Ridryder911
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I ask why would a Paramedic want someone else to "draw up their med.'s" and then injecting it for them? Really, what advantage does this allow?
R/r 911
emt-b meds
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I ask why would a Paramedic want someone else to "draw up their med.'s" and then injecting it for them? Really, what advantage does this allow?
R/r 911
Emt-ps
This whole thread really bothers me. There is a nice way to point out an error made by another and then there is "bashing" I don't know if it was in this forum or a different one but I've seen comments such as "the dumb nurses in the nursing homes" There are good nurses and there are poor nurses- the same with EMT's no matter what their credentials are. If we want to build up our profession -then we should build each other up in a constructive manner. I find it very distasteful when EMT's bash first rather than politely correct. people learn faster that way.
This whole thread really bothers me. There is a nice way to point out an error made by another and then there is "bashing" I don't know if it was in this forum or a different one but I've seen comments such as "the dumb nurses in the nursing homes" There are good nurses and there are poor nurses- the same with EMT's no matter what their credentials are. If we want to build up our profession -then we should build each other up in a constructive manner. I find it very distasteful when EMT's bash first rather than politely correct. people learn faster that way.
Littlebit, i suggest you go back and read the start of this post... when the original mistake was made, one person suggested he research the topic in past posts, and another person pointed out the spelling mistakes in a couple of sentences, that's it... kind of exactly what you are suggesting should have happened... BUT the person who make the mistakes didn't say, "ok, thanks, i'll get that straightened out", he fired back a snide remark about how spelling mistakes don't matter... that is why this thread took off...
i find there is a lot of insecurities out here, mostly from the lower level emt's... i have seen more experienced members posts where they admit mistakes, say "i stand corrected", etc...
but the emt-b's and students want to fight everything... now before you jump on me, i am an emt-b... you know what? CC's and Paramedics know more than we do... they have more knowledge and experience, and that is the way is should be... why people throw out the "stupid low level emt-b" stuff is beyond me... pure insecurities... if you are good at your level, be proud of it, but listen to those who know better...
i hope to be an ALS provider one day, and i am happy and competent at the basic level right now...
i find there is a lot of insecurities out here, mostly from the lower level emt's... i have seen more experienced members posts where they admit mistakes, say "i stand corrected", etc...
but the emt-b's and students want to fight everything... now before you jump on me, i am an emt-b... you know what? CC's and Paramedics know more than we do... they have more knowledge and experience, and that is the way is should be... why people throw out the "stupid low level emt-b" stuff is beyond me... pure insecurities... if you are good at your level, be proud of it, but listen to those who know better...
i hope to be an ALS provider one day, and i am happy and competent at the basic level right now...
I have a couple of thoughts after reading this thread, but first, a little about myself. I'm 16 years old, still in high school, and I'm a recently certified EMT-B in Connecticut (so I can guarantee I'll see medic001918 around). I don't pretend to know anything about anything, but I'd still like to make a few points.
1) The curriculum for an EMT-B is the minimum requirement to obtain a certification. The minimum may not be very high, but it provides a starting point. Just because someone is only an EMT-B doesn't preclude him or her from knowing anything else about emergency medicine (or just medicine in general). I think the "stupid, lowly EMT-B" comments could stem from this line of thought. I'm sure a lot of EMT-Bs have a strong interest in the field and will continue to pursue their education (even if it just involves reading a few articles) past the minimum curriculum. One of the students in my class already had a bachelor's degree in biology before starting. The AP classes I take in school also help me understand how the human body works (especially from biology), and chemistry has helped me understand a little about drug interactions. So, while it may not be much and it doesn't affect our scope of practice, there's no level of knowledge that all EMT-Bs are automatically at.
It seems obvious, but I thought I'd post it as at least a reminder.
2) To all of the paramedics and nurses and whoever has any other funny acronyms following their names: what are you doing about the "stupid EMT-Bs?" I take every opportunity that I get to teach people around me something that they may not know. Do you do the same? Even though what you say to us may not hit home the first time you say it, and even if it doesn't effect how much medical care we're allowed to give, don't you think that you could be sharing a lot with us from your thousands of hours of training? What we learn as EMT-Bs could have some benefits for you, too. Maybe next time we watch you push narcan a little too fast, we'll grab the emesis bins with enough time left so that no one has to wipe down the floor of the ambulance or walk in puke.
These were just a couple of thoughts. I know I'm new, so you can disregard them if you'd like.
Best wishes,
Joe
1) The curriculum for an EMT-B is the minimum requirement to obtain a certification. The minimum may not be very high, but it provides a starting point. Just because someone is only an EMT-B doesn't preclude him or her from knowing anything else about emergency medicine (or just medicine in general). I think the "stupid, lowly EMT-B" comments could stem from this line of thought. I'm sure a lot of EMT-Bs have a strong interest in the field and will continue to pursue their education (even if it just involves reading a few articles) past the minimum curriculum. One of the students in my class already had a bachelor's degree in biology before starting. The AP classes I take in school also help me understand how the human body works (especially from biology), and chemistry has helped me understand a little about drug interactions. So, while it may not be much and it doesn't affect our scope of practice, there's no level of knowledge that all EMT-Bs are automatically at.
It seems obvious, but I thought I'd post it as at least a reminder.
2) To all of the paramedics and nurses and whoever has any other funny acronyms following their names: what are you doing about the "stupid EMT-Bs?" I take every opportunity that I get to teach people around me something that they may not know. Do you do the same? Even though what you say to us may not hit home the first time you say it, and even if it doesn't effect how much medical care we're allowed to give, don't you think that you could be sharing a lot with us from your thousands of hours of training? What we learn as EMT-Bs could have some benefits for you, too. Maybe next time we watch you push narcan a little too fast, we'll grab the emesis bins with enough time left so that no one has to wipe down the floor of the ambulance or walk in puke.
These were just a couple of thoughts. I know I'm new, so you can disregard them if you'd like.
Best wishes,
Joe
DisasterMedTech
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Joe-
I think your post is the saving grace of this thread. People assume that because in general, the number of hours for EMT-B certification is about 120 hours (thats an average that everyone has latched onto, including the NREMT when they say that the training shall not consist of less than 120 hours of didactic work. Before I ever came to EMT training, I had completed coursework in psychology, abnormal psychology, biology, chemistry, biochemistry, anatomy and physiology, epidemiology, medical terminology, diagnostics and the "psychology of trauma" (which focused on how to help your patients and yourself get through traumatic experiences). I have military level training in landing zone operations and search and rescue.
So what does all of that prove? It proves that when paramedics, nurses...whoever it is with the extra-long strings of initials after their names arent the only ones with training and expertise...start bashing Basics, saying we are worthless, wondering what we are doing drawing up meds, etc they are, without knowing it, making rash generalizations which are often not based in reality, but rather ego. If as health care providers we can lose the ego and remember that what we are there for, whether paramedic, basic, MFR, CCP, etc, is to help our patients and often to keep them from dying until they can be handed off to a higher level of care. It would seem that what is most important is the level of patient care. Basic and paramedics owe it to themselves and to the patients they will be asked to save to have as much training as possible and be as good (not just competent) as we can. Im taking AHLS (advanced hazmat life support) in January of 2008. I cant get certified in it because the certification is only allowed to EMT-P and higher. The reason for this is that 98% of the interventions taught in this course cannot be carried out by a Basic operating properly within his/her protocols. But what happens when I am on a crew and we are called to a patient who has been exposed to hazardous materials or I am deployed with a disaster team to a chemical spill. I might be working next to a paramedic who hasnt had this particular course and I might be able to think of something he doesnt. Ive worked with paramedics that are 10 years younger than I am and often it has been shear life experience that has proven valuable.
When you label someone as "just a basic" or "crazy" or "stupid" you minimize and devalue that person. You put your label on them because you think you know what they are made of, that you know everything of which they are capable. How many paramedics out there are capable of tucking the ego away in favor of patient care and turning to your Basic partner and saying, as my EMT instructor says "I got nothin'. What are you thinking?" Most paramedics I have worked with wouldnt do this. But I have work with a few (maybe less than 5) that will do this. When you pigeon hole your partner, you cut off a valuable patient care resource and many times, the Basic senses or has been outright told that he isnt all that valuable as a member of the crew and might very well have that answer that the paramedic is looking for but wont say so because he has been told either in word or actions of the paramedic that Basics should be seen and not heard. Would you get into your ambulance every day when you start your shift and start tossing out extension tubing, pressure dressings, etc because there might be a more advanced way of doing something. Of course you wouldnt. So why toss away a person that happens to be a Basic simply because you assume you know what they can and cannot do. Ive known paramedics who wont ask a Basic to spike a bag because they assume that the Basic wasnt taught this and cant do it. Do yourself a favor if any of the above pertains to you. Talk to your Basic partner. Find our what their interests are. Ask what kind of education they have outside of EMT school. You might just be surprised at what they know and what they can do. Also it would be helpful to remember that they are not a lesser form of plant life, they are not something you clean off the bottom of your boot. They are a trained professional and deserve to be treated as such.
A PS to RidRyder- when you put quotes around something you say someone else has said, you are indicating that it is EXACTLY what they said. If you look back at where you quoted me, it is obvious that you didnt even bother to re-type accurately what I said.
I think your post is the saving grace of this thread. People assume that because in general, the number of hours for EMT-B certification is about 120 hours (thats an average that everyone has latched onto, including the NREMT when they say that the training shall not consist of less than 120 hours of didactic work. Before I ever came to EMT training, I had completed coursework in psychology, abnormal psychology, biology, chemistry, biochemistry, anatomy and physiology, epidemiology, medical terminology, diagnostics and the "psychology of trauma" (which focused on how to help your patients and yourself get through traumatic experiences). I have military level training in landing zone operations and search and rescue.
So what does all of that prove? It proves that when paramedics, nurses...whoever it is with the extra-long strings of initials after their names arent the only ones with training and expertise...start bashing Basics, saying we are worthless, wondering what we are doing drawing up meds, etc they are, without knowing it, making rash generalizations which are often not based in reality, but rather ego. If as health care providers we can lose the ego and remember that what we are there for, whether paramedic, basic, MFR, CCP, etc, is to help our patients and often to keep them from dying until they can be handed off to a higher level of care. It would seem that what is most important is the level of patient care. Basic and paramedics owe it to themselves and to the patients they will be asked to save to have as much training as possible and be as good (not just competent) as we can. Im taking AHLS (advanced hazmat life support) in January of 2008. I cant get certified in it because the certification is only allowed to EMT-P and higher. The reason for this is that 98% of the interventions taught in this course cannot be carried out by a Basic operating properly within his/her protocols. But what happens when I am on a crew and we are called to a patient who has been exposed to hazardous materials or I am deployed with a disaster team to a chemical spill. I might be working next to a paramedic who hasnt had this particular course and I might be able to think of something he doesnt. Ive worked with paramedics that are 10 years younger than I am and often it has been shear life experience that has proven valuable.
When you label someone as "just a basic" or "crazy" or "stupid" you minimize and devalue that person. You put your label on them because you think you know what they are made of, that you know everything of which they are capable. How many paramedics out there are capable of tucking the ego away in favor of patient care and turning to your Basic partner and saying, as my EMT instructor says "I got nothin'. What are you thinking?" Most paramedics I have worked with wouldnt do this. But I have work with a few (maybe less than 5) that will do this. When you pigeon hole your partner, you cut off a valuable patient care resource and many times, the Basic senses or has been outright told that he isnt all that valuable as a member of the crew and might very well have that answer that the paramedic is looking for but wont say so because he has been told either in word or actions of the paramedic that Basics should be seen and not heard. Would you get into your ambulance every day when you start your shift and start tossing out extension tubing, pressure dressings, etc because there might be a more advanced way of doing something. Of course you wouldnt. So why toss away a person that happens to be a Basic simply because you assume you know what they can and cannot do. Ive known paramedics who wont ask a Basic to spike a bag because they assume that the Basic wasnt taught this and cant do it. Do yourself a favor if any of the above pertains to you. Talk to your Basic partner. Find our what their interests are. Ask what kind of education they have outside of EMT school. You might just be surprised at what they know and what they can do. Also it would be helpful to remember that they are not a lesser form of plant life, they are not something you clean off the bottom of your boot. They are a trained professional and deserve to be treated as such.
A PS to RidRyder- when you put quotes around something you say someone else has said, you are indicating that it is EXACTLY what they said. If you look back at where you quoted me, it is obvious that you didnt even bother to re-type accurately what I said.
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JJR512
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As an EMT-B in Maryland, my BLS ambulance is required to carry Epi-Pens (adult and junior), activated charcoal without sorbital, and glucose. Consultation with medical control is required for the charcoal. Additionally, we can assist patients to administer their own albuterol inhaler, and nitroglycerin tablet or spray. Some jurisdictions have a supplemental protocol that allows EMT-Bs to administer MARK I (I personally know nothing about that). Finally, let's not forget oxygen.
Do I know the pathophysiology of each of those medications? No. I know what they do, but not necessarily exactly why they do what they do. I also know when I can and can't give each of them.
So here's my point: Some people are saying that EMT-Bs should not be allowed to give any meds because they are not taught, as part of the EMT-B curriculm, how the meds do what they do and why they work. My feeling is that the doctors who wrote the protocols that specify when I can and cannot use the meds do know those details and they wrote the protocols so that an EMT-B can use those meds without having to know the details of how and why they work.
Ultimately, if I follow protocol and administer a medication appropriately and something bad happens, is it my fault for not knowing how that medication works, or is it Dr. Alcorta's fault for writing (or signing off on) a poor protocol? (Dr. Alcorta is Maryland's chief medical director.) Well, I'll tell you that I don't personally think it's my fault (again, assuming I properly followed the protocols).
Do I know the pathophysiology of each of those medications? No. I know what they do, but not necessarily exactly why they do what they do. I also know when I can and can't give each of them.
So here's my point: Some people are saying that EMT-Bs should not be allowed to give any meds because they are not taught, as part of the EMT-B curriculm, how the meds do what they do and why they work. My feeling is that the doctors who wrote the protocols that specify when I can and cannot use the meds do know those details and they wrote the protocols so that an EMT-B can use those meds without having to know the details of how and why they work.
Ultimately, if I follow protocol and administer a medication appropriately and something bad happens, is it my fault for not knowing how that medication works, or is it Dr. Alcorta's fault for writing (or signing off on) a poor protocol? (Dr. Alcorta is Maryland's chief medical director.) Well, I'll tell you that I don't personally think it's my fault (again, assuming I properly followed the protocols).
Ridryder911
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Good points Joe, and I will answer them in regards to myself.
What do I do to change things? Last Saturday, I was a clinical preceptor for a Paramedic program (In OKC, they require Paramedic students to have an EMS instructor/preceptor present in the hospital setting). This means I had 4 Paramedic students in ICU and 3 in CCU setting. I made sure that each performed detailed patient assessments, including heart tones, performed detail neuro assessments. I monitored them while administering medications, observed them while they placed a patient on a vent with the right settings and controls, and was even able pace one patient. Meanwhile, I continuously asked them detailed and tough questions during the tour, expecting an answer by the end of the shift (i.e why at a cellular level Glucagon works in Beta Blocker overdose).
Many were not used to real clinicals. All of these students have been a basic less than one year, with less work experience than that. Challenging, yes, but they did an excellent job. Again, I believe we can get what we ask for from people, the problem most programs never ask more than the "minimum".
I teach continuously at work. That is my job. The same as it is your job to clean up the mess, prepare the unit for another response. If I push Narcan to fast, I will admit it and yes, clean up my own mess. (p.s. I never push Narcan < 3-5 minutes. I learned my lesson)
I have been riding with a basic/medic student for the past month. I expect them to listen and observe closely. I do not want to repeat myself or perform an action over and over again. By not paying attention, this only gives me the reflection that you do not care what I am teaching, nor care about the profession.
Yes, there are stupid questions. Those that you should had already known the answer to and those that you failed to even attempt to research and look up for yourself before asking. I and many other professionals realize, one is much more to remember something if that person researches the answer for themselves.
I find very few Paramedics that do not enjoy teaching. Rather I find many basics that develop an attitude that they do not need to learn anything that they cannot provide or perform immediately. Many really do not want to know more, rather just be able to perform the associated skill (the fun part). This causes a lot of frustration between the levels.
The "Stupid EMT/B" came from watering down the curriculum. Review the EMT Basic 14 years ago, and one can definitely tell the difference. Although shorter in number of hours, it was much greater in detail than the current one. So yes, there is a reason why seasoned medics as well as seasoned Basics describe EMT the current courses as being nothing much more than advanced first aid. I highly encourage anyone to perform a comparison. One will see there is not much difference between the two. It is not the current Basics fault, rather we have allowed the system to lower it standards. Hopefully, with the new curriculum we can change this.
Joe, you have a good perception of wanting to pursue to be better. That is what it takes to provide good patient care. Be sure to keep that attitude in your development, no matter what profession you choose.
R/r 911
BBFDMedic28
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Dear Shane
NREMT-P
Allow me to answer your questions and clear up some misconceptions you have.
Comment: This spelling issue is not about a simple spelling error, it's about misspelling medications that are commonly administered. There's a significant difference between the two. Medications errors have been committed in the healthcare profession due to misspellings.
My response: There is a nice way to point out the errors. And since when did we start administering meds in this forum? By saying the above you make it sound as though a med admin error was committed due to their misspelling.
Comment: How is an EMT more qualified than advanced first aid? Please share with us. You can provide oxygen, and hold direct pressure. The assessment and critical thinking skills provided in most EMT-Basic programs is poor at best in it's current form. The anatomy & physiology is not there to perform proper assessments. Without being able to perform a proper assessment and understanding of how the human body works, the information gained is of little value. If you don't believe me, consider reading the current curriculum. For the most part, every complaint gets "high flow oxygen, rapid transport and call a medic." I've seen this trend continue. Look at the dumbing down of CPR and the EMT program itself. Compare the program now to someone who's had their card for fifteen or twenty years. There's a huge difference in what was taught. The EMT-Basic program really is little more than advanced first aid. I'm sorry that offends you.
My response: ONE Example of difference between First Aid and EMS..... First Aid training will give you no clue as to the indiations for certain drugs...EMT training will give you the indications, contraindications, and other info as well as the ability to admin them.
Comment: In it's current form, the program is nothing to be proud of. The industry as a whole could use to be restructured and requirements changed. All the way from EMT-Basic to Paramedic. I won't leave myself out of it. I'm in favor of raising the standards across the board.
My response: If you arent happy or proud of what you are doing....get out.
Comment: If you're going to quote me, please do it correctly.
My response: I wasn't quoting you. I was giving an example of what should have been said. IE instead of ripping into someone, you should say "we have already disscussed that issue".
Comment: If you feel so strongly that the EMT-Basic program is more than advanced first aid, why not share your medications with us to be discussed? We can all discuss our feelings on the issue?
My response: Because everyone was put out with this topic except me and the original poster. I was going to discuss it with that person in a manner that noone else had to hear it.
Medic 28
NREMT-P
Allow me to answer your questions and clear up some misconceptions you have.
Comment: This spelling issue is not about a simple spelling error, it's about misspelling medications that are commonly administered. There's a significant difference between the two. Medications errors have been committed in the healthcare profession due to misspellings.
My response: There is a nice way to point out the errors. And since when did we start administering meds in this forum? By saying the above you make it sound as though a med admin error was committed due to their misspelling.
Comment: How is an EMT more qualified than advanced first aid? Please share with us. You can provide oxygen, and hold direct pressure. The assessment and critical thinking skills provided in most EMT-Basic programs is poor at best in it's current form. The anatomy & physiology is not there to perform proper assessments. Without being able to perform a proper assessment and understanding of how the human body works, the information gained is of little value. If you don't believe me, consider reading the current curriculum. For the most part, every complaint gets "high flow oxygen, rapid transport and call a medic." I've seen this trend continue. Look at the dumbing down of CPR and the EMT program itself. Compare the program now to someone who's had their card for fifteen or twenty years. There's a huge difference in what was taught. The EMT-Basic program really is little more than advanced first aid. I'm sorry that offends you.
My response: ONE Example of difference between First Aid and EMS..... First Aid training will give you no clue as to the indiations for certain drugs...EMT training will give you the indications, contraindications, and other info as well as the ability to admin them.
Comment: In it's current form, the program is nothing to be proud of. The industry as a whole could use to be restructured and requirements changed. All the way from EMT-Basic to Paramedic. I won't leave myself out of it. I'm in favor of raising the standards across the board.
My response: If you arent happy or proud of what you are doing....get out.
Comment: If you're going to quote me, please do it correctly.
My response: I wasn't quoting you. I was giving an example of what should have been said. IE instead of ripping into someone, you should say "we have already disscussed that issue".
Comment: If you feel so strongly that the EMT-Basic program is more than advanced first aid, why not share your medications with us to be discussed? We can all discuss our feelings on the issue?
My response: Because everyone was put out with this topic except me and the original poster. I was going to discuss it with that person in a manner that noone else had to hear it.
Medic 28
medic001918
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If you're active somewhere in Central Connecticut, you more than likely will see me or have seen me around the hospitals at some point since I work for two services.
To answer your question about if I take the time to educate and teach those that work with me, the answer is yes. My full time position puts me riding with volunteer EMT's and the opportunity to teach is rather plentiful. Couple that with the having paramedic students riding with me and I can say that that I do my part. It doesn't change that the larger problem with EMS as a whole is a lack of education in the first place. This is something that I continually advocate for, but I don't see changing any time soon unfortunately.
Maybe I'll see you around the hospital sometime.
Shane
NREMT-P
Ridryder911
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This is called "cook-book"medicine. This is what majority of Paramedics are against. Patients never really fall into just one category or another, medicine is NEVER black and white.
Do I realize it is not your fault? Yes. Does this change my attitude about the problem? No.
In regards to :
BBFDMedic28 said:
I much rather change it. Change the minimum level to be on an EMS unit as a Paramedic and the role of the Basic would strictly be for first response. Each patient deserves the examination and assessment of advanced level and treatment of ALS if needed. The role of the Basic would be strictly for stabilization prior to EMS transport and assisting Paramedics at different levels.
The public expects to be treated by Paramedics and like other public health and public services should be given the right to.
R/r 911
JJR512
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I understand that it seems I have basically stated that all I have to know is what the protocols tell me to do, so if I can memorize them and follow instructions, what else do I need to know, right? Well, to some extent, that's true, but...doesn't that apply to paramedics as well?
What I am saying is that although a paramedic has gone through a lot more schooling and completed a great deal more practical...ermm...practice than an EMT-B, and, yes, knows and understands a lot more than an EMT-B, isn't it also true, by the same token, that a medical doctor has been through a lot more school and practice and knows and understands a great deal more than a paramedic? Whether you're a basic or a paramedic, aren't you following protocols that were written by medical doctors, and aren't you following their instructions (or "recipes")? Aren't you learning the things that they have determined you should know, and aren't you making the decisions that they have decided you should be able to make?
In short, I'm saying that (using your analogy) basics may be making cupcakes from a boxed package and paramedics may be making crème brûlées from scratch, but we're all just following recipes handed down to us from the master chefs.
Paramedics may have more options, more things they can do, more choices to make, and more education to help them make those choices, but when it comes right down to it, you're still doing what a doctor has ordered you to do.
What I am saying is that although a paramedic has gone through a lot more schooling and completed a great deal more practical...ermm...practice than an EMT-B, and, yes, knows and understands a lot more than an EMT-B, isn't it also true, by the same token, that a medical doctor has been through a lot more school and practice and knows and understands a great deal more than a paramedic? Whether you're a basic or a paramedic, aren't you following protocols that were written by medical doctors, and aren't you following their instructions (or "recipes")? Aren't you learning the things that they have determined you should know, and aren't you making the decisions that they have decided you should be able to make?
In short, I'm saying that (using your analogy) basics may be making cupcakes from a boxed package and paramedics may be making crème brûlées from scratch, but we're all just following recipes handed down to us from the master chefs.
Paramedics may have more options, more things they can do, more choices to make, and more education to help them make those choices, but when it comes right down to it, you're still doing what a doctor has ordered you to do.
bstone
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Worked for 5 years as an EMT-B in Chicago North EMS system. I still have a valid IL EMT-B license. Never knew we had glucagn as part of our protocols. Our PMD doesn't allow it, seemingly. In the states where I trained and work as an Intermediate, it's just another tool in the box.
reaper
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JJR512,
You have a point for some systems. Where I work our protocols are basically a list of what is available for us to use. we still get to make the decision of when and how we utilize our tools.
That is why I hate algorithms in protocols. That is cook book medicine. A monkey can follow a algorithm. A human can use his brain to decide what to do.
You have a point for some systems. Where I work our protocols are basically a list of what is available for us to use. we still get to make the decision of when and how we utilize our tools.
That is why I hate algorithms in protocols. That is cook book medicine. A monkey can follow a algorithm. A human can use his brain to decide what to do.
Ridryder911
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Actually no. My protocols are only 15 pages thick for everything. Each starts with the statement: "This protocol is a guideline or suggestion only and maybe used in its entirety or may not, depending upon the discretion of the Paramedic. The Paramedic has the education of treating appropriately depending on the state and judgement of the Paramedic. Medical control should be contacted for advice, if needed or if possible." As well, not all physicians are created equal. Many have never intubated, or even rotated in an ER more than a 8 hr shift, as well have never read an ECG. I know, I teach or attempt to the residents and physicians in ACLS.
We went from 600 pages to the 15 for a reason. Our medical director realizes and emphasizes we have the skill to assess and make a clinical impression (diagnosis) based upon our education and yes clinical experience. Since this reduction of protocols have we reduced our treatment? Actually no, we have increased the number of medications and treatments.
Protocols for Paramedics should be used as guidelines only, not a prescription. There is no way one could write for every illness or injury, as well as every event. Many EMS Medical Directors feel the need to attempt to, rather they open themselves and the medic to more potential litigation by not having that medic perform treatment appropriately for the patient individual needs, again if one must follow every portion of a protocol may not be the best medicine. I know of services that promote one to treat the protocols instead of the patient. That is wrong.
A patient may never meet a protocol, what do you do then? You treat appropriately. That is why education and knowledge is essential. Medicine is an art as much as it is a science. Each patient is unique, each disease and injury has its own idiosyncrasy. It may respond or may not respond to the standard treatment, or may not even need to be treated in some and while in others quite the opposite.
That is why progressive EMS services do not promote such cookbook medicine. Realizing there will never be a step by step to treat most patients, nor should there be. They much rather focus on education and continuous reviewing of their care to make sure they are meeting the demands of the medical community and to the patients.
R/r 911
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JJR512-
i can't believe that you don't have a better knowledge of how those meds work... i completed my EMT-B course last spring, and we sure as heck knew how the meds worked... why would i give one witout knowing what it did...
do i know on a cellular level, perhaps not... do we learn that albuterol acts on beta-2 receptors to dilate smooth muscles of the lungs? yes... did we learn that it also acts on some degree on the beta-1 receptors of the heart? yes...
which would prevent us from administering albuterol to someone with a heart history, angina pectoris, etc...and certainly, armed with the knowledge that albuterol simply makes pt's breathe easier is just silly...
we were given this information and encouraged to learn in more detail, as of course, what we learn is a MINIMUM standard...
so, as a fellow EMT-B, do i think you would be partially to blame? yes i do... because if i didn't know, i would feel responsible as well..
if there are important things you don't feel you know, why don't you just go online and learn them? instead of passing the buck?
in other words, go out and be better than you have to be...
but if you don't want to do that, certainly don't complain if things go wrong.
-fellow EMT-B
i can't believe that you don't have a better knowledge of how those meds work... i completed my EMT-B course last spring, and we sure as heck knew how the meds worked... why would i give one witout knowing what it did...
do i know on a cellular level, perhaps not... do we learn that albuterol acts on beta-2 receptors to dilate smooth muscles of the lungs? yes... did we learn that it also acts on some degree on the beta-1 receptors of the heart? yes...
which would prevent us from administering albuterol to someone with a heart history, angina pectoris, etc...and certainly, armed with the knowledge that albuterol simply makes pt's breathe easier is just silly...
we were given this information and encouraged to learn in more detail, as of course, what we learn is a MINIMUM standard...
so, as a fellow EMT-B, do i think you would be partially to blame? yes i do... because if i didn't know, i would feel responsible as well..
if there are important things you don't feel you know, why don't you just go online and learn them? instead of passing the buck?
in other words, go out and be better than you have to be...
but if you don't want to do that, certainly don't complain if things go wrong.
-fellow EMT-B
DisasterMedTech
Forum Crew Member
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I guess I really come down somewhere in the middle of this argument. Do I think I and my fellow Basics are ambulance drivers? No. Do I think we could and should know more and be trained in greater detail and for a longer period of time? Yes. I'd like to see the NREMT set the standard at 500 hours for EMT-Basic training. It would allow for a greatly expanded instructional level on the topics we now cover as well as things like basic ECG reading and also being able to not only measure vital signs, but know what they mean enough so as to be able to interpret them correctly at least at a rudimentary level. Until such changes can be made, it is incumbent upon us as Basics to continue to train past the level we currently do. Journal articles written at the scholarly and not the pop culture level, additional course work and certifications all add to our ability to add to the level of expertise that Basic-Paramedic crews can bring to pre-hospital emergency medicine. To be fair, I also dont think that 1000-1500 hours for Paramedic training is sufficient to allow them to reliably practice at the level of responsibility that so many do. I recently saw a newly graduated paramedic who started an IV which arriving at the hospital was determined to have accessed the vein, exited it and punctured it again in a second location. This kind of botched intervention is without excuse. IV access, at least in Illinois, is one of the very first skills taught to paramedic students and one that is drilled into them throughout their entire training. We need to smarten up and stop dumbing down the level of education for all EMS providers. Since the 500 hours I suggest for Basics is more than 3 times the current average, I dont think that 2000-2500 hours is too much to ask of our paramedic students. When I lived in New Mexico, I did an internship in a clinic where acupuncture was practiced. The state of NM requires in excess of 2000 hours for acupuncture licensure and acupuncturists are not providing invasive airways or decompressing a pneumo-thorax.
Ridryder911
EMS Guru
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I suggest we look at our neighbors up North. Minimal one year for entry level, with general education of 2-3 yrs and top level of a Baccalaureate degree.
R/r 911
R/r 911
I'm sorry, but everybody who has brought up how some basic's will get extra training on their own, you're making a point that is really worthless. It's good to know that some people do, but it doesn't change the fact that the minimum requirements for certification as an EMT-B are just that; minimal. It's also good to keep in mind that most people who certify as a basic, unless they are continuing on to a higher certification or different medical branch, will not take many, if any, advanced medical courses.
I hate cookbook medicine. Except where it concerns EMT-B's. For what they are taught, and what they are expected to do, it's very appropriate. They don't get the depth of knowledge to figure out more than simple, basic, easy to recognize problems, and their treatements are the same. Which is as it should be, given what the educational standards are. Teach them how use administer O2, no biggie. Asprin too for chest pain. Oral glucose for hypoglycemia, assisting with a patient's nitro for chest pain and inhalers for difficulty breathing. None of those are an issue, the basic indications/contraindications are pretty easy to get, and the risk is pretty minimal for the most part. Charcoal...with proper training that can also be a basic med. Same for subq/IM epi, but then anaphylaxis needs to be covered in extreme detail. I've got no problem with any of these meds being available to an EMT-B, even with the standards we have today. At least in my state.
If you are a basic and tired of being called a "lowly basic" or whatever crap you hear, do something about it. Get a higher cert. Show people that you actually know what you're doing. But don't ever forget that your certification is called BASIC for a reason; you get minimal training and minimal skills and minimal knowledge. Which is really as it should be, and if you've got a head on your shoulders instead of a big chip, you can still be a lot of help to whichever medic you work with.
I hate cookbook medicine. Except where it concerns EMT-B's. For what they are taught, and what they are expected to do, it's very appropriate. They don't get the depth of knowledge to figure out more than simple, basic, easy to recognize problems, and their treatements are the same. Which is as it should be, given what the educational standards are. Teach them how use administer O2, no biggie. Asprin too for chest pain. Oral glucose for hypoglycemia, assisting with a patient's nitro for chest pain and inhalers for difficulty breathing. None of those are an issue, the basic indications/contraindications are pretty easy to get, and the risk is pretty minimal for the most part. Charcoal...with proper training that can also be a basic med. Same for subq/IM epi, but then anaphylaxis needs to be covered in extreme detail. I've got no problem with any of these meds being available to an EMT-B, even with the standards we have today. At least in my state.
If you are a basic and tired of being called a "lowly basic" or whatever crap you hear, do something about it. Get a higher cert. Show people that you actually know what you're doing. But don't ever forget that your certification is called BASIC for a reason; you get minimal training and minimal skills and minimal knowledge. Which is really as it should be, and if you've got a head on your shoulders instead of a big chip, you can still be a lot of help to whichever medic you work with.
Okay, I'm back with a few more thoughts/reactions.
Of course we should all be increasing our knowledge of medicine, but I'm not sure that I agree with doubling the amount of class hours that it takes to achieve certifications. We have to look back and think about what kind of a need we have for this kind of training. I think that a lot of this would discourage people from entering the field. And what kind of a benefit would basics derive from this extra training?
The way I see it, EMS is just about getting people to the hospital alive. This task obviously involves several different skills. I think that EMT-Bs have an appropriate level of training for the task that they perform. They do a quick assessment to determine the severity of the sickness/injury, and they take the proper actions to ensure that the patient arrives at the hospital in order for doctors to perform definitive care. The way I see it, as long as the patient arrives at the hospital in a salvageable condition, we've done our jobs.
What would an extra thousand hours of paramedic training do for EMS? Well, the first thing I think it would do is decrease the number of paramedics we see around. Who wants to pay twice as much for a course that's twice as long? You can keep adding hours, but eventually everyone who goes through the training is going to emerge with an MD, and I don't really think we need that.
Also, while I know I'm still incredibly new here, I think maybe we all have to take a reality check. The notion that a doctor doesn't know what he/she is doing when it comes to medicine can be dangerous. While it's true that many have not performed intubations since medical school, or that many have forgotten the finite details involved with reading an ECG, they're still doctors. Paramedic training simply doesn't compare, and it would be asinine to disagree with that point. I understand that many doctors will be out of practice when it comes to functions that don't directly relate to his/her job, but they do have a big picture that your average EMS provider (I mean very few exceptions could compare to doctors) does not. Four years of college and four years of medical school do not equal 1000 hours of paramedic school.
My other point may be more controversial, but I feel that it needs to be said. I didn't appreciate the comment that EMT-Bs should clean the truck and prepare it for the next call. Don't get me wrong. That's part of our job, but the way it was said (without mentioning any of the other things EMTs are trained to do) implied that that's all we do. EMT-Bs may not know much when it comes to medicine, but we do know something. Most of us didn't do the coursework so that we could just drive ambulances really fast. We also have a genuine inclination to want to help people, just like you (the paramedics). The only thing that I ask is that you at least use us for what we can do.
Thanks again,
Joe
Of course we should all be increasing our knowledge of medicine, but I'm not sure that I agree with doubling the amount of class hours that it takes to achieve certifications. We have to look back and think about what kind of a need we have for this kind of training. I think that a lot of this would discourage people from entering the field. And what kind of a benefit would basics derive from this extra training?
The way I see it, EMS is just about getting people to the hospital alive. This task obviously involves several different skills. I think that EMT-Bs have an appropriate level of training for the task that they perform. They do a quick assessment to determine the severity of the sickness/injury, and they take the proper actions to ensure that the patient arrives at the hospital in order for doctors to perform definitive care. The way I see it, as long as the patient arrives at the hospital in a salvageable condition, we've done our jobs.
What would an extra thousand hours of paramedic training do for EMS? Well, the first thing I think it would do is decrease the number of paramedics we see around. Who wants to pay twice as much for a course that's twice as long? You can keep adding hours, but eventually everyone who goes through the training is going to emerge with an MD, and I don't really think we need that.
Also, while I know I'm still incredibly new here, I think maybe we all have to take a reality check. The notion that a doctor doesn't know what he/she is doing when it comes to medicine can be dangerous. While it's true that many have not performed intubations since medical school, or that many have forgotten the finite details involved with reading an ECG, they're still doctors. Paramedic training simply doesn't compare, and it would be asinine to disagree with that point. I understand that many doctors will be out of practice when it comes to functions that don't directly relate to his/her job, but they do have a big picture that your average EMS provider (I mean very few exceptions could compare to doctors) does not. Four years of college and four years of medical school do not equal 1000 hours of paramedic school.
My other point may be more controversial, but I feel that it needs to be said. I didn't appreciate the comment that EMT-Bs should clean the truck and prepare it for the next call. Don't get me wrong. That's part of our job, but the way it was said (without mentioning any of the other things EMTs are trained to do) implied that that's all we do. EMT-Bs may not know much when it comes to medicine, but we do know something. Most of us didn't do the coursework so that we could just drive ambulances really fast. We also have a genuine inclination to want to help people, just like you (the paramedics). The only thing that I ask is that you at least use us for what we can do.
Thanks again,
Joe
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