2007: The Year of the EMT-Basic?
It’s December already. Where has the year gone? Heck, it was only October before I stopped writing “2006” on my checks.
From my perspective, the most significant EMS event in 2007 is not one single occurrence, but rather a cascade of events that are rooted as far back as the 2005 AHA Guidelines, or perhaps even earlier, with the Ontario Prehospital Advanced Life Support Study (OPALS). No doubt about it, 2007 has been the “Year of the EMT-Basic.”
More and more experts are questioning the efficacy of prehospital advanced life support, from the greater emphasis on effective, uninterrupted CPR and the de-emphasis of pharmacology and endotracheal intubation, to the advent of supraglottic airway devices that afford all levels of EMTs an effective means of airway management.
Numerous studies have questioned the necessity of intravenous lines and have shown that IVs started in the field are rarely used for fluid replacement or medications in the ER. Ken Mattox has been telling us for years that trauma patients do not require large volumes of intravenous fluids before surgery. Henry Wang’s studies have uncovered the unsettling claim that paramedics are not as proficient at endotracheal intubation as we’d like to believe. The EMS system in Volusia County, Fla., has decreed that a supraglottic airway shall be the first line airway device for all its paramedics. OPALS has shown us that, for cardiac arrest at least, an EMT-Basic supplied with an AED is just as effective as a paramedic, and a great deal cheaper to deploy. In the systems that use it, prehospital administration of CPAP has resulted in a significant decline in the number of endotracheal intubations.
Were it not for pre-hospital 12-lead EKGs and STEMI alerts, 2007 may just have been the year when a majority of researchers and EMS experts began to seriously consider the question, “Do we even need paramedics anyway?”