| Brian D. Katcher 2005-01-19, 11:09 am |
| See Further Down.......
"Dave S" <DoggtyredRN@earthlink.net> wrote in message
news:uF_Gd.776$Ju1.136@newsread3.news.pas.earthlink.net...
>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...)
NYC DOES currently use a tiered system. There are dual medic busses and
duel EMT busses. They have changed response scenarios over the years but it
is still basically run in such a way that ALS goes to ALS jobs and BLS does
the rest. OBVIOUSLY that is not a foolproof system. Unfortunately the
CRO's (call receiving operators) are not permitted to use their God given
brains (thanks to the upper brass). As soon as a caller mentions that a
patient had a heart attack (27 years prior), Medics get sent for the bloody
nose job. Medics also get sent to every unconscious call without BLS
backup. This ensures that if the call is an arrest or pending train wreck
of another kind, the wait for backup is longer, AND that if it;s a drunk on
the side of the street, it can no longer be handed off to BLS so the medics
can go back in service and be available for the arrest coming in 2 blocks
away. Until a few years ago, all unconscious calls were a dual response and
many times BLS would cancel ALS because the call didn't require ALS
interventions. This is no longer an option.
>
> 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:
>
>
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