Re: Progressive services?

[Guest guest]

Rob,

Please explain to me how it is that an ALS provider can preform a better

assessment than a BLS provider. What initial assessment does a ALS provider do

that a BLS doesn't? In every service I have worked I have used the same method

of preforming an initial assessment as the medic I have worked with. It isn't

until this initial assessment is preformed that the medic puts on the cardiac

monitor. And generally the monitor isn't put on until after the blood pressure,

cbg, pulse rate, and so forth are obtained by the BLS provider.

So please explain to me where I am not following you on this line of thought.

AP

[Guest guest]

Rob,

Please explain to me how it is that an ALS provider can preform a better

assessment than a BLS provider. What initial assessment does a ALS provider do

that a BLS doesn't? In every service I have worked I have used the same method

of preforming an initial assessment as the medic I have worked with. It isn't

until this initial assessment is preformed that the medic puts on the cardiac

monitor. And generally the monitor isn't put on until after the blood pressure,

cbg, pulse rate, and so forth are obtained by the BLS provider.

So please explain to me where I am not following you on this line of thought.

AP

[Guest guest]

On Saturday, April 3, 2010 11:38, " " aggiesrwe03@...> said:

> 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.

Absolutely agreed! But unfortunately, we cannot discuss individuals in a broad

systemic discussion like this. Every provider is too different. Therefore, the

only relevant or logical discussion is limited to the patches on one's shoulder,

not the individual provider's excellence or deficiencies.

> It's funny we seem to agree while at the same time disagree.

And thank you for mentioning that! I try very hard to find the common ground in

these issues in order to give us a foundation to build from. I truly hope that

everyone can see the common ground in this discussion, and set their personal

bias aside long enough to explore them rather than condemn them outright.

Rob

[Guest guest]

On Saturday, April 3, 2010 11:38, " " aggiesrwe03@...> said:

> 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.

Absolutely agreed! But unfortunately, we cannot discuss individuals in a broad

systemic discussion like this. Every provider is too different. Therefore, the

only relevant or logical discussion is limited to the patches on one's shoulder,

not the individual provider's excellence or deficiencies.

> It's funny we seem to agree while at the same time disagree.

And thank you for mentioning that! I try very hard to find the common ground in

these issues in order to give us a foundation to build from. I truly hope that

everyone can see the common ground in this discussion, and set their personal

bias aside long enough to explore them rather than condemn them outright.

Rob

[Guest guest]

On Saturday, April 3, 2010 11:38, " " aggiesrwe03@...> said:

> 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.

Absolutely agreed! But unfortunately, we cannot discuss individuals in a broad

systemic discussion like this. Every provider is too different. Therefore, the

only relevant or logical discussion is limited to the patches on one's shoulder,

not the individual provider's excellence or deficiencies.

> It's funny we seem to agree while at the same time disagree.

And thank you for mentioning that! I try very hard to find the common ground in

these issues in order to give us a foundation to build from. I truly hope that

everyone can see the common ground in this discussion, and set their personal

bias aside long enough to explore them rather than condemn them outright.

Rob

[Guest guest]

On Saturday, April 3, 2010 15:50, " Alyssa Woods " amwoods8644@...> said:

> Two years of school does not a competent medic make. I've met medics

> that refused to do anything but BLS because every time they did, they

> screwed up in an epic way. Their BLS p...

Alyssa, the problem with this contention is the same as previous contentions.

You are attempting to compare bad paramedics to good EMTs in order to skew the

facts. You can't logically do that since, if your paramedics are that bad

systemwide, then you can bet you also have a serious deficiency in your EMTs.

You cannot separate the two.

Again, we have all seen horrible providers at every level of medical practice,

as well as exceptional ones. Cherry picking the examples of each that you want

to highlight is not honest debate.

But you are mistaken in your original assumption. Two years of school does

indeed make a more competent medic than ten weeks does, or three weeks in the

case of an EMT.

Rob

[Guest guest]

On Saturday, April 3, 2010 15:50, " Alyssa Woods " amwoods8644@...> said:

> Two years of school does not a competent medic make. I've met medics

> that refused to do anything but BLS because every time they did, they

> screwed up in an epic way. Their BLS p...

Alyssa, the problem with this contention is the same as previous contentions.

You are attempting to compare bad paramedics to good EMTs in order to skew the

facts. You can't logically do that since, if your paramedics are that bad

systemwide, then you can bet you also have a serious deficiency in your EMTs.

You cannot separate the two.

Again, we have all seen horrible providers at every level of medical practice,

as well as exceptional ones. Cherry picking the examples of each that you want

to highlight is not honest debate.

But you are mistaken in your original assumption. Two years of school does

indeed make a more competent medic than ten weeks does, or three weeks in the

case of an EMT.

Rob

[Guest guest]

On Saturday, April 3, 2010 15:50, " Alyssa Woods " amwoods8644@...> said:

> Two years of school does not a competent medic make. I've met medics

> that refused to do anything but BLS because every time they did, they

> screwed up in an epic way. Their BLS p...

Alyssa, the problem with this contention is the same as previous contentions.

You are attempting to compare bad paramedics to good EMTs in order to skew the

facts. You can't logically do that since, if your paramedics are that bad

systemwide, then you can bet you also have a serious deficiency in your EMTs.

You cannot separate the two.

Again, we have all seen horrible providers at every level of medical practice,

as well as exceptional ones. Cherry picking the examples of each that you want

to highlight is not honest debate.

But you are mistaken in your original assumption. Two years of school does

indeed make a more competent medic than ten weeks does, or three weeks in the

case of an EMT.

Rob

[Guest guest]

On Saturday, April 3, 2010 15:57, " Grayson " Grayson902@...> said:

> I'm suggesting to you that Boston does so well *because* they have less

> medics, not *in spite of* that fact. No doubt you will disagree, but the

> possibility at the very least merits consideration.

I don't so much disagree as I do simply hold a healthy scepticism over what is

merely empirical data, and not proven evidence. As you yourself admit, it is

only supposition that there is a cause and effect relationship between any of

this data and the systemic elements you credit.

You want to talk skills degradation? How about all those certified paramedics

who spend five years as an " EMT " , working alongside another EMT, seeing very few

ALS patients, and never performing an intubation, while they wait for the Boston

political machine to finally -- if ever -- officially anoint them as a

paramedic? Why don't we count them in the skills degradation equation? How

does that affect your numbers now?

And if BLS airway management is such an incredibly reliable thing -- especially

in such an outstanding system as Boston -- then why would intubation numbers

have any effect on cardiac arrest saves anyhow? I thought we were being told

here that BLS airway management is all anyone really needs, so why do we worry

about intubation skills degradation? You can't have it both ways.

And how myopic are we if we view intubation rates as the hallmark of a system?

Is intubation important? Sure! Although, it's hard to tell here, the way it is

both held up as a gold standard one moment, and then discounted as no better

than BLS management the next. Regardless, two years of education does not boil

down to one " skill " . If it did, why would we have paramedics at all? A

paramedic is NOT -- I emphasise NOT -- just an EMT with a couple of extra

skills, despite what places like Texas A&M teach. There is a whole lot more

packed into that extra thousand or more hours than IV and airway. Can you guys

honestly not think of a few things that paramedics know and do that EMTs do not,

that are important? Seriously? I just never bought into the " skills " based

theory of paramedic practice. There's simply a lot more to it. And if there

isn't in Boston, then that is a damning indictment of their quality.

As for cardiac arrest survival numbers, I thought we outgrew that nonsense after

the Seattle debacle. I don't think the goal of EMS was ever to resurrect the

dead, and that is a disingenuous number to hang a system's reputation on. There

are simply too many factors that randomly influence this number, many of them

having absolutely nothing to do with the EMS system. As Seattle showed us, it

mostly has to do with the talent of the statistician who is cooking the numbers.

Let's look at some relevant numbers. The job of EMS is not to resurrect the

dead. The job of EMS is to prevent death. How many of their patients crash

after contact? How many of those who crash are revived? Is it any better or

worse than anyone else's? How often do EMTs make the scene of an ALS patient?

How often are those patients reclassified, and ALS summoned, and how often are

they simply transported without proper care?

So far, the only justification I have heard for EMTs in a frontline EMS system

is that it allows medics to dump those who are not worthy of their awesome

skillz onto a lackey, so they don't have to be bothered with them. And, unless

they are operating a much more reliable phone triage system than any I have ever

seen (doubtful), that is resulting in a lot of patients not getting the level of

care they needed. It baffles me that those who often complain about so-called

" paragods " will come out and support this sort of practice.

We're tossing around a lot of old school, politically correct " conventional

wisdom " here that simply has not held up to close scrutiny and lies in the ash

bin alongside MAST pants and The Golden Hour. The way things have always been

is just not sufficient " evidence " upon which to base our practices. And our

practices are only as good as the evidence we base them upon. All I really ask

here is that we not take so much " evidence " for granted, as we have always done

with EMS Myths later proven false, and instead try to look outside the box every

now and then.

On a parenthetical note, I hold in the highest professional respect and

esteem. None of this discussion is personal. Actually, the fact that I choose

to engage him in this discussion is validation of my respect for him, in that I

trust that it will be an honest and intelligent debate, free of ad hominems or

patronisation, as we have seen from other posters. I just don't want anyone

here to suspect for one moment that this is an argument, or that it signifies

any animosity. Quite to the contrary. I always appreciate and respect the

level of discourse from . And to my delight, he seems to understand and

believe that.

Rob

[Guest guest]

On Saturday, April 3, 2010 15:57, " Grayson " Grayson902@...> said:

> I'm suggesting to you that Boston does so well *because* they have less

> medics, not *in spite of* that fact. No doubt you will disagree, but the

> possibility at the very least merits consideration.

I don't so much disagree as I do simply hold a healthy scepticism over what is

merely empirical data, and not proven evidence. As you yourself admit, it is

only supposition that there is a cause and effect relationship between any of

this data and the systemic elements you credit.

You want to talk skills degradation? How about all those certified paramedics

who spend five years as an " EMT " , working alongside another EMT, seeing very few

ALS patients, and never performing an intubation, while they wait for the Boston

political machine to finally -- if ever -- officially anoint them as a

paramedic? Why don't we count them in the skills degradation equation? How

does that affect your numbers now?

And if BLS airway management is such an incredibly reliable thing -- especially

in such an outstanding system as Boston -- then why would intubation numbers

have any effect on cardiac arrest saves anyhow? I thought we were being told

here that BLS airway management is all anyone really needs, so why do we worry

about intubation skills degradation? You can't have it both ways.

And how myopic are we if we view intubation rates as the hallmark of a system?

Is intubation important? Sure! Although, it's hard to tell here, the way it is

both held up as a gold standard one moment, and then discounted as no better

than BLS management the next. Regardless, two years of education does not boil

down to one " skill " . If it did, why would we have paramedics at all? A

paramedic is NOT -- I emphasise NOT -- just an EMT with a couple of extra

skills, despite what places like Texas A&M teach. There is a whole lot more

packed into that extra thousand or more hours than IV and airway. Can you guys

honestly not think of a few things that paramedics know and do that EMTs do not,

that are important? Seriously? I just never bought into the " skills " based

theory of paramedic practice. There's simply a lot more to it. And if there

isn't in Boston, then that is a damning indictment of their quality.

As for cardiac arrest survival numbers, I thought we outgrew that nonsense after

the Seattle debacle. I don't think the goal of EMS was ever to resurrect the

dead, and that is a disingenuous number to hang a system's reputation on. There

are simply too many factors that randomly influence this number, many of them

having absolutely nothing to do with the EMS system. As Seattle showed us, it

mostly has to do with the talent of the statistician who is cooking the numbers.

Let's look at some relevant numbers. The job of EMS is not to resurrect the

dead. The job of EMS is to prevent death. How many of their patients crash

after contact? How many of those who crash are revived? Is it any better or

worse than anyone else's? How often do EMTs make the scene of an ALS patient?

How often are those patients reclassified, and ALS summoned, and how often are

they simply transported without proper care?

So far, the only justification I have heard for EMTs in a frontline EMS system

is that it allows medics to dump those who are not worthy of their awesome

skillz onto a lackey, so they don't have to be bothered with them. And, unless

they are operating a much more reliable phone triage system than any I have ever

seen (doubtful), that is resulting in a lot of patients not getting the level of

care they needed. It baffles me that those who often complain about so-called

" paragods " will come out and support this sort of practice.

We're tossing around a lot of old school, politically correct " conventional

wisdom " here that simply has not held up to close scrutiny and lies in the ash

bin alongside MAST pants and The Golden Hour. The way things have always been

is just not sufficient " evidence " upon which to base our practices. And our

practices are only as good as the evidence we base them upon. All I really ask

here is that we not take so much " evidence " for granted, as we have always done

with EMS Myths later proven false, and instead try to look outside the box every

now and then.

On a parenthetical note, I hold in the highest professional respect and

esteem. None of this discussion is personal. Actually, the fact that I choose

to engage him in this discussion is validation of my respect for him, in that I

trust that it will be an honest and intelligent debate, free of ad hominems or

patronisation, as we have seen from other posters. I just don't want anyone

here to suspect for one moment that this is an argument, or that it signifies

any animosity. Quite to the contrary. I always appreciate and respect the

level of discourse from . And to my delight, he seems to understand and

believe that.

Rob

[Guest guest]

On Saturday, April 3, 2010 15:57, " Grayson " Grayson902@...> said:

> I'm suggesting to you that Boston does so well *because* they have less

> medics, not *in spite of* that fact. No doubt you will disagree, but the

> possibility at the very least merits consideration.

I don't so much disagree as I do simply hold a healthy scepticism over what is

merely empirical data, and not proven evidence. As you yourself admit, it is

only supposition that there is a cause and effect relationship between any of

this data and the systemic elements you credit.

You want to talk skills degradation? How about all those certified paramedics

who spend five years as an " EMT " , working alongside another EMT, seeing very few

ALS patients, and never performing an intubation, while they wait for the Boston

political machine to finally -- if ever -- officially anoint them as a

paramedic? Why don't we count them in the skills degradation equation? How

does that affect your numbers now?

And if BLS airway management is such an incredibly reliable thing -- especially

in such an outstanding system as Boston -- then why would intubation numbers

have any effect on cardiac arrest saves anyhow? I thought we were being told

here that BLS airway management is all anyone really needs, so why do we worry

about intubation skills degradation? You can't have it both ways.

And how myopic are we if we view intubation rates as the hallmark of a system?

Is intubation important? Sure! Although, it's hard to tell here, the way it is

both held up as a gold standard one moment, and then discounted as no better

than BLS management the next. Regardless, two years of education does not boil

down to one " skill " . If it did, why would we have paramedics at all? A

paramedic is NOT -- I emphasise NOT -- just an EMT with a couple of extra

skills, despite what places like Texas A&M teach. There is a whole lot more

packed into that extra thousand or more hours than IV and airway. Can you guys

honestly not think of a few things that paramedics know and do that EMTs do not,

that are important? Seriously? I just never bought into the " skills " based

theory of paramedic practice. There's simply a lot more to it. And if there

isn't in Boston, then that is a damning indictment of their quality.

As for cardiac arrest survival numbers, I thought we outgrew that nonsense after

the Seattle debacle. I don't think the goal of EMS was ever to resurrect the

dead, and that is a disingenuous number to hang a system's reputation on. There

are simply too many factors that randomly influence this number, many of them

having absolutely nothing to do with the EMS system. As Seattle showed us, it

mostly has to do with the talent of the statistician who is cooking the numbers.

Let's look at some relevant numbers. The job of EMS is not to resurrect the

dead. The job of EMS is to prevent death. How many of their patients crash

after contact? How many of those who crash are revived? Is it any better or

worse than anyone else's? How often do EMTs make the scene of an ALS patient?

How often are those patients reclassified, and ALS summoned, and how often are

they simply transported without proper care?

So far, the only justification I have heard for EMTs in a frontline EMS system

is that it allows medics to dump those who are not worthy of their awesome

skillz onto a lackey, so they don't have to be bothered with them. And, unless

they are operating a much more reliable phone triage system than any I have ever

seen (doubtful), that is resulting in a lot of patients not getting the level of

care they needed. It baffles me that those who often complain about so-called

" paragods " will come out and support this sort of practice.

We're tossing around a lot of old school, politically correct " conventional

wisdom " here that simply has not held up to close scrutiny and lies in the ash

bin alongside MAST pants and The Golden Hour. The way things have always been

is just not sufficient " evidence " upon which to base our practices. And our

practices are only as good as the evidence we base them upon. All I really ask

here is that we not take so much " evidence " for granted, as we have always done

with EMS Myths later proven false, and instead try to look outside the box every

now and then.

On a parenthetical note, I hold in the highest professional respect and

esteem. None of this discussion is personal. Actually, the fact that I choose

to engage him in this discussion is validation of my respect for him, in that I

trust that it will be an honest and intelligent debate, free of ad hominems or

patronisation, as we have seen from other posters. I just don't want anyone

here to suspect for one moment that this is an argument, or that it signifies

any animosity. Quite to the contrary. I always appreciate and respect the

level of discourse from . And to my delight, he seems to understand and

believe that.

Rob

[Guest guest]

Who said their intubation success rates had anything to do with their

cardiac arrest resuscitation numbers? I didn't make that assertion.

When it comes right down to that, with CPAP and the de-emphasis of

intubation in cardiac arrest, they're intubating fewer people than ever.

But they still manage to do a good job when it is necessary.

More and more, it seems that the research is showing that BLS

interventions make the biggest difference in outcomes, which, if

anything, shoots more holes in your " ALS for everyone " argument.

>

> On Saturday, April 3, 2010 15:57, " Grayson " Grayson902@...

> > said:

>

> > I'm suggesting to you that Boston does so well *because* they have less

> > medics, not *in spite of* that fact. No doubt you will disagree, but the

> > possibility at the very least merits consideration.

>

> I don't so much disagree as I do simply hold a healthy scepticism over

> what is merely empirical data, and not proven evidence. As you

> yourself admit, it is only supposition that there is a cause and

> effect relationship between any of this data and the systemic elements

> you credit.

>

> You want to talk skills degradation? How about all those certified

> paramedics who spend five years as an " EMT " , working alongside another

> EMT, seeing very few ALS patients, and never performing an intubation,

> while they wait for the Boston political machine to finally -- if ever

> -- officially anoint them as a paramedic? Why don't we count them in

> the skills degradation equation? How does that affect your numbers now?

>

> And if BLS airway management is such an incredibly reliable thing --

> especially in such an outstanding system as Boston -- then why would

> intubation numbers have any effect on cardiac arrest saves anyhow? I

> thought we were being told here that BLS airway management is all

> anyone really needs, so why do we worry about intubation skills

> degradation? You can't have it both ways.

>

> And how myopic are we if we view intubation rates as the hallmark of a

> system? Is intubation important? Sure! Although, it's hard to tell

> here, the way it is both held up as a gold standard one moment, and

> then discounted as no better than BLS management the next. Regardless,

> two years of education does not boil down to one " skill " . If it did,

> why would we have paramedics at all? A paramedic is NOT -- I emphasise

> NOT -- just an EMT with a couple of extra skills, despite what places

> like Texas A&M teach. There is a whole lot more packed into that extra

> thousand or more hours than IV and airway. Can you guys honestly not

> think of a few things that paramedics know and do that EMTs do not,

> that are important? Seriously? I just never bought into the " skills "

> based theory of paramedic practice. There's simply a lot more to it.

> And if there isn't in Boston, then that is a damning indictment of

> their quality.

>

> As for cardiac arrest survival numbers, I thought we outgrew that

> nonsense after the Seattle debacle. I don't think the goal of EMS was

> ever to resurrect the dead, and that is a disingenuous number to hang

> a system's reputation on. There are simply too many factors that

> randomly influence this number, many of them having absolutely nothing

> to do with the EMS system. As Seattle showed us, it mostly has to do

> with the talent of the statistician who is cooking the numbers.

>

> Let's look at some relevant numbers. The job of EMS is not to

> resurrect the dead. The job of EMS is to prevent death. How many of

> their patients crash after contact? How many of those who crash are

> revived? Is it any better or worse than anyone else's? How often do

> EMTs make the scene of an ALS patient? How often are those patients

> reclassified, and ALS summoned, and how often are they simply

> transported without proper care?

>

> So far, the only justification I have heard for EMTs in a frontline

> EMS system is that it allows medics to dump those who are not worthy

> of their awesome skillz onto a lackey, so they don't have to be

> bothered with them. And, unless they are operating a much more

> reliable phone triage system than any I have ever seen (doubtful),

> that is resulting in a lot of patients not getting the level of care

> they needed. It baffles me that those who often complain about

> so-called " paragods " will come out and support this sort of practice.

>

> We're tossing around a lot of old school, politically correct

> " conventional wisdom " here that simply has not held up to close

> scrutiny and lies in the ash bin alongside MAST pants and The Golden

> Hour. The way things have always been is just not sufficient

> " evidence " upon which to base our practices. And our practices are

> only as good as the evidence we base them upon. All I really ask here

> is that we not take so much " evidence " for granted, as we have always

> done with EMS Myths later proven false, and instead try to look

> outside the box every now and then.

>

> On a parenthetical note, I hold in the highest professional

> respect and esteem. None of this discussion is personal. Actually, the

> fact that I choose to engage him in this discussion is validation of

> my respect for him, in that I trust that it will be an honest and

> intelligent debate, free of ad hominems or patronisation, as we have

> seen from other posters. I just don't want anyone here to suspect for

> one moment that this is an argument, or that it signifies any

> animosity. Quite to the contrary. I always appreciate and respect the

> level of discourse from . And to my delight, he seems to

> understand and believe that.

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

Who said their intubation success rates had anything to do with their

cardiac arrest resuscitation numbers? I didn't make that assertion.

When it comes right down to that, with CPAP and the de-emphasis of

intubation in cardiac arrest, they're intubating fewer people than ever.

But they still manage to do a good job when it is necessary.

More and more, it seems that the research is showing that BLS

interventions make the biggest difference in outcomes, which, if

anything, shoots more holes in your " ALS for everyone " argument.

>

> On Saturday, April 3, 2010 15:57, " Grayson " Grayson902@...

> > said:

>

> > I'm suggesting to you that Boston does so well *because* they have less

> > medics, not *in spite of* that fact. No doubt you will disagree, but the

> > possibility at the very least merits consideration.

>

> I don't so much disagree as I do simply hold a healthy scepticism over

> what is merely empirical data, and not proven evidence. As you

> yourself admit, it is only supposition that there is a cause and

> effect relationship between any of this data and the systemic elements

> you credit.

>

> You want to talk skills degradation? How about all those certified

> paramedics who spend five years as an " EMT " , working alongside another

> EMT, seeing very few ALS patients, and never performing an intubation,

> while they wait for the Boston political machine to finally -- if ever

> -- officially anoint them as a paramedic? Why don't we count them in

> the skills degradation equation? How does that affect your numbers now?

>

> And if BLS airway management is such an incredibly reliable thing --

> especially in such an outstanding system as Boston -- then why would

> intubation numbers have any effect on cardiac arrest saves anyhow? I

> thought we were being told here that BLS airway management is all

> anyone really needs, so why do we worry about intubation skills

> degradation? You can't have it both ways.

>

> And how myopic are we if we view intubation rates as the hallmark of a

> system? Is intubation important? Sure! Although, it's hard to tell

> here, the way it is both held up as a gold standard one moment, and

> then discounted as no better than BLS management the next. Regardless,

> two years of education does not boil down to one " skill " . If it did,

> why would we have paramedics at all? A paramedic is NOT -- I emphasise

> NOT -- just an EMT with a couple of extra skills, despite what places

> like Texas A&M teach. There is a whole lot more packed into that extra

> thousand or more hours than IV and airway. Can you guys honestly not

> think of a few things that paramedics know and do that EMTs do not,

> that are important? Seriously? I just never bought into the " skills "

> based theory of paramedic practice. There's simply a lot more to it.

> And if there isn't in Boston, then that is a damning indictment of

> their quality.

>

> As for cardiac arrest survival numbers, I thought we outgrew that

> nonsense after the Seattle debacle. I don't think the goal of EMS was

> ever to resurrect the dead, and that is a disingenuous number to hang

> a system's reputation on. There are simply too many factors that

> randomly influence this number, many of them having absolutely nothing

> to do with the EMS system. As Seattle showed us, it mostly has to do

> with the talent of the statistician who is cooking the numbers.

>

> Let's look at some relevant numbers. The job of EMS is not to

> resurrect the dead. The job of EMS is to prevent death. How many of

> their patients crash after contact? How many of those who crash are

> revived? Is it any better or worse than anyone else's? How often do

> EMTs make the scene of an ALS patient? How often are those patients

> reclassified, and ALS summoned, and how often are they simply

> transported without proper care?

>

> So far, the only justification I have heard for EMTs in a frontline

> EMS system is that it allows medics to dump those who are not worthy

> of their awesome skillz onto a lackey, so they don't have to be

> bothered with them. And, unless they are operating a much more

> reliable phone triage system than any I have ever seen (doubtful),

> that is resulting in a lot of patients not getting the level of care

> they needed. It baffles me that those who often complain about

> so-called " paragods " will come out and support this sort of practice.

>

> We're tossing around a lot of old school, politically correct

> " conventional wisdom " here that simply has not held up to close

> scrutiny and lies in the ash bin alongside MAST pants and The Golden

> Hour. The way things have always been is just not sufficient

> " evidence " upon which to base our practices. And our practices are

> only as good as the evidence we base them upon. All I really ask here

> is that we not take so much " evidence " for granted, as we have always

> done with EMS Myths later proven false, and instead try to look

> outside the box every now and then.

>

> On a parenthetical note, I hold in the highest professional

> respect and esteem. None of this discussion is personal. Actually, the

> fact that I choose to engage him in this discussion is validation of

> my respect for him, in that I trust that it will be an honest and

> intelligent debate, free of ad hominems or patronisation, as we have

> seen from other posters. I just don't want anyone here to suspect for

> one moment that this is an argument, or that it signifies any

> animosity. Quite to the contrary. I always appreciate and respect the

> level of discourse from . And to my delight, he seems to

> understand and believe that.

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

Who said their intubation success rates had anything to do with their

cardiac arrest resuscitation numbers? I didn't make that assertion.

When it comes right down to that, with CPAP and the de-emphasis of

intubation in cardiac arrest, they're intubating fewer people than ever.

But they still manage to do a good job when it is necessary.

More and more, it seems that the research is showing that BLS

interventions make the biggest difference in outcomes, which, if

anything, shoots more holes in your " ALS for everyone " argument.

>

> On Saturday, April 3, 2010 15:57, " Grayson " Grayson902@...

> > said:

>

> > I'm suggesting to you that Boston does so well *because* they have less

> > medics, not *in spite of* that fact. No doubt you will disagree, but the

> > possibility at the very least merits consideration.

>

> I don't so much disagree as I do simply hold a healthy scepticism over

> what is merely empirical data, and not proven evidence. As you

> yourself admit, it is only supposition that there is a cause and

> effect relationship between any of this data and the systemic elements

> you credit.

>

> You want to talk skills degradation? How about all those certified

> paramedics who spend five years as an " EMT " , working alongside another

> EMT, seeing very few ALS patients, and never performing an intubation,

> while they wait for the Boston political machine to finally -- if ever

> -- officially anoint them as a paramedic? Why don't we count them in

> the skills degradation equation? How does that affect your numbers now?

>

> And if BLS airway management is such an incredibly reliable thing --

> especially in such an outstanding system as Boston -- then why would

> intubation numbers have any effect on cardiac arrest saves anyhow? I

> thought we were being told here that BLS airway management is all

> anyone really needs, so why do we worry about intubation skills

> degradation? You can't have it both ways.

>

> And how myopic are we if we view intubation rates as the hallmark of a

> system? Is intubation important? Sure! Although, it's hard to tell

> here, the way it is both held up as a gold standard one moment, and

> then discounted as no better than BLS management the next. Regardless,

> two years of education does not boil down to one " skill " . If it did,

> why would we have paramedics at all? A paramedic is NOT -- I emphasise

> NOT -- just an EMT with a couple of extra skills, despite what places

> like Texas A&M teach. There is a whole lot more packed into that extra

> thousand or more hours than IV and airway. Can you guys honestly not

> think of a few things that paramedics know and do that EMTs do not,

> that are important? Seriously? I just never bought into the " skills "

> based theory of paramedic practice. There's simply a lot more to it.

> And if there isn't in Boston, then that is a damning indictment of

> their quality.

>

> As for cardiac arrest survival numbers, I thought we outgrew that

> nonsense after the Seattle debacle. I don't think the goal of EMS was

> ever to resurrect the dead, and that is a disingenuous number to hang

> a system's reputation on. There are simply too many factors that

> randomly influence this number, many of them having absolutely nothing

> to do with the EMS system. As Seattle showed us, it mostly has to do

> with the talent of the statistician who is cooking the numbers.

>

> Let's look at some relevant numbers. The job of EMS is not to

> resurrect the dead. The job of EMS is to prevent death. How many of

> their patients crash after contact? How many of those who crash are

> revived? Is it any better or worse than anyone else's? How often do

> EMTs make the scene of an ALS patient? How often are those patients

> reclassified, and ALS summoned, and how often are they simply

> transported without proper care?

>

> So far, the only justification I have heard for EMTs in a frontline

> EMS system is that it allows medics to dump those who are not worthy

> of their awesome skillz onto a lackey, so they don't have to be

> bothered with them. And, unless they are operating a much more

> reliable phone triage system than any I have ever seen (doubtful),

> that is resulting in a lot of patients not getting the level of care

> they needed. It baffles me that those who often complain about

> so-called " paragods " will come out and support this sort of practice.

>

> We're tossing around a lot of old school, politically correct

> " conventional wisdom " here that simply has not held up to close

> scrutiny and lies in the ash bin alongside MAST pants and The Golden

> Hour. The way things have always been is just not sufficient

> " evidence " upon which to base our practices. And our practices are

> only as good as the evidence we base them upon. All I really ask here

> is that we not take so much " evidence " for granted, as we have always

> done with EMS Myths later proven false, and instead try to look

> outside the box every now and then.

>

> On a parenthetical note, I hold in the highest professional

> respect and esteem. None of this discussion is personal. Actually, the

> fact that I choose to engage him in this discussion is validation of

> my respect for him, in that I trust that it will be an honest and

> intelligent debate, free of ad hominems or patronisation, as we have

> seen from other posters. I just don't want anyone here to suspect for

> one moment that this is an argument, or that it signifies any

> animosity. Quite to the contrary. I always appreciate and respect the

> level of discourse from . And to my delight, he seems to

> understand and believe that.

>

> Rob

>

>

--

Grayson, CCEMT-P www.kellygrayson.com

[Guest guest]

On Monday, April 5, 2010 06:57, " Grayson " Grayson902@...> said:

> Who said their intubation success rates had anything to do with their

> cardiac arrest resuscitation numbers? I didn't make that assertion.

You went to such lengths to highlight their intubation prowess, and the issue of

skills degradation that I made the mistaken assumption that it was somehow

relevant to the discussion. Obviously I was wrong. Sorry about that.

> When it comes right down to that, with CPAP and the de-emphasis of

> intubation in cardiac arrest, they're intubating fewer people than ever.

> But they still manage to do a good job when it is necessary.

Compared to what other systems? You can't really just say they're " good "

without giving us a standard for measure.

> More and more, it seems that the research is showing that BLS

> interventions make the biggest difference in outcomes, which, if

> anything, shoots more holes in your " ALS for everyone " argument.

Not at all. You're still arguing only skills. I am not. I taught my 10 year

old sister the core ALS medic skills in a weekend. Should we allow her to

practise? Again, skills are not the measure of medical competency. There is a

lot of headwork that goes along with it, without which, the skills are useless.

Rob

[Guest guest]

On Monday, April 5, 2010 06:57, " Grayson " Grayson902@...> said:

> Who said their intubation success rates had anything to do with their

> cardiac arrest resuscitation numbers? I didn't make that assertion.

You went to such lengths to highlight their intubation prowess, and the issue of

skills degradation that I made the mistaken assumption that it was somehow

relevant to the discussion. Obviously I was wrong. Sorry about that.

> When it comes right down to that, with CPAP and the de-emphasis of

> intubation in cardiac arrest, they're intubating fewer people than ever.

> But they still manage to do a good job when it is necessary.

Compared to what other systems? You can't really just say they're " good "

without giving us a standard for measure.

> More and more, it seems that the research is showing that BLS

> interventions make the biggest difference in outcomes, which, if

> anything, shoots more holes in your " ALS for everyone " argument.

Not at all. You're still arguing only skills. I am not. I taught my 10 year

old sister the core ALS medic skills in a weekend. Should we allow her to

practise? Again, skills are not the measure of medical competency. There is a

lot of headwork that goes along with it, without which, the skills are useless.

Rob

[Guest guest]

On Monday, April 5, 2010 06:57, " Grayson " Grayson902@...> said:

> Who said their intubation success rates had anything to do with their

> cardiac arrest resuscitation numbers? I didn't make that assertion.

You went to such lengths to highlight their intubation prowess, and the issue of

skills degradation that I made the mistaken assumption that it was somehow

relevant to the discussion. Obviously I was wrong. Sorry about that.

> When it comes right down to that, with CPAP and the de-emphasis of

> intubation in cardiac arrest, they're intubating fewer people than ever.

> But they still manage to do a good job when it is necessary.

Compared to what other systems? You can't really just say they're " good "

without giving us a standard for measure.

> More and more, it seems that the research is showing that BLS

> interventions make the biggest difference in outcomes, which, if

> anything, shoots more holes in your " ALS for everyone " argument.

Not at all. You're still arguing only skills. I am not. I taught my 10 year

old sister the core ALS medic skills in a weekend. Should we allow her to

practise? Again, skills are not the measure of medical competency. There is a

lot of headwork that goes along with it, without which, the skills are useless.

Rob

[Guest guest]

rob.davis@... wrote:

>

>

> On Monday, April 5, 2010 06:57, " Grayson " Grayson902@...

> > said:

>

> > Who said their intubation success rates had anything to do with their

> > cardiac arrest resuscitation numbers? I didn't make that assertion.

>

> You went to such lengths to highlight their intubation prowess, and

> the issue of skills degradation that I made the mistaken assumption

> that it was somehow relevant to the discussion. Obviously I was wrong.

> Sorry about that.

>

I merely reported their intubation success rates because that is one of

the most degradable skills, and one often viewed as a core measure of

quality of an ALS system. Didn't mean to give you the impression that

was the reason for the cardiac arrest resuscitation rates.

>

>

> > When it comes right down to that, with CPAP and the de-emphasis of

> > intubation in cardiac arrest, they're intubating fewer people than ever.

> > But they still manage to do a good job when it is necessary.

>

> Compared to what other systems? You can't really just say they're

> " good " without giving us a standard for measure.

>

Compared to *any* other systems. In this case, I was simply referring to

intubation success, which, as I recall, is over 95%. But I'll ask this,

what is *your* standard of measure for a *good* ALS system, and why?

That way, we're comparing apples to apples.

>

>

> > More and more, it seems that the research is showing that BLS

> > interventions make the biggest difference in outcomes, which, if

> > anything, shoots more holes in your " ALS for everyone " argument.

>

> Not at all. You're still arguing only skills. I am not. I taught my 10

> year old sister the core ALS medic skills in a weekend. Should we

> allow her to practise? Again, skills are not the measure of medical

> competency. There is a lot of headwork that goes along with it,

> without which, the skills are useless.

>

I grant you that. Assessment prowess is by far the more important part

of the two, and the harder one to measure. But in that vein, it's damned

hard to measure that it does any *good* either. You contend that ALS

assessment is essential for most patients. I see the merit of that

position, but I remain skeptical, because you're no more able to quote

hard numbers to support that contention than anyone else is able to

quote hard numbers that say it *doesn't* matter.

So basically here, we're arguing opinions.

But again in regard to ALS assessment and Boston, many of their BLS

transports *do* get an ALS assessment, and then turned over to the

EMT-Basics for BLS treatment and transport. Not all calls get an ALS

response, but many do, even if they don't wind up being transported by

an ALS unit. Boston uses a customized dispatch protocol, similar to

MPDS, but probably altered enough that Clawson wouldn't indemnify their

trained seals in dispatch.

So let me ask you this: You've gone to great length to argue that anyone

less than a well-educated paramedic is unqualified to do a thorough

assessment, yet have stated frequently in this thread that ALS

interventions aren't needed nearly as often. What, then, would be your

issue with a system that sends BLS trucks to low-acuity calls (the

majority of runs in most systems), yet still sends ALS trucks to triage

the other, potentially higher acuity calls?

Sounds like a good way to get maximum resources, if you ask me.

>

>

> Rob

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

rob.davis@... wrote:

>

>

> On Monday, April 5, 2010 06:57, " Grayson " Grayson902@...

> > said:

>

> > Who said their intubation success rates had anything to do with their

> > cardiac arrest resuscitation numbers? I didn't make that assertion.

>

> You went to such lengths to highlight their intubation prowess, and

> the issue of skills degradation that I made the mistaken assumption

> that it was somehow relevant to the discussion. Obviously I was wrong.

> Sorry about that.

>

I merely reported their intubation success rates because that is one of

the most degradable skills, and one often viewed as a core measure of

quality of an ALS system. Didn't mean to give you the impression that

was the reason for the cardiac arrest resuscitation rates.

>

>

> > When it comes right down to that, with CPAP and the de-emphasis of

> > intubation in cardiac arrest, they're intubating fewer people than ever.

> > But they still manage to do a good job when it is necessary.

>

> Compared to what other systems? You can't really just say they're

> " good " without giving us a standard for measure.

>

Compared to *any* other systems. In this case, I was simply referring to

intubation success, which, as I recall, is over 95%. But I'll ask this,

what is *your* standard of measure for a *good* ALS system, and why?

That way, we're comparing apples to apples.

>

>

> > More and more, it seems that the research is showing that BLS

> > interventions make the biggest difference in outcomes, which, if

> > anything, shoots more holes in your " ALS for everyone " argument.

>

> Not at all. You're still arguing only skills. I am not. I taught my 10

> year old sister the core ALS medic skills in a weekend. Should we

> allow her to practise? Again, skills are not the measure of medical

> competency. There is a lot of headwork that goes along with it,

> without which, the skills are useless.

>

I grant you that. Assessment prowess is by far the more important part

of the two, and the harder one to measure. But in that vein, it's damned

hard to measure that it does any *good* either. You contend that ALS

assessment is essential for most patients. I see the merit of that

position, but I remain skeptical, because you're no more able to quote

hard numbers to support that contention than anyone else is able to

quote hard numbers that say it *doesn't* matter.

So basically here, we're arguing opinions.

But again in regard to ALS assessment and Boston, many of their BLS

transports *do* get an ALS assessment, and then turned over to the

EMT-Basics for BLS treatment and transport. Not all calls get an ALS

response, but many do, even if they don't wind up being transported by

an ALS unit. Boston uses a customized dispatch protocol, similar to

MPDS, but probably altered enough that Clawson wouldn't indemnify their

trained seals in dispatch.

So let me ask you this: You've gone to great length to argue that anyone

less than a well-educated paramedic is unqualified to do a thorough

assessment, yet have stated frequently in this thread that ALS

interventions aren't needed nearly as often. What, then, would be your

issue with a system that sends BLS trucks to low-acuity calls (the

majority of runs in most systems), yet still sends ALS trucks to triage

the other, potentially higher acuity calls?

Sounds like a good way to get maximum resources, if you ask me.

>

>

> Rob

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

rob.davis@... wrote:

>

>

> On Monday, April 5, 2010 06:57, " Grayson " Grayson902@...

> > said:

>

> > Who said their intubation success rates had anything to do with their

> > cardiac arrest resuscitation numbers? I didn't make that assertion.

>

> You went to such lengths to highlight their intubation prowess, and

> the issue of skills degradation that I made the mistaken assumption

> that it was somehow relevant to the discussion. Obviously I was wrong.

> Sorry about that.

>

I merely reported their intubation success rates because that is one of

the most degradable skills, and one often viewed as a core measure of

quality of an ALS system. Didn't mean to give you the impression that

was the reason for the cardiac arrest resuscitation rates.

>

>

> > When it comes right down to that, with CPAP and the de-emphasis of

> > intubation in cardiac arrest, they're intubating fewer people than ever.

> > But they still manage to do a good job when it is necessary.

>

> Compared to what other systems? You can't really just say they're

> " good " without giving us a standard for measure.

>

Compared to *any* other systems. In this case, I was simply referring to

intubation success, which, as I recall, is over 95%. But I'll ask this,

what is *your* standard of measure for a *good* ALS system, and why?

That way, we're comparing apples to apples.

>

>

> > More and more, it seems that the research is showing that BLS

> > interventions make the biggest difference in outcomes, which, if

> > anything, shoots more holes in your " ALS for everyone " argument.

>

> Not at all. You're still arguing only skills. I am not. I taught my 10

> year old sister the core ALS medic skills in a weekend. Should we

> allow her to practise? Again, skills are not the measure of medical

> competency. There is a lot of headwork that goes along with it,

> without which, the skills are useless.

>

I grant you that. Assessment prowess is by far the more important part

of the two, and the harder one to measure. But in that vein, it's damned

hard to measure that it does any *good* either. You contend that ALS

assessment is essential for most patients. I see the merit of that

position, but I remain skeptical, because you're no more able to quote

hard numbers to support that contention than anyone else is able to

quote hard numbers that say it *doesn't* matter.

So basically here, we're arguing opinions.

But again in regard to ALS assessment and Boston, many of their BLS

transports *do* get an ALS assessment, and then turned over to the

EMT-Basics for BLS treatment and transport. Not all calls get an ALS

response, but many do, even if they don't wind up being transported by

an ALS unit. Boston uses a customized dispatch protocol, similar to

MPDS, but probably altered enough that Clawson wouldn't indemnify their

trained seals in dispatch.

So let me ask you this: You've gone to great length to argue that anyone

less than a well-educated paramedic is unqualified to do a thorough

assessment, yet have stated frequently in this thread that ALS

interventions aren't needed nearly as often. What, then, would be your

issue with a system that sends BLS trucks to low-acuity calls (the

majority of runs in most systems), yet still sends ALS trucks to triage

the other, potentially higher acuity calls?

Sounds like a good way to get maximum resources, if you ask me.

>

>

> Rob

>

>

--

Grayson

www.kellygrayson.com

[Guest guest]

Three weeks? My EMT took me three months. (Though I suppose there are

worse things - there's one paramedic program which is ten weeks.) And

please do not confuse me; I will agree with your main argument. I'm

just saying do not confuse going to the class with having the

knowledge. Anyone can attend a class. Not everyone can carry that

knowledge into their work, on any level.

Alyssa Woods, NREMT-B/FF

> On Saturday, April 3, 2010 15:50, " Alyssa Woods " amwoods8644@...

> > said:

>

> > Two years of school does not a competent medic make. I've met medics

> > that refused to do anything but BLS because every time they did,

> they

> > screwed up in an epic way. Their BLS p...

>

> Alyssa, the problem with this contention is the same as previous

> contentions. You are attempting to compare bad paramedics to good

> EMTs in order to skew the facts. You can't logically do that since,

> if your paramedics are that bad systemwide, then you can bet you

> also have a serious deficiency in your EMTs. You cannot separate the

> two.

>

> Again, we have all seen horrible providers at every level of medical

> practice, as well as exceptional ones. Cherry picking the examples

> of each that you want to highlight is not honest debate.

>

> But you are mistaken in your original assumption. Two years of

> school does indeed make a more competent medic than ten weeks does,

> or three weeks in the case of an EMT.

>

> Rob

>

>

[Guest guest]

Three weeks? My EMT took me three months. (Though I suppose there are

worse things - there's one paramedic program which is ten weeks.) And

please do not confuse me; I will agree with your main argument. I'm

just saying do not confuse going to the class with having the

knowledge. Anyone can attend a class. Not everyone can carry that

knowledge into their work, on any level.

Alyssa Woods, NREMT-B/FF

> On Saturday, April 3, 2010 15:50, " Alyssa Woods " amwoods8644@...

> > said:

>

> > Two years of school does not a competent medic make. I've met medics

> > that refused to do anything but BLS because every time they did,

> they

> > screwed up in an epic way. Their BLS p...

>

> Alyssa, the problem with this contention is the same as previous

> contentions. You are attempting to compare bad paramedics to good

> EMTs in order to skew the facts. You can't logically do that since,

> if your paramedics are that bad systemwide, then you can bet you

> also have a serious deficiency in your EMTs. You cannot separate the

> two.

>

> Again, we have all seen horrible providers at every level of medical

> practice, as well as exceptional ones. Cherry picking the examples

> of each that you want to highlight is not honest debate.

>

> But you are mistaken in your original assumption. Two years of

> school does indeed make a more competent medic than ten weeks does,

> or three weeks in the case of an EMT.

>

> Rob

>

>

[Guest guest]

Three weeks? My EMT took me three months. (Though I suppose there are

worse things - there's one paramedic program which is ten weeks.) And

please do not confuse me; I will agree with your main argument. I'm

just saying do not confuse going to the class with having the

knowledge. Anyone can attend a class. Not everyone can carry that

knowledge into their work, on any level.

Alyssa Woods, NREMT-B/FF

> On Saturday, April 3, 2010 15:50, " Alyssa Woods " amwoods8644@...

> > said:

>

> > Two years of school does not a competent medic make. I've met medics

> > that refused to do anything but BLS because every time they did,

> they

> > screwed up in an epic way. Their BLS p...

>

> Alyssa, the problem with this contention is the same as previous

> contentions. You are attempting to compare bad paramedics to good

> EMTs in order to skew the facts. You can't logically do that since,

> if your paramedics are that bad systemwide, then you can bet you

> also have a serious deficiency in your EMTs. You cannot separate the

> two.

>

> Again, we have all seen horrible providers at every level of medical

> practice, as well as exceptional ones. Cherry picking the examples

> of each that you want to highlight is not honest debate.

>

> But you are mistaken in your original assumption. Two years of

> school does indeed make a more competent medic than ten weeks does,

> or three weeks in the case of an EMT.

>

> Rob

>

>

[Guest guest]

the easiest way to keep many of your skills up in that situation is to

teach them to your partner...maybe the advanced invasive skills are off limits,

but certainly a P can teach advanced patient evaluation to a B partner...

and one of the tricks behind being a good clinician is to understand the

'range of normal,' so even a 'basic trip,' if handled properly, is a learning

experience.

Just because you're only " officially " on a basic truck, is there any reason

you can't use your Littmann Cardio Pro stethescope to listen for heart

murmurs and adventious lung sounds before the road noise starts? And then ask

the patient if your partner can listen to those sounds as well?

Even if you are 'stuck' doing NH to Dialysis transfers...that gives you a

set of serial exams of the same patients...which actually builds your

appreciation of range of normal even faster.

A lot of folks forget that the root word for 'Doctor' in Greek is also the

root for 'Teacher.' this ideal needs to be carried down into the mud and

the blood, and good medics should seek to teach their skills to the folks

coming up behind them. It's surprising how much you have to educate yourself

when your students are actually interested enough to ask questions.

ck

In a message dated 4/5/2010 03:43:12 Central Daylight Time,

rob.davis@... writes:

You want to talk skills degradation? How about all those certified

paramedics who spend five years as an " EMT " , working alongside another EMT,

seeing

very few ALS patients, and never performing an intubation, while they wait

for the Boston political machine to finally -- if ever -- officially

anoint them as a paramedic? Why don't we count them in the skills degradation

equation? How does that affect your numbers now?

[Guest guest]

the easiest way to keep many of your skills up in that situation is to

teach them to your partner...maybe the advanced invasive skills are off limits,

but certainly a P can teach advanced patient evaluation to a B partner...

and one of the tricks behind being a good clinician is to understand the

'range of normal,' so even a 'basic trip,' if handled properly, is a learning

experience.

Just because you're only " officially " on a basic truck, is there any reason

you can't use your Littmann Cardio Pro stethescope to listen for heart

murmurs and adventious lung sounds before the road noise starts? And then ask

the patient if your partner can listen to those sounds as well?

Even if you are 'stuck' doing NH to Dialysis transfers...that gives you a

set of serial exams of the same patients...which actually builds your

appreciation of range of normal even faster.

A lot of folks forget that the root word for 'Doctor' in Greek is also the

root for 'Teacher.' this ideal needs to be carried down into the mud and

the blood, and good medics should seek to teach their skills to the folks

coming up behind them. It's surprising how much you have to educate yourself

when your students are actually interested enough to ask questions.

ck

In a message dated 4/5/2010 03:43:12 Central Daylight Time,

rob.davis@... writes:

You want to talk skills degradation? How about all those certified

paramedics who spend five years as an " EMT " , working alongside another EMT,

seeing

very few ALS patients, and never performing an intubation, while they wait

for the Boston political machine to finally -- if ever -- officially

anoint them as a paramedic? Why don't we count them in the skills degradation

equation? How does that affect your numbers now?