Jeremy, you also bring up some interesting topics which are being discussed at local and national levels.
Quote from EMTJeremy
I can understand and somewhat agree with what you are saying. EMS plays an important role in the outcome of the patient. Physicians and nurses rely on the pre-hospital assessment to prepare for their patients. A Trauma Code is very different than a finger amputation- Though they'll both likely be going to the OR, different specialists need to be called for each one. It is the pre-hospital report that prepares these resources. Even knowing the difference between a stable and unstable patient can make a world of difference at the hospital.
Trauma Activation fees can range from $1000 to $25,000 per patient. Thus, criteria is very strict and usually it is someone inside the hospital who makes the actual decision to activate the alert which may get at least 12 health care professionals responding including a representative from the trauma surgeons.
Essentially, the report given to the hospital should follow the criteria that has been established by physicians to give those at the hospital the correct information. The guidelines include information such as BP parameters and level of consciousness which takes the mystery out of the determination for appropriate level of care at the hospital.
The costs and RISKS for activating a helicopter are also pretty extreme and when activated for a patient who is walking out of the trauma center before the helicopter gets back to base has brought a lot of scrutiny to when and who should activate the helicopter. This is an area that must be examined more closely to stop to over use of helicopter especially when a trauma center is just a few miles away. If an ambulance has to wait on scene for 20 minutes to fly to a hospital that could be driven to at a normal rate of speed in 15 minutes, the patient is not benefited.
STEMIs are another situation and some hospitals are more comfortable activating the cath lab if the ECG can be transmitted from EMS to a physician first.
In some areas EMS is limited to transporting to the nearest facility regardless of condition of the patient which then requires another transport either by helicopter or CCT.
Regardless, it is a physician or a group of several physicians that advise and make the protocols for EMTs and Paramedics to follow. Some protocols may seem more like guidelines with some degree of flexibility but that again is determined by a physician what is appropriate for the EMS in his or her area.
Quote from EMTJeremy
Our Medical Director for my Volunteer Collegiate EMS squad is from Germany. She said Doctors rode on ambulances there so they can start treatment right away. Since we don't have this in the US, it is the paramedic or EMT that is responsible for not only getting the pt to the hospital but starting what can be life-saving interventions on them
Just my 2c!!
How about the cost effectiveness and level of care comparison between the systems. Physicians have much more assessment and treatment abilities than EMTs or Paramedics (especially in the US). In other countries you may have only one responder to a patient and that patient may be treated and not transported. There might only be a doctor, nurse and a driver for calls. Some countries have Emergency Care Practitioners which may be a nurse or a Paramedic with several years of education and experience. The US is a long way off from that. Some systems will use 2 nurses who are the equivalent of nurse practitioners in training. Here in the US we send 3 expensive vehicles with 4 - 6 Paramedics to every calls and then may a BLS ambulance will transport while the FD vehicle follows to retrieve their Paramedics. Often the treatment is just a ride to the hospital since only the obvious symptoms for broad diagnoses can be determined with treatment initiated in the field. For cost, each FF/Paramedic may make $60k - $100k depending on location. At another $20k - $40k per year for each towards their benefit package. Now consider the contract with the ambulance and maintenance of all the responding EMS/FD vehicles including gas and insurance. EMS in even the smallest cities is very costly. How is the tax base and what allocations for the different regions determined? Let's also consider the cost to the patients. Do you understand how a patient is billed, what part insurances will cover and how your EMS agency is funded even if it is volunteer?
There are also more controversies such as BLS vs ALS, scoop and run or stay and play as well as if advanced procedures by Paramedics are necessary or even detrimental when proficiency levels are not maintained. We are now seeing more extraglottic devices used instead of ETI in field EMS. What about lights and sirens for every call both to and from?
EMS systems, which include the hospitals, have many factors to consider so the responsiblity is not solely based on the opinion of the EMT or Paramedic. Yes, you can pat yourself on the back if you get a patient who still has a pulse to the hospital but you can not ignor all the professionals, both medical and non, that make up the entire EMS and healthcare system. If you want to be successful in EMS (definitely for Flight or CCT) you have to consider a broader picture and one that involves patient/provider safety as well as outcomes.