In America the systems with the lowest mortality rates (as accounted for…yada yada) have the shortest transport times. Get 'em to the hospital where real definitive medical care is provided. A load and go system staffed with Basics has a higher survival rate than a system loaded with Para's and progressive protocols. Hmmmm

Our balancing act is to provide the care the patient needs while we get them to the hospital where the long term fixes can be made.

In America the systems with the lowest mortality rates (as accounted for…yada yada) have the shortest transport times. Get 'em to the hospital where real definitive medical care is provided. A load and go system staffed with Basics has a higher survival rate than a system loaded with Para's and progressive protocols. Hmmmm

Our balancing act is to provide the care the patient needs while we get them to the hospital where the long term fixes can be made.

In America the systems with the lowest mortality rates (as accounted for…yada yada) have the shortest transport times. Get 'em to the hospital where real definitive medical care is provided. A load and go system staffed with Basics has a higher survival rate than a system loaded with Para's and progressive protocols. Hmmmm

Our balancing act is to provide the care the patient needs while we get them to the hospital where the long term fixes can be made.

My feeling is that it all comes down to education and training. In the US, a high school graduate takes between 1-2 years to become a licensed Paramedic. This is really nearly the same amount of time as a Registered Nurse spends in training when it comes down to it. However, nurses have the opportunity to further their education and training and thus have the ability to practice medicine at a higher level of care than their colleagues – this taking the form of completing a Master's Degree and becoming licensed as an Advanced Practice Nurse: such as a Nurse Practitioner, Nurse Anesthetist, or Nurse Midwife, etc. Paramedicine should have such similar opportunities for advanced training, and instead of simply attending inservices or seminars, the completion of graduate education should open up a broader scope of practice for paramedics. Whether this scope increases the primary care aspect of the profession, or perhaps includes additional surgical capabilities paramedics would be granted to perform in the field.

Several years ago, two Paramedics, while working in an ambulance for the hospital which is currently my own employer, were presented with a pregnant patient in cardiac arrest. After all interventions failed to resuscitate the patient, in direct consultation with a physician over a mobile phone, the paramedics were directed to and instructed how to perform an emergency C-section on the patient, and the paramedics extracted a viable baby from the womb of the mother. After resuscitating the baby, she was successfully transported to the hospital (where she lived in NICU for 3-5 days, but unfortunately died). These paramedics were regarded as heroes by their colleagues and the media. However, their paramedic certifications were subsequently suspended then revoked by the state Department of Health for operating outside of their scope of practice.

EMS 2.0 really is the next evolution of our profession. However, standards of education and scope of practice really need to be in place across the country so that all providers at various levels are on parity.

Pop over and let me know what you think:

http://999medic.com/2009/10/19/my-thoughts-on-e...

I will comment on this on my blog as I feel my comment will be too long for here.

I will try and get it out tonight mate!

On the second go-round, in 1994 (I let my license lapse as my employment in the early 90s ruled out any EMS stuff), we could do more, but still very little in the overall scheme of things.

This time (2008), we can do all sorts of things that had been unimaginable back then — 324 mg aspirin for cardiacs, asthma inhalers, assisting patients with (their own) nitro and epi injectors (under medical control, of course). Of course, the Red Cross now offers training in epi and asthma as part of their First Aid curriculum.

Yes, the course has become much more complex over the years, and I'm sure it's even worse for paramedics, but on the other hand, at the Basic level, we can now do a LOT more to help keep the patient alive until we can meet up with a paramedic unit. (Here in Maine, most of the volunteer services still run EMTI at best; paramedics are usually either full-time FD/EMS staff in the larger towns or employed by the commercial services).

A lot more complicated, a lot more responsibility, and — for the most part — little to no pay for the volunteer squads (in my town, we get $10/hr while out on calls, after attending the class on our own time).

But, to us, it's worth it. If we can save one life that might have been lost otherwise, it's worth it.

Starry-eyed? Naive? Maybe. But for those out here in the trenches in the boonies, we do the best we can with what we've got.

I can understand the concerns about the extra liability, especially given how litigious our society has become. Maybe part of EMS 2.0 has to be increased legal protection, for all of us in EMS – it's insane that we still have to worry about whether or not we're covered under a Good Samaritan law.

We basics can't do a fraction what you paramedics can do, but the more your training and responsibilities increase, there is a trickle-down to those at our level, allowing us to better assist you guys. That, in turn, leads to better patient care, and to me, that should always be the main concern.