Recently fellow bloggers have put forth a topic of discussion that I feel I would weigh in on. Medic 999 posed the question of "Do we really need Paramedics on ambulances?", which caused a well thought out response, "We don't need more Medics" from 510 Medic.
Both Bloggers are Paramedics and offer, in my opinion, a surprising response. They both seem to say that more medics is not the solution to an overwhelming problem in EMS. There is no need to have a Paramedic on every single ambulance let alone two. In fact I am willing to argue that the common place of having Medics on every single rig has lead to a decline in patient care and a Medic's overall ability.
Now don't get on your soap box and assume I'm saying that Medics abilities are poor, or we don't need medics. One the contrary my dear reader, I am merely making reference to my comment on 510 Medic's blog, which was:
"I agree totally, I feel it is leading to a downward spiral of our providers. EMT’s who may not get the experience from the BLS truck, may not be as experienced with the “basics”. EMT’s only riding on ALS trucks then feel the need to advance them selves in order to get more patient contact and more experience. Thus becoming Paramedics, and with declining con-ed budget’s, are still not being as experienced as their predecessors. These newly carded Paramedics who have a lack of the “basics” typically turn out to be poorer providers. "
By this I refer to the idea that EMT's are rushing them selves into a Medic class before having confidence in their own ability or exposure to really bad patients. EMT's see Medics doing more skills, being paid more, and being the "life saver". They do not get a sound fundamental skill set that they can rely on through their career in EMS by rushing their advancement. These providers are then welcomed into a world of diminishing providers by being thrown into the captains chair by being cleared. The expectation of a systematic transition to gain and hone the much needed street skills is pushed aside to the need for a warm body to fill a schedule hole. The response to the negligence of clearing a provider before they are ready? They can make up needed skills in the continuous education training that is expected of all providers and catch up on their need. Sounds great, and almost reasonable right? Except we enter the new age of declining education budgets and fewer instructors. Now the much needed continuous education isn't being offered or being set aside for a later date. Now the new medics have to rely on their experience and their fundamental skill set. When all else fails they can rely on the basics after all right?
So if you have followed along, you may have picked up on the
criticism systematic failure that faces EMS.
"I’m not saying we need to triple the BLS trucks on the road but rather put weight on the experience gained for our EMT’s in a BLS setting. As with any performance overhaul its typically a good idea to start at the bottom/beginning."
I think we need to understand and credit that there is an enormous amount of applicable skills that can be learned in the Basic ambulance arena. By putting weight on this experience, EMS will only benefit with strengthening our base structuring and ultimately our future Medics.