leviathan said:
Yes...precisely why more education needs to be put in place. Nothing is unjustified about following protocols, but as others were saying, that makes you a technician, and not a clinician. Ontario Paramedics get a fair amount of education in order to be able to make their own decisions (or at least deviate from their protocol when they deem it necessary). Of course, does any research show that increasing the education of paramedics in turn increase the effectiveness of pre-hospital care, or does the protocol-driven system meet the needs of EMS?
good question
the answer is No.
What research is out there, and believe me there isnt much; basically says that calling a cab (which typical has a faster response time in an urban area) and having them drive "Really Fast" to the hospital has better outcomes than an ALS response. Now, yes this was a research study oft quoted.
I think that, for the most part, this is true. Easily 98% of patients are simply being driven into the ER, not signifigantly treated. Out of that 98% easily 90 % could be BLS response (which also has research behind it suggesting BLS does the primary care quicker and gets to hospital faster (less "stay and play" more "Load and go".)).
Now, as a medic and a flight RN i have personally been in situations where i KNOW i have made the difference between that person dying and living to walk out of the hospital, so have any of you who are seasoned medics. I would estimate those calls at about 10 a year orso in flight and much less when i was on the ground. Remember, the only stat that is relevant is survival to discharge.
At the end of the day, there is no way to account for the cost of even ONE life you save. So, if all your calls are 99%'ers except that 1 which you save, then everything we do is worth it from my perspective.
As for education in the USA for medics, it is as a whole disjointed, seperated and weak. The majority of programs here are 6 month with 1400 hour didatic and the rest clinical and ride time. The focus is on the national registry exam which is ABSOLUTELY a cookbook exam (in fatc many of the questions on it are wrong based on todays research and common sense ie: lido pre RSI for head injuiry and start iv's distal and work in). This being the case paramedics are left to their own desire and motivation to better themselves. Like any profession, this barely constitutes 10% of people. So, you end up with alot of cookbook medics.
Add to that the FireDept problem in the USA and you essestially ring the death bell for critical thinking in paramedicine. A smart man knows that he can either do one thing 100% or 2 things with a split of the same. A Paramedic Fireman is splitting his personal resources and it is often to the tune of 90% Fireman and 10% Medic, this is evidenced by the term "FireMedic". What ends up happening is that an individual spends the majority of time learing about fireman stuff and neglecting (or spending little) learing the "WHYs" of medicine.
The next factor about why protocol driven Paramedicine wont change in the USA has everything to do with legality. You have been there when you patched for something, Oh lets say a dead guy, and the physician tells you to work them and bring them in. Stupid, but it happens. This happens because of the physicians JUSTIFIED fear of liability, it isnt the right medical thing to do often, but it is self protective for the physician. So, based on this, you wont find EMS changing much, ever from my perspective. Your ability to deviate will be directly related to your medical director. Also, add to the pot the negative experiences an ER will have with some stupid medics who make absolutely idiotic mistakes negatively impacting (read: Killing) a patient. This often causes ER staff including physicians, to be very conservative and wary of all EMS since there is little interaction and the worst things are never forgotten.
I teach one of the 6 month medic classes where i live. I tried to make it 2 year, then tried for 1 year. The response that i got from students was this:
"Why would I bother taking a 2 year program (or 1 year) when i can take a 6 month program and make the SAME money as the 2 year but be doing it for 1.5 more years?"
It is hard to argue with that logic when your trying to pay the rent. Same goes for the FD. People join it for the retirement & money (often better than 3rd service retiirement & money) the respect, (if you work 3rd service with an ALS FD your often treated like a taxi and like crap) and the advancement (there really isnt any advancement in private EMS but in FD you can advace quite easily and make more money).
Its all a catch 22.
Sorry for the rant, but I was frustrated with it when i was there and i feel for you guys now.
