I am currently attempting to co-write an article for a national publication in regards to Problems in EMS. I am both a ER- RN for over 18 years and a field Paramedic. I believe there are some points that need to be addressed and changed.
I would like to hear both the bad and the good points as well. Please, constructive criticism and downplay bashing if possible.
My main focus will be on education, professionalism, and patient care, etc..
If you feel you dont want to post them, you can PM me.
What's the biggest problem with EMS in this country? That's an easy one . . . NO NATIONAL STANDARDS!!!
While the term Paramedic is Universal, what the name actually describes is a hodgepodge of pre-hospital providers with no uniformity in training/education, standards or protocols. As a result, the pre-hospital care you recieve in Miami may be entirely different than that which you recieve in Memphis. This is rediculous and it lessens the legitamacy of the profession. I have been a paramedic for 15 years and had my BSN for 10. When I went to paramedic school I chose to remain in my home state to take the class, which took just short of 2 years in length by the time all of the class, hospital and preceptorship time was completed. Some of my co-workers decided to take the class in a neighboring state and they were finished in 11 months. What's wrong with this picture??? In order for paramedicine to be on par with the nursing profession in terms of respect and pay, a uniform national standard is a must, otherwise it will continue to be the forgotten public safety field and the red-headed step child to police and fire.
Does this mean it should become a degreed profession? With the cost of a college education these days I would have to say no. When I went to nursing school I recieved my degree and most of what I learned was a joke! Instead of concentrated medical training most of my nursing classes revolved around care plans and nursing theory! Nothing that had any real world application. The best training I recieved was on the job and after I graduated.
Instead I feel that all paramedicine programs should be nationally acredited with uniform standards so that a paramedic is a paramedic no matter where you are in the country. There should also be a minimum standard for prehospital protocols. In the county I work there are 4 different protocols because the individual hospital providers determine their own. So a bad CHF patient in one town can recieve CPAP from the paramedics when he calls 911, but the CHF patient a few blocks away in the next town cannot.
If one thing needs to be changed this is it. I hope this helps your article.
I live in a rural area and our medics rule! They are absolutely the best people to have around when the poo hits the propeller.
My pet peeves are- 24h shifts- how can anyone get straight out of bed and drive safely, let alone assess and treat?
Inconsistent education. We can have almost any skill level show up with a stretcher, from first responders to our expert EMT's. It would be a boost for the profession if ambulances required a higher level of certification from at least one person on the truck. Admittedly, in our area, that would shut down half our rigs, so it's not likely to come true anytime soon.
I have to say our Fire Rescue folks (the ALS folks) are pretty good, have solid protocols, and know how to use them.
I have a big thank you for a few tonite, who brought in an old man, seriously SOB, and I was on my own with him. They hung around, helped me get in monitored, hooked up and even helped me turn the guy so I could change his filled diaper (they'd given 20 of Lasix enroute). They didn't have to do that, could have given report and run, but I appreciated the few extra minutes they gave me and the patient, since our ER techs were tied up.
One thing I'd like to see is slightly better education for our BLS folks, especially in the area of medications. Just maybe a familiarization course of common meds. They always are amazed that I can pretty much sum up the patient's medical history from their med list. A little more info might give them more insight into what's up with the patient, even if BLS doesn't treat with meds.
Having been a volley EMT for over 25 years as well as an LPN, has been such a wonderful (at times)experience for me. I have had the opportunity to see things from both sides of the fence. Have had to perform CPR on a 6 month old who mom found unresponsive in his car seat while driving to the market. Turns out it was a congenital undected heart defect. I have crawled into the back of a dark, overturned car, reeking of ETOH and gas and vomit, only to find it was one of our own EMT's as the patient. Trying to control my own emotions, and comfort him as the firefighters were trying to use the jaws of life to free him. I sat in the back of an ambulance with a 88 year old female, just holding her hand, talking about anything to keep her concious till we make it to the hospital.
Working as an LPN in LTCF all of my nursing years (13) You will find that the thing that we EMT's appreciate is a good besdie report to the EMT's so that they can relay it to the ED staff. But, one thing I can not get, why do so many nursing homes wait 2 or 3 days after a serious fall to send them for eval at the ED????? Too busy, too much paperwork, ahh she is just old and they get that way. I think not!! They deserve dignity and care as well as anyone, maybe even more. If ya need any info, just write back and I'll help out as much as possible
if your article includes how to improve communication between nurses and EMT-P's I would add that our hospital provides CE for pre-hospital personnel EVERY MONTH. We do it in conjuction with the Fire Dept's educators. This has increased communication and helped the two disciplines to appreciate one another's expertise.
I'm an EMT-B on my way to nursing school and I can tell you one frustrating thing I deal with over and over. When I arrive to the ER with a PT the nurses don't want to hear anything, not a PT report, not anything we saw on scene (medical) or any info on MOI. I would figure it would be helpfull to hear the car was destroyed or just banged up, or the ladder was 20 ft high and not a step ladder. I do realize there are those unkept EMTs that roll into your ERs with f*$K Bush shirt and tell you nothing, but those of us vollys in uniform, well groomed, and good at thier jobs hate being discounted like boyscouts with a merit badge for applying cling. I am working to become a flight nurse and I know I have to pass through an ER to get there, I won't discount my EMTs until they prove thier tools. As far as the comments on meds I agree we should get more training on that, my squad makes a point to explain how meds match up to conditions to our new personel, makes things on scene quicker. My point is some of us take our jobs very seriously and are very good at it (I cancle medics all the time unless I am in way over my head) let us give you the report we just spent 15 min obtaining. It's not easy getting a pressure going 60 over bumby roads but we do let us report it. I have actually been pushed aside by a very young pompus nurse while trying to give a report, and barked at to make a bed for my unstable PT like I worked for her. Makes your efforts to keep the PT stable seem meaningless. Just wanted to share form the other side of the fence.
Street Doc
6 Posts
What's the biggest problem with EMS in this country? That's an easy one . . . NO NATIONAL STANDARDS!!!
While the term Paramedic is Universal, what the name actually describes is a hodgepodge of pre-hospital providers with no uniformity in training/education, standards or protocols. As a result, the pre-hospital care you recieve in Miami may be entirely different than that which you recieve in Memphis. This is rediculous and it lessens the legitamacy of the profession. I have been a paramedic for 15 years and had my BSN for 10. When I went to paramedic school I chose to remain in my home state to take the class, which took just short of 2 years in length by the time all of the class, hospital and preceptorship time was completed. Some of my co-workers decided to take the class in a neighboring state and they were finished in 11 months. What's wrong with this picture??? In order for paramedicine to be on par with the nursing profession in terms of respect and pay, a uniform national standard is a must, otherwise it will continue to be the forgotten public safety field and the red-headed step child to police and fire.
Does this mean it should become a degreed profession? With the cost of a college education these days I would have to say no. When I went to nursing school I recieved my degree and most of what I learned was a joke! Instead of concentrated medical training most of my nursing classes revolved around care plans and nursing theory! Nothing that had any real world application. The best training I recieved was on the job and after I graduated.
Instead I feel that all paramedicine programs should be nationally acredited with uniform standards so that a paramedic is a paramedic no matter where you are in the country. There should also be a minimum standard for prehospital protocols. In the county I work there are 4 different protocols because the individual hospital providers determine their own. So a bad CHF patient in one town can recieve CPAP from the paramedics when he calls 911, but the CHF patient a few blocks away in the next town cannot.
If one thing needs to be changed this is it. I hope this helps your article.