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Thanks 231X. Those of you who know me know it was NEVER about recognition..it was ALWAYS about the patient. I'll let my actions speak for themselves. I am done justifying myself to others, at least until the next time :lol: .
I am glad to see that REMAC is becoming more proactive with skills, such as needle decomp, and Adult I/O.
The thing I have been hearing more about lately is the Quick Clot. I understand thet state is in the process of adding this to the BLS Trauma protocol. I am not 100% familiar with it, what I do know it has come along way from when it was first introduced - a powdery type substance to a sack filled with the clotting agent they is less messy.
Other than that, i agree, what else can we do? Get our patient to an ER rapidly & safely.
I've been sitting on the sidelines on this one watching for awhile, but I want to add my opinion here:
I feel it all depends on the tech in charge. The experience level, the confidence level, etc.
I waited 13 years before going from BLS provider to ALS provider. I can honestly say this gave me the confidence to recognize when I should "scoop and run" and when I can stay and perform ALS interventions. Also being an instructor has an effect on my confidence level. I have the ability to practice my skills and am constantly challenging myself to improve. I'm also surrounded by some of the best EMS practitioners in the area and learn from them all the time.
If I were to find any kind of a "knock" on today's newer ALS providers, it is simply lack of experience. I truly believe you should have to have at least 3 years as an EMT-B under your belt as a pre-requisite for taking an ALS level course. You NEED to have patient contacts to develop your BLS skills before you can even think ALS.
I will tell you I am an anomaly in my current FD. Almost anyone that rides with me will tell you I am one of the "fastest" techs to work any call with because of the way I organize myself. And quite often the "routine ALS" 9 times out of 10, is done while en route. I do my sticks while moving, etc. I can also say that when I feel I can best serve the patient by staying I do...I'd much rather work an arrest in the house, etc. then in a moving bus. That's because I am confident in my skills and I really truly believe that the INTERVENTIONS will benefit my PATIENT.
None of it is about me. It is about what is best for my patient.
Yeah I gotta agree with you there, the nightmare AMT's that I see are the Johnny Come Lately six week EMT's who've never been on a multi-trauma or worked a code. Well said.
And I have worked with medics who could tube someone blind folded and start a line from across the room like they were throwing darts on a Thrusday night in Rockaway, but I just don't see this talent as much as I'd like anymore.
Sorry Have to chime in hear been following this for a bit ...... I am an NYC Paramedic and practice ALS in Nassau as well. Im fortunate enough to have tought both on the EMT and Paramedic level. The lack luster AEMT's that are being referred to can be taught and should be. A good a education although not as good as experience can help!
The prominent problem to be found in volunteer AMT's in the county is where there isnt a high influx of ALS worthy calls. Now, when I say ALS worthy, I'm not looking to dip into the arguement of, any ALS call can be run BLS (and vice versa) because technically, that IS correct. Look at NYC for example, last year, NYC EMS ran a total of 1.2 million calls a year. Now, for those non math proficient, look at your call volume your EMS providers respond to. And then how many times is ALS needed, and when does ALS respond? Now, I'm not saying only career medics are good and vollies are not, because i've seen many burnt out ALS providers from both sides. IT IS THE EXPERIENCE/TRAINING THAT MAKES THE EMT/AEMT.
Now, to no fault of some ALS providers, sometimes they lack the street time with ALS, and theres where the comments start to chime in.
Do you guy's pull this **** out of your archives? I see the same post from the same people all the time. Let me tell you where some of the problems in EMS/ALS come from. For all the "Glory Boy" EMT'S that always snicker at ALS intervention's instead of helping in the back of the bus on the ALS run are the first problem. All the EMT's that I have seen both Vollie/Paid seem to think that since it is a ALS run they dont have to do anything. It is always BLS before ALS, and as the ALS provider is in the back I should'nt have to tell you to address the LAC on the knee, or to get me a set of vitals, and put the pt. on O2 etc. When the ALS provider in the back is doing it all (airway, vitals, line, monitor, hx, rx, tx, etc) it does waste alot of time. My opinion on that is this some ole timers who have been EMT'S for ten years, or have been in the Dept. for a lifetime cant stand to have to listen to a probie who is a medic or cc. And those people just cant stand not to be the one incharge, I seen many people both firemedic's and non-firemedic's tear into EMS/ALS but when you get them in the bar and get a few in them the truth comes out "I would take the class but I don't have the time" or "I was in a class but I had to drop out for work" and the next day it's the same ****. ALS is in the field comes down to simple mathmatics. If you have a unstable cardiac pt. who is crapping out the meds are priority, the hosp is going to give the pt. the same meds that you can give. Thus being said if you load and go, say 2-3min on scene loading, 4-5min transport, and lets be fair and say 6-7min in the ER before you give your report and the line gets started and meds administered. Thats approximately 12-15min. Now on the other hand you arrive at scene start your line and give your meds in lets say 4-5min you have just saved approx 10min in getting the pt. the first line meds which have either prevented the pt's condition from getting worse and or becomming Fatal. Simple math the quicker the pt. get the meds, the better the outcome. And last but not least I myself or people I have delt with have never stopped on a call and said oh boy this could be the big one Edith or have wanted a pt. to code so he/she could revive him/her and get a save. Nobody ever said you had to be a brain surgeon to be an ALS provider, so it is only a matter of following protocols and treating the pt. It is always the sour EMT'S who think the AEMT'S think they are above everyone. and trust me I got better things to think of then what he/she has or has'nt done
Do you guy's pull this **** out of your archives? I see the same post from the same people all the time. Let me tell you where some of the problems in EMS/ALS come from. For all the "Glory Boy" EMT'S that always snicker at ALS intervention's instead of helping in the back of the bus on the ALS run are the first problem. All the EMT's that I have seen both Vollie/Paid seem to think that since it is a ALS run they dont have to do anything. It is always BLS before ALS, and as the ALS provider is in the back I should'nt have to tell you to address the LAC on the knee, or to get me a set of vitals, and put the pt. on O2 etc. When the ALS provider in the back is doing it all (airway, vitals, line, monitor, hx, rx, tx, etc) it does waste alot of time. My opinion on that is this some ole timers who have been EMT'S for ten years, or have been in the Dept. for a lifetime cant stand to have to listen to a probie who is a medic or cc. And those people just cant stand not to be the one incharge, I seen many people both firemedic's and non-firemedic's tear into EMS/ALS but when you get them in the bar and get a few in them the truth comes out "I would take the class but I don't have the time" or "I was in a class but I had to drop out for work" and the next day it's the same ****. ALS is in the field comes down to simple mathmatics. If you have a unstable cardiac pt. who is crapping out the meds are priority, the hosp is going to give the pt. the same meds that you can give. Thus being said if you load and go, say 2-3min on scene loading, 4-5min transport, and lets be fair and say 6-7min in the ER before you give your report and the line gets started and meds administered. Thats approximately 12-15min. Now on the other hand you arrive at scene start your line and give your meds in lets say 4-5min you have just saved approx 10min in getting the pt. the first line meds which have either prevented the pt's condition from getting worse and or becomming Fatal. Simple math the quicker the pt. get the meds, the better the outcome. And last but not least I myself or people I have delt with have never stopped on a call and said oh boy this could be the big one Edith or have wanted a pt. to code so he/she could revive him/her and get a save. Nobody ever said you had to be a brain surgeon to be an ALS provider, so it is only a matter of following protocols and treating the pt. It is always the sour EMT'S who think the AEMT'S think they are above everyone. and trust me I got better things to think of then what he/she has or has'nt done
That was one of the most thoughtful, articulate, and well written posts that I have seen in a long long time. WELL SAID. I agree with everything that you said. (Are you sure you're a truckie???... You seem too well spoken, literate, articulate, smart, etc. LOL)
No seriously good job.
Ex-Capt. Rescue
EMT-CC EMT-P, CLI, Preceptor, etc.
Well I've been a tech for 18 year's the last three as an als provider and I can Say delaying patient transport for als is insane. Unless you have a prolonged extrication or it's a couple of minutes away. I always tell the emt's in my departent don't wait for als if your patient is fubar were less then ten minutes away from a hospital sorry to say it's SJE in the rock but I can't help that. Two things I can't understand delaying transport for als and for a medivac.
Never got that ... middle of the day, no anticipated delays on any major thoroughfare, call for a helicopter and then your waiting for the helicopter to land? Are you really helping the patient and is that time that you spent waiting for the helicopter to land, going to be made up once the helicopter is in the air?
There was an extrication several years ago that multiple agencies were involved in. An elderly member of a fire department crashed through a metal fence and then came to a stop in a shopping center parking lot. He wasn't really pinned, but due to the type of car (min-van with sliding passanger side door) and how he was positioned in it, it was just easier to immobolize him and remove the B-post, and then slide him onto a back board. He was concious, alert, talking, lucid, knew where he was, embarassed about having the accident and very cooperative. Both fire agencies worked amazingly well together and coordinated a very nice extrication that took less than 5 minutes.
Just before sliding the patient onto a long board, a member of EMS climbed into the car (barely fit after some deep breaths) and insisted on cutting through the patients jacket, shirt and long sleeved under shirt so that she could palp out a blood pressure ... that she was never able to get. As a matter of fact, she even delayed us from sliding the patient onto the long board and out of the car, just because she needed to attempt a B/P. All the while this 'lady' is telling us to "move, move, move ... get the patient out, work faster."
Low and behold we get the patient out and into the back of the bus and next thing we know, were under/overing the Hurst hoses, sweeping up glass and ready to leave and EMS IS STILL ON THE SCENE?!?!?!?!? We're going on 20 minutes now and one of the chief's asks a firefighter who's an EMT how the patient is? The answer he is given is that the patient appears stable, however if EMS was in such a rush to get the patient out of the car, why are they still dicking around the scene? Then a member of EMS who is also a firefighter tells the chief that "EMS has to do what EMS has to do." Made no sense. No one in my department could make any logic of it.
I don't know If your implying that It's me who doesn't do his job if this is the case I have to say thats farther from the truth I always do what's best for my patient and what wht protocol requires me to do aI just say that waiting for an als provider who isn't even in his car most of the time when the request goes out lets be honest have to stop a pee before we leave the house never know when and if you'll get a chance. I'm just saying that some BLS provider's wait to long and put their patients in harms way. thats all I'm saying.
I agree with that ... that too many BLS providers call for help and then wait it out. Make the call right off the bat if you must (it is rare that your going to need to), package and move. ALS providers telling the bus to hold up and wait, calling for ALS to the scene when your blocks from the hospital (it's been done, I've seen it done with an agency close by) delaying transport because the ALS is three minutes out - yet the hospital is one minute away. Even better is the ALS being performed in the back of the bus ... while in the hospital parking lot. To add a disclaimer to this, I know and have worked with plenty of exceptional ALS providers, these comments are not directed towards them in any way shape or form. It's the novice AMT who has his/her card and believes that they are end all be all - regardless of their level of experience. They're not helping the patient.
The ALS Debate
