Monday, March 12, 2007

Gripes and More Gripes

One of my gripes about working in this district is that we are not allowed much of a scope of practice. There are NO paramedics in this district, despite there being at least 10 EMTs who are eager and willing to undergo the training. I mean c’mon, transport times for some patients approach 45 mins., if there’s no extrication or bad roads. Even short transport patients could benefit from advanced care at times. No intubation, no intra-osseous access, no needle decompressions, no cardiac or anti-seizure drugs, and perhaps the biggest travesty…no pain management options beyond the BLS level. I had a guy a little while back that was pinned by a boulder at a construction site and fractured his pelvis and his femur. There was a 45-minute extrication followed by a 20-minute transport. This big, rugged guy cried for 30 minutes. Tell me that it is good patient care to let this go on. And before anyone says: What about helicopter transport?, the nearest service is DHART out of Dartmouth Hitchcock in New Hampshire, a minimum of one hour response time, if the weather allows flying in the first place.

I don't know what the problem is. My guess is that the district's medical director is not on board with making this level of advanced care available, for whatever reason. Assistance from the hospital is unlikely, they seem to be stuck in the stone age at times. And the ego problem looms large too: "We can't let lowly EMTs or Medics do what our nurses can do."

Why is Vermont often at the forefront of advancement for this state and its people (Civil Unions, Dr. Dynasaur, Act 250, etc.) and lags so far behind the rest of the Northeast and most of the country when it comes to an EMS system??

1 comment:

Anonymous said...

An age old question that has been going on in Franklin/Chittenden County ironically for more than 10 years, maybe longer! On the one hand, you have a predominelty all volunteer base, with many Squads doing so few calls a year (Much less ALS calls)to be able to justify the skills. Then you have squads that DO run many calls per year,but are so close to the Hospital the argument from the Hospital is "These are so close we don't need Paramedics". It is so hard when you have the Hospital against you as well as The State EMS Office (Who are supposed to be FOR the progression of EMS). Plus just for good measure, factor in one Squad being jealous of another who might be able to run Paramedics, and they cannot. I guess this one will be a topic of conversation for quite some time to come!