What will the future of EMS look like? How do we get there?

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Permalink Reply by Nathan on November 5, 2009 at 10:01pm

Do you guys think we will ever do chest tubes? I know some do now but I mean will it ever be common? Ive only done one field needle decompression so far and I wasn't that impressed with the immediate results. (Ill admit it was more hemothorax than pneumo so it didnt vent that well) Ive seen many many chest tubes placed and It seems pretty basic. I even had a total of three placed in myself. It was quite unpleasant but not terrible. (ya Im a tall thin white male)

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Permalink Reply by Skip Kirkwood on November 6, 2009 at 10:54am

I've heard of a few flight programs, etc., that do chest tubes in the field, but never seen any evidence of patient benefit. Unfortunately I have seen evidence of a bunch of liver biopsies performed by medics who were trying to do lateral decompression. It would be nasty to see a liver stabbed with a chest tube trochar!

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Permalink Reply by dr-exmedic on November 6, 2009 at 1:35pm

Skip Kirkwood said:

It would be nasty to see a liver stabbed with a chest tube trochar!

Well, that's the problem--they're not supposed to be using the trochars to put them in! :)

Delaying delivery to a trauma center seems to kill pts, and chest tube isn't exactly a skill I would even attempt in the back of a moving ambulance, so there doesn't seem to be even a theoretical basis for doing them in the field (unless you believe you can safely insert a chest tube in the back of a moving ambulance--in which case you need to stay far, far away from me and my family should any of us be injured).

Incidentally, we've occasionally had transfers from outside facilities who should've gotten a chest tube, but the referring doc hadn't put one in in years and didn't feel comfortable doing so. If there are ED docs who don't get enough chest tubes to feel comfortable, that should tell you something else about whether EMS chest tubes are a really good idea....

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Permalink Reply by Earl Culvey on November 6, 2009 at 1:41pm

There is a lot of really good discussion here. I believe, that like some here, that we NEED to define ourselves as a separate entity. Whether we call it EMS, Paramedicine or whatever. If we stuff ourselves into some other category we are doing ourselves a great injustice. Maybe, someday we can ALL get our s**t together and work together towards the greater good.

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Permalink Reply by Skip Kirkwood on November 6, 2009 at 3:50pm

I approach the question of "new procedures" by asking a series of questions.

1. What is the evidence of the need? Show me the data about patients who needed chest tubes and suffered adverse outcomes because they couldn't get one in the field.

2. How much time and money does it take to initially train personnel to proficiency?

3. How much time and money must be expended to maintain proficiency, and what interval?

Resources are limited, and I have to decide if THIS expenditure is worthwhile, from an evidence and cost perspective, as opposed to the other things that could be done with that time and money. It's a challenging decision-making process.

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Permalink Reply by Joshua Todd on November 7, 2009 at 3:14am

I see the future as requiring an Associates Degree for Paramedic with a Bachelors available in Community paramedicine. More in depth A&P, psychology, education on social services, etc. It frustrates me not that we are mobile social workers as that is partly what I signed up for, rather my frustration comes from not being given an adequate education to fully fulfill the social work expectations that have come into our profession especially in the urban areas of my community. We need more knowledge not more interventions.

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