EMT-B Certification

[crazycajun]

My question is this. Should the EMT-B certification continue to exist or should it be done away with? It seems every year the training gets shorter and the incoming number of EMT's gets larger. Is it time to get better organized and require a more advanced program?

 

[tickle me doe face]

This is an interesting topic.

I was just reading the Ontario Prehospital Advanced Life Support study, which found that ALS had no better long term outcomes than BLS with respect to heart attacks.

Actually, they found that the few cases where ALS had a better outcome of any sort , were when the patient was in respitory distress, chest pain, or diabeetes.

Therefore, in an EMS system that already has optimal rapid
defibrillation, advanced life support interventions did not improve patient survival.

Here is the link to the study!

 

[mcdonl]

Due to education and geography we need to have the ability for volunteers in rural communities to get EMT-B licenses. But, there needs to be a minum standard of field and hospital time in order for it to be succesful. No field time is a recipe for disaster, particuraly in environments like I mention, where the EMT-B is likley to be in the thick of it right off the bat.

 

[Melclin]

Excuse my slur...I just got home from the pub, but...

I was just reading the Ontario Prehospital Advanced Life Support study, which found that ALS had no better long term outcomes than BLS with respect to heart attacks.

Actually, they found that the few cases where ALS had a better outcome of any sort , were when the patient was in respitory distress, chest pain, or diabeetes.



Here is the link to the study!

In cardiac arrest. Not MI.

It also doesn't take into account the value of good post-ROSC management, which is a decidedly ALS ball game.

OPALS tells us that intubation and ACLS meds do little to augment the basics of compressions/RRD. Thats it. Its doesn't say "Advanced prehospital care in general, has no benefit".

 

[tickle me doe face]

In cardiac arrest. Not MI.

It also doesn't take into account the value of good post-ROSC management, which is a decidedly ALS ball game.

OPALS tells us that intubation and ACLS meds do little to augment the basics of compressions/RRD. Thats it. Its doesn't say "Advanced prehospital care in general, has no benefit".

right, it said ALS does not improve survival rates in resescitation.

 

[fast65]

While I think EMT-B's are very valuable, I do believe we need to start moving towards a more advanced level of initial care. The training seems to be dwindling down to merely "give oxygen and transport". Sure, some might not like the idea, but the fact of that matter is that we need to start advancing our education if we want to start being seen as health care professionals.

 

[tickle me doe face]

I think that option 1 "Do away with it all together and make EMT-A the minimum?" is the leas feasible of all

 

[fast65]

I think that option 1 "Do away with it all together and make EMT-A the minimum?" is the leas feasible of all

And why do you believe that?

 

[tickle me doe face]

And why do you believe that?

It seems like it allows for people to advance there clinical skills, without advancing clinical knowledge.

Like when EMT-I's call themselves medics.

 

[fast65]

It seems like it allows for people to advance there clinical skills, without advancing clinical knowledge.

Like when EMT-I's call themselves medics.

I think the general inference is that with an advanced level of care and skill set, they get the education to supplement it. We are talking about just advancing the level of care, we're talking about advancing the education to go along with it. We don't need a more advanced skill set, we need to more A&P, pathophysiology, pharmacology, etc, then we can look at advancing the skill set.

 

[Shishkabob]

The thing is, EMTs are taught the wrong stuff for what their job ends up being most of the time: Help to an ALS provider. Very rarely is an EMT actually in charge of a scene to where an ALS provider will not be available, but much of EMT class is teaching them about how to run such calls.




So, if we were to go off of what their role ends up being, yes, the education is adequate, however it should still be changed to reflect the true role. But if we were to go off of what EMT classes teaches them their role is (in charge of emergency scenes), then no, what they are taught is not adequate.



In my world, it would be an AEMT (Intermediate) on the truck with a Paramedic.

 

[tickle me doe face]

I understand that lots of EMT's are not kept on a medic's leash.

I also know for fact that local services run trucks with 2 emt's and no medic!

 

[Shishkabob]

And I'm going to assume they are a first responder organization that waits for the ambulance which has a Paramedic, no?

 

[Backwoods]

The thing is, EMTs are taught the wrong stuff for what their job ends up being most of the time: Help to an ALS provider. Very rarely is an EMT actually in charge of a scene to where an ALS provider will not be available, but much of EMT class is teaching them about how to run such calls....

In a urban area/a dept. that actually has medics, this would be true. But in a rural area with a department like mine all you have is EMT-Bs.

 

[MrBrown]

There is no level analogous to EMT here, we have 3 day trained first responders who work on the nana taxi (PTS) or at private hire events and above them are Technician level Ambulance Officers who require a Diploma and sit somewhere more toward the Advanced EMT level but without IV cannulation

Should the 120 hour wonder be retained? Sure, as a first responder

 

[Shishkabob]

In a urban area/a dept. that actually has medics, this would be true. But in a rural area with a department like mine all you have is EMT-Bs.

Rural BLS departnement that transports without ALS ever, EVER, being on a call? How many calls a year do you get?


I work in a rural county where all the VFDs are first responders / EMTs. Still transported by an ALS ambulance. I don't expect the volles to be able to do much in the wait they have till I get there, because, well... they can't.




(PS, my thing doesn't hold true for places that do a tiered response with an EMT ambulance and Paramedic fly car... which is why I said MOST of the time)

 

[Tigger]

I understand that lots of EMT's are not kept on a medic's leash.

I also know for fact that local services run trucks with 2 emt's and no medic!

I work on a double basic truck, and from a pre-hospital care perspective, it sucks. For the IFT side of things, it's generally fine. I would have appreciated more information on dialysis, radiation, and other topics associated with IFT transfers in class to be sure. But suck knowledge is not really required for one to become a proficient horizontal taxi tech.

When we get an actual EMS call, being a double basic truck sucks. We can do so little at most medical calls to alleviate any pain or discomfort it's almost embarrassing. Wait, actually it is embarrassing. We don't really have the ALS option here either, even being in a metro area. I'd rather just get the patient to the ER then wait around for one of the few ALS units. My company does not currently keep any medic trucks in the city, and we are not going to use one of the city's six medic trucks unless we absolutely have too since most of the time they are just going to transport to a nearby, acclaimed hospital. Even with all the hospitals in Boston, we can still have twenty minute transports where the patient lies there and suffers.


Sent from my out of area communications device.

 

[AK_SAR]

.....Very rarely is an EMT actually in charge of a scene to where an ALS provider will not be available....

That depends on where you are. Urban....rural with slightly longer access to ALS...or really rural where ALS might be many hours away?

In Alaska, only the larger communities have full time ALS available. Even on the road network, many smaller communities have only a local, volunteer EMS. It is very difficult (often impossible) for them to maintain a 24/7 ALS service. The nearest paramedic can be hours away by road. Even helicopter medevac can be an hour or more away, assuming the weather is good enough to fly. In addition, there are many tiny villages which are only accessable by air or water. In bush Alaska, the reality is often not the "golden hour", but rather the "golden 24 hours".

Granted, rural Alaska is probably an extreme situation. However, I have no doubt there are many areas, particularly in the western states, with similar issues.

 

[BEorP]

This is an interesting topic.

I was just reading the Ontario Prehospital Advanced Life Support study, which found that ALS had no better long term outcomes than BLS with respect to heart attacks.

Actually, they found that the few cases where ALS had a better outcome of any sort , were when the patient was in respitory distress, chest pain, or diabeetes.



Here is the link to the study!

Can you please tell me how the Ontario PCP training compares to EMT-B if we're putting them both in the "BLS" basket?

 

[tickle me doe face]

Can you please tell me how the Ontario PCP training compares to EMT-B if we're putting them both in the "BLS" basket?

I thought we were comparing comparable training levels?

the study said als did not equate to bigger survival rates in cardiac arrest