Re: Progressive services?

[Guest guest]

On Saturday, April 3, 2010 05:30, krin135@... said:

> and the reason it has been bastardized is that 'the basics' are all that

> EMT-Basics have to work with...so at least on occasion, the Basic sees the

> Forest, while the Medic is stuck in the trees...even in the best of systems.

Except that the " best " systems don't use EMT-Basics.

[Guest guest]

On Saturday, April 3, 2010 05:30, krin135@... said:

> and the reason it has been bastardized is that 'the basics' are all that

> EMT-Basics have to work with...so at least on occasion, the Basic sees the

> Forest, while the Medic is stuck in the trees...even in the best of systems.

Except that the " best " systems don't use EMT-Basics.

[Guest guest]

On Saturday, April 3, 2010 05:30, krin135@... said:

> and the reason it has been bastardized is that 'the basics' are all that

> EMT-Basics have to work with...so at least on occasion, the Basic sees the

> Forest, while the Medic is stuck in the trees...even in the best of systems.

Except that the " best " systems don't use EMT-Basics.

[Guest guest]

by golly, I think she's got it!

good summary, Alyssa

ck

In a message dated 4/3/2010 10:26:08 Central Daylight Time,

amwoods8644@... writes:

But, unfortunately, this world is not perfect, and we are limited by

the resources with which we work. This isn't just in the sense of

supplies, but in the sense of knowledge. But just like in the sense of

supplies, sometimes you can do more with less. A good basic knows how

to do that.

[Guest guest]

by golly, I think she's got it!

good summary, Alyssa

ck

In a message dated 4/3/2010 10:26:08 Central Daylight Time,

amwoods8644@... writes:

But, unfortunately, this world is not perfect, and we are limited by

the resources with which we work. This isn't just in the sense of

supplies, but in the sense of knowledge. But just like in the sense of

supplies, sometimes you can do more with less. A good basic knows how

to do that.

[Guest guest]

by golly, I think she's got it!

good summary, Alyssa

ck

In a message dated 4/3/2010 10:26:08 Central Daylight Time,

amwoods8644@... writes:

But, unfortunately, this world is not perfect, and we are limited by

the resources with which we work. This isn't just in the sense of

supplies, but in the sense of knowledge. But just like in the sense of

supplies, sometimes you can do more with less. A good basic knows how

to do that.

[Guest guest]

On Saturday, April 3, 2010 06:38, krin135@... said:

> Ultimately, the EMS system is only as good as the most observant member of

> the team working on the patient at the time.

Absolutely! But none of the examples you just listed are EMS systems, in the

respect that we are discussing.

Rob

[Guest guest]

On Saturday, April 3, 2010 06:38, krin135@... said:

> Ultimately, the EMS system is only as good as the most observant member of

> the team working on the patient at the time.

Absolutely! But none of the examples you just listed are EMS systems, in the

respect that we are discussing.

Rob

[Guest guest]

On Saturday, April 3, 2010 06:38, krin135@... said:

> Ultimately, the EMS system is only as good as the most observant member of

> the team working on the patient at the time.

Absolutely! But none of the examples you just listed are EMS systems, in the

respect that we are discussing.

Rob

[Guest guest]

I see where you're coming from, but the gold standard of airway

management is *adequate ventilation* and is not tied to a specific

device. If I think my patient can effectively be managed by nothing more

than BLS (and well over half of them can, is my best guess), then I see

nothing wrong with having the EMT-Basics handle the patient. I wouldn't

hand off a non-breathing patient to an EMT-B, but that's a different

animal from stating that an EMT-B is not qualified to manage an airway

effectively.

This isn't turfing or laziness, it's efficiency. You may feel that

*every* call deserves a medic. I don't. In fact, I think that this whole

" medic on every truck " mentality only serves to degrade the

effectiveness of ALS units through overwork and skill dilution, not to

mention the fact that it denies the seed corn of the next generation of

medics (the EMTs) the chance to develop any meaningful patient care

skills. Look no further than Volusia County, FL for proof of that. You

can't swing a dead cat at a scene there without hitting half a dozen

medics, and every damned one of them sucks at intubation bad enough that

they made a supraglottic airway their ALS airway of choice.

I'll use Boston EMS as an example of a system that does it right. Most

of their units are BLS, with just a handful of ALS units on duty at any

one time. *Most* of their transports are handled by the EMT-Basics. Yet

their 12-lead interpretation, intubation success rates, etc are as good

or better than the physicians they hand the patient off to. Not to

mention their cardiac arrest survival rate that would be the envy of

just about anywhere. the way they do things results in not only strong

medics, but strong EMTs as well, and they're not killing folks right and

left by handing off to the kids with the white patches.

If I am in control of patient care, and don't feel comfortable

delegating it to someone else, I don't. I retain control of the patient.

But ultimately, that decision is driven by the individual's skill level,

not their general level of certification.

>

> On Friday, April 2, 2010 10:45, " Grayson " Grayson902@...

> > said:

>

> > And EMTs can't ventilate and manage an airway?

>

> Some can, and some cannot. You've been around long enough to know

> that. I've seen as many failures as I have successes. But that's not

> even the point. The point is that it is not advisable to simply

> " manage " their airway when the possibility of actually managing the

> cause of their distress with ALS care exists.

>

> > Don't look now, Rob, but your anti-EMT bias is showing.

>

> And so is yours, every time you choose to take control of patient care

> instead of leaving it to an EMT. Think about it.

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

I see where you're coming from, but the gold standard of airway

management is *adequate ventilation* and is not tied to a specific

device. If I think my patient can effectively be managed by nothing more

than BLS (and well over half of them can, is my best guess), then I see

nothing wrong with having the EMT-Basics handle the patient. I wouldn't

hand off a non-breathing patient to an EMT-B, but that's a different

animal from stating that an EMT-B is not qualified to manage an airway

effectively.

This isn't turfing or laziness, it's efficiency. You may feel that

*every* call deserves a medic. I don't. In fact, I think that this whole

" medic on every truck " mentality only serves to degrade the

effectiveness of ALS units through overwork and skill dilution, not to

mention the fact that it denies the seed corn of the next generation of

medics (the EMTs) the chance to develop any meaningful patient care

skills. Look no further than Volusia County, FL for proof of that. You

can't swing a dead cat at a scene there without hitting half a dozen

medics, and every damned one of them sucks at intubation bad enough that

they made a supraglottic airway their ALS airway of choice.

I'll use Boston EMS as an example of a system that does it right. Most

of their units are BLS, with just a handful of ALS units on duty at any

one time. *Most* of their transports are handled by the EMT-Basics. Yet

their 12-lead interpretation, intubation success rates, etc are as good

or better than the physicians they hand the patient off to. Not to

mention their cardiac arrest survival rate that would be the envy of

just about anywhere. the way they do things results in not only strong

medics, but strong EMTs as well, and they're not killing folks right and

left by handing off to the kids with the white patches.

If I am in control of patient care, and don't feel comfortable

delegating it to someone else, I don't. I retain control of the patient.

But ultimately, that decision is driven by the individual's skill level,

not their general level of certification.

>

> On Friday, April 2, 2010 10:45, " Grayson " Grayson902@...

> > said:

>

> > And EMTs can't ventilate and manage an airway?

>

> Some can, and some cannot. You've been around long enough to know

> that. I've seen as many failures as I have successes. But that's not

> even the point. The point is that it is not advisable to simply

> " manage " their airway when the possibility of actually managing the

> cause of their distress with ALS care exists.

>

> > Don't look now, Rob, but your anti-EMT bias is showing.

>

> And so is yours, every time you choose to take control of patient care

> instead of leaving it to an EMT. Think about it.

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

I see where you're coming from, but the gold standard of airway

management is *adequate ventilation* and is not tied to a specific

device. If I think my patient can effectively be managed by nothing more

than BLS (and well over half of them can, is my best guess), then I see

nothing wrong with having the EMT-Basics handle the patient. I wouldn't

hand off a non-breathing patient to an EMT-B, but that's a different

animal from stating that an EMT-B is not qualified to manage an airway

effectively.

This isn't turfing or laziness, it's efficiency. You may feel that

*every* call deserves a medic. I don't. In fact, I think that this whole

" medic on every truck " mentality only serves to degrade the

effectiveness of ALS units through overwork and skill dilution, not to

mention the fact that it denies the seed corn of the next generation of

medics (the EMTs) the chance to develop any meaningful patient care

skills. Look no further than Volusia County, FL for proof of that. You

can't swing a dead cat at a scene there without hitting half a dozen

medics, and every damned one of them sucks at intubation bad enough that

they made a supraglottic airway their ALS airway of choice.

I'll use Boston EMS as an example of a system that does it right. Most

of their units are BLS, with just a handful of ALS units on duty at any

one time. *Most* of their transports are handled by the EMT-Basics. Yet

their 12-lead interpretation, intubation success rates, etc are as good

or better than the physicians they hand the patient off to. Not to

mention their cardiac arrest survival rate that would be the envy of

just about anywhere. the way they do things results in not only strong

medics, but strong EMTs as well, and they're not killing folks right and

left by handing off to the kids with the white patches.

If I am in control of patient care, and don't feel comfortable

delegating it to someone else, I don't. I retain control of the patient.

But ultimately, that decision is driven by the individual's skill level,

not their general level of certification.

>

> On Friday, April 2, 2010 10:45, " Grayson " Grayson902@...

> > said:

>

> > And EMTs can't ventilate and manage an airway?

>

> Some can, and some cannot. You've been around long enough to know

> that. I've seen as many failures as I have successes. But that's not

> even the point. The point is that it is not advisable to simply

> " manage " their airway when the possibility of actually managing the

> cause of their distress with ALS care exists.

>

> > Don't look now, Rob, but your anti-EMT bias is showing.

>

> And so is yours, every time you choose to take control of patient care

> instead of leaving it to an EMT. Think about it.

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

Define " best " systems, and provide proof of your assertion.

I know of at least one premier EMS systems that uses EMT-Basics for the

majority of their calls.

>

> On Saturday, April 3, 2010 05:30, krin135@...

> said:

>

> > and the reason it has been bastardized is that 'the basics' are all that

> > EMT-Basics have to work with...so at least on occasion, the Basic

> sees the

> > Forest, while the Medic is stuck in the trees...even in the best of

> systems.

>

> Except that the " best " systems don't use EMT-Basics.

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

Define " best " systems, and provide proof of your assertion.

I know of at least one premier EMS systems that uses EMT-Basics for the

majority of their calls.

>

> On Saturday, April 3, 2010 05:30, krin135@...

> said:

>

> > and the reason it has been bastardized is that 'the basics' are all that

> > EMT-Basics have to work with...so at least on occasion, the Basic

> sees the

> > Forest, while the Medic is stuck in the trees...even in the best of

> systems.

>

> Except that the " best " systems don't use EMT-Basics.

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

Define " best " systems, and provide proof of your assertion.

I know of at least one premier EMS systems that uses EMT-Basics for the

majority of their calls.

>

> On Saturday, April 3, 2010 05:30, krin135@...

> said:

>

> > and the reason it has been bastardized is that 'the basics' are all that

> > EMT-Basics have to work with...so at least on occasion, the Basic

> sees the

> > Forest, while the Medic is stuck in the trees...even in the best of

> systems.

>

> Except that the " best " systems don't use EMT-Basics.

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

On Saturday, April 3, 2010 07:09, krin135@... said:

> and for my money, the 'best' system would have a three responder team- two

> medics and a basic- with at least one of the medics qualified as an FTO- if

> the trip is 'only' a basic run, then one of the medics drives and the

> other precepts the basic in caring for the patient.

Now you're talking my language!

Rob

[Guest guest]

On Saturday, April 3, 2010 07:09, krin135@... said:

> and for my money, the 'best' system would have a three responder team- two

> medics and a basic- with at least one of the medics qualified as an FTO- if

> the trip is 'only' a basic run, then one of the medics drives and the

> other precepts the basic in caring for the patient.

Now you're talking my language!

Rob

[Guest guest]

On Saturday, April 3, 2010 07:09, krin135@... said:

> and for my money, the 'best' system would have a three responder team- two

> medics and a basic- with at least one of the medics qualified as an FTO- if

> the trip is 'only' a basic run, then one of the medics drives and the

> other precepts the basic in caring for the patient.

Now you're talking my language!

Rob

[Guest guest]

On Saturday, April 3, 2010 08:20, " Grayson " Grayson902@...> said:

> If I am in control of patient care, and don't feel comfortable

> delegating it to someone else, I don't. I retain control of the patient.

> But ultimately, that decision is driven by the individual's skill level,

> not their general level of certification.

Absolutely! But look at what you just said. You are there to make that

educated and informed decision. When a BLS unit responds to make that decision,

you are indeed turning over responsibility of a patient you never even evaluated

to someone else of lesser education and capabilities.

No, I don't believe that every patient needs ALS paramedic care. But I do

believe that they all need ALS paramedic evaluation to determine what level of

care they need. A basic EMT is not qualified to competently determine ALS

needs. They simply do not know what they do not know. If you want to turf your

patient to them after a thorough patient evaluation, I'm good with that. What I

am not comfortable with is EMT basics doing that evaluation and making that

decision themselves.

For clarification, we are talking about EMS here, not non-emergency transfers

and in-facility care, so let's not get off on irrelevant tangents.

Rob

[Guest guest]

On Saturday, April 3, 2010 08:20, " Grayson " Grayson902@...> said:

> If I am in control of patient care, and don't feel comfortable

> delegating it to someone else, I don't. I retain control of the patient.

> But ultimately, that decision is driven by the individual's skill level,

> not their general level of certification.

Absolutely! But look at what you just said. You are there to make that

educated and informed decision. When a BLS unit responds to make that decision,

you are indeed turning over responsibility of a patient you never even evaluated

to someone else of lesser education and capabilities.

No, I don't believe that every patient needs ALS paramedic care. But I do

believe that they all need ALS paramedic evaluation to determine what level of

care they need. A basic EMT is not qualified to competently determine ALS

needs. They simply do not know what they do not know. If you want to turf your

patient to them after a thorough patient evaluation, I'm good with that. What I

am not comfortable with is EMT basics doing that evaluation and making that

decision themselves.

For clarification, we are talking about EMS here, not non-emergency transfers

and in-facility care, so let's not get off on irrelevant tangents.

Rob

[Guest guest]

On Saturday, April 3, 2010 08:20, " Grayson " Grayson902@...> said:

> If I am in control of patient care, and don't feel comfortable

> delegating it to someone else, I don't. I retain control of the patient.

> But ultimately, that decision is driven by the individual's skill level,

> not their general level of certification.

Absolutely! But look at what you just said. You are there to make that

educated and informed decision. When a BLS unit responds to make that decision,

you are indeed turning over responsibility of a patient you never even evaluated

to someone else of lesser education and capabilities.

No, I don't believe that every patient needs ALS paramedic care. But I do

believe that they all need ALS paramedic evaluation to determine what level of

care they need. A basic EMT is not qualified to competently determine ALS

needs. They simply do not know what they do not know. If you want to turf your

patient to them after a thorough patient evaluation, I'm good with that. What I

am not comfortable with is EMT basics doing that evaluation and making that

decision themselves.

For clarification, we are talking about EMS here, not non-emergency transfers

and in-facility care, so let's not get off on irrelevant tangents.

Rob

[Guest guest]

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

[Guest guest]

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

[Guest guest]

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

[Guest guest]

On Saturday, April 3, 2010 08:26, krin135@... said:

> you will note that I didn't make any case for the practicality of said

> system, nor the dilution of Medic experience that it implies.

Very practical. In fact, probably cheaper than all the money that is wasted on

the administration of a pointless " SSM " system, once you include the cost of all

the gas and vehicle wear. But far too many administrators know that it's easier

to get money for hi-tech panaceas than for boots on the ground, so they

compromise.

Dilution of skills? I don't see how paramedics evaluating more patients than

they currently evaluate dilutes their skills. Patient assessment is the most

important and neglected of all the so-called " skills " . The more you do, the

better you get.

And with three EMS personnel on an ambulance, we'd save all the money now being

wasted on fire first responders and their apparatus, allowing for more

ambulances on the street and more patient contacts. Good luck fighting the IAFC

on that one though.

Rob