EMT-B Certification

[coastiewifejenna]

Another example

Where I come from there are several community colleges that offer the EMT basic class. Now one system requires 40 hours of ride time, the other class only required 25. The class that required 40 hours also showed up on our rigs and in our ERs and had a list of skills that they had practiced and signed off on and were allowed to preform. The class that only required 25 was told they were just to observe. Now I understand that it is based on the student and their willingness to try to learn new things. But how can these two programs that are literally 30 miles from each other with the likelyhood of having to work on a rig with these people make their teachers feel comfortable. If one of my students sat in a chair in my ER and just watched, there would be reprocussions. So I think that the system does need to be more uniformed in their requirements. I would be glad to work with one of the new basics that came from the 40 hour school but I would be skeptical of the 25 hour school.

 

[FrostbiteMedic]

I must stick my head in the discussion here. I think that we should do away with the EMT-B level and require the -A standard. Why do I think this? Because, at least in my state, the minimum license you will have and find work on an ambulance out here is EMT-IV (I/85 more or less). In fact, to my knowledge there are no colleges that offer the EMT-B standard out here, just a few (and I mean very few in the entire state) fire departments that offer it. I feel that even this (EMT-IV) standard left me somewhat unprepared for the situations I would face when I went to work, even after my clinicals. We are to upgrade to the EMT-A standard here soon, which, for us EMT-IV's, will mean 8 hours of upgrade training.

But the heart of the issue is education, education, education. To me, that is one thing that cannot be taken from a person.

 

[Aprz]

Very

Ask Tommerag. I made a bet with him two days ago about this! And he said "nope!"

 

[DrParasite]

why get rid of it?

is the education lacking? yes, in many areas.

however, if you make everyone become a paramedic, you end up having the problem California is in; everyone is a paramedic, no one does critical skills (intubation, RSI, chest decompression, etc) more than once a year. so you have a major dilution of skills.

I would guess that for everyone here, every 911 call they go on, 50% of them are either refusals or taxi rides to the hospital. And by taxi ride, i mean take patient from location, put in ambulance, and transport to ER. of the the other 50%, maybe half are treated by the acronym VOMIT (Vitals, oxygen, monitor, I/V access, and transport). and the final 25% require more, either a drug is administered, electricity, or some other ALS skill.

so using those rough numbers (which are guesses, i would guess the numbers is great than 50% for taxi rides and refusals), if the majority of your calls don't require ALS, why require an ALS provider to be there?

What I think most EMTs need is more experience before they get their cert. Paramedics need to do how many hours of ride time? if the EMT program is 120 hours, lets double that for 240, with the latter 120 hours being ride time on a BLS and ALS ambulance, where you are graded and need to know how to operate to pass.

also, a lot of these skills need practice. so if you don't work as an EMT, volunteer as an EMT, and never see a sick patient, you are not going to know what to do when one drops in your lap. maybe a requirement of 100 calls a year, 50 of them being your chart, so it can be verifying that you are putting into practice what you learn?

 

[JPINFV]

why get rid of it?

is the education lacking? yes, in many areas.

however, if you make everyone become a paramedic, you end up having the problem California is in; everyone is a paramedic, no one does critical skills (intubation, RSI, chest decompression, etc) more than once a year. so you have a major dilution of skills.

I think that's the big problem. As it stands right now, you either have the choice of someone who can't do much more past oxygen and a ride, or you get the special forces. The problem is how do you completely reform the levels so that every ambulance (I'll reiterate here that non-emergent and emergency transport (including from health care facilities) should be separate. "Emergency" being defined as "going to the emergency department") has a provider educated and equipped to handle the 95% of calls that require either no intervention or high use, low risk (e.g. IV, IV dextrose, cardiac arrests, CPAP, naloxone, anaphylaxis, etc) so that the remaining 5% of calls that require low use, high risk interventions are covered by providers who have experience providing low use, high risk interventions.

 

[okiemedic]

Instead of waiting for NREMT to make us learn more. Why don't we do it ourselves? I do that every day. If you are an EMT-b you should have a general understanding of what a Paramedic needs, wants and is thinking. that just makes a better team..

I've talked to Paramedics who've said their EMT's have saved their asses. on Multiple occasions.....

If you became an EMT, You got your certs and you do your CEU's just to retain that cert. You belong in an IFT truck...

If you became an EMT, You continually bush yourself to learn more, understand the signs and symptoms of certain illnesses...If you can communicate to Paramedics, nurses and doctors in a way that helps them get a leg up..You belong in a real EMS gig..

Its not whether we need more hours..Its whether we choose to be cracker box (cert) EMT's or real EMT's....It doesn't take long for an employer to figure out you know or don't know your stuff..

eliminating EMT-b is a bad idea...I don't want unconscious incompetent Paramedics in the field working IFT or 911..You can have all the hours of training in the world..But if you get in the field and freak...That is bad...

If you are in the field as an EMT-b for a year or two...You are conditioned for alot more....If you do what I said (understand the abilities of a Paramedic and what they need to do) You'll be a better paramedic because of it...

I'm not interested in playing the game of defacing the guy under me....We are (should be) all professionals here..We should know our jobs and understand how the guy under or above me can assist in the EMS process....Reread the chapter (introduction to the EMS system) "Roles of the EMS system...

I don't want to work with an EMT or Paramedic who thinks they know all..and wants everybody to know that...They are usually the ones to screw up first...I want to work with somebody who KNOWS the job and does it...

 

[crazycajun]

Instead of waiting for NREMT to make us learn more. Why don't we do it ourselves? I do that every day. If you are an EMT-b you should have a general understanding of what a Paramedic needs, wants and is thinking. that just makes a better team..
The whole point of furthering education and clinical hours (Ride Time) is to do just that.

I've talked to Paramedics who've said their EMT's have saved their asses. on Multiple occasions.....
I have also seen many EMT-B's cause major havoc at a scene.
If you became an EMT, You got your certs and you do your CEU's just to retain that cert. You belong in an IFT truck...
Agreed
If you became an EMT, You continually bush yourself to learn more, understand the signs and symptoms of certain illnesses...If you can communicate to Paramedics, nurses and doctors in a way that helps them get a leg up..You belong in a real EMS gig..
Agreed
Its not whether we need more hours..Its whether we choose to be cracker box (cert) EMT's or real EMT's....It doesn't take long for an employer to figure out you know or don't know your stuff..
So you would rather have an EMT-B by your side in a MCI than an EMT-A with more clinical knowledge and a larger scope to help the PT's?
eliminating EMT-b is a bad idea...I don't want unconscious incompetent Paramedics in the field working IFT or 911..You can have all the hours of training in the world..But if you get in the field and freak...That is bad...
Again, you would rather have an EMT-B that has 110 hours of training compared to a Paramedic who has 2 years of schooling plus 650 hours of field clinicals?

If you are in the field as an EMT-b for a year or two...You are conditioned for alot more....If you do what I said (understand the abilities of a Paramedic and what they need to do) You'll be a better paramedic because of it...
I know EMT-B's that have been in the field for several years and still don't grasp the concept. By eliminating the EMT-B and going to a more in depth education, many of the problems we have today with newbies will be weeded out in school and not on the street
I'm not interested in playing the game of defacing the guy under me....We are (should be) all professionals here..We should know our jobs and understand how the guy under or above me can assist in the EMS process....Reread the chapter (introduction to the EMS system) "Roles of the EMS system...
Nobody is defacing anyone. Everyone I know simply wants to advance EMS to the next level. With schools that are only 110 hours long (Some less than that) and the current curriculum being the joke that it is we will never be more than the laughing stock of the healthcare industry without change
I don't want to work with an EMT or Paramedic who thinks they know all..and wants everybody to know that...They are usually the ones to screw up first...I want to work with somebody who KNOWS the job and does it...
Hence the problem with today's EMT-B education level. Many think they know everything but most know very little.

My answers are in red. Might I ask what your current certification level is?

 

[okiemedic]

My answers are in red. Might I ask what your current certification level is?

I have also seen many EMT-B's cause major havoc at a scene.


Why? lack of experience? lazy?

So you would rather have an EMT-B by your side in a MCI than an EMT-A with more clinical knowledge and a larger scope to help the PT's?

This goes back to the Roles of the EMS system..If dispatch sends a BLS truck to an accident with severe trauma..That is a breakdown of the system..


Again, you would rather have an EMT-B that has 110 hours of training compared to a Paramedic who has 2 years of schooling plus 650 hours of field clinicals?

I want a Paramedic who's had REAL LIFE experience in the field as an EMT..Plus their Paramedic training....

650 hours can't really prepare you for everything you are gonna see..I've been dispatched to calls where guys have tried to have sex with a hole in a pool..Got his wiener stuck...That isn't a great example...But the more field experience the better...

I know EMT-B's that have been in the field for several years and still don't grasp the concept. By eliminating the EMT-B and going to a more in depth education, many of the problems we have today with newbies will be weeded out in school and not on the street

How will that help that particular kind of individual? Even if you upgrade the learning process..That person still passes..But is still not getting it..How does that help anything? I've met really smart EMT's and really dumb EMT's..I've also met really smart paramedics and really dumb ones...At some point..The turnover process effects those individuals...

I've noticed that where people end up in EMS correlates to how smart they are..Take where I currently work for example..We've got an EMT - B that you can't hardly understand when he talks..He sounds like boomhaur from king of the hill..But worse...We've got guys who don't tuck their shirts in..They never wash their cloths..They are always late to work or don't show up..They only do minimum so they can maintain their certifications and they choose to never further their education...

These same individuals complain why they can't get hired onto a 911 service..

Then you see the EMT-B's go on to work with 911 services and make more money....This has more to do with who you are and what you CHOOSE to learn and know rather then your certification status...

My point is..You are ALWAYS gonna have stupid people..Whether that is a Police officer...EMT, Paramedic or Firefighter...The laws of supply and demand weed those folks out..Some it may take longer then others..

If you want to change the roles of EMS..Why not just eliminate Paramedics and put nurses in Ambulances? or no..lets just put Doctors in Ambulances instead....

Lets go head and eliminate the door breach guy from swat too..Just use C4...Why even use Swat...lets just use snipers...No lets eliminate snipers too and just carpet bomb the area....

 

[okiemedic]

Before I forget...I've seen posts on here saying as an EMT B you won't see severe trauma cases...

I worked as a Volunteer Firefighter/MFR...I saw hundreds of Trauma incidents that we had to deal with before Paramedics got on the scene..I've seen people completely severed in half that was still alive...They are still alive today because of the work we did on them....I've also been on the scene of a Bus VS train collision...We managed to stabilize the few survivors..Spent the latter half recovering body fragments...


You need to learn and understand the scope of care the person ahead of you knows and is able too do..Because they won't always be around..By knowing that it'll make you a better EMT....

 

[Shishkabob]

Wait, so because I had no practical field experience before I did Paramedic school... I'm more of a liability on scene and of less help to my patients?

 

[okiemedic]

If you want to eliminate EMT-B why not eliminate MFR too?

I am an EMT-I student....

 

[crazycajun]

I have also seen many EMT-B's cause major havoc at a scene.


Why? lack of experience? lazy?
Nope. Lack of education and proper training

So you would rather have an EMT-B by your side in a MCI than an EMT-A with more clinical knowledge and a larger scope to help the PT's?

This goes back to the Roles of the EMS system..If dispatch sends a BLS truck to an accident with severe trauma..That is a breakdown of the system..
Again. No Emt-b means no BLS trucks

Again, you would rather have an EMT-B that has 110 hours of training compared to a Paramedic who has 2 years of schooling plus 650 hours of field clinicals?

I want a Paramedic who's had REAL LIFE experience in the field as an EMT..Plus their Paramedic training....
The paramedic could still have experience in the field as an EMT-A so what is your point
650 hours can't really prepare you for everything you are gonna see..I've been dispatched to calls where guys have tried to have sex with a hole in a pool..Got his wiener stuck...That isn't a great example...But the more field experience the better...

I know EMT-B's that have been in the field for several years and still don't grasp the concept. By eliminating the EMT-B and going to a more in depth education, many of the problems we have today with newbies will be weeded out in school and not on the street

How will that help that particular kind of individual? Even if you upgrade the learning process..That person still passes..But is still not getting it..How does that help anything? I've met really smart EMT's and really dumb EMT's..I've also met really smart paramedics and really dumb ones...At some point..The turnover process effects those individuals...
The EMT-B curriculum is a joke. Many that can pass it could not pass the EMT-A and the EMT-A is not that impressive and should also be revised
I've noticed that where people end up in EMS correlates to how smart they are..Take where I currently work for example..We've got an EMT - B that you can't hardly understand when he talks..He sounds like boomhaur from king of the hill..But worse...We've got guys who don't tuck their shirts in..They never wash their cloths..They are always late to work or don't show up..They only do minimum so they can maintain their certifications and they choose to never further their education...
If this theory is true that doesn't say much for you now does it
These same individuals complain why they can't get hired onto a 911 service..

Then you see the EMT-B's go on to work with 911 services and make more money....This has more to do with who you are and what you CHOOSE to learn and know rather then your certification status...

My point is..You are ALWAYS gonna have stupid people..Whether that is a Police officer...EMT, Paramedic or Firefighter...The laws of supply and demand weed those folks out..Some it may take longer then others..

If you want to change the roles of EMS..Why not just eliminate Paramedics and put nurses in Ambulances? or no..lets just put Doctors in Ambulances instead....

Lets go head and eliminate the door breach guy from swat too..Just use C4...Why even use Swat...lets just use snipers...No lets eliminate snipers too and just carpet bomb the area....

It sounds like you are very upset that you did not get an offer from 911

 

[crazycajun]

If you want to eliminate EMT-B why not eliminate MFR too?

I am an EMT-I student....

MFR IMO is great for teens, lifeguards and hose monkeys. Not for EMS

 

[okiemedic]

It sounds like you are very upset that you did not get an offer from 911

:lol: Not at all...

I am just returning back into EMS after 8 years out of it...I don't expect to go straight into 911...It is a goal eventually though..

The only reason I took this crap IFT job i got now is to get experience....I don't hold myself to the same standards as those employees i talked about...I come to work clean and pressed..I get more respect from patients and staff of facilities.....I know that my current position is only temporary...

I completely understand where you are coming from. I think we both want the same thing..Better EMT's...The current system is fine in my eyes. EMT-B EMT I/Advanced and Paramedic....Obviously the ones who can't pass to the advanced level won't..They'll be stuck at low pay IFT positions...

Keep in mind. It costs more to employ a paramedic. So that may mean there will be less coverage on the streets...

 

[traumaluv2011]

I don't know if it has already been mentioned, but I know that NJ state EMT testing is requiring another 30 hours, I believe, and will have added topics like finger sticks for blood glucometers and basic intubation instruction. I know in some states where the time to the hospital is at least 20 minutes, the EMT-Bs are ttrained to intubate. Not quite an EMT-I/EMT-A, but they know a little more than EMT-Bs. The refersher course is also going from 24 to 30 hours as well.

So as for the poll, they are not doing away with EMT-A, just adding a bit to the EMT-B core topics.

 

[traumaluv2011]

So as for the poll, they are not doing away with EMT-B, just adding a bit to the EMT-B core topics so that it is a little more advanced.

Correction*

 

[DrParasite]

I don't know if it has already been mentioned, but I know that NJ state EMT testing is requiring another 30 hours, I believe, and will have added topics like finger sticks for blood glucometers and basic intubation instruction.

those are proposed changes... whether or not they actually happen has yet to be seen.

 

[Tigger]

I am a basic, and I know that my job should not exist. The level of care I can provide independently for my patients is almost laughable, quite frankly. Honestly, what is the point of sending someone to a true medical emergency who is unable to even partially secure an airway. A basic isn't even really fit for working in an IFT setting, how much time did anyone's class spend on IFT related topics?

I think Tennessee has it right. The lowest level provider spends a semester in school and hopefully builds the necessary clinical knowledge base to start an IV and give basic medications. But they aren't just skill monkeys, they received an education in prehospital care, not training on set skills. Even the lowest level provider needs to be able to make real, autonomous clinical decisions based on knowledge of human anatomy and disease process.

If it were up to me, EMT basic classes would still exist, but they would be renamed as MFR and the minimum certification to set foot on an ambulance would be some sort of EMT-A/I-85/I-99 type certification, probably without intubation.


Sent from my out of area communications device.

 

[jjesusfreak01]

Wait, so because I had no practical field experience before I did Paramedic school... I'm more of a liability on scene and of less help to my patients?

Probably for a little while once you started working in the field...UNLESS...you were working in a system with a thorough field training program.

Personally, I think the EMT basic education (at least in my state) is alright where it is. Here is why. As an EMT-Basic, your role in EMS is going to be determined by the way your system is set up. In some places, you may be little more than a driver, and in some places you may be qualified to use advanced airways and allowed to attend on patients. The point is that above the standard EMT-B education it ought to be the role of the medical director and system administrators to finish training you to the role that they expect you to take in their system.

This is not to say that I don't think having an I/P combination on each truck would be a much better idea, but if a state wants to keep the EMT-B level and system administrators want to employ EMT-Bs, there is no problem with that.

 

[traumaluv2011]

I think it depends on the area your in. Some place rural like Tennessee where the hospital may be 30 minutes or more away, yes. Suburban and urban places can live with BLS care support for the 10-15 minute drives to the hospital. Ultimately, its getting to the hospital as quickly as possible that will save those critical patients. And for the non-critical patients in rural areas, the medics can make sure they stay that way.