BLS Skills -- What Should We Add?

[Outbac1]

why would you want to do it in such a short ammount of time. One of my fire co-workers is taking it at a community college. its over 2 college semesters, one night a week, for 4 hours. he says hes getting a lot out of it. i was misurable in my one college semester last year that was 8 hours a week. i think that time is necessary in between classes so that students have time to absorb all the information that they are getting thrown at them.

Then you really wouldn't like it here. 7-8 hrs a day 5 days a week for months on end. After school studying for hours each night to absorb the information.
Here we call it work. That nasty 4 letter word. You get out of it what you put into it.

Here people go to school to be a paramedic. To work full time at it. To earn a decent wage and benifits. To make a carreer out of it. Not to do it for fun or because it is cool and to be able to do that for minimum effort.

Maybe someday the USA will get its act together and be the EMS leader they want to be. I know there are many great, knowledgable medics there who want that to happen. I read their posts here everyday.

 

[EpiEMS]

Its mind boggling, specifically EMT-B. The national standard is around 110 clock hours I believe which is accepted in most states. These are the people who can staff an ambulance on there own and respond to emergencies as the highest level of care in some areas until definitive care.
Even if you where to keep this a vocational tech occupation, I would be curious to look at morbidity mortality rates in a system like this vs a system with providers who have more education and training. 110 hours can be completed in less than 3 weeks in some programs

I think the new curriculum has increased it a bit, to something closer to 150 hours. Granted, I don't think that's enough.

From an epidemiological perspective, I'd bet that you won't see that much of a difference. Consider the OPALS study -- pretty much the study that I first reference on any "ALS vs. BLS" thread, much as I don't like those threads. ALS systems don't increase survival to discharge for cardiac arrest (http://www.nejm.org/doi/full/10.1056/NEJMoa040325) or for trauma (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2292763/). There's lots of papers drawing on OPALS.

Now, that being said, when it comes to patient comfort? ALS is definitely preferable. If I get injured to the point where I can't drive myself or be driven to the hospital by a friend, I'd much rather have ALS transport -- pain control is the single biggest thing I can think that ALS brings (along with better assessment).

Yes, 110 hours (even 150 or 200 hours) is not enough. Does it mean the vo-tech model needs to die? Yes, absolutely, if at all feasible. But it's not necessarily because of outcomes. It's, in large part, because the process needs to be better.

 

[ExpatMedic0]

Yes I have read a few studies showing ALS for Trauma and arrest actually lead to negative patient outcomes in parts of the USA due to increased scene times or as a result of poorly written protocols, or simply lack of proper training.

However I can tell you from first hand experience it appears to makes a big difference in a lot of areas. Some that pop into my head are asthma emergencies, allergic reaction, cardiac complications before a full arrest.
Of course we would need to analyze the data or construct our own study to really make such a statement, but I have had some pretty satisfying days at work from calls like this.

 

[Lil Medic]

Personally I think EMT's should be required to obtain a more substantial certification of non skill related education. For example, some Community colleges offer a 1 year EMT certificate, which includes Anatomy and Physiology, psychology, medical terminology, sociology, etc.
I think that should be mandatory for even a regular EMT. Skill wise though I think they are set well (King airways and combitubes are blind airway devices). EMTs are BLS. That is why there are AEMTs and Paramedics, for the optional increase in interventions.

 

[Bullets]

The new curriculum mandates about 130-150 hours, but there are programs in NJ that are offering programs as long 300 hours with increases in AP and pharmacology

 

[hogwiley]

I say just get rid of EMT Basic and make AEMT the minimum. At least that way some schools would actually have AEMT classes. As my granny used to say, either S*** or get off the pot. Either get rid of Intermediate or make it possible for people to actually become one, or get rid of Basic and replace all these EMT basic classes that pump out EMTs like an assembly line with AEMT class.

I wanted to go to EMT specialist school for like 5 friggin years, because its short and sweet and teaches skills which are valuable and makes one a lot more employable in EMS, but not ONE school in my state has has an EMT specialist class in at least 5 years, and none of them are offering it any time soon, despite the fact the local paid ambulance service requires EMT specialist as the minimum for employment.

Keeping this license level but never providing the training required to achieve it has totally screwed over a lot of EMT basics who dont have the time or money to go to school to be a medic or want to gain some experience first, but cant work in EMS because there are no EMT Basic jobs, or none that pay anything close to a living wage.

I just got my phlebotomy cert but its pretty much useless for EMS because you cant use it in the field as a Basic. Ill just have to wait til I can go to Paramedic school for any other training, but Ive been forced to work in a hospital while im saving up because it was impossible to do as a Basic.

Sorry for the rant, but this has been a source of ongoing frustration for years.

 

[wanderingmedic]

I say just get rid of EMT Basic and make AEMT the minimum. At least that way some schools would actually have AEMT classes. As my granny used to say, either S*** or get off the pot. Either get rid of Intermediate or make it possible for people to actually become one, or get rid of Basic and replace all these EMT basic classes that pump out EMTs like an assembly line with AEMT class.

I agree. AEMT is a logical entry level into EMS.

 

[PotatoMedic]

I agree. AEMT is a logical entry level into EMS.

And sadly WA state I have not been able to find a class for intermediates. Oh well... Putting my medic application together. Only need one more letter of recommendation. Hard when you have only had one partner and the supervisor is an ***.

 

[NomadicMedic]

Yakima County ran an I class for a while. We routinely had intermediates working on the truck with a medic.

 

[GaMedic]

I agree. AEMT is a logical entry level into EMS.

Here in Georgia the state has stopped issuing Intermediate license. AEMT is the new Intermediate. People who are currently Intermediate level training have until 2016 I think to do the CE needed to upgrade their licenses. Several schools in the metro area have started offering bridge classes.

 

[emsdude89]

Here in Indiana we are trying out a device call "The Glove". It's a big glove that slips over the patients hand and arm. It's loaded up with electrodes. When the patient puts it on "correctly". An EMT-B is able to print and transmit a 12-Lead EKG. Pretty neat, when it works.

 

[STXmedic]

It barely fits on the average sized guy in the demonstration video.
http://youtu.be/OIX6qHGfy_Y
V6 looks to be sitting in V4's position. A good portion of the cardiac patients I make are considerably larger than that guy.

Seems like an expensive and less efficient way of getting basics to be able to transmit a 12-lead. If all they are doing is transmitting, just teach them where to put the electrodes...

 

[Veneficus]

It barely fits on the average sized guy in the demonstration video.
http://youtu.be/OIX6qHGfy_Y
V6 looks to be sitting in V4's position. A good portion of the cardiac patients I make are considerably larger than that guy.

Seems like an expensive and less efficient way of getting basics to be able to transmit a 12-lead. If all they are doing is transmitting, just teach them where to put the electrodes...

Just another gimmic device.

 

[ExpatMedic0]

Just another gimmic device.

Ya I agree, also could cause issues for patients of different sizes and shapes, breast, ect.
Cool idea though but seems like I always end up doing ECG's on a obese elderly woman with breast that often require a lift assist to deal with.

 

[Clare]

I am greatly confused

We learn in year one at uni how to acquire a 12 lead ECG; so long as you understand the basic electrophysiology of the leads (I forget the name of it, but it is some triangle...) coupled a simple anatomy of the thoracic cage it's pretty hard to stuff up putting on sticky dots and making sure its not full of artifact etc.

It's even taught to the vollies on nat dip

I also don't get why you transmit the ECG? The only time that that is done here is for cardiologist review for thrombolysis; surely nobody who is not ICP is thrombolysing so I don't get it ...

Am I just not getting something here that is screamingly obvious?

 

[ExpatMedic0]

I did ECG's in the hospital as a tech before I was a Paramedic, the only training i received on it was "on the job" I had no education in it. Its not complicated.

I can see the idea behind this device. I think it could help reduce scene times a little and would also make it possible for your BLS partner (if your an ALS/BLS unit) to set this up easily while freeing the ALS up for other things.
In theory... however I do not think it would work so easily on a lot of the patients we are doing a 12 lead on, plus the cost of the device maybe more than just normal leads.

Also I am not sure how much time would save...

 

[Clare]

Why not just teach how to acquire a 12 lead ECG? It's not that hard, if the vollies and first year uni students can learn and become proficient with it then surely that must be proof it is more than easy enough to learn?

 

[ExpatMedic0]

Yes I agree with you, and I think its very simple. I also do not support this device. I think it was a novel idea to save 1 or 2 minutes on scene time which I can see, but overall I do not think the device is worth it.

 

[systemet]

Why not just teach how to acquire a 12 lead ECG? It's not that hard, if the vollies and first year uni students can learn and become proficient with it then surely that must be proof it is more than easy enough to learn?

We teach our EMTs how to do this during orientation. We've also just always taught them to do it. It makes no sense not to if they're going to be working with a paramedic.

Frankly, it makes no sense not to teach them to do it first place, and have it as a BLS skill. But then you start running into problems with the short length of EMT training programs.

 

[Outbac1]

In the words of George Carlin.

“Put two things together which have never been put together before, and some schmuck will buy it.”