an expert) because these are high liability areas for them as well. Although it is not a substitute for the unpredictability of street medicine, hospitals (especially teaching hospitals) are an avenue where paramedics can obtain patient contacts under controlled circumstances to obtain additional experience.So how do we fix it? It would appear, according to your research, that neither regulation nor litigation are making a difference. So the answer may lie in quality education. Establishing partnerships between EMS agencies and hospitals in order to enhance the clinical experencies of EMTs and paramedics. It is the development and application of good clinical judgement that prevents the kind of scenario you have chosen to report.Respectfully,Tony Paramedic/Educator________________________________________________________\ __Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ _________________________________________________________________ Express yourself wherever you are. Mobilize! http://www.gowindowslive.com/Mobile/Landing/Messenger/Default.aspx?Locale=en-US?\ ocid=TAG_APRIL Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 22, 2008 Report Share Posted April 22, 2008 Tony, Very well done. Better than I said. Don > > Let me preface my comments by saying that my opinions are my own and do not reflect the position of any entity with which I am affiliated. Also, my comments are based on 24 years of prehospital experience as a field provider and educator. > > After reading your article today, I must admit that it appears that you researched your position well. However, you missed the mark with respect to the overarching issue. Paramedics are entrusted to perform many skills which, in the wrong (inexperienced) hands, can be dangerous. They also administer several medications that, in the wrong (inexperienced) hands, are much more dangerous than succinylcholine chloride. It is an unfortunate circumstance that the most critical (high liability) skills are performed on the smallest percentage of patients encountered by paramedics. The actual performance of a skill is a matter of practicing that skill under various conditions until the person develops the " muscle memory " to successfully complete the procedure; that has nothing to do with applying good judgement. That comes from quality experience assessing and treating patients in the clinical environment. Clinical judgement is acquired over time depending on > several factors related to the quantity and quality of patient encounters. > > As you mentioned in your article, the standard to become a paramedic in Texas is lower than other non-healthcare professions; that is a big problem that I hope will be addressed in the future. At the same time, hospitals/physicians are reducing or eliminating access to certain clinical departments (like the OR where paramedics learn to intubate in a controlled environment and under the direct supervison by an expert) because these are high liability areas for them as well. Although it is not a substitute for the unpredictability of street medicine, hospitals (especially teaching hospitals) are an avenue where paramedics can obtain patient contacts under controlled circumstances to obtain additional experience. > > So how do we fix it? It would appear, according to your research, that neither regulation nor litigation are making a difference. So the answer may lie in quality education. Establishing partnerships between EMS agencies and hospitals in order to enhance the clinical experencies of EMTs and paramedics. It is the development and application of good clinical judgement that prevents the kind of scenario you have chosen to report. > > Respectfully, > > Tony > Paramedic/Educator > > > ________________________________________________________________________________\ ____ > Be a better friend, newshound, and > know-it-all with Yahoo! Mobile. Try it now. http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ > Quote Link to comment Share on other sites More sharing options...
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