Finally ! Someone who cares about BLS and EMT's

VentMedic

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The basic truth is that IFT pays the bills and is how most private companies stay afloat. So financially it makes a lot more sense to have EMTs running transfters between 911 calls.

Also I can't believe that people think most IFTs need a medic. When I was on the truck most of the IFTs we were doing were "80 yo man who is normally in a wheel chair needs to get to his doctor's appointment and back." Most of these patients medically stable, but for some reason they don't have the mobility to physically walk out and get in a cab.

Sure there are the sicker people who are on lines, pressors etc. But most an EMT can handle. And if the stable patient who is going to the doctor suddenly codes, I'd much rather have an EMT in the back than an LPN whose code experience is "go call the doctor."

How much "medicine" is the EMT taught? Basic first aid is not adequate since many of these patients require little to no first aid. A CNA is also better trained to move some of the medical needs patients. They are familiar with some of the disease processes and the special care they may require. If the EMTs at least has some of the training that a CNA gets, then they might be better qualified to even take some of these patients to and from the doctors' offices. CNAs also have CPR cards and most of our hospital CNAs have done CPR many, many more times than some of the EMTs working 911 calls. The training of the EMT is just not adequate or appropriate for medical patients.

I'm also glad you mentioned the LPN. LPNs have more education and "hours of training" than most U.S. Paramedics. For a long time they did work codes in the EDs, ICUs and L&Ds when it took awhile for doctors to arrive and they still continued to work the code. Nobody just leaves the patient when a doctor arrives. But, healthcare has progressed and the 1 year LPN is no longer found in these areas. Yet, we still allow 3 month wonder Paramedics on the streets. What's with that? What does EMS continue to stand behind low standards when every other profession is raising theirs.
 

VentMedic

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i'd much rather have a paramedic.

However, if I were bedconfined and being moved from bed to stretcher I'd much rather have a CNA or MA, who'se education greatly revolves around moving and positioning patients than an EMT who'se ticked off he's not on an emergency call.

And of course there is that issue.

So many EMTs get their patch thinking they will be just like what they have seen on TV. The schools didn't tell them about IFT transport and there was not much of "that" medical stuff mentioned.

Some here should sit in the reception area or a nurses' station at a hospital to hear some of the hideous comments about "BS" calls and "BS" patients spoken openly. It definitely doesn't do much to build up respect for the EMT(P). There have even been comments in threads on this forum about lizard transfer trucks. It just shows a lack of knowledge pertaining to medicine and patient care.
 

zmedic

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Sasha; said:
i'd much rather have a paramedic.

However, if I were bedconfined and being moved from bed to stretcher I'd much rather have a CNA or MA, who'se education greatly revolves around moving and positioning patients than an EMT who'se ticked off he's not on an emergency call.

IFTs don't pay enough to fund having a medic do all the transfers, nor will insurance reimburse for ALS transfer if it's a BLS patient.

Again, if you had CNAs or LPNs doing transfers then that unit can't be used for 911 calls. I think EMTs can handle many basic transfers such as to doctors offices, and it helps the system and makes money while waiting for 911 calls to drop.

I'm not sure how much you need to know about disease processes to take the patient to the doctor. It's more of:

1. How do I get this patient from bed to stretcher/wheel chair, stretcher to rig, rig to office and reverse?

2. Does this patient look sicker than I can handle?

For basic IFTs you aren't giving meds, you aren't managing fluids, if doesn't really matter who knows more about the patients underlying disease. It's simply a transport.

Again this is why I really like mixed EMT/medic trucks. Because you have have the EMT in back getting experience on basic transfers, but if you show up and the patient looks unstable or gets worse in route the medic can attend. And it is more cost efficient than having double medic trucks run transfers.

Then again, if you want to make your paramedics want to quit, there is nothing like making them attend on lots of basic IFTs.
 

EMSLaw

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Wow. This is quite the thread. Good basic first aid skills are important for any level of provider. I've had patients, both on the ambulance and otherwise, who needed proper splinting and bandaging, and it's unfortunate how little of that is taught, even at the EMT level - honestly, even if EMT class is supposed to teach first aid, they do a very poor job of it. I learned more of the "basics" in a first responder class than I learned in EMT-B school.

The advantage of paramedics is that they have more tools in the box for when things go wrong. Anecdotally, it's unfortunate that they use so few of them, which in my view hurts some of the arguments made here. At least where I live, if the only reason a paramedic is called is for pain relief, then you'll be dissapointed - a patient with a fracture or dislocation (or any other condition) may be in great pain but the paramedics (either because of their inclination, or that of their medical director and protocols) will not give analgesics. I can't tell you how often I've transported a patient where every bump was agony.

Even if EMT's are going to be first responders, they should be adequately trained to that function, which requires more than the current level of training - whether it be by college level courses or a longer technical certificate. Our profession as a whole needs to be more concerned about alleviating the pain and suffering of our patients, and less about protecting our own egos and "turf."

No matter how long the classes are, those of us who want to do it will do it (speaking for myself, as long as there is an option aside from full-time days, but that's neither here nor there). Those who don't want to be bothered... won't be. Maybe we'll have less prehospital providers, but after a year or so on the street, I don't see that as a bad thing.
 

VentMedic

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IFTs don't pay enough to fund having a medic do all the transfers, nor will insurance reimburse for ALS transfer if it's a BLS patient.

But insurance companies are willing to pay for RN or other professionals instead of Paramedics.

Maybe if they were actually informed to what they are paying for an not rec'g they might have a different opinion. The crime is the insurance companies may be paying for a transport that has a stretcher as a very expensive "taxi" but the providers really can't provide much more care than those who are "drivers" with a CPR card on a medi-van.

The EMT does not need to disapper but rather just be "educated" rather than just trained.


Again, if you had CNAs or LPNs doing transfers then that unit can't be used for 911 calls. I think EMTs can handle many basic transfers such as to doctors offices, and it helps the system and makes money while waiting for 911 calls to drop.

How many EMTs actually do get to 911 calls?


I'm not sure how much you need to know about disease processes to take the patient to the doctor. It's more of:

1. How do I get this patient from bed to stretcher/wheel chair, stretcher to rig, rig to office and reverse?

2. Does this patient look sicker than I can handle?

For basic IFTs you aren't giving meds, you aren't managing fluids, if doesn't really matter who knows more about the patients underlying disease. It's simply a transport.

Again this is why I really like mixed EMT/medic trucks. Because you have have the EMT in back getting experience on basic transfers, but if you show up and the patient looks unstable or gets worse in route the medic can attend. And it is more cost efficient than having double medic trucks run transfers.

The thing is many EMTs don't most don't know how sick their patients are. Read some of the previous threads and see how little knowledge some have about what a fever can do to an elderly patient. But then, taking a temperature or even asking for one is something rarely done by EMTs.

Then again, if you want to make your paramedics want to quit, there is nothing like making them attend on lots of basic IFTs.

Another example that some just go into EMS for the cool trauma calls but really don't want to do much patient care. I personally enjoy having calls where the patients are not always on death's door or need intense medical treatment. Sometimes it is good to just do a thorough assessment and have a chance to converse with a patient. Yet, too few in this profession want any part of that boring crap which is associated with good bedside care on an ambulance.

I also would rather have a Paramedic or RN as a partner. For specialty transport, I would rather have a professional driver from the transport pool rather than an EMT who has a limited knowledge of medicine in reality but vast in their own belief might influence the way they drive putting the team and patient at risk.

However, again I will emphasize, the EMT does not need to disapper but rather just be "educated" rather than just trained.
 
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emtzach03

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this will be short. in both aspects bls or als, you are only as good as the amount of time you have been doing it. I know of senior BLS crews that have better diagnostic ability then a brand new ALS crew. The only difference is is the paragod attitude that is presented to the BLS crew. ALS has many ways of diagnosing illness and at times find them selfs overthinking and forgeting the simple basics that They used to use. Medications especially for pain is not used for many reasons, however proper pt care, placement, and positioning is what is important. It ultamitely comes down to the person careing for the pt. It can not be taught it has to be learned. As far as tho oversatuteration of ALS that just comes down to the amount of lawsuites over the years and people sayin "well if there was an ALS crew closer the Pt may have not........." its all monday morning quarterbacking in my opinion
 

VentMedic

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this will be short. in both aspects bls or als, you are only as good as the amount of time you have been doing it. I know of senior BLS crews that have better diagnostic ability then a brand new ALS crew. The only difference is is the paragod attitude that is presented to the BLS crew. ALS has many ways of diagnosing illness and at times find them selfs overthinking and forgeting the simple basics that They used to use. Medications especially for pain is not used for many reasons, however proper pt care, placement, and positioning is what is important. It ultamitely comes down to the person careing for the pt. It can not be taught it has to be learned. As far as tho oversatuteration of ALS that just comes down to the amount of lawsuites over the years and people sayin "well if there was an ALS crew closer the Pt may have not........." its all monday morning quarterbacking in my opinion

Written like an EMT-B...

Do all the EMT-Bs here only aspire to be a 110 hour minimally trained provider?

If it takes you "years" to master the few skills of EMT, maybe you shouldn't advance and will be destined to stay as an EMT. But, don't hold the rest of the profession back by continuing to agrue for the least amount of care provided to the patients by the least educated/trained provider.

Does anyone here even want to know what medicine is all about? Its really a very vast field.

Why do some take this "paragod" bashing attitude? Does a few hundred hours of education and training with a little extra responsibility really intimindate or frighten some of the EMTs here to where they get this attitude about Paramedics, nurses or doctors?

If you really think you are just like a Paramedic, why don't you have what it takes to finish a few hundred hours of schoool to get the certificaton? Why don't you go ahead and walk the talk?

Some things do come with experience but if you have no clue about various disease processes and certain aspects of treatment, it doesn't matter how good your intentions are. Street medicine can be done a lot better if one has some real education to apply to what is being taught in the street.

I personally feel there are some EMTs on this forum who do want to have more knowledge and education than just the U.S. EMT has to offer and do want to provide more knowledgable care. But, why do some constantly want to argue that 110 hours of training is acceptable patient care?
 
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firecoins

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How much "medicine" is the EMT taught? Basic first aid is not adequate since many of these patients require little to no first aid. A CNA is also better trained to move some of the medical needs patients. They are familiar with some of the disease processes and the special care they may require. .

Based on my experience I would tend to doubt that. CNAs seem to know very little. They tend to get in the way, trying to clean patients up why preventing access to paramedics.
 
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VentMedic

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Based on my experience I would tend to doubt that. CNAs seem to know very little. They tend to get in the way, trying to clean patients up why preventing access to paramedics.

How much do you know about CNAs? Have you ever looked at their education and training?

I would say you haven't a clue. You have probably never worked along side them and have y entered some health care facilities with an attitude about being pulled away from sleep or the computer to do some BS call.

Maybe what you actually saw was the CNAs protecting the patient's dignity and privacy even at a time of crisis. That is often something some EMTs forget. Example: bringing an almost naked conscious and alert patient without even a sheet to cover them through a busy ED or hospital entrance. Or, transporting a routine patient by just wrapping them in the same sheets the patient may have just had a bowel movement on and screaming to the CNAs to get lost so the hospital deal with it. Yeah, I can easily see you doing that.
 
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reaper

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Why is it that time and again you see the statement that medics forget the basics?

Do you think we walk up to a pt and not care if the are breathing?

If you need years to master the basics, then we are in worse shape then we could even imagine. It takes less then 10 seconds to determine ABC's. This is not something that is a great skill to master. Most medics have this out of the way in the first few seconds with the pt. Then they are moving on to determining what this pt needs and what treatment is needed. We do not have a "scoop and run mentality". We use the education that we have, to determine what is best for the pt.

I have heard EMT's complain that a medic sat on scene to long ,trying to get an IV or ETI. Have you ever stepped back to look and consider that maybe they determined that is what the pt needed at the time? Some say "we are only 10 minutes from a hospital, why delay"? Do you know what can happen to a Pt's brain function with 10 minutes of inadequate oxygenation or perfusion of the brain?

Yes, there are terrible medics out there. But, the majority are excellent providers and have the knowledge to do what needs to be done.

There are a lot of knowledgeable and educated EMT's out there. But, I look at someone who has been an EMT fulltime for 5 or more years as someone who is either to lazy or to scared to advance their education. If they cared for their Pt's care as much as they preached, they would be eager to advance their knowledge of medicine, to help their Pt's the best way possible.
 

emtzach03

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Written like an EMT-B...

Do all the EMT-Bs here only aspire to be a 110 hour minimally trained provider?

If it takes you "years" to master the few skills of EMT, maybe you shouldn't advance and will be destined to stay as an EMT. But, don't hold the rest of the profession back by continuing to agrue for the least amount of care provided to the patients by the least educated/trained provider.

Does anyone here even want to know what medicine is all about? Its really a very vast field.

Why do some take this "paragod" bashing attitude? Does a few hundred hours of education and training with a little extra responsibility really intimindate or frighten some of the EMTs here to where they get this attitude about Paramedics, nurses or doctors?

If you really think you are just like a Paramedic, why don't you have what it takes to finish a few hundred hours of schoool to get the certificaton? Why don't you go ahead and walk the talk?

Some things do come with experience but if you have no clue about various disease processes and certain aspects of treatment, it doesn't matter how good your intentions are. Street medicine can be done a lot better if one has some real education to apply to what is being taught in the street.

I personally feel there are some EMTs on this forum who do want to have more knowledge and education than just the U.S. EMT has to offer and do want to provide more knowledgable care. But, why do some constantly want to argue that 110 hours of training is acceptable patient care?
its amazing i guess you are one of those paragods i was refering to. i have no intentions on arguaing here i was making a point that there are very good BLS crews out there i am one of them you could ask for my references, and excuse the :censored: out of me for chosing to go into the army. It is taught BLS BEFORE ALS. Yes training is minimal its up to the indvidual to excel in there personal training. Dont preach so much you just look like a donkey doing so
 
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VentMedic

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its amazing i guess you are one of those paragods i was refering to. i have no intentions on arguaing here i was making a point that there are very good BLS crews out there i am one of them you could ask for my references, and excuse the :censored: out of me for chosing to go into the army. It is taught BLS BEFORE ALS. Yes training is minimal its up to the indvidual to excel in there personal training. Dont preach so much you just look like a donkey doing so

We are not arguing about you being in the Army. Why must you mention that when talking about the U.S. EMT training? We are not discussing what someone in the Army can do and please do NOT insult those in the Army who are well trained and educated to provide medical care.

What's with the BLS before ALS? ALS crews can do the basics of care also. Again, you need to understand "basics" of medical care and medicine and forget the "BLS/ALS" as labeling patient care.
 
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EMSLaw

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How much do you know about CNAs? Have you ever looked at their education and training?

I hate the comparison between EMTs and other allied health providers, as if the implication is that because certain other health workers have minimal education, we can as well. That doesn't make a lot of sense, especially when you consider that while we may be twenty minutes from an ER, they are twenty seconds away. EMTs and Paramedics have some of the greatest freedom to act in an emergency, and conversely the least didactic work to back it up. While that may have been fine in the days of Johnny and Roy, it's not so much now.

Incidentally, apparently the combination of an EMT-B and an LPN is the perfect storm of medical disaster. Note the State says that the EMT was the highest trained /pre-hospital/ practitioner at the scene, and should have known what to do. That should be a sobering reminder that we owe it to our patients to have a freaking clue.
 

Sasha

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Based on my experience I would tend to doubt that. CNAs seem to know very little. They tend to get in the way, trying to clean patients up why preventing access to paramedics.

Actually I'd be glad they're trying to clean the patient up before you take them. No telling how long they'd have to sit in their feces at the hospital before someone could get to them and change them, all the while their skin is breaking down and feces getting in ulcers.

I've learned if you jump in to help them, they'll be done quicker so you can do what you need to.
 

VentMedic

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emtzach03

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We are not arguing about you being in the Army. Why must you mention that when talking about the U.S. EMT training? We are not discussing what someone in the Army can do and please do NOT insult those in the Army who are well trained and educated to provide medical care.

What's with the BLS before ALS? ALS crews can do the basics of care also. Again, you need to understand "basics" of medical care and medicine and forget the "BLS/ALS" as labeling patient care.

i brought up my current work as reference to not having gotten my paramedic as of yet. my point of bls befor is that medics look down on basics as you have brought this to light. I understand you can perform bls care i was only upset at your comment attacking my level as a civilian, and you think i am insulting my brothers. i would give my life while rendering care... would you
 

VentMedic

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i brought up my current work as reference to not having gotten my paramedic as of yet. my point of bls befor is that medics look down on basics as you have brought this to light. I understand you can perform bls care i was only upset at your comment attacking my level as a civilian, and you think i am insulting my brothers. i would give my life while rendering care... would you

In my experience, I am of more use alive to those I serve in or out of the service. In the civilian world, scene safety is taught.

Again, DO NOT compare the U.S. EMT-B with the training of a medic in the Armed forces.

Do you not understand the pecking order of any profession? Is there not a rank existence in the Army? Or, do you believe you are equal or better than your superior officers?
 
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VentMedic

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For the record, a quick check of the nursing license list on another state website shows that no action was taken against the LPN.

The nurse was not on duty. The nurse was the same as a lay person in this situation and the EMT should have realized that.

If I come upon a scene while off duty, I can only give care as a lay person would but with a little more knowledge. I will not be able to take control of that scene as a medical provider...unless in Florida where I could if still employed with the FD.

The legal outcome would not have been any different if a doctor has been present unless the doctor announced he/she was assuming care of the mother or baby and offered to accompany them in a lead provider role assuming the responsibilities under his MD license.
 
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EMSLaw

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The nurse was not on duty. The nurse was the same as a lay person in this situation and the EMT should have realized that.

If I come upon a scene while off duty, I can only give care as a lay person would but with a little more knowledge. I will not be able to take control of that scene.

The EMT wasn't really on duty either - he stopped and picked up an ambulance from the Rescue Squad, without a partner, and went to the scene, rather than calling 911. That was part of the problem with the call. A fully manned ambulance, and probably ALS backup, should have been present.

From start to finish, the call was fouled up.
 
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