JPINFV
Gadfly
- 12,681
- 197
- 63
People have been complaining that I'm too harsh with my criticisms of EMT-B training and education. As a preface, let me say that critiquing a level is different than critiquing a person. Saying that x level is undereducated for what they do is criticism of the system, not any one person. If you feel personally injured because you're a basic and disagree with me, then let me apologize in advance, it's not personal. Furthermore, let me put out that policies, rules, procedures, and protocols must target the lowest common denominator, not the best and brightest. There can not be one treatment standard for EMT-Bs from one course and a completely different standard for EMT-Bs from a different course.
Is 120 hours enough? I say no. EMS personal work in an acute system away from many of the safeguards that are found in the hospital. Many times, there are no extra providers on scene [versus, say, a hospital. There isn't a pharmacy to discuss medications with, there isn't an RT to assist managing respiratory problems, there are no physicians on scene] as there is in a hospital. Yes, we do have "protocols" [which, in a representative number of systems, are guidelines and suggestions, not cookbook treatment plans] and online medical control [mostly, though there are exceptions though]. Even with online medical control, a provider has to have the education and training to understand what needs to be communicated to the base hospital. The provider must be able to operate, at the very least, as an interface between the physician and the patient, the proverbial hands and eyes.
So, I ask again, in a system like this, is 110 hours, give or take, enough? When 99% of medical scenarios in a given training class can be answered, regardless of the complaint, with a stock reply of "high flow O2 [15 LPM, of course, because the National Registry, whose tests are based off of the DOT standards, thinks that 120 hours isn't enough to decide between high and low flow, or even 10 LPM and 15], call someone else [paramedic intercept], position of comfort, and transport immediately" are we, as providers, really helping patients? Now it should be noted that treatment 'stops' not because there's nothing else the patient might need, but simply because the provider is out of options.
Let's look at the drugs that EMT-Bs can administer based on their assessment under DOT training standards [so no pre-prescribed "patient assist" drugs]. The drugs are simply oxygen, activated charcoal, and oral glucose. Some systems have expanded their scope of practice and protocols for EMT-Basics to include narcan, nitro, albuterol, and/or epinephrine for anaphylaxis shock (based on the EMT-B's assessment and judgement, not based on a patient's prior prescription for the medication), but these systems are hardly representative of EMS as a whole. The entire required pharmacology education and training for EMT-Bs [note: This includes patient assist medications] is one hour long. Is 1 hour honestly long enough to understand the what, why, and how of how oxygen is used by the body? The answer is no.
"Surely," you ask [and don't call me Shirley], "normal body functions is covered in depth during the A/P portion of the course?" Well, let's look at that, in terms of hours. The "Human Body" section required by US DOT is a only 2.5 hours long. Again, this is for all of the physiology and anatomy for the entire course. Therefore I put forth that the knowledge base required for EMT-Bs, especially since most courses don't require prerequisites such as anatomy and physiology, that the rest of the training is built around is woefully weak.
Now let's look at what EMT-Bs can do again for medical patients before they start circling the drain. We can use oxygen, glucose, and activated charcoal. Glucose can't be used in patients who are unable to maintain their own airways and activated charcoal is only useful in patients who ingested poison. Therefore, the only useful medication in the majority of medical patients that EMT-Bs can administer is oxygen. Even then, EMT-B education as it currently stands is woefully inadequate in even educating providers on how that drug is used by the body. If I, or a loved one, ever need emergency, I'd hope that the provider would be able to do something to reverse the cause of the emergency then engage in a mere stop-gap procedure.
Therefore, I propose that the 110 hours required by the DOT for EMT-Basics should be increased substantially. 2 hours of anatomy and physiology and another hour of pharmacology is not sufficient to warrant increasing our scope of practice drastically, considering that the current education is not sufficient for understanding what our current procedures and assessments are telling us.
Comments? Does anyone think that the current amount of education required of EMT-Bs is sufficient for practice in an uncontrolled environment? Furthermore, how do you reconcile the fact that parts of Canadia require their entry level worker to have a 2 year degree instead of 110 hours?
Is 120 hours enough? I say no. EMS personal work in an acute system away from many of the safeguards that are found in the hospital. Many times, there are no extra providers on scene [versus, say, a hospital. There isn't a pharmacy to discuss medications with, there isn't an RT to assist managing respiratory problems, there are no physicians on scene] as there is in a hospital. Yes, we do have "protocols" [which, in a representative number of systems, are guidelines and suggestions, not cookbook treatment plans] and online medical control [mostly, though there are exceptions though]. Even with online medical control, a provider has to have the education and training to understand what needs to be communicated to the base hospital. The provider must be able to operate, at the very least, as an interface between the physician and the patient, the proverbial hands and eyes.
So, I ask again, in a system like this, is 110 hours, give or take, enough? When 99% of medical scenarios in a given training class can be answered, regardless of the complaint, with a stock reply of "high flow O2 [15 LPM, of course, because the National Registry, whose tests are based off of the DOT standards, thinks that 120 hours isn't enough to decide between high and low flow, or even 10 LPM and 15], call someone else [paramedic intercept], position of comfort, and transport immediately" are we, as providers, really helping patients? Now it should be noted that treatment 'stops' not because there's nothing else the patient might need, but simply because the provider is out of options.
Let's look at the drugs that EMT-Bs can administer based on their assessment under DOT training standards [so no pre-prescribed "patient assist" drugs]. The drugs are simply oxygen, activated charcoal, and oral glucose. Some systems have expanded their scope of practice and protocols for EMT-Basics to include narcan, nitro, albuterol, and/or epinephrine for anaphylaxis shock (based on the EMT-B's assessment and judgement, not based on a patient's prior prescription for the medication), but these systems are hardly representative of EMS as a whole. The entire required pharmacology education and training for EMT-Bs [note: This includes patient assist medications] is one hour long. Is 1 hour honestly long enough to understand the what, why, and how of how oxygen is used by the body? The answer is no.
"Surely," you ask [and don't call me Shirley], "normal body functions is covered in depth during the A/P portion of the course?" Well, let's look at that, in terms of hours. The "Human Body" section required by US DOT is a only 2.5 hours long. Again, this is for all of the physiology and anatomy for the entire course. Therefore I put forth that the knowledge base required for EMT-Bs, especially since most courses don't require prerequisites such as anatomy and physiology, that the rest of the training is built around is woefully weak.
Now let's look at what EMT-Bs can do again for medical patients before they start circling the drain. We can use oxygen, glucose, and activated charcoal. Glucose can't be used in patients who are unable to maintain their own airways and activated charcoal is only useful in patients who ingested poison. Therefore, the only useful medication in the majority of medical patients that EMT-Bs can administer is oxygen. Even then, EMT-B education as it currently stands is woefully inadequate in even educating providers on how that drug is used by the body. If I, or a loved one, ever need emergency, I'd hope that the provider would be able to do something to reverse the cause of the emergency then engage in a mere stop-gap procedure.
Therefore, I propose that the 110 hours required by the DOT for EMT-Basics should be increased substantially. 2 hours of anatomy and physiology and another hour of pharmacology is not sufficient to warrant increasing our scope of practice drastically, considering that the current education is not sufficient for understanding what our current procedures and assessments are telling us.
Comments? Does anyone think that the current amount of education required of EMT-Bs is sufficient for practice in an uncontrolled environment? Furthermore, how do you reconcile the fact that parts of Canadia require their entry level worker to have a 2 year degree instead of 110 hours?
). I want more airway. I just want more of it. I want to know that I am providing the absolute best care that I can, no matter what level I'm at.