EMT-B/BLS care is there a point??

[mikeylikesit]

"Basics should continue to get thier education and not stop at cert and call it a career...if you want my respect."
Can you clairfy- does this mean unless they are certified at your level they don't have your respect? I hope I am reading it wrong. What gets my dander up and makes me respond to this post is way it is presented.
We've probably all had experiences in our life in which an individual in a position of authority is disrespectful just because of thier position or level of education. If you have a higher level of certification that is an opportunity to encourage and teach.
If I work with an individual who does an exceptional job or displays the potential to advance their education I will encourage however there are individuals who do not have the potential to advance- that does not mean I have less respect for them.

Not my level just enough continuing education that is not required just to keep their cert up, I'm talking like A&P IV ECG things that show that they have some interest in furthering their knowledge.

 

[Clibby]

Yet again, another EMT-B attempting, unsuccessfully, to justify their position. I'm sorry and please do not take this personally, but your examples, especially the "broken bone" one, are completely incorrect. Two words, PAIN MANAGEMENT. I don't care if the ER is pissing distance away, the patient deserves comfort. Preference being in the medicinal form, an act that a BLS provider again cannot provide.

Really? Then why are they BLS calls in every district in the state where I live? Medics don't grow on trees, which is what I think you guys don't get. (And please don't take that personally) They are needed on the trucks running the ALS calls. Would I rather have one on those types of calls? Yes, absolutely, they can make the patient feel better and there should be one in every 911 truck in a perfect world. But on the same note, would I want to have our only medic for the night tied up with a broken arm when a call for chest pain comes out. Now we have to wait 20 min for mutual aid or if we are running a BLS truck, we can tone for a medic who won't be on scene before we are long gone. All so a broken arm feels better. Its about prioritizing with limited resources. Again, I would love to have a medic for every call, and that's what we do during the day, but we don't have the personnel to do so. There are about 4 basics for every medic where I live. It would be fantastic if everyone could be medics, but they just aren't. Saying they should be doesn't do anything for the next call. You have to do the best you can with what you have until things change.

But that is not what bothers me.................

Just as Rid mentioned, the overall system is broke. Experience prior to entering medic school paves the way for horrible habits. Like having the belief its o.k. for a medic to walk away from a cardiac arrest patient and go to the truck to set up his intubation equipment instead of being prepared in the first place. Not to mention that intubation is the LAST think you should be worrying about during a code. Sounds like a half arsed C.F. to me, yet when you typed it, I bet you had no idea that it was remotely incorrect. Right?

Maybe I didn't explain it correctly. We responded to a difficulty breathing and the officer on scene said he was on a cannula and would most likely need to be transported. We had no reason to believe it was anything worse especially when the officer on scene told us everything seemed fine. When we saw him he was cyanotic, still breathing but was getting worse, and alert to verbal. There really isn't much a medic can do in a crowded room when he was on the couch. In the time it takes for him to run to the truck for a bag of meds and the monitor, we can have him in the truck and then transporting 20 sec later. Should he have had his bag? Yes he should have, but he was givin information that made it seem like he just needed the ALS bag, not the Med bag. He wasn't going to start an IV on him on scene or intubate someone who was still breathing at 6 respiration per minute anyway. Also for clarification, he was intubated because the airway could not be maintained with the OPA and his breathing got worse to the point where it stopped entirely in the truck. He had a pulse when he was put in the ambulance and it fell when he went into shock. He was not coding on scene, but his heart slowly failed from when we started the EKG. I looked over the EKG today and apparently it wasn't full arrest; he just had very low electrical activity and it looked like arrest to us at the time. We were going to push the atropine, it was actually already assembled, but his EKG and HR improved enough with just O2 that it was unnecessary. (When I say improved, I mean that when we were at the hospital he was back to being responsive to verbal and kept motioning to get the tube out.) The medic is one of the few I have worked with who knows exactly what he is doing all the time, and I have alot of respect for him. I just don't ask questions of a medic who has been doing this for 28y in the middle of a true emergency call. He knows his stuff and is very good at what he does. If you would like to read the call step by step, I can type it up, but it was just meant as an example of the things a basic can do for a medic.

YA Basic isn't useless...it's just that the bring extremely little to the table, especially when they have never worked with a paramedic before. In all honesty, ask yourself, if you were alone with a patient that needed ALS care, what could you do for them? Answer: next to nothing. While Basic's can assist on calls, they shouldn't be in charge, and shouldn't be taking patients on their own except in very controlled circumstances; your broken leg scenario proves that.

I don't disagree with a word you have said. Basics can cannot do anything, really. Its frustrating, annoying, and for the most part its just a tease for those who are hoping to go on to medic school. (Especially those like me who will be starting medical school next semester^_^) Also basics should never be in charge if there is a paramedic available. That would just be backwards and I don't even see how that is possible. The only BLS calls that we send are either calls when ALS is unavailable, or when the call is dispatched as being a basic call, which there are very few of. We don't like having BLS trucks, but we also don't have the resources or medics around to run ALS all the time on two trucks at night.

The amount of education that goes into learning to be an EMT-B is so minimal it's laughable; if you continue on to a higher level this will become more and more clear to you. The problem is that the majority of basic's don't know this, aren't willing to admit it, aren't willing to admit that they cannot adequately care for most patients, or all of the above. And when this get's pointed out they automatically get defensive about it.

Again, I know, I know, I know! My state is actually trying to get rid of EMT-I and make the requirements for EMT-B higher so we can run IVs, intubate, and push some more meds; but then again we have been hearing this for years and it still won't be enough. (But that's what is great about the field, nothing is ever enough, and I mean that in a good way. We constantly better ourselves in the field or in con-ed. We try to do more and more, but its never enough for me at least.) To be honest, I learned more first aid and emergency response as an Eagle Scout than in EMT-B class, which has helped me in the field. If someone cannot see how little we can do then they have never worked with ALS or on a true emergency.

The reason I am saying all this in our defense is that I've worked with medics before who brush off basics on calls as if they can't do anything. They can do things for the medic, a whole lot at that and we want to otherwise we wouldn't be there. (I work volunteer) They're not hard to do and to be honest it doesn't require much training other knowing how things work. The good basics are the ones who know their medic and know their truck more then anything. When a medic asks for something and you don't know where it is, guess what, you fail and your off the truck. The medic might as well have a FF with him.

Like I said before, basics do their job so medics don't have to worry about the little things. We know its not that much to do, hell a 12 yo can do it, but they are necessary. So when a medic doesn't think we can check glucose or ventilate with a BVM, it is disrespectful to us. That is why many of us get defensive; most of us are more intelligent than most 12 year olds. That's why we are there; use us! You have more important things to do.

 

[Flight-LP]

Really? Then why are they BLS calls in every district in the state where I live?

Because your state, or more specifically its EMS services, are doing it wrong!

Maybe I didn't explain it correctly. We responded to a difficulty breathing and the officer on scene said he was on a cannula and would most likely need to be transported. We had no reason to believe it was anything worse especially when the officer on scene told us everything seemed fine. When we saw him he was cyanotic, still breathing but was getting worse, and alert to verbal. There really isn't much a medic can do in a crowded room when he was on the couch. In the time it takes for him to run to the truck for a bag of meds and the monitor, we can have him in the truck and then transporting 20 sec later. Should he have had his bag? Yes he should have, but he was givin information that made it seem like he just needed the ALS bag, not the Med bag. He wasn't going to start an IV on him on scene or intubate someone who was still breathing at 6 respiration per minute anyway. Also for clarification, he was intubated because the airway could not be maintained with the OPA and his breathing got worse to the point where it stopped entirely in the truck. He had a pulse when he was put in the ambulance and it fell when he went into shock. He was not coding on scene, but his heart slowly failed from when we started the EKG. I looked over the EKG today and apparently it wasn't full arrest; he just had very low electrical activity and it looked like arrest to us at the time. We were going to push the atropine, it was actually already assembled, but his EKG and HR improved enough with just O2 that it was unnecessary. (When I say improved, I mean that when we were at the hospital he was back to being responsive to verbal and kept motioning to get the tube out.) The medic is one of the few I have worked with who knows exactly what he is doing all the time, and I have alot of respect for him. I just don't ask questions of a medic who has been doing this for 28y in the middle of a true emergency call. He knows his stuff and is very good at what he does. If you would like to read the call step by step, I can type it up, but it was just meant as an example of the things a basic can do for a medic.

I still don't think you are explaining it well, I am actually more confused now. "looked over the EKG today and apparently it wasn't a full arrest". Are you kidding me?!?!? It either is or is not a cardiopulmonary arrest and the EKG has ZERO to do with it. Did your patient have a pulse or not? There lies your answer.

"He wasn't going to start an IV on him on scene or intubate someone who was still breathing at 6 respiration per minute anyway". "he was intubated because the airway could not be maintained with the OPA and his breathing got worse to the point where it stopped entirely in the truck" "but his EKG and HR improved enough with just O2 that it was unnecessary"................ So he did need to be intubated after all!

Sorry but your example has no relevence on this thread. It only proves the deficiency described in your partner. Bottom line is your medic was lazy and complacent and instead of relying on his own objective assessment, took the word of someone else with minimal (if any???) medical training. And it bit him in the arse..............

Again, I know, I know, I know! My state is actually trying to get rid of EMT-I and make the requirements for EMT-B higher so we can run IVs, intubate, and push some more meds

This has been beaten to death already. If the current educational system is piss poor (which you agreed with), then why on earth would any educated person allow an EMT-B to start an IV, intubate, or even look at medication. Heck, most Paramedics couldn't tell you a thing about pharmacology at a cellular level, so do you honestly think that you as an EMT could? Not a chance.

Believe it or not, you can meet higher requirements and do all of these thing. In all 50 states. Its called becoming a Paramedic.

So when a medic doesn't think we can check glucose or ventilate with a BVM, it is disrespectful to us.

Considering you didn't with your patient in respiratory failure, it brings questions and doubts.............

Sorry to pi$$ in your Wheaties, but enough is enough. You do not have a leg to stand on with this topic. Nothing more really needs to be said.

God, I have a headache now....................................

Goodnight all, keep it safe!

 

[Amill]

I believe it is good for someone to gain some experience as a basic before getting their 2 year paramedic degree. I would want to make sure it was the field I wished to be in before I get the degree and decide I couldn't handle it or burn out quickly. But I definitely don't see EMT-B as a career or the level we should all stay at. We definitely need to keep expanding our skills and knowledge and continue towards a paramedic degree.

I'm also betting that most providers don't see the need to make every rig an ALS rig. Now I know we're supposed to always error on the patient but I doubt hospitals, private companies, and fire departments always think that way. Even on what seem to be simple calls that don't need ALS skills, the knowledge of paramedics should always be preferred over basics....But ALS costs more than BLS, and companies don't like to waste money when they don't feel they need to. Basics are cheap and easily dispensable.

 

[mycrofft]

Are you certain that they do not need that EKG? Really, what if they had a history of vertigo prior to fall? Ever heard of Sick Sinus Syndrome? IV's.. pain med.'s.. Really, you maybe a tough one but Granny might like that analgesic for a comminuted fracture, and yes I am sure they would like it IV in lieu of I.M..... yes, even just 3' in height. Again, the reason why ALS should be on each every call to assess and treat. The reason many basics assume calls are so simple, is because they have not been taught it might NOT be as simplistic as it seems...

R/r 911

Oh, excremento, I'm stepping right into it, but my first post was sort of about this so let me throw in my perspective from the 'long time at it' RN and former street and military EMT perspective:
1. In the Beginning, the EMT was created by the NHTSA, and it was good. (That's right, boys and girls, the pedigree is from the Department of Transportation, not Health, and contracting with America's ORTHOPAEDIC surgeons, not internists, to write the text) the accent was upon the survival of MVA victims despite primitive means of extrication, non-treatment, and a paucity of dedicated Emergency "rooms".
2. Seeing as how the EMT was alone, and due to crying and haranguing by the medical profession, the EMT was split in twain: EMT-A (ambulance), and EMT-P (paramedic). And it was good.
3. The State of California, and other entities, immediately created nationally unrecognized subvarieties such as "EMT-IV"; as the NAEMT was in its infancy and had no teeth, as infants are wont to lack, this sort of unseemly administrative gerrymandering created a plethora of titles with lots of varying duties, enabling employers to finely shave their personnel budgets and keep EMS providers divided.

Bad or nonexistent first aid does much more harm than an EMS response does good (e.g., a bad first aider can kill your patient, which is why they were taught to refer to their subjects as "victims", not "patients"). Most MI's resulting in the actual need for EMS response result in death, whether it is in the living room you walk into, or a week later in the ICU. Absolute airway embarassment will cause brain damage before you can arrive in most cases. We aren't God, and we aren't a hospital; we will hit the wall running full tilt to do what we can and learn/do whatever will make a difference, but waving letters after your name lacks humility before these facts and makes us look like the three stooges trying to pull rank on each other based on seniority. Shaving the apple to see who has the most appeal and trying to construct a hierarchy/family tree is a fool's errand, your local medical and EMS culture will have its own. We have to be a team. FONT]

 

[mycrofft]

Holding my nose and jumping in...

Mea culpa, press on...

 

[WuLabsWuTecH]

Is the EMT-B a watered down course? From what I have deemed so far, yes! It is a far cry from the Biology Classes i take in college (studying premedicine and Biomedical Engineering) and some things they teach are flat out wrong, but will work for the purposes of an EMT-B or sometimes even paramedic.

What I do believe is that EMT-B's are still critical componts of the EMS system. In my area, every single fire department run by the city of more than 700k and most (>95%) of the 1.7 million people in the metro area are covered solely by Fire Departments that have personnel trained as a FF/EMT-P. I find this to be a crude waste of resources. Of the 1600+ firefighers that work just for the city departments, there is absolutely NO NEED for all of them to be trained to that level. while i agree that an ALS unit in each district is something worthwhile if it is affordable for the city, making EVERY unit an ALS unit is a waste of money. Personally I like the 2 EMT-P/EMT-B trucks per station combination as it provides you with the ability to run 2 EMT-P's for those tougher calls, and otherwise run 1 of each during a routine call.

Being a realist, I realize that in the more rural areas, a tiered system works better as most calls can be handled by Basics and I'd rather have a basic at my doorstep in 5 minutes starting to assess vitals and take immediate interventions with ALS backup on the way in 15-20 minutes than to wait 15-20 for the ALS unit to get here with no treatment until then and them having to start at square 1 when they do get here.

(Disclaimer, those numbers ar ewhat I have heard in school for response times and are just used as an example. Sinec I live in the suburbs, our district's average response time is 3 minutes and the city's is 4 minutes)

Lastly, Rid mentioned earlier that EMT-B's are more or less just providing First Aid. This I HAVE to respectfully disagree with. When was the last time a first aid class taught you how to deliver a baby? Contraindications of giving nitro or epi? Identifying head trauma and holding a C-spine and securing the head onto a backboard? Use a CPAP machine?

Would you like me to obtain a history while you start assessing the patient? Take some vitals maybe? Setup the IV for you? Attach the leads to your EKG? Intubate the patient while you're getting the drugs ready? Provide CPR while you prep your cardiac drugs? (Do realize that they are teaching compressions only CPR to laypersons now!) Take a glucose reading?

Would a FR be able to do all of this? No! But do you really need another Paramedic to do this? No! I feel if used properly, Basics can really be an asset and provide not only ASSESSMENT but TREATMENT to patients in greater care than an FR

 

[Clibby]

Because your state, or more specifically its EMS services, are doing it wrong!

What's your suggestion? You have 5 basics and one medic on your night shift, you don't need to use them all. There are no other medics who can work nights, but two have their radios in town (hopefully on). Mutual assist is 13 min away to one side of town and about 15 from the other side. You try and hire more medics but the private companies steal a lot of them. We could pay the medics even more, but then we have to get more money to pay for them. Training more is cheating because it just doesn't happen at the rate of EMT-B. I'm all ears!!!

I still don't think you are explaining it well, I am actually more confused now. "looked over the EKG today and apparently it wasn't a full arrest". Are you kidding me?!?!? It either is or is not a cardiopulmonary arrest and the EKG has ZERO to do with it. Did your patient have a pulse or not? There lies your answer.

On scene, yes he had a pulse and he was breathing. In the truck, he started with one and it fell to no pulse and he stopped breathing. His bp and hr dropped too low to feel a carotid pulse, but the monitor showed severe bradycardia mistaken for artifacts (looks very similar to asystole in a moving truck, but has beats when the truck stops) which sped up as he was ventilated. IDK if the medic knew or not, but I thought it was asystole for awhile. What I mean is that his heart never actually stopped, but we lost his pulse. I had never seen a pt come back like that before without meds nor did we have the time to figure out why he went into respiratory arrest.

"He wasn't going to start an IV on him on scene or intubate someone who was still breathing at 6 respiration per minute anyway". "he was intubated because the airway could not be maintained with the OPA and his breathing got worse to the point where it stopped entirely in the truck" "but his EKG and HR improved enough with just O2 that it was unnecessary"................ So he did need to be intubated after all!

I never said he didn't, I just said that the medic wasn't going to do it in front of a panicked family especially when an OPA hadn't been inserted yet.

Sorry but your example has no relevence on this thread. It only proves the deficiency described in your partner. Bottom line is your medic was lazy and complacent and instead of relying on his own objective assessment, took the word of someone else with minimal (if any???) medical training. And it bit him in the arse..............

First all police and FF are first reponders, the guy should have known better than to just NRB him. Second I don't see how he was lazy. The pt was in the truck with EKG lines, intubated, and was having an 1 IV inserted in less than 3min on scene instead of setting up flushes and holding a bag and doing all that was done in the truck in the living room with a panicked family in the way, then getting him in the truck. The truck 20 steps from the door has flushes set up, bags hung, the monitor, and most importantly no family.

This has been beaten to death already. If the current educational system is piss poor (which you agreed with), then why on earth would any educated person allow an EMT-B to start an IV, intubate, or even look at medication. Heck, most Paramedics couldn't tell you a thing about pharmacology at a cellular level, so do you honestly think that you as an EMT could? Not a chance.

...well... the whole point of such a program is to educate them to a higher level with more training. Do you think they would just wake up one day and allow basics to intubate, push a few meds, start some IVs? Come on now; I hope they are a little smarter than that. If such a program ever does comes into existence it would have to involve more upgrade courses for current basics so they do know what they are doing. Those medics you speak of who don't know their stuff should take the course too. Many states still have extinct levels because people refuse to take the upgrade courses. I would think you would be all for more education, but now I'm just confused as to what you are looking for; obviously its not a solution.

Believe it or not, you can meet higher requirements and do all of these thing. In all 50 states. Its called becoming a Paramedic.

I really don't think you get it. You point out the obvious without looking at the what we have. Not everyone can afford the $$$ or time for medic school which is why there are basics. Without them the field would lose more that half the workforce, and in my area they would lose more than 75%. Your argument is similar to saying R.N.s are not needed in a hospital; if they want to treat patients to the highest care and understand everything then they should become and M.D. or D.O. Granted the situation is different, but an EMT-B is sort of to a paramedic in a truck what a R.N. is to an M.D. in a trauma room. They assist so the paramedic can do the best job he can; they just operate at different levels.

For me medic school would just be a waste of time. In 4 years I will hopefully be an M.D. and I don't have the time in between to go to medic school.

Considering you didn't with your patient in respiratory failure, it brings questions and doubts.............

What do you mean, the OPA not working? Idk if it was because the pt was too large and the fat on his throat put too much pressure on his trachea or if the basic just wasn't ventilating correctly, but the pt wasn't getting the ventilation necessary. He was tubed and ventilated and it worked. (BTW that basic was fired from our volunteer organization today b/c he didn't know his stuff, so I wouldn't put it past him.)

Sorry to pi$$ in your Wheaties, but enough is enough. You do not have a leg to stand on with this topic. Nothing more really needs to be said.

God, I have a headache now....................................

Goodnight all, keep it safe!

I agree I don't really feel like talking about it any more. Just know that I hate it when people question my intelligence without knowing me. I know my stuff, and I know more about how things work in the body than most people I work with. Just because I haven't trained as a paramedic doesn't mean I am incopetent nor does it mean I won't figure out how things work. Your tone is why so many basics get defensive and sometimes abrasive. To assume we are below you because we aren't paramedics is a paragod syndrome. We know you can treat pts, can interpret EKGs, push meds, and have had far more training in more areas than we do, but those of us who are intelligent can do our job assessing and assisting. I am very surprised to see this tone on this forum.

I hope your headache gets better.

 

[daedalus]

As some of you may know, I recently made the switch over to 911. As an objective observation, I have so far not seen a single patient benefit from ALS level care. Im still very new mind you, but the only treatment I have thus far seen make any difference in a patient's condition was lots of oxygen. I do not argue that paramedics are needed for most 911 calls because of their "advanced assessment" skills. However, from my calls so far, the only thing the medics do is start an IV, and by the time I open it up for them, we are always already in the hospital bay.

If you as an EMT educate yourself in medical terminology, and read up on assessment, you will gain the respect of the ED doctors and nurses for sounding professional, taking accurate assessments, and writing good reports. The ability to put in airways, administer oxygen, use an AED, and know when a patient truly needs an ALS intervention that will make a difference before the hospital is all that you will need for most emergency calls. So what if a patient has sick sinus syndrome? What are you going to do in the 5-10 minute transport that will make this patients life better? Put in a pacemaker? Or push a drug that the hospital cannot? No. In fact, the EMT can diagnose brady or tachycardia. The doc can run the strip. Patient can get better. If anything I have found ALS slows down most calls.

Please don't confuse my post with a intent in saying EMTs do not need more education. I do not agree with that statement. Im saying a good EMT BLS provider is almost always, from my experience, all the patient needs. We need to push for more training. I also realize the important role of ALS level care. An EMT is NOT as educated as a paramedic. But thats no excuse to waist time in the field providing useless procedures, or saying that an EMT who has a good education cannot provide good prehospital care.

 

[LE-EMT]

If the system is so broken why don't you/we fix it?????? what would it take to fix it? I am sure there are many people here that don't want to fix it because I am sure they don't believe that it is broken or just don't want to/cant afford to up grade. But seriously what would it take to fix this system that many don't believe is broken?? This is directed mainly to rid because well you are the who in almost every bls related post has not much to say other then they are in your mind useless. I am paraphrasing sir not putting words in your mouth. I don't disagree this is an objectionable question. Any others feel free to answer but I want educated answers not nonsense.

 

[Ridryder911]

[

As some of you may know, I recently made the switch over to 911. As an objective observation, I have so far not seen a single patient benefit from ALS level care. Im still very new mind you, but the only treatment I have thus far seen make any difference in a patient's condition was lots of oxygen. I do not argue that paramedics are needed for most 911 calls because of their "advanced assessment" skills. However, from my calls so far, the only thing the medics do is start an IV, and by the time I open it up for them, we are always already in the hospital bay.

If you as an EMT educate yourself in medical terminology, and read up on assessment, you will gain the respect of the ED doctors and nurses for sounding professional, taking accurate assessments, and writing good reports. The ability to put in airways, administer oxygen, use an AED, and know when a patient truly needs an ALS intervention that will make a difference before the hospital is all that you will need for most emergency calls. So what if a patient has sick sinus syndrome? What are you going to do in the 5-10 minute transport that will make this patients life better? Put in a pacemaker? Or push a drug that the hospital cannot? No. In fact, the EMT can diagnose brady or tachycardia. The doc can run the strip. Patient can get better. If anything I have found ALS slows down most calls.

Please don't confuse my post with a intent in saying EMTs do not need more education. I do not agree with that statement. Im saying a good EMT BLS provider is almost always, from my experience, all the patient needs. We need to push for more training. I also realize the important role of ALS level care. An EMT is NOT as educated as a paramedic. But that's no excuse to waist time in the field providing useless procedures, or saying that an EMT who has a good education cannot provide good prehospital care.

I would attempt to argue with you, but it very obvious you do not have the knowledge or understand emergency medicine nor cardiology yet. Not to be condensining but really who are you to determine what is needed or not? What medical expertise can you even base to make such opinon as such?

Just alike so many here believe their Basic Entry level couse automatically makes them eligible to know so much about emergency medicine, what is needed, what is not, on what & how things shoud be performed.. Wow ! A lot is offered in that 150 hour course.... So it must be the vast clinical exposure and in-depth praticum of clinical skills.. Oh.. What? You had how many clinicals?.. A week, two weeks... month.. a year? No? Oh, it must be all those areas you gained that knowledge in.. burn unit, surgery, pediatric ICU, CCU, Pysch hospitals.. No ? Wow! Yet, you are able to inform a higher licensed person that does have such, on what should and how it should occur? ... See the irony?

Yes such illness as Sinus Arrest (that occurs in Sick Sinus Syndrome) can be treated alike several hundred illnesses and injuries that can be performed and tx. in a Wal-Mart, a pasture, an EMS Unit, or that 3 million dollar CCU. Medicine is medicine. The same treatment is given for that Sick Sinus/ Arrest be it in the field, ER or CCU. External pacing takes about 30 seconds.. I use the same pads in the field, ER, ICU, CCU. Again the same for many things.

What is the rush to get to a hospital? I do the same thing. Are you aware your chances of living from a code is better outside a hospital than inside one? .. The only reason people rush back to a hospital is for two reasons.. they don't know what to do.... or they know there is nothing else they can do....

Seriously, what authority does a Basic EMT even have to base an opinion on what ALS is, how it is performed? Remember in medicine there is no such thing. ALS = Medical Care with medicine, treatments & medical interventions. So, I ask are you able to be more informed than those with more education and those that have a higher licensed? You can determine what is appropriate care? Wow! That Basic EMT course must be one heck of a course.. And yet, the text is written at sixth grade level and all of the information is contained in one paper back book.

I have not read where anyone called a basic any names, or even belittled except when they have made unrealistic even ignorant or potential dangerous opinions.

Does anyone else notice that those that have a higher education, more experience and higher medical license usually have the same focus? Again, I use the analogy of what would one think of a nurse aide attempting to tell a RN with a DnSc or Nursing Professor all about nursing or what is appropriate nursing interventions. One would think it would be it be strange and not realistic.... the same could be said here and the EMS profession.

Just FYI there are courses that teach C-Spine immobilization, delivering babies, even administering ASA.... it's called Basic First-Aid. Something ARC has been doing for decades.

R/r 911

 

[JPINFV]

If the system is so broken why don't you/we fix it?????? what would it take to fix it? I am sure there are many people here that don't want to fix it because I am sure they don't believe that it is broken or just don't want to/cant afford to up grade. But seriously what would it take to fix this system that many don't believe is broken?? This is directed mainly to rid because well you are the who in almost every bls related post has not much to say other then they are in your mind useless. I am paraphrasing sir not putting words in your mouth. I don't disagree this is an objectionable question. Any others feel free to answer but I want educated answers not nonsense.

Why won't it be fixed any time soon? As you said it, it's not in some people's best interests. You can't make an omelet without cracking a few eggs. A good start would be requiring an actual degreed education and not this 9 months BS with a 10 day A/P course (Example!. 10 days, and claims to be "comprehensive"). EMS can't honestly expect respect in a field where just about every other major player has a real college education. Heck, the lab tech in the lab that's training me for my thesis has a BS and the procedures she follows doesn't even allow for deviation at all.

Who cares about the people who 'can't afford it?' I don't hear too much of an out cry for a 1 year physician program or 120 hour PA program because 'people can't afford it.' No, people take out loans just like every other student under the sun.

Another reason it's not broken is because the public is just too ignorant of the profession. I have not talked to one person who was not shocked that I became a "paramedic" (Yes, I do clarify that I am an EMT-Basic and not a paramedic when this happens) with 120 hours of training. Of course they aren't exactly relieved when they learn that real paramedics still have less than a year of actual training with the prospect of no real education.

Is the system broken? Sure. Unfortunately, half of EMS is suckling from the tit of an EMS system that allows mediocrity and ignorance to flourish more than France was scamming the Oil for Food program pre-Iraq war while the general has no clue what the requirements are in the first place.

Seriously, how many people here have heard someone go, "AND you can do all that?" right after telling them how "long" an EMS course is?

 

[mycrofft]

Someone sorth the threads please

Why won't it be fixed any time soon? As you said it, it's not in some people's best interests. You can't make an omelet without cracking a few eggs. A good start would be requiring an actual degreed education and not this 9 months BS with a 10 day A/P course (Example!. 10 days, and claims to be "comprehensive"). EMS can't honestly expect respect in a field where just about every other major player has a real college education. Heck, the lab tech in the lab that's training me for my thesis has a BS and the procedures she follows doesn't even allow for deviation at all.

Who cares about the people who 'can't afford it?' I don't hear too much of an out cry for a 1 year physician program or 120 hour PA program because 'people can't afford it.' No, people take out loans just like every other student under the sun.

Another reason it's not broken is because the public is just too ignorant of the profession. I have not talked to one person who was not shocked that I became a "paramedic" (Yes, I do clarify that I am an EMT-Basic and not a paramedic when this happens) with 120 hours of training. Of course they aren't exactly relieved when they learn that real paramedics still have less than a year of actual training with the prospect of no real education.

Is the system broken? Sure. Unfortunately, half of EMS is suckling from the tit of an EMS system that allows mediocrity and ignorance to flourish more than France was scamming the Oil for Food program pre-Iraq war while the general has no clue what the requirements are in the first place.

Seriously, how many people here have heard someone go, "AND you can do all that?" right after telling them how "long" an EMS course is?

Rich discourse, spreading out into multiple channels. I'm hearing expostulation about the "structure" and heirarchy of EMS, appropriate measures, and still folks trying to climb on one anothers' shoulders.
To be brutally honest, given the pay rates versus cost of living for field EMS workers, the strict rules and constant exposure to top-down pressure as well as patient initiated complaints (initiating top-down pressure), you are going to have a field mostly composed of transients (newbies, med students, etc); firefighters; and a cadre of folks who have found their niche and will stay with EMS n matter what for emotional and personal reasons. Grocery workers with the teamsters make more money and may be getting better benefits.

If you want to be taken seriously and make a contribution, learn as much as you can, show interest, know when to just listen, get a professional outlook and appearance, and remember that at each echelon of care the patient passes up through what poeple are looking for is concise information passage, not miraculous diagnoses and elegant treatment. As Mike Perry (and others) say, air in and out, blood around and around, all else is gravy; as my EMT instructure Lance said, "unless you have xray vision and a radiology certificate, it ain't a fractured tibia, fibula,etc, it's a 'broke leg'; 'broke' is 'broke', treat the break and get 'em in".

 

[Ridryder911]

If the system is so broken why don't you/we fix it?????? what would it take to fix it? I am sure there are many people here that don't want to fix it because I am sure they don't believe that it is broken or just don't want to/cant afford to up grade. But seriously what would it take to fix this system that many don't believe is broken?? This is directed mainly to rid because well you are the who in almost every bls related post has not much to say other then they are in your mind useless. I am paraphrasing sir not putting words in your mouth. I don't disagree this is an objectionable question. Any others feel free to answer but I want educated answers not nonsense.

I am trying to. I work almost weekly with legislative, EMS educators, administrators, EMS medical directors. I speak at conventions attempting all to be aware of the problems.. as many has pointed out are quite unaware or do not have time, money or resources to change things.. and of of course some do not want to change, because salaries would have to increase, increase competition and accountability would occur.

Why fix something, if it is was working to your advantage?

Start at the beginning. Look at your instructor. Do they have a formal degree? Even maybe an associate? Okay.. how about experience? Okay, they became one because it was an easy moonlight job & one only has to take a 40 hour EMS Instructor Course.. Wow!
Amazing, we require little 5 year old Johnny teacher/educator to have a Bachelor's Degree (preferred Master/Graduate) to teach a 5 year old to color within the lines, but to learn about life threatening injuries & illness... A person that attended a 2 week course (150 hours) and then a 1 week instructor course.. Bingo! They can teach! .. Now, think about that.. across the nation, most instructors have not a clue about adult education, very little about emergency medicine.. but they teach it? Worse you believed it!

Levels.. The only reason for multiple levels is an excuse for a Paramedic. Sorry, that is a fact! This level is almost, or can do similar, etc. Yadda, yadda.. B.S. Town & cities do not want to pay for the level, so the state invents titles/excuses. Amazing every nursing home has a RN, every hospital has at least one RN per floor & division.. Amazing they can find the money to pay for that... again unlike EMS, nursing focuses more on patient care and education... how sad. They joined forces with organizations to ensure that their profession will always be in demand, that patients will somehow have access to them. When was the last time you found a volunteer nurse position at a hospital?

Again, it amazes me the arrogance that someone that barely knows the names of the bones in the body, (definitely not the names of the bone markings) that their anatomy course was a whopping 10 pages long.. to determine if a person is ill or not! Then to tell me that know they know when ALS is taking to long, needed, and or even how to perform and treat better!! That they would not even know pancreatitis if it bit them.. and definitely not aware that it is life threatening illness... yet, I am supposed to trust them to screen patients? C'mon what arrogance and how pompous! .. And they call us Paragods? When in fact, the EMT has very tiny amounts of training and assume they are aware of emergency medicine...that is simply dangerous.

We need to place the EMT's for what they are trained for. Medical first responder.. that's it. Sorry the lame excuses of "saving ALS for real stuff" is just that. Seriously, ER's are full with lame stuff all the time, and very often that so called lame is not really lame after all. The cramp in the leg, is diagnosed as a DVT, the nausea & vomiting is really an AMI or undiagnosed DM w/DKA. Then alike what was mentioned, analgesics/pain control. Really, how can someone say they are for patient care when they would allow a patient to suffer in pain? How inhumane! You would actually rather have someone tolerate manipulation of a fracture for splinting and movement while bone ends ripping tissue and nerve endings rather than have someone administer pain control?.. Yep, that is a BLS call.. Ever had a fracture? Wanted something for pain? ..

Again, there is no such thing in medicine as BLS or ALS. It is patient care. Only in EMS did have to invent such terminology because to make things so simple minded. You do not find treating an acute appendicitis, BLS perform this and ALS perform that.. No, you only find to do the following.. period. Again, only in EMS we continue to allow sub-standard care and actually feel good about ourselves.

The mind set has to be increased from the first day of class of what limitations the EMT has, not so much what they can do. The encouragement of wanting to obtain a deeper more involved education to be able to deliver better and more proper care. Something that we are not apparently doing .. or EMT would be just a phase. Nearly everyone would be expanding their education level immediately.

So why do we have so many excuses of not continuing? Simply; because we allow it. Some complain the costs, the time, the what-ever! What other profession (especially medical) costs so little, so little time is involved that can immediately get a job and perform? Why do EMT's feel that they do not need get a student loan, but can seem to find money for l/s for their vehicle? See something here? Even manicurist that rubs and trims toenails goes to school longer than a EMT, more sadly event a beautician that cuts your hair usually goes longer in school that many Paramedics... Now, that's scary!

So what to do?

Join a organization that is promoting EMS and increasing standards.. NAEMT, NEMSE, etc..
Local associations, demand better legislation for funding, increasing reimbursements, and demand increase level of care.. State wide. Instead of attempting to defend yourself recognize that you do not understand the system or patient care enough, but promote and educate yourself to realize there is a problem. (one cannot fix the problems, until one recognizes them)

Quit whining about what you can do and do the right thing. Go back to school and get an education to understand & know what and to how to treat appropriately..Anyone can do it. That is if it is a priority in their life. Don't allow excuses for poor care.. seriously, if you are a humanitarian enough one would not poor care.

Basically get involved!

 

[Alexakat]

A good start would be requiring an actual degreed education and not this 9 months BS with a 10 day A/P course

I've said this before, but I strongly believe an EMT-B should be educated to an associate's degree level & a paramedic should be educated to a bachelor's degree level!

 

[mikeylikesit]

I've said this before, but I strongly believe an EMT-B should be educated to an associate's degree level & a paramedic should be educated to a bachelor's degree level!

LOL you would spend more time on generals than you would the whole damn program.

 

[Ridryder911]

LOL you would spend more time on generals than you would the whole damn program.

Yeah, what we could learn from all that reading and writing stuff!... Seriously, it is because the Paramedic does not have the general education they cannot understand most medical regime.

One surely would not disagree being educated would be a bad thing would they? Or in other words it is okay to be ... ignorant?

R/r 911

 

[BossyCow]

It seems to me that the two camps on this discussion, as usual are addressing different issues. While I can understand and respect the frustration that a Medic feels when there are not enough Medics to adequately serve their response area and the EMTs are undertrained and/or unprofessional. I don't think any EMT-B here is going to say that ALL basics are highly professional in their appearance, training and skills. There are bad apples spoiling the barrel.

On the other hand, to say that there is no need, ever in any situation for an EMT-B and that all of them should be replaced with Medics, is also inaccurate.
There is not one solution that will work for every district, agency and demographic.

I do not believe that EMT-B's save Medics. I do not believe that all Medics need to be EMT-Bs first. But I also do not believe that all EMT-Bs need to be Medics. I think its perfectly acceptable to take pride in my role in EMS. I can get to a patient before ALS. By the time ALS arrives, the medic has a full set of vitals, an IV set up, the scene is controlled, a history has been taken, ABCs assessed and if needed, CPR in progress, Major bleeds controlled and a monitor in place. This doesn't replace ALS but certainly assists it.

Can all of that be done by a medic? Certainly it can, but why should my pt wait the 20 minutes that it takes for a medic to arrive before those interventions are begun? In many areas of the country, the understaffing of ALS units is a serious problem. Trashing EMT-Bs for stepping up to help mitigate the impact to patients is I believe, the wrong approach.

I admit that some areas of the country and some agencies within my own area of practice seem to be against any sort of quality control or improvement. But I'm not sure that over regulation is the key to eliminating that. There will always be schlock agencies doing the minimum of what is required.

I would love to see the EMT-B curriculum include A&P, Medical Terminology and a ton more clinical time, perhaps even a probationary period of assisting on calls before being fully certified. I paid for and took those classes myself because I wanted to know the information. I include that information in the classes I teach to the EMTs I am responsible for. I also do my fair share of hair pulling and ranting about the quality of EMT-Bs that my state gives permission to treat pts. But I do not believe that eliminating EMT-B is the solution.

There are many reasons why someone may want to limit (yes folks, its a limitation) their certification to EMT-B. Understanding the priorities within our lives is not a character flaw. Part time employment doesn't mean that we are unable or incapable. The economic reality of some areas requires people to work more than one job. A family with children may have to work around a childcare schedule. Should we remove entry level or technical jobs from the job pool? All those currently doing those jobs can do what? Either upgrade to more 'professional' careers or simply go on welfare?

Assisting in the delivery of quality patient care is admirable. Respect of our fellow human beings, regardless of what they do for a living is simple courtesy. Elitism has no place in society and is not a prerequisite to personal pride or integrity. While we all have our ideas of what we would do if we ruled the world, fortunately for society, none of us do. In the meantime, can't we just treat each other with respect?

 

[mikeylikesit]

Yeah, what we could learn from all that reading and writing stuff!... Seriously, it is because the Paramedic does not have the general education they cannot understand most medical regime.

One surely would not disagree being educated would be a bad thing would they? Or in other words it is okay to be ... ignorant?

R/r 911

Hell no, I’m saying an associate’s degree for an EMT-B.
I have a Bachelor in Paramedics like he stated above so that I can teach one day. Between the English Comp. Psychology, Sociology, Kinesiology, Microbiology, and all sorts of other good things I feel it helps a ton.

 

[JPINFV]

To be brutally honest, given the pay rates versus cost of living for field EMS workers, the strict rules and constant exposure to top-down pressure as well as patient initiated complaints (initiating top-down pressure),

Do you think nothing will change without disturbing the status quo? The strict rules, top down pressure, and lack of respect will not change on its own. Otherwise it would be like getting dessert before eating dinner.