Re: Progressive services?

[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]

I used to have a future in EMS, and then I went back to school for some

real 'larnin''...

ck

In a message dated 4/6/2010 05:04:17 Central Daylight Time,

wegandy1938@... writes:

You sound like some kind of a doctor or somethin. Ain't no future for you

in EMS, boy.

[Guest guest]

I used to have a future in EMS, and then I went back to school for some

real 'larnin''...

ck

In a message dated 4/6/2010 05:04:17 Central Daylight Time,

wegandy1938@... writes:

You sound like some kind of a doctor or somethin. Ain't no future for you

in EMS, boy.

[Guest guest]

I used to have a future in EMS, and then I went back to school for some

real 'larnin''...

ck

In a message dated 4/6/2010 05:04:17 Central Daylight Time,

wegandy1938@... writes:

You sound like some kind of a doctor or somethin. Ain't no future for you

in EMS, boy.

[Guest guest]

and helos for 3 am headaches...

ck

In a message dated 4/6/2010 05:26:20 Central Daylight Time,

wegandy1938@... writes:

Dang! You gave up sirens fer CTs?

G

From: krin135@...

Subject: Re: Progressive services?

Date: April 6, 2010 3:17:45 AM MST

To: texasems-l

I used to have a future in EMS, and then I went back to school for some

real 'larnin''...

ck

In a message dated 4/6/2010 05:04:17 Central Daylight Time,

wegandy1938@... writes:

You sound like some kind of a doctor or somethin. Ain't no future for you

in EMS, boy.

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

------------------------------------

Yahoo! Groups Links

[Guest guest]

and helos for 3 am headaches...

ck

In a message dated 4/6/2010 05:26:20 Central Daylight Time,

wegandy1938@... writes:

Dang! You gave up sirens fer CTs?

G

From: krin135@...

Subject: Re: Progressive services?

Date: April 6, 2010 3:17:45 AM MST

To: texasems-l

I used to have a future in EMS, and then I went back to school for some

real 'larnin''...

ck

In a message dated 4/6/2010 05:04:17 Central Daylight Time,

wegandy1938@... writes:

You sound like some kind of a doctor or somethin. Ain't no future for you

in EMS, boy.

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

------------------------------------

Yahoo! Groups Links

[Guest guest]

and helos for 3 am headaches...

ck

In a message dated 4/6/2010 05:26:20 Central Daylight Time,

wegandy1938@... writes:

Dang! You gave up sirens fer CTs?

G

From: krin135@...

Subject: Re: Progressive services?

Date: April 6, 2010 3:17:45 AM MST

To: texasems-l

I used to have a future in EMS, and then I went back to school for some

real 'larnin''...

ck

In a message dated 4/6/2010 05:04:17 Central Daylight Time,

wegandy1938@... writes:

You sound like some kind of a doctor or somethin. Ain't no future for you

in EMS, boy.

[Non-text portions of this message have been removed]

[Non-text portions of this message have been removed]

------------------------------------

Yahoo! Groups Links

[Guest guest]

Adventitious lung sounds?  Lordy mercy.  Where'd you come up with them big

words?  Next you'll be talkin about vesicular sounds, tracheal sounds,

bronchotracheal sounds, bronchovesicular sounds,  consolidation, tactile and

vocal fremitus, egophony, whispered pectoriloquy, and bruits.  

Us paramedics don't know nuthin 'bout them thangs.  Don't need it.  Won't never

use it.  Ain't taught.  Ain't on the NREMT-P exam, and iffin it ain't on there,

we don't need to know it.

You sound like some kind of a doctor or somethin.  Ain't no future for you in

EMS, boy.

G

From: krin135@...

Subject: Re: Progressive services?

Date: April 6, 2010 2:46:55 AM MST

To: texasems-l

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]

Adventitious lung sounds?  Lordy mercy.  Where'd you come up with them big

words?  Next you'll be talkin about vesicular sounds, tracheal sounds,

bronchotracheal sounds, bronchovesicular sounds,  consolidation, tactile and

vocal fremitus, egophony, whispered pectoriloquy, and bruits.  

Us paramedics don't know nuthin 'bout them thangs.  Don't need it.  Won't never

use it.  Ain't taught.  Ain't on the NREMT-P exam, and iffin it ain't on there,

we don't need to know it.

You sound like some kind of a doctor or somethin.  Ain't no future for you in

EMS, boy.

G

From: krin135@...

Subject: Re: Progressive services?

Date: April 6, 2010 2:46:55 AM MST

To: texasems-l

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]

Adventitious lung sounds?  Lordy mercy.  Where'd you come up with them big

words?  Next you'll be talkin about vesicular sounds, tracheal sounds,

bronchotracheal sounds, bronchovesicular sounds,  consolidation, tactile and

vocal fremitus, egophony, whispered pectoriloquy, and bruits.  

Us paramedics don't know nuthin 'bout them thangs.  Don't need it.  Won't never

use it.  Ain't taught.  Ain't on the NREMT-P exam, and iffin it ain't on there,

we don't need to know it.

You sound like some kind of a doctor or somethin.  Ain't no future for you in

EMS, boy.

G

From: krin135@...

Subject: Re: Progressive services?

Date: April 6, 2010 2:46:55 AM MST

To: texasems-l

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]

Dang!  You gave up sirens fer CTs?

G

From: krin135@...

Subject: Re: Progressive services?

Date: April 6, 2010 3:17:45 AM MST

To: texasems-l

I used to have a future in EMS, and then I went back to school for some 

real 'larnin''...

ck

In a message dated 4/6/2010 05:04:17 Central Daylight Time, 

wegandy1938@... writes:

You sound like some kind of a doctor or somethin. Ain't no future for you 

in EMS, boy.

[Guest guest]

Dang!  You gave up sirens fer CTs?

G

From: krin135@...

Subject: Re: Progressive services?

Date: April 6, 2010 3:17:45 AM MST

To: texasems-l

I used to have a future in EMS, and then I went back to school for some 

real 'larnin''...

ck

In a message dated 4/6/2010 05:04:17 Central Daylight Time, 

wegandy1938@... writes:

You sound like some kind of a doctor or somethin. Ain't no future for you 

in EMS, boy.

[Guest guest]

Dang!  You gave up sirens fer CTs?

G

From: krin135@...

Subject: Re: Progressive services?

Date: April 6, 2010 3:17:45 AM MST

To: texasems-l

I used to have a future in EMS, and then I went back to school for some 

real 'larnin''...

ck

In a message dated 4/6/2010 05:04:17 Central Daylight Time, 

wegandy1938@... writes:

You sound like some kind of a doctor or somethin. Ain't no future for you 

in EMS, boy.

[Guest guest]

On Monday, April 5, 2010 08:34, " Grayson " Grayson902@...> said:

> 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.

A " good " ALS system is like pornography; I know it when I see it. As you note,

all of the standards that we have traditionally held up as measures of quality

are rapidly falling into Dr. Bledsoe's myth bin. We now know that cardiac

arrest saves is a bogus standard. Less and less of the care we provide is

showing to make any difference in survival numbers. And now it is starting to

appear that even response times are a dubious measure.

> So basically here, we're arguing opinions.

Exactly, which is why I clearly admitted that at the beginning of this

discussion. When it comes right down to it, it is the only honest position to

take. But that does not have to mean that it's mental masturbation to consider

quality anymore. We simply have to take measure of other factors. Mortality is

not the only measure of patient care. What about morbidity and palliative care?

It's worn out Business 101, but any organisation is only as good as it's people.

And it's people can only perform to the competency level of it's management.

Whenever I view the quality of a service, I focus on the people. The forest

isn't providing us with any tangible answers, so it's time to look at the trees.

A system that is " good " by my personal definition may not post any better

statistics than any other system, but if you are an employee or patient of that

organisation, you will definitely feel the difference. And after all, EMS is

about people, not numbers.

> 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?

The first part of that paragraph answered the question posed in the second half.

Until that well-educated paramedic does the assessment, we do not know that the

patient is low-acuity (assuming you're not doing IFTs, which would not be EMS).

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

I'm not sure exactly what you mean by this. But it just seems to me that, if

you have enough paramedics to staff all of your units with them, that would be

maximising your resources, and not compromising the care level of any of your

patients.

Rob

[Guest guest]

On Monday, April 5, 2010 08:34, " Grayson " Grayson902@...> said:

> 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.

A " good " ALS system is like pornography; I know it when I see it. As you note,

all of the standards that we have traditionally held up as measures of quality

are rapidly falling into Dr. Bledsoe's myth bin. We now know that cardiac

arrest saves is a bogus standard. Less and less of the care we provide is

showing to make any difference in survival numbers. And now it is starting to

appear that even response times are a dubious measure.

> So basically here, we're arguing opinions.

Exactly, which is why I clearly admitted that at the beginning of this

discussion. When it comes right down to it, it is the only honest position to

take. But that does not have to mean that it's mental masturbation to consider

quality anymore. We simply have to take measure of other factors. Mortality is

not the only measure of patient care. What about morbidity and palliative care?

It's worn out Business 101, but any organisation is only as good as it's people.

And it's people can only perform to the competency level of it's management.

Whenever I view the quality of a service, I focus on the people. The forest

isn't providing us with any tangible answers, so it's time to look at the trees.

A system that is " good " by my personal definition may not post any better

statistics than any other system, but if you are an employee or patient of that

organisation, you will definitely feel the difference. And after all, EMS is

about people, not numbers.

> 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?

The first part of that paragraph answered the question posed in the second half.

Until that well-educated paramedic does the assessment, we do not know that the

patient is low-acuity (assuming you're not doing IFTs, which would not be EMS).

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

I'm not sure exactly what you mean by this. But it just seems to me that, if

you have enough paramedics to staff all of your units with them, that would be

maximising your resources, and not compromising the care level of any of your

patients.

Rob

[Guest guest]

On Monday, April 5, 2010 08:34, " Grayson " Grayson902@...> said:

> 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.

A " good " ALS system is like pornography; I know it when I see it. As you note,

all of the standards that we have traditionally held up as measures of quality

are rapidly falling into Dr. Bledsoe's myth bin. We now know that cardiac

arrest saves is a bogus standard. Less and less of the care we provide is

showing to make any difference in survival numbers. And now it is starting to

appear that even response times are a dubious measure.

> So basically here, we're arguing opinions.

Exactly, which is why I clearly admitted that at the beginning of this

discussion. When it comes right down to it, it is the only honest position to

take. But that does not have to mean that it's mental masturbation to consider

quality anymore. We simply have to take measure of other factors. Mortality is

not the only measure of patient care. What about morbidity and palliative care?

It's worn out Business 101, but any organisation is only as good as it's people.

And it's people can only perform to the competency level of it's management.

Whenever I view the quality of a service, I focus on the people. The forest

isn't providing us with any tangible answers, so it's time to look at the trees.

A system that is " good " by my personal definition may not post any better

statistics than any other system, but if you are an employee or patient of that

organisation, you will definitely feel the difference. And after all, EMS is

about people, not numbers.

> 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?

The first part of that paragraph answered the question posed in the second half.

Until that well-educated paramedic does the assessment, we do not know that the

patient is low-acuity (assuming you're not doing IFTs, which would not be EMS).

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

I'm not sure exactly what you mean by this. But it just seems to me that, if

you have enough paramedics to staff all of your units with them, that would be

maximising your resources, and not compromising the care level of any of your

patients.

Rob

[Guest guest]

On Monday, April 5, 2010 13:47, " Alyssa Woods " amwoods8644@...> said:

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

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

When I say three weeks, I am referring to the minimum hour requirement (120

hours) broken down to a 40 hour week. Whether a school does it in three weeks,

or drags it out for six months, it's still just 120 hours. Admirably, there are

plenty of community college programmes that more than double those hours in

their programme, and kudos to them. But unfortunately, most cater to the lowest

common denominator.

> 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.

Oh, how right you are! I wish you were a manager! Because most of them seem to

think a patch is a patch is a patch. The fact that you recognise the fallacy of

that assumption speaks very well of you.

Rob

[Guest guest]

On Monday, April 5, 2010 13:47, " Alyssa Woods " amwoods8644@...> said:

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

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

When I say three weeks, I am referring to the minimum hour requirement (120

hours) broken down to a 40 hour week. Whether a school does it in three weeks,

or drags it out for six months, it's still just 120 hours. Admirably, there are

plenty of community college programmes that more than double those hours in

their programme, and kudos to them. But unfortunately, most cater to the lowest

common denominator.

> 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.

Oh, how right you are! I wish you were a manager! Because most of them seem to

think a patch is a patch is a patch. The fact that you recognise the fallacy of

that assumption speaks very well of you.

Rob

[Guest guest]

On Monday, April 5, 2010 13:47, " Alyssa Woods " amwoods8644@...> said:

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

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

When I say three weeks, I am referring to the minimum hour requirement (120

hours) broken down to a 40 hour week. Whether a school does it in three weeks,

or drags it out for six months, it's still just 120 hours. Admirably, there are

plenty of community college programmes that more than double those hours in

their programme, and kudos to them. But unfortunately, most cater to the lowest

common denominator.

> 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.

Oh, how right you are! I wish you were a manager! Because most of them seem to

think a patch is a patch is a patch. The fact that you recognise the fallacy of

that assumption speaks very well of you.

Rob

[Guest guest]

Beautiful, Doc! This is what I always say! It's another reason that every

patient deserves a thorough assessment. But what happens in tiered systems, as

well as systems with mixed medic/basic crews, is that those dialysis transfers

and other non-emergent patients are simply dumped on the basic, and the medic

doesn't participate at all. There is no advanced assessment. There is no

teaching. Because the so-called " paragods " start to believe that they are only

there to whip out their awesome skillz on emergent ALS patients, and that their

EMT is there to " pay his dues " .

On Tuesday, April 6, 2010 04:46, krin135@... said:

> 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.

[Guest guest]

Beautiful, Doc! This is what I always say! It's another reason that every

patient deserves a thorough assessment. But what happens in tiered systems, as

well as systems with mixed medic/basic crews, is that those dialysis transfers

and other non-emergent patients are simply dumped on the basic, and the medic

doesn't participate at all. There is no advanced assessment. There is no

teaching. Because the so-called " paragods " start to believe that they are only

there to whip out their awesome skillz on emergent ALS patients, and that their

EMT is there to " pay his dues " .

On Tuesday, April 6, 2010 04:46, krin135@... said:

> 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.

[Guest guest]

Beautiful, Doc! This is what I always say! It's another reason that every

patient deserves a thorough assessment. But what happens in tiered systems, as

well as systems with mixed medic/basic crews, is that those dialysis transfers

and other non-emergent patients are simply dumped on the basic, and the medic

doesn't participate at all. There is no advanced assessment. There is no

teaching. Because the so-called " paragods " start to believe that they are only

there to whip out their awesome skillz on emergent ALS patients, and that their

EMT is there to " pay his dues " .

On Tuesday, April 6, 2010 04:46, krin135@... said:

> 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.

[Guest guest]

" A " good " ALS system is like pornography; I know it when I see it "

LMAO. Love the comparison Rob!!!! LOL

-Chris

Sorry for the spelling and punctuation this was typed on tge tiny

keyboard on my iPhone

On Apr 7, 2010, at 9:03, " rob.davis@... "

rob.davis@...

> wrote:

> On Monday, April 5, 2010 08:34, " Grayson " Grayson902@...>

> said:

>

>> 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.

>

> A " good " ALS system is like pornography; I know it when I see it.

> As you note, all of the standards that we have traditionally held up

> as measures of quality are rapidly falling into Dr. Bledsoe's myth

> bin. We now know that cardiac arrest saves is a bogus standard.

> Less and less of the care we provide is showing to make any

> difference in survival numbers. And now it is starting to appear

> that even response times are a dubious measure.

>

>> So basically here, we're arguing opinions.

>

> Exactly, which is why I clearly admitted that at the beginning of

> this discussion. When it comes right down to it, it is the only

> honest position to take. But that does not have to mean that it's

> mental masturbation to consider quality anymore. We simply have to

> take measure of other factors. Mortality is not the only measure of

> patient care. What about morbidity and palliative care? It's worn

> out Business 101, but any organisation is only as good as it's

> people. And it's people can only perform to the competency level of

> it's management. Whenever I view the quality of a service, I focus

> on the people. The forest isn't providing us with any tangible

> answers, so it's time to look at the trees. A system that is " good "

> by my personal definition may not post any better statistics than

> any other system, but if you are an employee or patient of that

> organisation, you will definitely feel the difference. And after

> all, EMS is about people, not numbers.

>

>> 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?

>

> The first part of that paragraph answered the question posed in the

> second half. Until that well-educated paramedic does the

> assessment, we do not know that the patient is low-acuity (assuming

> you're not doing IFTs, which would not be EMS).

>

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

>

> I'm not sure exactly what you mean by this. But it just seems to me

> that, if you have enough paramedics to staff all of your units with

> them, that would be maximising your resources, and not compromising

> the care level of any of your patients.

>

> Rob

>

>

>

> ------------------------------------

>

>

[Guest guest]

" A " good " ALS system is like pornography; I know it when I see it "

LMAO. Love the comparison Rob!!!! LOL

-Chris

Sorry for the spelling and punctuation this was typed on tge tiny

keyboard on my iPhone

On Apr 7, 2010, at 9:03, " rob.davis@... "

rob.davis@...

> wrote:

> On Monday, April 5, 2010 08:34, " Grayson " Grayson902@...>

> said:

>

>> 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.

>

> A " good " ALS system is like pornography; I know it when I see it.

> As you note, all of the standards that we have traditionally held up

> as measures of quality are rapidly falling into Dr. Bledsoe's myth

> bin. We now know that cardiac arrest saves is a bogus standard.

> Less and less of the care we provide is showing to make any

> difference in survival numbers. And now it is starting to appear

> that even response times are a dubious measure.

>

>> So basically here, we're arguing opinions.

>

> Exactly, which is why I clearly admitted that at the beginning of

> this discussion. When it comes right down to it, it is the only

> honest position to take. But that does not have to mean that it's

> mental masturbation to consider quality anymore. We simply have to

> take measure of other factors. Mortality is not the only measure of

> patient care. What about morbidity and palliative care? It's worn

> out Business 101, but any organisation is only as good as it's

> people. And it's people can only perform to the competency level of

> it's management. Whenever I view the quality of a service, I focus

> on the people. The forest isn't providing us with any tangible

> answers, so it's time to look at the trees. A system that is " good "

> by my personal definition may not post any better statistics than

> any other system, but if you are an employee or patient of that

> organisation, you will definitely feel the difference. And after

> all, EMS is about people, not numbers.

>

>> 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?

>

> The first part of that paragraph answered the question posed in the

> second half. Until that well-educated paramedic does the

> assessment, we do not know that the patient is low-acuity (assuming

> you're not doing IFTs, which would not be EMS).

>

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

>

> I'm not sure exactly what you mean by this. But it just seems to me

> that, if you have enough paramedics to staff all of your units with

> them, that would be maximising your resources, and not compromising

> the care level of any of your patients.

>

> Rob

>

>

>

> ------------------------------------

>

>

[Guest guest]

" A " good " ALS system is like pornography; I know it when I see it "

LMAO. Love the comparison Rob!!!! LOL

-Chris

Sorry for the spelling and punctuation this was typed on tge tiny

keyboard on my iPhone

On Apr 7, 2010, at 9:03, " rob.davis@... "

rob.davis@...

> wrote:

> On Monday, April 5, 2010 08:34, " Grayson " Grayson902@...>

> said:

>

>> 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.

>

> A " good " ALS system is like pornography; I know it when I see it.

> As you note, all of the standards that we have traditionally held up

> as measures of quality are rapidly falling into Dr. Bledsoe's myth

> bin. We now know that cardiac arrest saves is a bogus standard.

> Less and less of the care we provide is showing to make any

> difference in survival numbers. And now it is starting to appear

> that even response times are a dubious measure.

>

>> So basically here, we're arguing opinions.

>

> Exactly, which is why I clearly admitted that at the beginning of

> this discussion. When it comes right down to it, it is the only

> honest position to take. But that does not have to mean that it's

> mental masturbation to consider quality anymore. We simply have to

> take measure of other factors. Mortality is not the only measure of

> patient care. What about morbidity and palliative care? It's worn

> out Business 101, but any organisation is only as good as it's

> people. And it's people can only perform to the competency level of

> it's management. Whenever I view the quality of a service, I focus

> on the people. The forest isn't providing us with any tangible

> answers, so it's time to look at the trees. A system that is " good "

> by my personal definition may not post any better statistics than

> any other system, but if you are an employee or patient of that

> organisation, you will definitely feel the difference. And after

> all, EMS is about people, not numbers.

>

>> 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?

>

> The first part of that paragraph answered the question posed in the

> second half. Until that well-educated paramedic does the

> assessment, we do not know that the patient is low-acuity (assuming

> you're not doing IFTs, which would not be EMS).

>

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

>

> I'm not sure exactly what you mean by this. But it just seems to me

> that, if you have enough paramedics to staff all of your units with

> them, that would be maximising your resources, and not compromising

> the care level of any of your patients.

>

> Rob

>

>

>

> ------------------------------------

>

>