BLS, ALS... Are we doing it right?

[actanonverba]

Does anybody think the EMT-Hierarchy is a bit.... ineffective?
I recognize the availability of the EMT-B training but also its many limitations. Further, there are many aspects that the EMT-B program neglects...pathophysiology, anatomy and physiology, and pharmocology... I would think these are NECESSARY for any compotent healthcare provider, especially in understanding WHY it is we do what we do... and how to create the best LONG TERM patient outcomes. It suprises me even more that the health care system's "first-line of defense" can only slap on an oxygen mask and put you on a stretcher. . Yes, ALS is not necessary on every call. But would training everybody to the EMT-P level be an effective solution to providing compotent and confident patient care?

[opsoverkill]

Welcome to the State of NJ. day late dollar short on everything.

[thelurker]

I feel that there is a definite need for the EMT-I level here in NJ.

[RngrVnc33]

actanonverba said:

Does anybody think the EMT-Hierarchy is a bit.... ineffective?
I recognize the availability of the EMT-B training but also its many limitations. Further, there are many aspects that the EMT-B program neglects...pathophysiology, anatomy and physiology, and pharmocology... I would think these are NECESSARY for any compotent healthcare provider, especially in understanding WHY it is we do what we do... and how to create the best LONG TERM patient outcomes. It suprises me even more that the health care system's "first-line of defense" can only slap on an oxygen mask and put you on a stretcher. . Yes, ALS is not necessary on every call. But would training everybody to the EMT-P level be an effective solution to providing compotent and confident patient care?

Actually the first line of defense can NOT put you on a stretcher(i.e First Responders) An ineffective system in theory, however for the most part patients do not require ALS in the field, rapid transport being the key. If anything in this flawed system needs to be fixed it would be the abuse of the 9-1-1 system. Giving EMT's the ability to deny transport via ambulance for those instances not requiring an emergent response and those patients using the ED as their primary care physician would greatly increase the level of care to those patients that need it! Many progressive departments to the south of us have similar policies in effect, thus increasing their patient care!

[hp4l]

As an EMT that rides the engine to EMS calls, there have been times where I felt that ALS could be recalled but I'm not the one going on the rig. I try to let the BLS make the decision unless it is extremely obvious. Unfortunatly, there are too many medic dependant EMTs. I wish we could change that.

[actanonverba]

Does NJ even recognize First Responders?

[opsoverkill]

No the State does not recognize any First responder programs

[tootall]

OK so lets face it there aren't good EMTs in the world....there aren't good Paramedics in the world and there are not good Doctors in this world.

Who creates EMTs that are Medic Dependant? In my opinion it is their agency that does. MOST BLS agencies are still in the stone age when it comes to how they either A) Train their people after they complete EMT-B school or B) they themselves think we should still provide Mayberry EMS Services.

Do some people forget what EMS stands for? EMERGENCY Medical Services....EMERGENCY meaning get to the pt figure out what is wrong with them and get to the hospital...I have seen to many times EMTs trying to play either Doctor, Nurse, or Preacher. Do YOUR job!!! Treat the pt with respect and get the to the hospital.

As for everyone being Paramedics...hell NO!! Been to a system that had 97% ALS and 3% BLS in the field. Why do I need a paramedic to take care of a splinter?

EMT-B training....just like FF1 teaches you the basics...on how not to kill somone...if they want to learn A and P or Patho take a class or two. Take classes because you want to not because you have to.

EMT-I - I was one....you do everything an EMT-P can do except the class does not teach you the pathophysiology of the disease. Most people think EMT-I means you start IVs and thats about it...NOPE...IVs, ET tubes, Drugs, surgical airways... you name it you can do it...just with some more guidance...less standing orders....well sort of like paramedics here in NJ!

[opsoverkill]

Right on the mark TO0TALL.

If you are a EMT and want to expand your knowledge one of the great classes I took was AMLS advanced medical life support. It really made you think about what the pt was presenting and the treatment that was correct for that pt. I do believe PHTLS is a prereq. for it which is another class that is worth taking AMLS is offered at Mount Laurel EMS check their website for more info @
www.mlems.org

[Click Click 27]

In Regards to the EMT-I program in the NJOEMS Study Recommendation # 49, according to the study, they believe that NJOEMS should not persue the EMT-I program pretty much because of the fact that it is too costly for departments to train emt's to that level and buy and maintain equippment,

it could overwhelm the training assets because it would be in high demand,

also would cause a rise in medical direction and liability insurance cost,

and they believe that the paramedic program that is already implemnted is providing excellent care, it' only problem is with the delivery system.

[hp4l]

I thought that NJ did have a First Responder program. I'm pretty sure we have a few in Cinn City.

[opsoverkill]

No Certified First Responders that are Certified By the State.

The state does not deny you the chance to take a first responder class such as the Red Cross program. But, they do not recognize it so the departments that have first responders are taking all the responsibility with regards to scope of practice and liability issues with a first responder program. And that also opens up alot of liability to the person that taught the program.

This was a consideration with Mount Laurel Fire but due to all the issues with liabilities and scope of prac etc. it was decided to stick with the EMT cert process

[marylandmissy]

I currently work in a system that a majority of our FF's are forced to become ALS providers. It's not the way to go. Yes there is a HIGH demand for ALS providers, but you can not force people to through the program. To be a medic you have to want to be a medic. Also, to provide quick ALS care to your citizens a great idea is to place ALS providers on the engines! An engine is usually the first to arrive on scene and most likely there for a while waiting for the medics (since they are always busy). While on scene those ALS providers can provide care and then either jump to the BLS unit and go...or if they need more assistance they can meet the medics en route. I have volunteered in a system that has paramedic engines along with paramedic transport units...and IT WORKS! You achieve the goal of providing rapid ALS intervention to your citizens. Also, allowing the medics on the engines decreases your burn-out rates...which where I work are very high. I understand I come from a completely different system. And still trying to understand the NJ way...and I just don't get it!

[actanonverba]

Thanks for your input everybody. I'm really only familiar with the New Jersey way, so hearing everybody's different perspectives is definitely eye-opening.
"Do some people forget what EMS stands for? EMERGENCY Medical Services....EMERGENCY meaning get to the pt figure out what is wrong with them and get to the hospital...I have seen to many times EMTs trying to play either Doctor, Nurse, or Preacher. Do YOUR job!!! Treat the pt with respect and get the to the hospital."
I think there's alot of validity to this statement. Especially when the role of the EMS provider seems to get blurred with a little psychology, a little nursing, a little medicine, and a lot of transport. I know I'm guilty of taking a little bit longer to gather a comprehensive hx or assessment, or doing an extra set of vitals, or maybe going to extremes to ensure pt. comfort, but hey, the number one role of the healthcare provider is being a patient advocate. and getting them the hospital.

I know you've been exposed to a variety of systems. What do you think is the "ideal"? Would you make any changes in the current training program? Would the EMS system be tiered? ALS on the engine/truck?

[thelurker]

actanonverba said:

I know you've been exposed to a variety of systems. What do you think is the "ideal"? Would you make any changes in the current training program? Would the EMS system be tiered? ALS on the engine/truck?

I like the programs that provide a Medic and EMT on the ambulance, but the chase vehicle program has worked for us so far, so I am not sure we should bother messing with that. As far as ALS engine/trucks concept, I am not sure that would go over well in too many communities. As it is, we catch a good bit of flack from both the residents and the cops for showing up with an Engine to EMS calls in our town. In addition to that, most of the EMS provided by the Engine crews is Vitals, O2, and wait. Every now and then, we do CPR or something, but usually it's just Vitals and O2. I am not sure the people in the County of Burlington really want their firemen sticking them with needles and such.

[hp4l]

I think the biggest problem with having ALS on the engines would be training. There are already EMT, FI/FO, and Instructor CEU's that we must maintain. And I'm sure there will be FF CEU's some day. If not, there is plenty of training that we must do on the department level and on the county/state level to keep our education to what it should be. I would personally prefer Medics in an ambulance before an engine. I think they need to focus on EMS primarily.

I also don't think that the BLS and ALS get enough credit in most areas of this county. Sure, there are some that may not deserve it, but listen to a scanner one day and listen to who is running their asses off in their local and the ones around them. As an EMT that rides the engine, thank you to those that come bail us out.

[Anger Management]

Does anybody remember what was the certification back in the early 90's was that New Jersey recognized? I think it was three letters. Not sure. I know you guys are all like what the hell is this guy talking about?!?!? A couple of guys had this certification and were able to treat pts. as per the Rescue Squads SOP. I know this is kinda off subject, but this made me think of it.

[gotothelight]

You know, I've been an EMT for 24 years and I often find that a competent EMT can out-treat an RN in an emergency situation. Those RN's NOT being E.R. nurses mind you. It's all in your experience and knowledge base. How many times have you rolled up on an accident scene to find a nurse or doctor there, doing absolutely nothing or running around hysterically, while we calmly handle the job? I think we should have our scope of care expanded to include the LMA's and we should be able to do a friggin' finger stick for blood sugar for God sake! As always, NJ takes baby steps!

[tootall]

hp4l said:

I think the biggest problem with having ALS on the engines would be training. There are already EMT, FI/FO, and Instructor CEU's that we must maintain. And I'm sure there will be FF CEU's some day. If not, there is plenty of training that we must do on the department level and on the county/state level to keep our education to what it should be. I would personally prefer Medics in an ambulance before an engine. I think they need to focus on EMS primarily.

I also don't think that the BLS and ALS get enough credit in most areas of this county. Sure, there are some that may not deserve it, but listen to a scanner one day and listen to who is running their asses off in their local and the ones around them. As an EMT that rides the engine, thank you to those that come bail us out.

I don't see training being an issue. Its like anything else if you plan properly there is no issue...only when we wait til the last month of our cert to take care of all the CEUs.

Your statement about Medics should be on Ambulances because they need to focus on EMS is a common one in this area because the state has made ALS so tabu. Why can't a quality ALS provider ride an engine? Are their skills going to lack because they am on a suppression pierce? Or can we increase more appropriate Pt care in the long run. How many times do you sit on scene waiting for ALS or BLS to show up? Imagine if you had a medic on your engine to start doing what needed to be done.

We all know that the fire service is 75% EMS today. Why do we fight being better at our jobs?

Iv said it before and I will say it again...ALS is coming to a Fire Department near you...do you wanna be on the outside or be on the inside?

[thelurker]

tootall said:

hp4l said:

I think the biggest problem with having ALS on the engines would be training. There are already EMT, FI/FO, and Instructor CEU's that we must maintain. And I'm sure there will be FF CEU's some day. If not, there is plenty of training that we must do on the department level and on the county/state level to keep our education to what it should be. I would personally prefer Medics in an ambulance before an engine. I think they need to focus on EMS primarily.

I also don't think that the BLS and ALS get enough credit in most areas of this county. Sure, there are some that may not deserve it, but listen to a scanner one day and listen to who is running their asses off in their local and the ones around them. As an EMT that rides the engine, thank you to those that come bail us out.

I don't see training being an issue. Its like anything else if you plan properly there is no issue...only when we wait til the last month of our cert to take care of all the CEUs.

Your statement about Medics should be on Ambulances because they need to focus on EMS is a common one in this area because the state has made ALS so tabu. Why can't a quality ALS provider ride an engine? Are their skills going to lack because they am on a suppression pierce? Or can we increase more appropriate Pt care in the long run. How many times do you sit on scene waiting for ALS or BLS to show up? Imagine if you had a medic on your engine to start doing what needed to be done.

We all know that the fire service is 75% EMS today. Why do we fight being better at our jobs?

Iv said it before and I will say it again...ALS is coming to a Fire Department near you...do you wanna be on the outside or be on the inside?

Craig, I know you used to work in a system that has made a commitment to the ALS system, but I have to back Jim on this one.
Item #1- Training. You have the enjoyment of working for a department that places a strong emphasis on training, and damn we envy that, but you have to realize, most departments in this county still look on training as a "necessary evil," that is sometimes not even necessary, just evil, and do not support the environment that you get to work in on a day to day basis. As you suggest, waiting until the last 3 months to get your CEU's is ill advised, however, some departments dont even cover the cost of fire training, let alone EMS so time management is a moot point in those cases.

Item #2- EMS in the Fire Service. I know that in many other parts of this nation, Fire Department and EMS are the same words, however, here in the Northeastern part of the country, there is still a pretty hard division line between the two, and although the line has been softening, I don't see EMS being completely integrated for many years, maybe not even during our careers. There will be the old school hold outs no matter what. Need an example, look at the FD that was made popular in a movie about 15 or so years ago. They just finally are issuing bunker pants, which is something we all take for granted here. Yes, some departments will buy into the EMS thing, but I am sure many won't.

Item #3- Insuring EMS activities. Like it or not, in this sue happy country that we live in, any department who would like to persue these activities will have to carry malpractice insurance. Right now, there are departments having trouble paying their current bills. Many would not be interested in paying another bill.

Item #4- Funding. For Municipal and District run departments, this could be a line item in the budget, but for the departments that still rely on donations, funding an EMS program is usually not feasible. Equipment, supplies, and the extra costs of Fuel and Maintence will make many departments shy away. Although billing is a way to re-coup some if not all of your expenses, billing is not an available option unless you are also providing transport to the facility.

While, you may feel that I am close minded, and resistant to this, you are not too far from the truth, however, today we had many calls, all EMS, and it was the perfect example of why we should have an (shudder) ambulance. I agree that EMS is becoming an increasing part of the fire service in Burlington County, and if de-regulation ever happens, I am sure there will be the organizations who jump on the opportunity, however, as long as home rule exists in NJ, you will probably not see the majority of fire organizations supply EMS and even fewer will become ALS providers also.