Friday, January 25, 2013

Sometimes the Nurses were right.

When I started in EMS I was informed by my instructor that my biggest enemy in patient care was going to be nurses. Nurses didn't like EMS because they hated the lights and sirens. They hated that the paramedics could intubate and run off of standard orders. They hated us because of many reasons. All of which were related to jealousy. By the way my EMT had been married to a nurse that he called Cruella DeVille.

I found that most nurses that I encountered were supportive. Their biggest complaints were often involving no IV's on patients or call ins they felt were inadequate. They were my skill instructors in Intermediate and Paramedic class. They helped us constantly and we helped them. I found there was a rivalry, but it was more akin to that of the Army and Marines, friendly and for the most part productive.

In our looking forward to EMS 2.0 and the community paramedic concept, we need to learn from the nurses we know. Mainly long term impact on the patient of our treatment. Oxygen is the most abused drug on the ambulance. We consider it safe and it makes the patient think we are doing something. However Oxygen Toxicity is becoming recognized as more prevalent than previously thought.

Thinking clinically will lead to better care all around. A major problem is coming from system protocols that are not updated often. You can still be in a position of doing something that will either harm your patient or possibly harm your ability to provide for your family. This is especially true in states like Illinois that still utilize a resource hospital instead of services hiring their own medical director.

Yes, these things we can learn from nurses. It turns out that when the nurse was mad at you for bringing in a patient on 15 lpm per nonrebreather he or she was right. You were possibly harming that patient. Welcome to EMS 2.0. We have to admit we were wrong sometimes.

Thoughtfully yours.

Saturday, January 19, 2013

EMS Evolution, can we learn from what is already happening.

If you ask any EMS provider you will find that 90% of your calls are non emergent. Many of the patients we see do not need transport, they need an evaluation. Unfortunately the Federal Government classifies EMS as transport not as a medical provider and this is a problem. Paramedics with proper education can work with doctors effectively to lower the costs of medical care while providing better care. This would be a great boon to the Medicare system as it would lower the costs associated with the ER visits.

So you ask me how I know this can work. I know that it can work because I have worked as a Remote Paramedic. In many places including the offshore oil industry there is a need for an advanced medical provider, but there are not enough doctors to go around. Enter the Remote Paramedic. What you do in this profession is be available for the people employed on the installation. You have communication with a medical doctor that gives you final orders for treatment of the patient. The Remote Paramedic treats everything from sinus infections to STEMI's. Oil Companies pay large amounts of money for these medics and it has proven to be highly effective. So why can't we bring this to the streets.

This concept isn't new, as I have read about the idea of Prehospital Physicians Assistants before. But what I am proposing is that we have a new certification for street paramedics similar to the CCEMT-P. It isn't quite as glorious as transporting patients with multiple drips going but I promise it would do help more people than anyone can realize. It would curb ER abuse as well as add a new revenue stream for some embattled ems providers. It would also start moving paramedics to a place that is more respected and allow us to earn the respect we feel we deserve. I hope some of you agree with me.

Why join the conversation?

I am a paramedic who has decided to join the conversation on EMS 2.0. I have seen certain Large EMS agencies go into areas and out politic better services harming patients. I have seen people argue that they are right by justifying that it is the protocol when it is obviously is harming the patient. I know medics that absolutely refuse to perform 12 lead and 15 lead EKG's because it “takes too long”

I recently discovered and, and discovered that there is a major discussion n these and other things going on in the blogosphere. I decided that I wanted to join in. Maybe you will find my point of view fascinating. It might seem self indulgent. You might even consider it completely wrong.

But this is a valuable conversation that I see going on and I have decided to join it. Hopefully I can add to it. So here are my bonafides. I am a NREMT-P. I started in EMS in 1998 and became a Illinois Liscensed Paramedic in 2002. I added my NREMT-P in 2005. In 2007 I went to work for a company called Acadian Integrated Solutions for 4 years. When there was a lack of work I returned to working on the ambulance in Illinois, and found that I had rediscovered my love of EMS while wanting to build more. I am now a Supervisor and a proponent of improving EMS in many ways. I will start in my next post on this.

Thank you for your time.