Posts Tagged ‘EMS2.0’

EMS 2.0

Posted: January 12, 2012 in EMS
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This is a topic making its way around the social media sites and blogsphere. Not many people know about it though unless they read certain blogs. I can provide a list if anyone wants.

EMS 2.0 is basically a remapping of the current EMS system. It focuses primarily on ALS, but I think us supposedly lowly EMTs can learn from it as well. And I have posted on this before, so if you have read my blog Flawed, then you don’t need to read this if you wish.

The current system teaches us that all patients(PTs) NEED to go to the emergency department(ED). Why though? If someone has a stubbed toe, or has had abdominal pain for the past month, why should they go to the ED? An Urgent Care Clinic or their own doctor would be so much better for this!! I think EMS providers should be trained in recognizing certain illnesses and injuries that do not require an ED, and be able to transport them to an Urgent Care.  I don’t know how many times I have had to take a PT in to the ED, just to have the staff get upset with ME over them being there. Yes, abdominal pain can be deadly in some circumstances, but if you have had it for the past 12 hours, and are walking straight with no tenderness, then you do not need to go to an ED. If it suddenly started, and it feels like your inside are being ripped apart, well, they be being ripped apart and you need immediate lifesaving help, otherwise known as an ED.  Some EDs will take, and put a PT into the waiting room when they come in by ambulance, if they do not need immediate life saving treatment, which is awesome!

Still confused? OK, think of it this way, for some reason, something happened to you, you got in accident, fell off of a ladder, tripped and hit your head. 911 is called, we come, do our thing, and rush you to the hospital so you can at least be checked over. All fine things as who knows what is going on, somethings we can not do in the field like a CT Scan. But now, here you are at the ED, waiting, and waiting, and waiting. You complain about how long it takes to get your CT scan results read, so you can be released and go back to whatever it was you had been doing. Well, chances are that it is taking so long, because there are a few PTs there with the sniffles or an upset stomach, and think they are more important then you. If they had gone to an Urgent Care, chances are you may have been able to be seen faster. Now, you may be waiting because someone worse then you came in, and this should be the case if triage is working correctly.

Other people abuse ambulances them selves. Like the PT on Medicare/Medicade/self-pay, with a flu, requesting to go to a hospital on the other side of the county, when we have to drive past two other hospitals to get there. What can we do about that? For starters, take them to an Urgent Care! Maybe ask them, politely of course, if they want to go by ambulance and get the bill, or if they want to have a friend or family member drive them? Obviously we can not refuse to transport someone who is not a threat to us, because if that was an option, someone somewhere would abuse it and a PT would die.

How can this affect us EMT-Bs  you ask? I think if ALS can choose whether a PT needs an ED, or an UC, then we should be able to gain some privileges as well. Now this applies mainly to NY, as everyone is different. I think we should be able to drop a King Airway, start an IV so the ED has access, and a few other things I can’t think of right now.

If you are new to my blog, and do not know the levels of EMS, here is a general outline.

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Posted: January 4, 2011 in EMS
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The following does not represent my employer, nor does it represent the views of my employer. Rather it represents EMS in general. And my opinion.

I am new to EMS, only being in it for 2 years. So disregard this if you want.

The EMS system is flawed. There I said it. Many of us know it already though.

The biggest flaw I can think of is a simple one really. Some one with the sniffles calls 911, 911 dispatches an ambulance, the ambulance takes them to the ED. Now, that took an ambulance out of service, took up a bed and staff at the ED, and cost the patient hundreds if not a thousand dollars. I don’t have a problem with the ambulance doing the transport really. Most of the time another crew is standing by to take the next emergency call. My problem is transporting that patient to the ED. Why not just go to a local Urgent Care, or even the patients doctor if allowed? How much money would that save the patients insurance company? Effectively lowering insurance premiums? It would free up room and staff at the ED as well. How many times have you driven yourself to the Emergency Department, just to wait 2-10 hours to get seen? We all know that while you wait in the waiting room, whether it be with sniffles your self, or a more serious condition, there is someone sitting in a bed, sniffing or holding their stomach with indigestion. If we could transport to an Urgent Care, the more serious patients would get better care in the ED.

There are other flaws of course. Time on scene is one I hear about often from my patients, and family members. I have worked with some partners who get on scene, and as soon as the patient is in the rig, we are moving. There have been others who spend a rather large amount of time on scene. I have been on scene for 45 minutes before, while my partner works in the rig. Now, there are certain things that need to be done before transport begins, I understand this. I, myself, like to get a set of vitals before transport begins. Even if I got a set in the house or outside. I get in that rig, and take another set. Then we go. It doesn’t take long for a good set of vitals. ALS providers have things to do. IVs to start, 12-leads to do. I understand that as well. And it is fine to do them before we go, just as, I as a BLS provider, do certain thing’s before moving. But there comes a point where just sitting on scene gets ridiculous. Some things can be done during transport. Just think of how it looks to the family or bystanders. The ambulance comes screaming in, the medics jump out, grab their stuff and go in. Do their thing and wheel the patient out on the stretcher. Load them into the ambulance. Then sit there, and sit there, and sit there. If you do spend a while on scene, let the family know why at least. It is the professional thing to do.

Education I like to learn, I can sit down with a manual and just read it. But when I was attending class, there where something’s our instructor covered real fast, saying we don’t need to know it. But then, it was on the test. And besides, why would it be in the book, and on his syllabus, if it wasn’t important? Maybe this was just my instructor, I do not know. As I am new to EMS, this may be just me. But from what I read online, it is a big deal. The US in general could revamp education.

EMS2.0- This is a big topic for EMS bloggers. And I figure it is my turn to chime in. Some people look at ems2.0 as expanding our box and scope of practice. I figure, we a need new a box. A lot of the old timers in EMS don’t think anything needs to change. I disagree, we should be able to transport to Urgent Cares, time on scene should be modified, education should be revamped, BLS providers should have capabilities such as the King airway. But none of this will happen while we are looked at as “Ambulance Drivers”. To get EMS2.0 to truly take effect, we must get the publics support. Until the recognize this as a career, and demand better care. It will not happen. The more EMS providers we got onboard, the better. But with out the publics support, the old-timers will not recognize the need for change.

Thoughts? I would love some feedback.