EMT-B Certification

[crazycajun]

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.

So why would it be a problem for them to get an A cert instead of a B cert? It seems the PT's in that area would benefit more have ALS personnel than BLS personnel.

 

[crazycajun]

Like when EMT-I's call themselves medics.

If this is in reference to my info screen, IT says EMT-I Medic Student which means I am in Medic school.

 

[tickle me doe face]

If this is in reference to my info screen, IT says EMT-I Medic Student which means I am in Medic school.

No, not a pot shot at you.

I've seen EMT-I's refer to themselves as medics in blog posts, articles, threads, etc. though

 

[crazycajun]

No, not a pot shot at you.

I've seen EMT-I's refer to themselves as medics in blog posts, articles, threads, etc. though

I have seen basics do the same. It really doesn't bother me one way or the other. When I first got certified in the 80's I was considered an EMT-A which was a paramedic back then. When we switched to NREMT certs I didn't have time to go through the transition so I just kept the EMT-I. Now I wish I would have done it back then.

 

[tickle me doe face]

I have seen basics do the same. It really doesn't bother me one way or the other. When I first got certified in the 80's I was considered an EMT-A which was a paramedic back then. When we switched to NREMT certs I didn't have time to go through the transition so I just kept the EMT-I. Now I wish I would have done it back then.

Oh. thought there was a difference, like paramedic was the be all end all

 

[Backwoods]

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

A neighboring township does have medics but we normally dont call for them. And we get about 120ish calls a year

 

[Aprz]

This is just a list I compiled thinking about what an EMT can do where I live. Obviously this varies slightly depending on where you live, but for the most part, I believe it should be mostly similar.

• MIs/Atraumatic Chest Pain
    º Cannot
         Cannot do 3-leads.
         Cannot administer ASA.
         Cannot administer NTG.
    º Can
         "Assist" with NTG.
         Adminsiter oxygen.
         Put in position of comfort.
         Transport to nearest appropriate facility.
• Asthma/SOB
    º Cannot
         Cannot administer albuterol.
         Cannot nebulize.
    º Can
         "Assist" with albuterol.
         Administer oyxgen.
         Put in position of comfort (semi or high Fowler's).
         Transport to nearest appropriate facility.
• Diabetes
    º Cannot
         Cannot check BGL.
         Cannot administer glucose.
         Cannot administer glucagon.
    º Can
         Can "assist" with glucose, or order them to eat/drink.
         Administer oxygen.
         Put in position of transport.
         Transport to nearest appropriate facility.
• Anaphylaxis
    º Cannot
         Cannot administer epinephrine.
    º Can
         Can "assist" with epi pen.
         "Assist" with epi pens.
         Administer oxygen.
         Put in position of comfort.
         Transport to nearest appropriate facility.
• Trauma
    º Cannot
         Cannot administer any drug for pain management.
         Cannot start an IV.
    º Can
         Rest
         Ice
         Compress/Splint
         Elevate
         Backboard
         Put on a c-collar.
         KED
         Traction splint
         Put on gauze.
         Direct pressure.
         Tourniquet.
         Administer oxygen.
         Put in position of comfort.
         Transport to nearest appropriate facility.
• Opiate OD
    º Cannot
         Administer naloxone.
    º Can
         PPV
         Administer oxygen.
         Put in position of comfort.
         Transport to nearest appropriate facility.

This list isn't about what an EMT can/can't do, especially compared to an AEMT, Paramedic, RN, Physician, etc; it's about whether an can handle most common emergencies. I believe they can't.

The curriculum for an EMT is so contradicting and lacks. EMTs are tested on various conditions like emphysema, acute bronchitis, pulmonary embolus, myocardium infarction, angina pectoris, abdominal aortic dissection, ectopic pregnancies, etc., yet they are often told they cannot diagnose. Like JPINFV has mentioned over and over, how can you treat without diagnosing? I may have an answer for that.

In my opinion, EMTs alreadly lack the ability to treat (for most situations). If you didn't notice, they usually go through the same treatment algorithm: oxygen, position, transport. Unfortunately, EMTs aren't even very well educated in usually the only drug they can administer, oxygen. They often believe it's benign, it can only benefit the patient, and sometimes students are even told that it serves as a placebo for pain management! A lot of EMTs I've met are confused about the name of positions, don't know the name of positions, and cannot speculate what's the best position for patients. Generally they know that the patient should be sitting up (semi-Fowler's or high-Fowler's) if they are short of breath, or lying down (supine) if they are in shock. They may possibly even be incorrectly taught to place the patient in the supine position with their legs lifted up (a modified trendelenburg position, "the shock position") for shock. If the patient is pregnant or vomiting, place the patient on their side ((left) lateral recumbent, or the "recovery position" post ROSC or spontaneous respiration in their AHA CPR class). A lot of EMTs aren't introduced to the V/Q ratio, yet we think about blood pooling back from the thighs in the modified trendelenburg position only, or that it won't compromise airway because airway only has to do with the mouth, right?

A lot of EMTs know how to do vital signs (V/S), but often they aren't aware of other values such as mean arterial pressure (MAP) or pulse pressure, which both can be either rapidly estimated or figured out, or on an NIBP, it'll be the third number. A lot of EMTs are confused on the normal V/S for pediatrics and geriatrics, don't know how to choose the correct size sphygmomanometer for their patients, believe that the bell of the stethoscope is for pediatric patients (if you have a smaller iPod, smaller head phones are appropriate for it), will not consider/speculate the possible rhythms when taking a pulse (something a Paramedic can do... what are you going to think if you palpate a fast irregular rhythm?), etc. Some programs don't introduce their EMTs to different respiratory rhythms like Cheyne-Stokes, Biots, Kussmaul, Apneustic, etc., they cannot visually associate that with conditions. I don't believe it's in the curriculum to teach the late sign of respiratory distress, often cyanosis is mentioned, but not as a late sign, and EMTs can barely value SpO2 <sarcasm>other than some sort of game of trying to get 100%.</sarcasm>

Essentially an EMT is person that is CPR certified with a little bit of training in first aid, can backboard, push gurneys, drive an ambulance, ask questions, and relay the answer to those questions. This is both why EMT should be trashed, and a reason why you shouldn't waste time waiting to go to medic school so you can gain "experience" as an EMT (however, a benefit of waiting is observing Paramedics, experience sitting in an ambulance, and see if that's what you want to do, which is a benefit I like, but I don't believe it should be enforced).

I believe an AEMT more closely matches somebody who can manage most emergencies, and I think it's a near acceptable minimum, however, I wish we'd start mimicking nursing by requiring chemistry, biology, anatomy, physiology, etc., even if it wasn't the entire class, but rather what pertained to our drugs, the patient's condition, why you need to size an NPA or OPA, etc.

I believe an AEMT more closely matches somebody who can manage most emergencies, and I think it's a near acceptable minimum, however, I wish we'd start mimicking nursing by requiring chemistry, biology, anatomy, physiology, etc., even if it wasn't the entire class, but rather what pertained to our drugs, the patient's condition, why you need to size an NPA or OPA, etc.

 

[BEorP]

I thought we were comparing comparable training levels?

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

PCPs in Ontario have at least two years of college education. This is very different from the 120 hour minimum for EMT-B.

But you are correct that ACLS has not been shown to improve survival to hospital discharge.

 

[Aprz]

PCPs in Ontario have at least two years of college education. This is very different from the 120 hour minimum for EMT-B.

But you are correct that ACLS has not been shown to improve survival to hospital discharge.

In California, the minimum is 110. The 3-month program I went to raised the bar, 119 hours.

 

[Chief Complaint]

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

Like when EMT-I's call themselves medics.

EMT-I's are absolutely medics in some parts of the country. If the state uses the I-99 standard they are medics if you ask me.

I'm an Intermediate and I, as well as every single agency in Virginia, refers to us as medics. My protocols are exactly the same as a Paramedic's protocols in my county.

 

[Tigger]

EMT-I's are absolutely medics in some parts of the country. If the state uses the I-99 standard they are medics if you ask me.

I'm an Intermediate and I, as well as every single agency in Virginia, refers to us as medics. My protocols are exactly the same as a Paramedic's protocols in my county.

So then what's the difference between you and a paramedic, and why bother even having paramedics at all?

 

[tickle me doe face]

EMT-I's are absolutely medics in some parts of the country. If the state uses the I-99 standard they are medics if you ask me.

I'm an Intermediate and I, as well as every single agency in Virginia, refers to us as medics. My protocols are exactly the same as a Paramedic's protocols in my county.

but you aren't a paramedic?

 

[tickle me doe face]

PCPs in Ontario have at least two years of college education. This is very different from the 120 hour minimum for EMT-B.

But you are correct that ACLS has not been shown to improve survival to hospital discharge.

oh. thanks. I didn't realize the article menioned PPC's, or even what they were.

 

[tickle me doe face]

EMT-I's are absolutely medics in some parts of the country. If the state uses the I-99 standard they are medics if you ask me.

I'm an Intermediate and I, as well as every single agency in Virginia, refers to us as medics. My protocols are exactly the same as a Paramedic's protocols in my county.

If we are going to play that game, then I am a Flight/Trauma Nurse Practitioner.

 

[JPINFV]

but you aren't a paramedic?

...some states call their EMT-I/99s "EMT-Paramedic." Well, one state... Iowa.

 

[fast65]

If we are going to play that game, then I am a Flight/Trauma Nurse Practitioner.

Would you like to offer an explanation?

 

[Chief Complaint]

So then what's the difference between you and a paramedic, and why bother even having paramedics at all?

The only real difference, and its an important one if you ask me, is that Paramedics have a better understanding of advanced pathophysiology. Other than that, no real difference.

The counties want people with the highest level of certification/education, so they prefer P's to I's. Paramedics are given priority when there are jobs to be had.

but you aren't a paramedic?

Thats correct.

If we are going to play that game, then I am a Flight/Trauma Nurse Practitioner.

Im not following.

 

[8jimi8]

If we are going to play that game, then I am a Flight/Trauma Nurse Practitioner.

Interesting.

 

[coastiewifejenna]

From a student perspective

So I know that I am fairly new to the EMS field but I have noticed a few things that may have been overlooked. So I came from Central Illinois where it is all rural communities and volunteer departments. However, I am from one of the two larger towns in the area so we have a municipal fire department and we also have private services. Now where I live all of the firefighters are required to have their medic licenses. This is a new change and so most of the guys dont have very much experience. There are two private services in my town also. These two services switch who is on 911 each week. But the fire dept goes out for evey call. 95% of the time they leave in the first 2 minutes they are there but they get to say that they went "on the call". I went to a call and the private service asked the FD guys if they knew how to splint this ankle with a pillow and they hesitated and said no and then closed the door to the back of our rig. Now we were going to give these individuals the opportunity to learn a skill and they opted not to. And these guys have their medic licenses??? I looked at my other medic and said OMG. We tried I guess. I just think that it speaks volumes about why you get into this. They were forced to keep their jobs at the FD and we do this because we wana help people. So I dont think it necessarily has to do with time persay as much as it would be experience. # of runs of a list of things you have to observe before you get your EMT license not just the # of hours you sat at the shop. Quality over quantity.

 

[MrBrown]

Interesting.

Very