EMT-Intermediate

[Nickjm908]

Hey guys.... first post here... was looking for some input our EMT-I class is just starting and one of our assignments is position on the need for EMT-I's whatever you call the person between medic and basic in your state... many people say they should be done away with? idk about everyone but i think they're a crutial part in the EMS system... send some feedback !!

Thx NICK:excl:

 

[Sapphyre]

First, Welcome!

Now, for you question. My state doesn't even use EMT-I (We call them EMT-II) except in select rural counties. Do I think it's a good thing, You bet.

 

[upstateemt]

In NY we have EMT-D's (Basics), EMT-I's ( IV's and Intubation) and EMT CC's (give most meds based on protocols and with MD orders) and Paramedics (who do it all).

Do I think it works? ABSOLUTELY!!!

 

[BossyCow]

My state allows for EMT-B with adjunct skills of IV and Airway. They are known as an EMT-B-IV or EMT-B Airway. We also have EMT-I but few systems use them.

 

[VentMedic]

Ever wonder why EMS can not make any headway for reimbursement or professional standards?

Present this mish mash mess of "skills" and "certs" to the people who lobby for Government and insurance dollars for healthcare and you will get nowhere just as we have gotten. The legislators usually say "come back when you know who you are and what you do".

Each State, county, city and service has their own "arrangement" of providers. Yet, those in EMS get upset when people can't tell the difference between an EMT-Airway or EMT-D or EMT-I and/or whatever. There should be a "casting list" like in the theaters handed out with each EMS call so the lay person knows who is playing what at the scene along with a "list of skills" available.

Skills without the education to back it up is like reading just one part of the book and not having the full story.

There should only be two "entry" levels: EMT and Paramedic. Yes, I also say Paramedic as an entry level because it should be a degree with the option to advance through more education and skills that follow to accept more responsibility in medicine.

 

[MSDeltaFlt]

Ever wonder why EMS can not make any headway for reimbursement or professional standards?

Present this mish mash mess of "skills" and "certs" to the people who lobby for Government and insurance dollars for healthcare and you will get nowhere just as we have gotten. The legislators usually say "come back when you know who you are and what you do".

Each State, county, city and service has their own "arrangement" of providers. Yet, those in EMS get upset when people can't tell the difference between an EMT-Airway or EMT-D or EMT-I and/or whatever. There should be a "casting list" like in the theaters handed out with each EMS call so the lay person knows who is playing what at the scene along with a "list of skills" available.

Skills without the education to back it up is like reading just one part of the book and not having the full story.

There should only be two "entry" levels: EMT and Paramedic. Yes, I also say Paramedic as an entry level because it should be a degree with the option to advance through more education and skills that follow to accept more responsibility in medicine.

Vent,

You remind me of the old Merrill Lynch commercial. When you speak, people listen. I wonder why that is. It's probably because you provide emperical data to back up each and every font in your posts.

 

[reaper]

One of the few things FL does right, They do not recognize EMT-I. They have two certifications. EMT-B and Paramedic. FL does allow EMT's to do other skills, but is up to the MD in each service and it is not a cert on it's own.

I personally think I's are a waste of time and money. If you want to go to school for EMT-I, then why not go all the way and finish to Paramedic?

I know, start bashing, but this is how I feel about it.

Just my .02!

 

[Ridryder911]

As I have posted before, any level between the EMT and Paramedic is just an excuse. Why many states have eliminated the Intermediate level altogether. Either the person that does not want to finish their education or administrators that want to be able to bill but not really provide ALS services.

It hurts the system and it hurts the patients.


R/r 911

 

[Nickjm908]

thanks

Thanks for all the input back so far guys!! this one is going out to Ridryder911... i'm studying to be a paramedic and feel that its going to be helpful to learn to tube, and start lines on people and practice over the summer so when the time rolls around for my paramedic course to begin i can concentrate on my rythms, and meds.....just doing my I to move up in EMS as many people I know are doing. Just wondering (not being cocky or anything...) but hoe does it hurt the system/patient?

 

[KEVD18]

nick, do a search. the intermediate issue has been discussed several times, as recently as last week.

most of the view points on the issue are well documented.

 

[upstateemt]

As I have posted before, any level between the EMT and Paramedic is just an excuse. Why many states have eliminated the Intermediate level altogether. Either the person that does not want to finish their education or administrators that want to be able to bill but not really provide ALS services.

It hurts the system and it hurts the patients.


R/r 911

How do you figure that? As a CC EMT with a BSN in Nursing and CCRN certification (as you do) I consider my education "finished" and my patient care equal to any Paramedic and see no advantage to spending $5,000 to obtain certification that changes little of what I do.

In my area CC's and Medic's work side by side with little differentiation (other than pay) in what they do. I work with a CC who is a post doctoral student using his CC to help him work his way through his education.

In my county there are 7 or 8 ambulance services and all but 1 function with 90% volunteer crews (including my own). Only 2 services "bill". Most of us have full time jobs outside of the ambulance. My CC certification was 18 credits and over 350 hours of clinical. If Paramedic was the only option for advanced care there would be very little ALS coverage in my county.

There is an important place in EMS for both CC's and EMT-I's despite what some "Para-Gods" might think.

 

[triemal04]

How do you figure that? As a CC EMT with a BSN in Nursing and CCRN certification (as you do) I consider my education "finished" and my patient care equal to any Paramedic and see no advantage to spending $5,000 to obtain certification that changes little of what I do.

In my area CC's and Medic's work side by side with little differentiation (other than pay) in what they do. I work with a CC who is a post doctoral student using his CC to help him work his way through his education.

In my county there are 7 or 8 ambulance services and all but 1 function with 90% volunteer crews (including my own). Only 2 services "bill". Most of us have full time jobs outside of the ambulance. My CC certification was 18 credits and over 350 hours of clinical. If Paramedic was the only option for advanced care there would be very little ALS coverage in my county.

There is an important place in EMS for both CC's and EMT-I's despite what some "Para-Gods" might think.

So you're saying that every EMT-I or whatever it's called has a higher level of medical training than the I level? Cause you know that's BS, right?

The EMT-I is a stopgap measure. Nothing more, nothing less. It is a way a system to function without having to pay for paramedic level services. Which is to bad because in the vast majority of cases it can be done; look at Texas of all places.

This is to say nothing of the fact that while many I classes may teach lots of the fancy skills that make people thump their chests, the most important thing they DON'T teach is how to think and understand what is really going on. (granted a lot of paramedic schools also do a piss poor job at this, but not so much as I classes). It's funny in a sick sort of way; where I live the EMT-I level was just upgraded a huge amount. Multiple medications were added to their scope as well as a few skills, bringing them fairly close to the level of a paramedic in that regard. Of course, the class is all of 144 hours long and all existing I's were grandfathered in.

See the problem? EMT-I's, (and not just here) get taught about some drugs and some skills, and that's it. All they get taught is cookbook mediciene, nothing more. Unfortunately, to be apply to properly administer meds and perform ANY procedure, it takes a little more knowledge than that.

There may be places out there that do a good job at teaching I's...but overall...not so good. And not needed.

 

[Outbac1]

We have Intermediates here but they stopped registering new ones about 6 or 7 years ago. When they started about 10 - 12 years ago it was an add on course in modules as a quick way to get "ALS" medics. Since then our old "basic" level EMA or P1 has been significantly upgraded to the new national standard Primary Care Paramedic, PCP.

Those that were "Intermediates" stayed as Intermediates, ICP, but there are no new permanent registrations. The next step we have is Advanced Care Paramedic, ACP, which is similar to your EMT-P. Instead of keeping middle steps we moved the bottom step much higher. A much better overall solution.

The only "new" ICPs are US EMT-Ps who move here. They are registered as ICP until they can sit the Provincial exam which they must do within one year. If they fail it they get bumped down to PCP. I haven't heard of any that fail. US registered EMT-I, B, B-IV etc. are not even considered for registration at any level.

Personally I think you should go for EMT-P. Your Basic is, well too basic and EMT-I is a poor halfway step. For those willing to travel for work there is way more opportunity if you have your EMT-P or ACP. We just lost one of our ACPs to the mining camps up north. 3 weeks on, 3 weeks off and $400.00 - $600.00 day(or more), plus all expenses. Not bad if you want the lifestyle.

 

[mikie]

Why many states have eliminated the Intermediate level altogether.

Missouri has! (Though a rumor has surfaced that they are drafting a scope of practice for them h34r

 

[Ridryder911]

How do you figure that? As a CC EMT with a BSN in Nursing and CCRN certification (as you do) I consider my education "finished" and my patient care equal to any Paramedic and see no advantage to spending $5,000 to obtain certification that changes little of what I do.

In my area CC's and Medic's work side by side with little differentiation (other than pay) in what they do. I work with a CC who is a post doctoral student using his CC to help him work his way through his education.

In my county there are 7 or 8 ambulance services and all but 1 function with 90% volunteer crews (including my own). Only 2 services "bill". Most of us have full time jobs outside of the ambulance. My CC certification was 18 credits and over 350 hours of clinical. If Paramedic was the only option for advanced care there would be very little ALS coverage in my county.

There is an important place in EMS for both CC's and EMT-I's despite what some "Para-Gods" might think.

You stated it yourself.. "90%" volunteer crews. Why does only 2 services bill? Does your hospital not bill? Placing a band-aid on an arterial bleed never cures anything. I don't understand EMS communities not charging for services? You get for what you pay for. Want 24 hour coverage, fast response times, ensuring that the individual is specifically educated for that type of care, to work in that environment? Then there is a price. The same if a community wants a hospital. I don't see any free hospitals anywhere, nor do I see free full time nursing or physicians. Just because it is EMS, why should EMS settle for such?

Let's pretend it is nursing. Would you settle on the LPN/LVN's only at hospitals? The highest nursing care offered in the emergency department would be a LPN/LVN. Let's say that LPN is working on a Doctorate in business.... so what? Who cares? Does this mean they are educated anymore in patient care?

Yes, LPN's are essential in patient care and technically can perform majority of the same procedures a RN can. Why should the hospital not just employ LPN's. They are much cheaper and if "trained a little more in skill..i.e hemodynamic, vent care, central lines, etcthey could do the same thing as a RN .. right? Obviously no. The same as a Intermediate. They are NOT the same thing, alike in nursing the LPN is not the same as a RN. Completing the program half way does not ensure that one has thouroughly completed the objective to meet the gold standard of patient care in the prehospital setting. The same in comparrision of the LPN vs. the RN. That is why JCAHO has recognized such and placed regulations against using LPN's in critical care areas.. Simply put they are not educated enough to perform such nursing actions. If we had a similar active organization such as JCAHO, the same would be true for EMS in using Intermediates in the realm of ALS care.

Fortunately in my state I lobbied that no matter what, to administer Paramedic level care one has to be a licensed as a Paramedic. I don't care if it is a NP, PA, RT, e i o u. If you want the level then do so.. be one. I would expect and demand the same as in nursing.

* Your EMS educational facility should work with pre-existing health care personal. For example RN's and RT's at my education only have to take required courses for the Paramedic. The clinical sites are modified so they do not work in areas of employment or speciality. The costs for a certificate or applied to their pre-existing degree is <$3,000.00 Many companies are paying for such re-imbursements.

 

[upstateemt]

Triemal104, I have read the first sentence of your post over and over and cannot make any sense of it....... I believe my first post in this thread gave a good explanation of what an EMT I is in my state.

Ridryder, I cannot and won't get into the paid vs volly debate. In a perfect world all EMT's would be paid and all services would be adequately staffed. This isn't a perfect world. My all vollunteeragency responds to slightly over 300 calls a year with an all ALS crew on a budget of about $50,000 a year in a poor rural community where many people don't have insurance or money to pay for an ambulance.

We were chosen as EMS responder magazines "Gold" award last year and have a response time of less than 6 minutes. With 2 Paramedics, 4 Critical Cares and 5 drivers. The level of care we offer and knowledge we maintain are exceptional.

In large metropolitan areas there may indeed be no room for volunteers, but in the many small farming communities and other rural areas of this country vounteers continue to provide an important service.

 

[Ridryder911]

I honor you that your EMS is an exception not the norm. That is why, you won the award. Yet, at the same time as a profession as a whole we need to ensure the best for the patient. Sorry, small, farming, etc. is not an excuse. I have worked in communities < 800 so I do understand. Does your community have clinics or a nearby hospital? Do they make an exception on the license?... I didn't think so; however we attempt to exempt EMS from the normal health rules.

The sole reason for the Intermediate level was even developed and introduced was a bridge from EMT to Paramedic, NEVER to replace or to be used as an alternative. Unfortunately, what it has been used for. As well, the sole reason the EMT courses were "watered down" was the complaints of the volunteer communities. Now, we still see such along with the Fire Services complaining that becoming educated and mandating a requirement of acreditation is too much, and should EMS really have to have a education?

No, not all are this way... but; unfortunately the representation of these special groups are the ones that caused and continous to be the opposing factors of increasing education and becoming a profession. Thus they are a hindurance.

R/r 911

 

[snaketooth10k]

"Para-Gods"

I lol'd ^_^

 

[BossyCow]

In our area an EMT-I is used to bridge that gap while transporting a critical pt to the rendezvous with ALS. It is not designed or utilized to replace ALS but to give a few extra tools to the extremely rural area. The size of the population is less of an issue than the distance needed to be travelled to transport the pt to the care they need.

The fastest I can get ALS on those rare occasions when its available is about a fifteen minutes and generally its longer if the call is on the west end of my district. There is a huge no-mans land between my district and the district to the west that is good for 4 or 5 really serious MVAs a year. This is a minimum 45 minute transport in either direction to a hospital. Airlift is rarely an option due to the geography. When we do use airlift, we transport about a half hour to an LZ.

If I can get more skills in any area that will help me deliver a more stable pt to ALS, the ED or Airlift, I'm sure gonna take those classes and learn those skills.

 

[triemal04]

upstateemt- That was only half serious, but the basic point still doesn't change. YOU may have your BSN and CCRN and thus should be able to provide a very high level of care as an EMT-I (or EMT-CC I suppose) utilizing all the available medications and procedures available at that level, but the average person that becomes an Intermediate is not going to have that extra medical education; they'll have what they get in class and that's all. And generally speaking, for the amount of things they can do/number of meds they can administer, the time spent in class is not near enought. Clearer now?