| Dave S 2005-01-17, 10:08 pm |
| I will tell you I've never worked in NYC as a paramedic. That in and of
itself should have no bearing on how valid or invalid my comments are...
unless of course you think theres a right way, a wrong way and a NY way
of doing things..
I have worked vollie and paid... dual medic and single.. solo first
responder and on an engine company.
Two paramedics are a luxury. If you have them.. great. Its always nice
to have a second medic to run things by. Its also nice to have an online
medical control with either veteran medics working from expanded
protocols or emergency medicine physicians who have a clue. But if I had
to choose between a system that went to status ZERO frequently on a
regional basis (no units available) because there aren't enough
paramedics to staff enough dual-medic units, then its time to either
hire and train more staff... or redeploy your forces to provide better
service.
Truth is... most of what you run lights and sirens to is NOT a life
threatening emergency. Sick.. yes.. hurt.. yes.. needs medical
attention... yes.. but "Going to die if you dont 'do something' in 2
minutes or less" is the exception rather than the norm. Starting an IV
on the premise "that it might be needed" hardly qualifies as a true ALS
run. Yea you can bill ALS, and you provided an ALS skill, but unless you
are giving meds or a fluid bolus the IV is not really that therapeutic
now is it (in saying this, I also acknowledge that when you have someone
crump on you, its nice to already have the IV.. rather than have to
start one on a now-shocky patient).
So.. that being said.. putting a basic or intermediate EMT on the bus
gives you a second set of hands... and if you have someone who is a team
player, they can be worth their weight in gold, even if they cant push
the drug themselves. THey can spike bags, ambu-bag the pt while you
prepare to intubate, grab meds for you (once you are comfortable with
their abilities... you still do the med calcs and push em), get medical
control online while you are assessing, hook up the monitor and run a
strip for you (dont have to know how to interpret to connect a
monitor..) get your vital signs.. Being a paramedic does not give you a
monopoly on quality patient care. THere are MANY places that would
consider themselves fortunate just to have two basics to put on a bus to
make a run. If you have a well designed system with active field
supervisors, a call that truly requires a second medic would have the
paramedic supervisor dispatched on the initial tone or enroute soon
after. You also need a good mentoring system in place so that when the
medics are out there "alone" they have been well prepared to operate as
a full time team leader. With the right employees, proper training and
support, even the vaunted NYC could safely respond with a single
paramedic on the bus.
Other options include keeping dual medic busses, but augment them with
dual basic busses.. and running a tiered system (I would predict much
wailing and gnashing of teeth in NY over that one...)
Another one would be to take the medics off altogether and run them
"squad style" in responder vehicles, and have ALL the ambulances staffed
with basics.. the medic intercepts/meets on scene.
Dual medic units used in a tiered system, in which the medics are
reserved for presumed ALS calls, were shown to have better skill
maintenance (in the form of successful IV's, successful intubations,
etc) than in a single medic system in which all trucks were paramedic
and EMT. The basic-only busses were used for the simple stuff, who didnt
NEED ALS..
Anyways.. my 2cents.
Dave EMT-P, RN
Brian D. Katcher wrote:
> Harry,
> Do you currently work in NYC as a Paramedic or have you ever? Have you ever
> been in a situation when another set of trained hands (ALS) would come in
> handy? Or maybe another Paramedic's thoughts/ideas/input? If you haven't,
> then you must be the best damn paramedic in the world.
> So, what happens when you need that other medic? Call for backup? WAIT for
> him/her to arrive? Hey, I think we're increasing time to patient care here,
> aren't we?
> Think about it.
>
> In the mean time, everyone be safe out there.
>
> "Harry Bosch" <emmett@sti.net> wrote in message
> news:LImdnVp00YcJoH7cRVn-1Q@sti.net...
>
>
>
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