Medic working BLS only.

[STXmedic]

he knows about outside things I may not recognize. Yes, he may, but I know and understand every skill I was taught as a basic. If I'm dealing with anything outside of that, ALS it is.

Exactly my point. What if you DONT recognize it.

 

[Veneficus]

I think management in this case is making a mistake and that they are not properly utilizing their resources to the best benefit of all involved.

In order to make best use of resources, this "medic" if the only one at that level should see all patients. He should then disposition them to be transported, sign refusal, whatever. Since he has nothing to function past that of anyone else, he should remain at the track unless he is part of the last unit to transport before none are available.

I do not think he should ride a call, there is absolutely nothing he can do that a Basic Can't in a rig with only BLS equipment on it.

A medic is not somehow automatically superior at basic psychomotor skills. In the situation you described, I stand by my bolded statement.

 

[Lola99]

Exactly my point. What if you DONT recognize it.

So what if it were a night that that medic wasn't working the races? 2 basics / 2 drivers. If something goes wrong or I suspect it will I call ALS.
If there's something that could potentially be more than I see, I'm pulling Mr. Medic in, absolutely, but I don't see needing that in the situations I presented. I'm asking about EVERY transport, not the more difficult ones (which honestly are nearly 1 in a million out there, which is why none of this is a big deal, just wanted opinions)

 

[brentoli]

. Example; a month before I finished my P, was on B/B IFT, made a call for a diabetic w/BGL of 23. Called the ER, told them my education situation and what I felt the patient needed, and he cleared me for an IV and D50. Once you get his approval, he signs off on your report and you're covered. Does this medic need to jump every transport y'all get? Probably not. Is there a time when having a medic who's not cleared for interventions should jump a call, if not just to monitor the patient? Absolutely.

Can't carry equipment outside of the services scope of practice without a waiver in IN.

 

[brentoli]

While I see the points being made about education and assessment I don't see how it changes much without interventions. If I am a mechanic, and the car is making a noise... I can diagnose the noise, I can tell you how to fix the noise, I can even tell you how to not to get the noise again. What diffrence does it make if there's no wrenches anywhere within 10 miles? Without a wrench I'm no better than the redneck standing with his hood up saying "yep, its dun broke.

Instead of debating why doesn't a paramedic take charge on scene, why isn't the question where is the ALS to begin with? The EMS commission has always debated the issue of ALS sometimes vs. ALS none of the time and the answer is always if a service can't staff ALS 24/7/365 the service can't be ALS.

 

[Shishkabob]

While I see the points being made about education and assessment I don't see how it changes much without interventions. If I am a mechanic, and the car is making a noise... I can diagnose the noise, I can tell you how to fix the noise, I can even tell you how to not to get the noise again. What diffrence does it make if there's no wrenches anywhere within 10 miles? Without a wrench I'm no better than the redneck standing with his hood up saying "yep, its dun broke.

Except said mechanic can recognize a catestrophic event coming and tell you not to attempt to start the car and call for a tow truck.

 

[Chimpie]

Our department (industrial facility) was providing a service to the First Responder level only. We had EMTs and Medics working with us but they were limited to the MFR scope just like the rest of the us.

When on calls, we all were the same level. Whether the responder was a MFR, Basic or 'Medic, no one had seniority of the call unless they were a senior ranking officer (Lt, Capt., Chief).

 

[Lola99]

Instead of debating why doesn't a paramedic take charge on scene, why isn't the question where is the ALS to begin with? The EMS commission has always debated the issue of ALS sometimes vs. ALS none of the time and the answer is always if a service can't staff ALS 24/7/365 the service can't be ALS.

I don't understand. We're not ALS, nor do we try to be. That's the point? Unless you mean outside of this case.

 

[Lola99]

Our department (industrial facility) was providing a service to the First Responder level only. We had EMTs and Medics working with us but they were limited to the MFR scope just like the rest of the us.

When on calls, we all were the same level. Whether the responder was a MFR, Basic or 'Medic, no one had seniority of the call unless they were a senior ranking officer (Lt, Capt., Chief).

So did the medics (or EMTs in your case, too) ever try to act outside of that as if they had seniority like my Mr. Medic does? And if not, how would you handle one if they did?

Like I said, management has said he has no seniority, but he continues to "bully" call-wise. Part of the problem is that management is too nice and just won't deal with it, but aside from that...

 

[Veneficus]

While I see the points being made about education and assessment I don't see how it changes much without interventions. If I am a mechanic, and the car is making a noise... I can diagnose the noise, I can tell you how to fix the noise, I can even tell you how to not to get the noise again. What diffrence does it make if there's no wrenches anywhere within 10 miles? Without a wrench I'm no better than the redneck standing with his hood up saying "yep, its dun broke.

It is not exactly that simple.

With some basic things like a stethoscope I can find a myriad of things. From the neck to the abdomen. A BP cuff can give me an ankle brachial index. My understanding and knowledge of pathology allows me to find a myriad of things, as well as monitor a patient clinically over time.

Bt I am not unique to this, the more education and experience a person has the better at it they are.

Just by the numbers at 120 for basic, 750 for medic, that is 6.25 times the education.

Instead of debating why doesn't a paramedic take charge on scene, why isn't the question where is the ALS to begin with? The EMS commission has always debated the issue of ALS sometimes vs. ALS none of the time and the answer is always if a service can't staff ALS 24/7/365 the service can't be ALS.

Cost?
Availabillity?

ALS isn't a need, it is a want.

 

[Chimpie]

So did the medics (or EMTs in your case, too) ever try to act outside of that as if they had seniority like my Mr. Medic does? And if not, how would you handle one if they did?

Like I said, management has said he has no seniority, but he continues to "bully" call-wise. Part of the problem is that management is too nice and just won't deal with it, but aside from that...

No, no one acted with seniority unless they seniority. We had too much respect for each other. If someone did (sometimes we had bad days) we were all open enough with each other to be able to talk it out.

If the behavior continued I'm sure we would have worked it up the chain.

If you've done this and there are still problems, start documenting dates/times the 'bullying' occurred and the dates/times you talked to your supervisors about it.

Maybe everyone needs to sit together to try and work it out.

 

[Lola99]

No, no one acted with seniority unless they seniority. We had too much respect for each other. If someone did (sometimes we had bad days) we were all open enough with each other to be able to talk it out.

If the behavior continued I'm sure we would have worked it up the chain.

If you've done this and there are still problems, start documenting dates/times the 'bullying' occurred and the dates/times you talked to your supervisors about it.

Maybe everyone needs to sit together to try and work it out.

That company has a lot of interpersonal issues. It's a well-known fact. That's why this seems so troubling, I think. It's full of drama, but it's very flexible with me living 4 hours away in college, so it's still worth it. I just wanted some opinions outside my own on this.
Thank you.

 

[Shishkabob]

Like I said, management has said he has no seniority, but he continues to "bully" call-wise. Part of the problem is that management is too nice and just won't deal with it, but aside from that...

I don't care if someone is my captain, chief, or the President of the United States. If I am the highest credentialed medical professional, any and every patient care decision is up to me. If an loewer certified supervisor gets in between me and the best care I can give to my patient, even if I'm just acting in the role of another EMT, you can bet your butt I'm taking it as high as I can, be it med control or state boards. Guess I'm a jerky medic.

 

[brentoli]

It is not exactly that simple.

With some basic things like a stethoscope I can find a myriad of things. From the neck to the abdomen. A BP cuff can give me an ankle brachial index. My understanding and knowledge of pathology allows me to find a myriad of things, as well as monitor a patient clinically over time.

Aside from a more detailed report how can you develop any course of treatment? No one disputes you can perform a better assessment.

 

[Lola99]

I don't care if someone is my captain, chief, or the President of the United States. If I am the highest credentialed medical professional, any and every patient care decision is up to me. If an loewer certified supervisor gets in between me and the best care I can give to my patient, even if I'm just acting in the role of another EMT, you can bet your butt I'm taking it as high as I can, be it med control or state boards. Guess I'm a jerky medic.

I agree if there's something wrong with the care they're getting from the lower certified techs, but if not, what's the harm?

 

[brentoli]

I don't understand. We're not ALS, nor do we try to be. That's the point? Unless you mean outside of this case.

I got on a tangent sorry.

 

[Veneficus]

Aside from a more detailed report how can you develop any course of treatment? No one disputes you can perform a better assessment.

A better assessment decides if an ALS unit needs to be involved or not.

It decides how much effort needs to be put into to talking people into being evaluated at a hospital when they don't want to be.

It identifies occult injuries that maybe completely unknown to a more junior provider.

It decides who needs to be transported, how urgently, and in what order.

What to watch for if the person refuses treatment or transport to determine if they are worsening before they crash.

It determines who is at great risk of having complications with treatment available, and adjusting for that or seeking permission to.

 

[CAOX3]

I don't care if someone is my captain, chief, or the President of the United States. If I am the highest credentialed medical professional, any and every patient care decision is up to me. If an loewer certified supervisor gets in between me and the best care I can give to my patient, even if I'm just acting in the role of another EMT, you can bet your butt I'm taking it as high as I can, be it med control or state boards. Guess I'm a jerky medic.

Here is the issue, no one operates at the als level in my service unless given the green light by our medical director. Just because you passed the bare minimum test offered by the state means little in my service and to my medical director.

Your an emt unless he tells you otherwise. You are free to seek employment elsewhere that's your choice but you won't even wear a medic patch or see the inside if an als ambulance until he gives you the go ahead, take it to all the state boards and medical directors you want it won't change anything you operate as a medic when he says you do.

Until then your an emt and your operate under the structure of the command and while we like to operate as a team, considering the suggestions of all the team members involved the responsibility lies with the senior provider at your assigned level.

 

[JPINFV]

Here is the issue, no one operates at the als level in my service unless given the green light by our medical director. Just because you passed the bare minimum test offered by the state means little in my service and to my medical director.

Your an emt unless he tells you otherwise. You are free to seek employment elsewhere that's your choice but you won't even wear a medic patch or see the inside if an als ambulance until he gives you the go ahead, take it to all the state boards and medical directors you want it won't change anything you operate as a medic when he says you do.

Until then your an emt and your operate under the structure of the command and while we like to operate as a team, considering the suggestions of all the team members involved the responsibility lies with the senior provider at your assigned level.

Here's the problem with this. Just because someone is limited to EMT interventions and EMT diagnostic tools (however, being in California, I could play word games with how the scope of practice is written in terms of diagnostics. "Evaluate the ill and injured" and "obtain vital signs including, but not limited to" are broad), doesn't mean that the assessment is necessarily limited to an EMT level assessment or EMT level clinical reasoning. If I went back to work on the ambulance tomorrow, even though I would be an EMT, that doesn't preclude me from using techniques such as percussion or considering the medications that the patient is on, even though I didn't learn it in EMT class.

 

[Akulahawk]

Here is the issue, no one operates at the als level in my service unless given the green light by our medical director. Just because you passed the bare minimum test offered by the state means little in my service and to my medical director.

Your an emt unless he tells you otherwise. You are free to seek employment elsewhere that's your choice but you won't even wear a medic patch or see the inside if an als ambulance until he gives you the go ahead, take it to all the state boards and medical directors you want it won't change anything you operate as a medic when he says you do.

Until then your an emt and your operate under the structure of the command and while we like to operate as a team, considering the suggestions of all the team members involved the responsibility lies with the senior provider at your assigned level.

Here's the problem with this. Just because someone is limited to EMT interventions and EMT diagnostic tools (however, being in California, I could play word games with how the scope of practice is written in terms of diagnostics. "Evaluate the ill and injured" and "obtain vital signs including, but not limited to" are broad), doesn't mean that the assessment is necessarily limited to an EMT level assessment or EMT level clinical reasoning. If I went back to work on the ambulance tomorrow, even though I would be an EMT, that doesn't preclude me from using techniques such as percussion or considering the medications that the patient is on, even though I didn't learn it in EMT class.

While I'm not in DO school as JP is... I also have a MUCH more advanced education than a Paramedic does. I just also happen to be a Paramedic. While working BLS, I'd be "stuck" with BLS tools. That doesn't mean that I can't evaluate the patient at the higher level limited by equipment at hand... However, the problem is that if I were to do the full scope of what I can do, that could be considered "Practicing Medicine without a License" depending upon the exact circumstances.

I have worked BLS as a Medic before. Normally, I'd switch off calls with my BLS partner. However, I'm also responsible for my partner's actions as I'm far more educated. If the SHTF... I'm the one that's going to be held responsible because I'm the most medically qualified.

My take on educational hours
EMT=150 hours
Paramedic=1275 hours
ATC = appx 3500 hours (I ended up doing something like 5500+ due to being in two internship programs, one at a JC and other while at a 4 year, + claswork)
Doc = Ungodly numbers of hours...