Basic's Have their Place Too.

[MedicPrincess]

Got to talk with a still rather new medic tonight. New as to say she has less than 3 years in the field. With all there is to see, do, and learn I would call that still rather new.

So anyway....Medic, another person in my dept, and i were talking about how the EMS systems runs here and how much a Medic makes vs. a Basic.

Medic Girl says her truck tonight has 3 people on it, all of them being Medics. I (on the lookout for a job now), inquire as to whether their service is short of EMT's, as normally the trucks here are EMT/Medic ran.

She replied with Not necessarily short, but she believes it is always better to have 2 ALS providers on everycall as opposed to a solely BLS person. She also indicated that is the only way she likes to run.

So, being the new-ever so eager-Basic I am, I ask, Well an EMT has their place.
To which she responds "Yea. Sweeping my truck."

UGH. So, I decided not to even engage her. But after she left my other co-worker and I talked more about it. He is Pre-Med, and asked what I meant about an EMT having their place, because isn't the Medics skillset so much more advanced, and that should mean they should be able to provide for the patient so much more..

Never wanting to miss an opportunity to express my opinion I too the time to explain the whole BLS before ALS idea. I also had him think about the DR on in the ER tonight. This man can diagnose 9 outta 10 patients from the door to their room, without laying a hand on them. He doesn't need all his fancy drugs, and tests, and interventions as he remembers, and will tell you he does, he takes everything back to basics.

So what would you guys rather have, 2 Medics or 1 EMT/1 Medic?

 

[Stevo]

perhaps the newbie has not been privy to the addage "Medics save lives, EMT's save Medic's" Princess

~S~

 

[hfdff422]

It is easy to feel overly confident by having all the whiz-bang gizmos that a paramedic can have along with the more advanced training. In certain situations a medic is critical and will give the patient the greatest chance of survival. In other situations, the medic cant change how fast you get to the hospital, and that IV is only a convenience for the hospital staff. In our system, most of the volly's busses are BLS, when we get a medic (when one is available) we are usually well involved in patient care by the time they get to us, if not transporting. B's in our area are actually quite capable of rendering patient care due to this. B's that come from a medic bus background get a little worried about being on their own. I'm not saying seeing the lights of that medic truck coming down the road isn't the greatest sight in the world in a caridac situation, or when the baby is presenting a limb first- but BLS skills will usually get a viable patient to the hospital.

What really gets to me are the medics that wont ever drive the bus. "No this is an ALS ambulance, that is the level of care this broken arm is getting!"?? Letting the B handle the run once in a while will pay dividends when you really need a seasoned EMS provider. Where I come from, you don't become a B because you are incapable of handling ALS training (yes it does happen), but rather you become a B because you can't afford the time investment or it would be pointless (most volly's).

Oh, by the way, You can't be a paramedic or intermediate until you are a basic anyway, the only way to be a good paramedic is to be a good basic first. A crappy paramedic started as a crappy B (or they froget their BLS training), so take the time to make sure that your B's can give a high level of patient care.

 

[Firechic]

So, being the new-ever so eager-Basic I am, I ask, Well an EMT has their place.
To which she responds "Yea. Sweeping my truck."

What an ignorant and offensive statement.

My department runs 2 paramedics per MICU which I prefer for several reasons. Yes, BLS is always before ALS. We have lots of really advanced "toys" that on a normal basis are not required, BUT when I do need to use them, I need another medic. My biggest pro for dual medics is that the EMTs around my neck of the woods do not have the knowledge regarding pharmacology, disease processes, cardiology, EKG interpretation, assessments, etc. Our protocols are aggressive and at times a second set of eyes and a consult for another opinion on the scene is helpful.
The EMTs I work with cannot help us in that capacity. I know every system is different, but this is how it is where I work.

 

[CaptainPanic]

I would have reported that as a degrading comment to the supervisor. With the lawsuit happy world we are in you could probably get the ACLU involved over that one, LOL.

But seriously the statement offended even me. If I were there I would have degraded her to a puddle, and if I were the supervisor, I would limit her skills to that of an EMT until she proved herself otherwise. Once she gets put back into a BLS position she'll be more appreciative of her training and that EMTs can help Medics, and oh interns sweep out the bus. :lol:

-CP

 

[Stevo]

i could speak volumes on the ACLU

but people tend to run to them when they fel they are wronged, yet not make much effort to uphold the American ideals they stand for if not.

none of us are free anymore here, but few really realize the common denominator inclusive in being free to begin with

sad that.....

~S~

 

[hfdff422]

Originally posted by Stevo@Nov 11 2005, 02:15 PM
i could speak volumes on the ACLU

but people tend to run to them when they fel they are wronged, yet not make much effort to uphold the American ideals they stand for if not.

none of us are free anymore here, but few really realize the common denominator inclusive in being free to begin with

sad that.....

~S~

Like stevo said, ummmmm... wait he is off topic...... I think.

 

[Jon]

Around here, many places run Dual medic, many run single medic.

Philly runs 2 medics 24x7 on every ambulance (well.. used to (until last month)... now using FF/EMT's to staff a few BLS rigs that run BS calls).

Many "smaller" transport co's only have 1 ALS provider on at a time, but they have 24 hour ALS coverage. Too often, the ALS driver doesn't know what they are doing, and sometimes can't even read a map :lol: . At my current part-time job, we've got a few folks who like to drive ALS: Me, who is almost, but not quite, through medic school, another was an EMT-I in CA, and is now and EMT-B b/c PA dosen't have an "I." The others all have spent time as ER techs, all of us "know how" to do many of the ALS interventions (pushing 1:1000 epi is similar to flushing a line - but we would NEVER do an ALS skill, Ever). We've also all spent time riding with medics for years... we all know how to hook up a monitor, run through IV tubing, or hold cricord pressure.

My parttime job is addressing this training issue, and the ALS staff are putting together a class of "ALS for BLS" - how EMT's can help the medic.

My point is - too often, someone who shouldn't even have an EMT card drives a medic... they make all of us look bad.

Jon

 

[TTLWHKR]

Originally posted by Stevo@Nov 11 2005, 07:46 AM
perhaps the newbie has not been privy to the addage "Medics save lives, EMT's save Medic's" Princess

~S~

As a Paramedic... I would never say that. That's what people with a huge ego and a tiny... um nevermind... any way.

We all save lives... We just have different methods.

Never put yourself above your partner, you're both on the same level, training aside.

 

[hfdff422]

In Indiana ALS assist is a necessary component of EMT-B training. It is on our state CE sheets for our recerts as well.

 

[Stevo]

Never put yourself above your partner, you're both on the same level, training aside.

well said TTLWHKR, ems does attract a lot of class A personalities doesn't it? and such youngsters with their chests puffed out can be hard to listen to...

they lack the humility expereince brings, which most silverbacks are well aware of

~S~

 

[ndilley]

medicstudentjon could you let me know more about that als for bls program b/c my service has only two 24/7 trucks and sometimes we only have one medic for the entire county (about 17,000 people) which means there are 3 basics. Often the medic assumes that the emts know how to help them (with 12 leads, etc.) and they don't... i think that kind of class would be great for my service.

 

[TTLWHKR]

"ALS Assistant" can't actually do anything extra, outside of their SOP.. It just trains the EMT to set up the medics equipment.

I.E. run a line, place electrodes, get out his protocol drugs during resuscitation, cric pressure, setting up for intubation.

I'm a State Certified EMT Instructor; and I've taught the class on four occasions. The first two times it was strictly... by a whim. There was no booklets, so I winged it with what I would want them to know v.s. what the sheet told me to teach them.

In the third class, we let them intubate a dummy a couple times, made it more hands on than classroom. It was 13 hours long after all, when it was extended to 16, I really made it fun. Possibly illegal too..

At the time, the class was pointless, because it was just an experiment, they couldn't assist the medic yet, legally.

So in my last class, not only was it educational, but fun (which is prolly why they didn't ask me to do another).

It is my philosophy that people learn more when they are doing it, than sitting and listening about it.

So; I made the 16 hour class into an 18 hour class...

We taught them to do 4, 6 and 12 lead EKG's, and how to interpret the rythmn.
How to choose the correct ET Tube, intubate, listen for proper placement, assist with NG tube insertion, and how to get a tricky tube with some lido jelly and a little bit of know how... Let them intubate for a while, on the ugly head.

Then we did IV's... That is, we showed them how to find a vein, and place a cath.. easiest place for an IV is the forearm or the back of the hand. I.e. peripheral IV. Then they practiced on dummy arms, then on anyone who would agree to being poked. Ran lines.

Taught them how to do an albuterol treatment while the medic was busy doing something else, how to do a SubQ injection, lido jelly on a difficult BLS nasal airway (to numb the nares) i.e. people stop fighting back.

Pharmacology for their region, what drugs they would need for different problems, how to draw meds from a vial or amp; assemble predrawn syringes, load the vacutainer chamber, set up for bone injection, **tear my tape properly, place a tegaderm, set up a saline lock, set up the pressure infuser and put the CPAP together...

Sure most of it they can't use, but it was fun, and they all passed. Some of that would come in handy, as a medic, when I'm faced with the "oh s*** factor". When I need another hand, and my only partner has to drive; I'd wish for an EMT from my ALS2BLS class. I wouldn't let them do an IV, or intubate; but they would know what to do for me with out forcing me to triple task.

 

[Stevo]

That's cool that you've taken the time TTLWHKR, i hope some future medics reminice fondly of your efforts

around here we play the armchair medic all the time, in fact of the medics that do frequent us we are farmiliar with their particulars, one likes a T tap, one likes a hand with seleck's manuver, most like to be handed blood tubes, etc...

if, as a basic, one is taught to subscribe to a continuity of care, one should take the time to realize what that is

~S~

 

[Jon]

Alex's class is simlar to the class that is taught locally.

It is strictly explained to the class that "You CAN'T DO THIS" but - here's how to do it right .

As Alex said - by the EMT knowing how to do ______, they know what the Medic will need.

Jon

 

[TTLWHKR]

Originally posted by MedicStudentJon@Nov 12 2005, 08:09 PM


Jon

Oh, I didn't know that.




Alex

 

[ResTech]

We have the ALS Technician course here in South-Central, PA and covers everything already mentioned basicly. One neat little thing they do is bring is pig lungs and have the students observe ventilation of the lungs with explanation of A&P. Kinda nice thing to use to illustrate. I know where I work if ur trusted u do some things u prob shouldnt. Nothing major but it helps the medic out. For example, giving SL NTG, applying NTG paste, giving ASA, setting up the neb and actually giving albuterol, and I even flushed the lock immediately after the medic gave adenosine. Itz all about helping hands.

 

[Yoder-Ambulance]

"ALS Assistant" can't actually do anything extra, outside of their SOP.. It just trains the EMT to set up the medics equipment.

I.E. run a line, place electrodes, get out his protocol drugs during resuscitation, cric pressure, setting up for intubation.

I'm a State Certified EMT Instructor; and I've taught the class on four occasions. The first two times it was strictly... by a whim. There was no booklets, so I winged it with what I would want them to know v.s. what the sheet told me to teach them.

In the third class, we let them intubate a dummy a couple times, made it more hands on than classroom. It was 13 hours long after all, when it was extended to 16, I really made it fun. Possibly illegal too..

At the time, the class was pointless, because it was just an experiment, they couldn't assist the medic yet, legally.

So in my last class, not only was it educational, but fun (which is prolly why they didn't ask me to do another).

It is my philosophy that people learn more when they are doing it, than sitting and listening about it.

So; I made the 16 hour class into an 18 hour class...

We taught them to do 4, 6 and 12 lead EKG's, and how to interpret the rythmn.
How to choose the correct ET Tube, intubate, listen for proper placement, assist with NG tube insertion, and how to get a tricky tube with some lido jelly and a little bit of know how... Let them intubate for a while, on the ugly head.

Then we did IV's... That is, we showed them how to find a vein, and place a cath.. easiest place for an IV is the forearm or the back of the hand. I.e. peripheral IV. Then they practiced on dummy arms, then on anyone who would agree to being poked. Ran lines.

Taught them how to do an albuterol treatment while the medic was busy doing something else, how to do a SubQ injection, lido jelly on a difficult BLS nasal airway (to numb the nares) i.e. people stop fighting back.

Pharmacology for their region, what drugs they would need for different problems, how to draw meds from a vial or amp; assemble predrawn syringes, load the vacutainer chamber, set up for bone injection, **tear my tape properly, place a tegaderm, set up a saline lock, set up the pressure infuser and put the CPAP together...

Sure most of it they can't use, but it was fun, and they all passed. Some of that would come in handy, as a medic, when I'm faced with the "oh s*** factor". When I need another hand, and my only partner has to drive; I'd wish for an EMT from my ALS2BLS class. I wouldn't let them do an IV, or intubate; but they would know what to do for me with out forcing me to triple task.

I love this post and have to say that any medic worth his/her gold patch should be doing this with their B partner every day. Putting this into a military perspective, a good medic should be like a good NCO, a teacher and mentor. A good Medic must be willing to pass on the knowledge obtained through school or experience. One learns almost as much through teaching as one does through doing.

 

[FFEMT1764]

I would much rather have a well trained and eager to learn basic on my truck than a medic who is burned out and, well, lazy is a nice way to put it. To the other arguement, they are some Crappie! basics out there who think they know more than me...thye have 3-6 months of experience in EMS, and lil ole me has 12+ years....but they still "know" more than me...so I sometimes wish I was on the QRV (1 medic in a scantly equipt puckup truck), but most times I prefer a basic partner...1, they can get more experience as I will let them ride any call they want that isnt ALS and they are comfortable with. 2, I have no problem explaining things to people who are willing and interested in learning.

 

[emtd29]

So, being the new-ever so eager-Basic I am, I ask, Well an EMT has their place.
To which she responds "Yea. Sweeping my truck."

SWEEP YOUR OWN TRUCK!!!