Comments on: ALS Kills People

By: Bsjrn

Bsjrn — Sat, 06 Nov 2010 04:12:24 +0000

I agree with more education and practicals. As far as killing anyone, aren’t they already dead if you’re applying acls measures. You can’t kill a dead man but you can resuscitate one. This was a good post and insightful.

By: Abigail Duarte

Abigail Duarte — Sat, 29 May 2010 22:04:04 +0000

Haha I am really the only reply to this great post?!

By: Sevyrr

Sevyrr — Wed, 21 Apr 2010 17:18:10 +0000

Great post and I agree with you. The system I work in is great, we do 5-6 hour paramedic OTEP every month with skills labs. Also there is normally only 1 medic on a call and we get cancled if the BLS agency on scene can handle it. I was way over my needed tubes for my first and second recerts and we just got some new meds added to help with RSIs and STEMIs. I am a firm believer in training on the skills/meds we don’t use as often and BLS before ALS. Someone once told me that the difference between a paramedic and an EMT is that a paramedic has a broader knowledge base, therefor needs to be a diagostician. Meaning that instead of cookbook medicine(if I see this I do this, if I see that I do that), I am too assess the patient and formulate what I believe is wrong with the patient and base my treatment modalities on that. I believe it is far more important to do a complete assessment and have an idea of whats going on then it is to perform ALS interventions that may not be needed. I like what sirenman said about tubes too. Thanks for a great topic.

By: Train Like you Play « Rescue Monkey

Train Like you Play « Rescue Monkey — Tue, 20 Apr 2010 18:03:17 +0000

[...] Like you Play Jump to Comments Jeramedic posted a blog called ALS Kills People. It’s a good read, click here, then come back (my rant will make more sense I [...]

By: totwtytr

totwtytr — Mon, 05 Apr 2010 01:22:40 +0000

Interesting discussion, so let me change that! First, there is no good analogy between physician education and EMS education. Second, most calls are BLS and should be handled by BLS providers. Which means that ALS providers should be far fewer in EMS systems. Look at the systems that have low intubation success rates and high esophageal intubation rates. They are all ALS systems where the medics have far fewer tubes per year than tiered systems. Every call does not require a paramedic, in fact most don’t.

As Jeramedic’s post states, the problem is with EMS education, particularly BLS education. Refreshers, whether BLS or ALS, are pretty boring as a rule. The additional education required can vary widely, as we all know.

Sirenman has a point, but it’s truly a matter of being able to document how well we do our jobs in addition to being able to do our jobs well. Until we can demonstrate on a consistent basis that we are able to perform the skills the current scope of practice well, we’ll not only not see more skills, we’re likely to see fewer skills in general.

By: sirenman

sirenman — Fri, 26 Mar 2010 21:06:12 +0000

This is a subject that kind of gets me a little hot under the collar, protocols, medictions, procedures being dropped becuse of incompetence or poor skill levels.
We all make mistakes but jus pure incompetence is not excusable. I have been in EMS for 25 years and I’ve seen the scope of practice expand and now begin to contract and all based on our inability to do our jobs. I agree with you that good bls has often been overlooked because of preoccupation with als. example anyone who says they have never missed an intubation is lying, the crime isn’t missing the tube it’s failing to recognize that the tube isn’t placed properly and responding with good bls savvy and removing the tube and bagging the patient ( BLS!!) we all are in some way responsible for this either by our own incompetence or because we look the other way to avoud conflict. forums like this are a start toward fixing this. thanks for you hard work here jeramedic and I’m glad to see so many others care about this. we can fix this but it wont be easy.

By: MsParamedic

MsParamedic — Sat, 27 Feb 2010 19:11:09 +0000

Jer, you really stirred the pot with this post and I LOVE IT!

Several great points are made up there, but I’d definitely like to say that Harwetopa said it best: “The EMT comes before the P” I don’t know how often I’ve rolled up on scenes where basic things were not done that should have been ie: bleeding control over meds etc etc. And I wanted to comment on Tim’s question about “inexperienced ALS providers,” Well, Tim, we all start out at the bottom of the food chain. But we learn as we go. We have what we’re taught and we build from there. It’s not like they stick a Bus Boy on the ambulance one day and say- SAVE LIVES TODAY, KID. We learn as we go, we use our resources to the fullest extent. I’m only one and a half years into being a medic… do I know everything? HELL NO. So what do I do when I’m on a call and I get stumped? I call my medical director, I call my boss, I call my colleagues who have been medics longer than I’ve been breathing. One day, I’ll be the medic the new kid calls, because with time comes experience. Yeah, we don’t get to do hard core ALS stuff super often, like crics and cardioverting, and decompression- it’s why you’re required CE hours. But as Jeremiah said above, 48 hours isn’t enough. We have to push ourselves as medics who want to *grow* versus stay stagnant in our healthcare to seek additional resources. We need to go to labs and attend hospital seminars, some systems like mine set up QI labs. Our medical director sees what skills we haven’t performed in a while and opens up time in the hospital under his direction to perform those. If there is one person or a few people struggling with intubations, IV sticks, EKG interpretation, protocol evaluation, we are pulled off to the side and given hospital clinicals again. Employers who pay attention to these things should be given gold stars. Now, Tim, I understand you live in a place with a cool system… but there are other ways of successfully functioning out here. I’m not bashing you or anything… I’m just simply showing you the other side.

Bazinga, as Justin Schorr would say.

By: Harwetopa

Harwetopa — Sat, 27 Feb 2010 01:15:56 +0000

Great post, Jeremiah. I cannot count the times I have told EMT students of all levels “The EMT comes BEFORE the P!” Good solid ALS skills are supported by good, solid BLS skills. I just wish the majority of Basics I work with would get out of the habit of assuming that only Paramedics can handle emergencies. They are the backbone of EMS…equally, I just wish many of the Paramedics I work with would remember the BLS before the ALS.

By: jeramedic

jeramedic — Fri, 26 Feb 2010 23:27:46 +0000

“paramedics in the field need to use their skills in an appropriate manner and the BLS providers need to be decisive in their patient care”
Yes sir.

By: Sean Leonard

Sean Leonard — Fri, 26 Feb 2010 23:09:11 +0000

I hear what your saying. One time we had a medic pull a combitube from a burn patient so he could put in an ET tube. The combitube was doing an adequate job but when he pulled it, he almost lost the airway.
These guys don’t get to practice these skills often enough, so they get overzealous in the field.
The other problem that ALS presents is dependence. It’s not so much of a problem in urban areas where the PM’s are 5 minutes away and the hospital is 10 but where I’m at, we have a 45 minute transport time and the Paramedics are 30 minutes away. We can’t afford to sit around on scene and screw around waiting for them to show up (and some people do just that). It seems like because paramedics are available, BLS providers are afraid to make a decision when a call requires ALS. Even if your just gonna scoop and run and meet ALS in route, for god’s sake just make a decision.
Now don’t get me wrong, I’m not saying that ALS doesn’t have a place in the field. That’s just foolish. What I’m saying is that the paramedics in the field need to use their skills in an appropriate manner and the BLS providers need to be decisive in their patient care when a call does require an ALS response which isn’t as often (at least where I’m at) as dispatch reports would have you believe.