emt-b meds

[jrm818]

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.
.

The way I see it, you're dead wrong (pun intended). The purpose of EMS is goes waayyy beyond being a fast ride to the hospital. Are you going to be patting yourself on the back when you start bringing vegtables into the hospital, since they're still technically alive? EMS does include fast evaluation and transport to appropirate definitive care, but it also includes early treatment for any number of emergent conditions which can be alleviated pre-hospitally, preventing further damage. Similarly, don't underestimate the need for a detailed examination by somebody who is medically trained. Any number of minor conditions present very similarly to major conditions, and it takes a good deal of training to differentiate the two. Sending someone with a AAA back to bed for a tummy-ache is not a good thing.

And what does "salvageble" mean? Quadruple amputee? Massive brain damage? Etc. etc. There is a lot that can be done pre-hospitally that has a range of implications (miniscule-major) for long-term patient outcome. You need to do some major horizon-broadening. Maybe a few extra hours of instruction would help with that.

Additionally, some definitive care (particulary in arrest cases) can be provided pre-hospitally. And sorry to all the MD podiatrists, OB/GYNs, psychiatrists, GP's, etc. out there, but I'll take the paramedic in an emergency, thanks. Ever wonder what happens if you GP finds out you're having an MI? They call 911.

 

[skyemt]

jolt,

it's ironic, but your post belittles emt-b's more than any other...
you just don't seem to get the big picture... we all do the "same tasks", as you put it... scene safety, assess the patient, perform appropriate interventions... emt-b's do this... don't paramedic's? of course they do...
the difference is in the level of interventions provided... a paramedic can do far more to treat a pt than an emt-b... but can't an emt-b assess a pt as well as a higher level provider? of course he can, if he wants to learn how to do ti...

man, you make it sound like emt-b's are fedex drivers who "scoop and run"... make it to the hospital as fast as possible...what about the times you have to slow down and actually think about things? or do you not think...

it sounds like you don't... because why else would you say that more education doesn't matter...

also, you refer to emt-b's doing "quick assessment to determine severity of sickness/injury"... well, ok... maybe the initial assessment to determine life threats... but what about getting a history? what about interviewing family to get a baseline mental status...what about a thorough sample history?
what about trying to determine the nature of the illness... i'm sure you've heard of "load and go" for priority pt's, and "stay and play" for the others...
sounds like you never even heard of it! just load and go... get to the hospital as fast as possible! no time for histories! quick assessments only!

if a paramedic said half the things you did, the other emt-b's would be up in arms!

 

[Flight-LP]

Wow, a lot to digest in only one day since I read this last..................

EMT's - Have you noticed a trend in this and every other B vs. P thread????

All of the name calling, usually self -descriptive, has come from the EMT's end of the keyboard. There has not been ONE degrading comment from a Paramedic, only the truth. And I'm sorry, EMT education is minimal and acceptable at best. Personally I think it is way substandard.

A wise one spoke recently and said some very powerful words. "If your not happy, do something about it. Advance your certification". The truth has been spoken. Unless you show self improvement by affording your patients the best that they deserve, then you do not have a leg to stand on when a Paramedic points out your minimal education. Honestly, you need to just deal with it.

With that in mind, I will point out that I do recognize the offerings and limitations of my EMT partners. And they operate within that limited scope when they work with me on a unit. I do agree with Rid on a hot topic though. Personally, if it was up to me, there wouldn't be an EMT-B on a 911 unit, it would be a dual medic truck. I believe in giving the community what they pay for. My service gets over $10 million annually, most from taxation. With that amount in mind, I am going to offer them the best service and care there is. I realize that many will not agree, that is fine, each is entitled to an opinion, and I also realize that many will dismiss this idea as "not feasible". Especially amongst volunteer and BLS agencies. But alas, this yet another topic for another day. Just one more issue for our never ending drama we call EMS!!

 

[Littlebit]

The whole thing that set me off is how I percieved some of the messages toward EMT B's.
There is a place for EMT B's same as anywhere in the health profession- CNA's are needed - LPN's are needed- but if we treat these individuals as though they provide the "dirt work" we'd be in a mess of trouble.
Some individuals are completely happy and content with the "level of care they provide" and all positions are important.
I've worked in a variety of settings- I started out as a CNA - and have advanced to management positions and the biggest lesson I learned "is to treat all with respect- no matter what positon or certification they hold." I would encourage anyone to advance thier education or skills but not by belittling thier current position.
Personally I feel most EMS providers have a 6th sense- they are able to recognize ominous signs and symptoms - we've all heard or seen the incidents where they bring in a patient on all fours because it was the only way to keep an airway patent (just an example) Or we've heard the stories of a Paramedic who was so bent on ACLS they forgot ABC's.
Supporting our profession (EMS) and teamwork is I guess what I'm trying to get across.

 

[skyemt]

flight-lp, you had me until the end...
dual medic truck for 911!!!
what a brilliant idea... broken ankle, lets send two paramedics!
separated shoulder! send two medics!

you do realize that in most of the country, 90% of 911 calls are NOT als calls, don't you?

please, do step down from that high horse... many emt's are quite capable...

if we need ALS, i'd be more than happy to have you show up.

 

[skyemt]

as this post progressess, i wonder a couple of things...

what if the emt-b's out here spent as much time learning more as they do defending minimal education??

what if the paramedics out here spent as much time educating emt-b's out here as they do putting them down??

wouldn't we all be better off?

 

[Flight-LP]

flight-lp, you had me until the end...
dual medic truck for 911!!!
what a brilliant idea... broken ankle, lets send two paramedics!
separated shoulder! send two medics!

you do realize that in most of the country, 90% of 911 calls are NOT als calls, don't you?

please, do step down from that high horse... many emt's are quite capable...

if we need ALS, i'd be more than happy to have you show up.

I too think it is brilliant! Although I actually believe it vs. your attempt at sarcasm. We do staff dual Paramedic trucks on occasion and yes a good portion of our calls are BLS. But the pt. benefits from having an ALS assessment performed and an underlying cause and diagnosis being identified through a critical thought process. Very few EMT's can offer that. Just because you don't stick an IV in them, shove a tube down their throat, or give them cool drugs, does not remotely mean that they deserve any level of care less. Plus it allows a reduced workload for medics and has increased morale throughout the organization.

If I were a patient and I was experiencing oh lets say abdominal pain, if the pain became unbearable, I would probably call 911. The last thing I want when an ambulance shows up, is the attendant to then call for a Paramedic. I want that Paramedic on the first ambulance that arrives. So do the majority of educated consumers, i.e. your clientele. Like it or not, EMS is a business, a customer service based one at that. When people pay for a premium service, then thats what they want and around here thats what they get. Not everyone believes in paying for EMS. All I have to say then is you get what you pay for and deserve what you get.

Thank you for your contributions though, your responses are insightful and a welcome change from some of the ignorant and negative views and beliefs that have been floating around................................

 

[DisasterMedTech]

I agree. There seems to be a trend in paramedic thinking that says "EMTs are minimally trained, so let's eliminate them." Would these same paramedics say "that arm is bleeding, let's cut it off?"

As Ive said, I would like to see the amount of training for all levels of EMS providers increased, but...until they are, medical directors are physicians who are considerably more trained that paramedics. They set and enforce protocol. Yes I know there are paramedics on protocol boards. I just wonder how many of them set the final protocols. Not many Im guessing. The medical director in my region says that EMTs are qualified for combi-tubing, epi administration and reducing and field stabilizing a broken femur via traction, among other interventions. I dont really have a horse in this race: Im not intimidated or threatened by paramedics nor do I feel inferior because I am a basic. There should be changes, but until there are, it is what it is and Im going to do what Im trained to do safely, well and within my protocols.

 

[triemal04]

I agree. There seems to be a trend in paramedic thinking that says "EMTs are minimally trained, so let's eliminate them." Would these same paramedics say "that arm is bleeding, let's cut it off?"

Don't recall a medic saying that we should eliminate basics; there is a place for them, and they can fill a role in EMS IF used properly. What I recall is medic's saying that the training of basics (and of a lot of paramedics) is minimal and should be upgraded. I also recall medic's saying that basics don't recieve enough training for some of the skills they are allowed in some areas. (Due to that pesky minimal training and only being trained in BASIC areas)

And I say that quite often in fact; it's why there is a sawzall on my ambulance.

 

[JJR512]

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.

The Maryland protocols have some algorithms. I'm not sure if I could say it's algorithm heavy, but I have no basis of comparison. I understand your point, though. And it's worth remembering that whether the protocol is about a basic skill or an advanced skill, it only tells you what skill to use; it doesn't tell you how to actually perform it. That's where education comes in.

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."

I suppose all EMS protocols could be written like that. If I've been taught to apply pressure to an arterial bleed, do I really need a protocol that says "If the patient has an arterial bleed, first apply pressure"? No, one that says "You've been taught what to do in this situation so do it" would suffice.

Still, the point I was making in the post you were quoting from goes beyond the protocols. You'll notice I mentioned a paramedic's education as well. It's not just the protocols that are written and defined by the doctors, the doctors also have a lot to do with defining a paramedic's education curriculum. The overall point is that when a paramedic performs a skill in the field, he/she is doing it because a doctor wanted that skill performed in that situation; whether the paramedic decides to use that skill in that situation because it's written in a protocol or in a text book, it makes no difference. Paramedics, just like basics, are doing what the doctors want us to do; we're operating under their license, and when we screw up, we report to them.

Which brings me to...

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.

Come on, man, we all know that all physicians are not created equal, nor are all basics, all nurses, all plumbers, or all fry cooks. But I don't think those physicians who have never intubated or worked in an ER are the ones writing the protocols, so they're not really the ones I'm talking about, are they? So they can be left out of the conversation.

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...

I think you misunderstood me, or perhaps I wasn't clear enough, and if so, I apologize. I know how the meds work as well as what I've been taught in EMT-B class, which sounds to be the same as you. What I meant is that I do not know how they work how they work, or, as you said, what exactly they're doing on a cellular level, or microphysiological level.

...
It seems that some times some people are saying, or trying very hard not to say but meaning it anyway, that EMT-Bs, because they are not trained and educated as much as paramedics, are useless and should be done away with. For example, the notion that all 911 units should be staffed with ALS providers only.

Let's remember that we as EMT-whatevers are working in the field under the license of our respective medical directors; as such, we are working out there on their behalf. If it was possible to send a physician out on every call for medical assistance, there would be no need for paramedics. If it were possible to send out paramedics to every call for medical assistance when there are no physicians available to respond, then there would be no need for EMT-Bs. Would the world be a better place if all EMS providers were trained to EMT-P level? Yes. Would the world be an even better place than that if all EMS providers were trained to MD level? Yes. But the latter isn't possible, so the world has to make do with paramedics, and by the same token, neither is the former possible, so the world will just have to make do with EMT-Bs.

 

[Ridryder911]

Disaster, you have to remember that there is NO national mandating rule for medical directors to be emergency physicians. In fact, I know in my state that is a Dermatologist is the medical director of a service, as long as they are currently licensed and have a valid ACLS card.

In fact, if you were to review NEMSP organization, you will see that they found very few EMS medical directors nationally were ER or critical care residency trained. This is why they are promoting their EMS medical directors course.

Back to protocols, there are medical community and standards of care.( i.e NHTSA standard). In other words, one could only have to simply perform the standards as taught by the curriculum and be covered in some areas. Just like NP's, PA-C's etc have a scope of practice and standards without specific protocols.

I agree basics definitely should NOT be eliminated, but their role should be changed. A formal assessment should be only be made by Paramedic level representing EMS. The same as an initial triage or MSE can only be provided by an RN or physician representative in the ED.

Basics should be first responders to initially care for the patient and to assist in care. The 120 -200 hour length course, and the current curriculum is insufficient for EMS units.

R/r 911

 

[skyemt]

i'm not really sure why there is such an EMT-B/Paramedic debate on this thread...

i even find myself drawn into it, because my pride takes a ding when i read that i shouldn't be manning a 911 truck.. yikes, of course i should!

but then, sadly, if it is a real emergency, one involving an unstable pt, of course it is an ALS emergency, and i know i am not the best qualified level of provider... if it were me needing life saving care, yes the first unit i'd like to see is a Paramedic unit...

yes, my level of studies is not sufficient, i believe, for the tasks even emt-b's perform... i do my best to supplement my education on-line, extra classes, etc... but, it does not make me a higher level provider, just makes me better at the level i'm at...

one day i will be a higher level provider, for all of the reasons said on this thread an elsewhere... i just want to get a couple of years of experience first... then next step for us is EMT-CC, which doesn't really get mentioned here much...

so, at the end of the day, after reading these posts, i have to agree with many of the paramedics sentiments... and if it bothers me, as it does, than i should just get a higher level certificate, which i will...

but, as emt-b's, we are not paramedics, will never be the best level care...
in many cases, even in districts near me, i wouldn't want many emt-b's showing up if my family had an emergency... we don't have the training, don't have the knowledge, can't provide the interventions necessary in a "true" emergent situation...

this is not a put down on emt-b's, i don't think any less of myself... and i want to be the best emt i can at whatever current level i'm at... to paraphrase another post, to "be an asset to a higher level provider"...
that's about the best i can do right now...

but instead of debating the value of emt-BASIC, if you want to be better, be a higher level provider, than go out and study and get the certificate.

BASIC is basic, not inadequate... and there is nothing wrong with that... but the scope of a BASIC is small, and rightfully so...

so, in ending, an emt-basic is not worthless, but worth less than a paramedic.

 

[reaper]

Sky,

I think that is one of the best posts ever written on the subject!

I applaud you.

 

[medic001918]

i'm not really sure why there is such an EMT-B/Paramedic debate on this thread...

i even find myself drawn into it, because my pride takes a ding when i read that i shouldn't be manning a 911 truck.. yikes, of course i should!

but then, sadly, if it is a real emergency, one involving an unstable pt, of course it is an ALS emergency, and i know i am not the best qualified level of provider... if it were me needing life saving care, yes the first unit i'd like to see is a Paramedic unit...

yes, my level of studies is not sufficient, i believe, for the tasks even emt-b's perform... i do my best to supplement my education on-line, extra classes, etc... but, it does not make me a higher level provider, just makes me better at the level i'm at...

one day i will be a higher level provider, for all of the reasons said on this thread an elsewhere... i just want to get a couple of years of experience first... then next step for us is EMT-CC, which doesn't really get mentioned here much...

so, at the end of the day, after reading these posts, i have to agree with many of the paramedics sentiments... and if it bothers me, as it does, than i should just get a higher level certificate, which i will...

but, as emt-b's, we are not paramedics, will never be the best level care...
in many cases, even in districts near me, i wouldn't want many emt-b's showing up if my family had an emergency... we don't have the training, don't have the knowledge, can't provide the interventions necessary in a "true" emergent situation...

this is not a put down on emt-b's, i don't think any less of myself... and i want to be the best emt i can at whatever current level i'm at... to paraphrase another post, to "be an asset to a higher level provider"...
that's about the best i can do right now...

but instead of debating the value of emt-BASIC, if you want to be better, be a higher level provider, than go out and study and get the certificate.

BASIC is basic, not inadequate... and there is nothing wrong with that... but the scope of a BASIC is small, and rightfully so...

so, in ending, an emt-basic is not worthless, but worth less than a paramedic.

Well spoken. Strong work.

Shane
NREMT-P

 

[Guardian]

I think Sky’s post is obvious in some ways and we need to redirect our focus.

I’ll reiterate my position on emt-basics as I think it is appropriate. I have never had a problem with EMTs or their training. They are necessary now more than ever. I have no problem with an EMT riding on my truck. You give me a good EMT and you will see a happy man. My war has always been against public deception. The public has a right to know they are receiving basic level care, and substandard ALS (emt-ABCD etc, anything but paramedic). We are deceiving the public by letting them remain ignorant and even fooling them by giving emt-abcds the ambiguous title of “Medic” which the public thinks is a term meaning paramedic.

 

[DisasterMedTech]

I think Sky’s post is obvious in some ways and we need to redirect our focus.

I’ll reiterate my position on emt-basics as I think it is appropriate. I have never had a problem with EMTs or their training. They are necessary now more than ever. I have no problem with an EMT riding on my truck. You give me a good EMT and you will see a happy man. My war has always been against public deception. The public has a right to know they are receiving basic level care, and substandard ALS (emt-ABCD etc, anything but paramedic). We are deceiving the public by letting them remain ignorant and even fooling them by giving emt-abcds the ambiguous title of “Medic” which the public thinks is a term meaning paramedic.

Other than in the military, Ive never heard a basic being called a medic. I also agree that a "medic" and a "paramedic" are not the same thing. As for public deception, talk to the agencies and operations managers. We have several services in my hometown that have an agency patch on one sleeve and a flag on the other and no indication anywhere on the uniform as to what level that EMT is. Also, if you believe that the public has a right to know you need to educate the public in the differences between a Basic and a Paramedic and then get LEOs to stop calling anyone on an ambulance a paramedic (eg: Dont worry. The paramedics are on their way).

Im glad to hear what you have to say about EMT-Bs on trucks. Other than in a code situation, Ive always sort of wondered what that second paramedic would be doing in most cases. One of them is going to be driving and one treating just like in an ALS/BLS rig. I also think that for many, MANY agencies especially in smaller communities, the cost of dual paramedic rigs is cost prohibitive. I guess its 6 of one and half dozen of the other. Which is more important that they have? More EMT-Ps or more crews. Most communities recognize this situation and opt to have two rigs instead of one because that one would be staffed by two paramedics. The argument (which you arent making, of course) is that the standard of care is only acceptable when there are two paramedics on board is ludicrous. Yeah, lets pay a paramedics wages to the second crew member just so he can take vitals and load the cot just like his Basic counterpart would be doing. If there is a statistic out there that shows that dual paramedics have a higher success rate in terms of the outcome of treating their patients, Id like to see it and have the source cited. Ive never seen such a study, and I have looked high and low for it. I think of things like the field reduction/stabilization of a femur fracture. The EMT-Basic is taught this skill, practices it and is signed off on it. While traction/reduction usually involves two providers, are there folks out there who really think that the outcome will be better if one paramedic is holding the patient and the other is setting the tension on the traction splint?

I have a friend who is in EMT school right now. She is doing her time in emergency departments. Last night a paramedic/basic rig brought in a patient with a skull fracture after a 10 foot fall onto concrete. The patient was brought in sitting up in Fowler's, not on a board and not collared. If the paramedic is ultimately responsible for the decisions on that rig, that sort of shoots the theory that simply because there is a paramedic on a rig that the standard of care is higher. Knowledge without limitations gets people killed.

(dons flame suit)

 

[Guardian]

Other than in the military, Ive never heard a basic being called a medic.

Are you new to ems? really, are you new?

I also agree that a "medic" and a "paramedic" are not the same thing. As for public deception, talk to the agencies and operations managers. We have several services in my hometown that have an agency patch on one sleeve and a flag on the other and no indication anywhere on the uniform as to what level that EMT is. Also, if you believe that the public has a right to know you need to educate the public in the differences between a Basic and a Paramedic and then get LEOs to stop calling anyone on an ambulance a paramedic (eg: Dont worry. The paramedics are on their way).

Im glad to hear what you have to say about EMT-Bs on trucks. Other than in a code situation, Ive always sort of wondered what that second paramedic would be doing in most cases. One of them is going to be driving and one treating just like in an ALS/BLS rig. I also think that for many, MANY agencies especially in smaller communities, the cost of dual paramedic rigs is cost prohibitive. I guess its 6 of one and half dozen of the other. Which is more important that they have? More EMT-Ps or more crews. Most communities recognize this situation and opt to have two rigs instead of one because that one would be staffed by two paramedics. The argument (which you arent making, of course) is that the standard of care is only acceptable when there are two paramedics on board is ludicrous. Yeah, lets pay a paramedics wages to the second crew member just so he can take vitals and load the cot just like his Basic counterpart would be doing. If there is a statistic out there that shows that dual paramedics have a higher success rate in terms of the outcome of treating their patients, Id like to see it and have the source cited. Ive never seen such a study, and I have looked high and low for it. I think of things like the field reduction/stabilization of a femur fracture. The EMT-Basic is taught this skill, practices it and is signed off on it. While traction/reduction usually involves two providers, are there folks out there who really think that the outcome will be better if one paramedic is holding the patient and the other is setting the tension on the traction splint?

I have a friend who is in EMT school right now. She is doing her time in emergency departments. Last night a paramedic/basic rig brought in a patient with a skull fracture after a 10 foot fall onto concrete. The patient was brought in sitting up in Fowler's, not on a board and not collared. If the paramedic is ultimately responsible for the decisions on that rig, that sort of shoots the theory that simply because there is a paramedic on a rig that the standard of care is higher. Knowledge without limitations gets people killed.

(dons flame suit)

The old cost prohibitive argument never stands up under scrutiny. I'm not really going to go there however, because I already blew out a thread this year on that topic. Also, do a search for medic=emt and you can read the huge thread on that topic as well.

 

[Guardian]

here's the link http://emtlife.com/showthread.php?t=2753&highlight=bubba

 

[JJR512]

Are you new to ems? really, are you new?

People do speak differently in different parts of the country. The term "medic" referring to anyone who gets off an ambulance may be common in your area but never happen in another area. Similarly, volunteers are called "squirrels" in some parts of the country but not others. Remember there are regional differences before you think someone is a moron.

 

[skyemt]

Guardian,

you say my post, which actually offers a different point of view for emt-b, is obvious, yet you go back to the tired rant of "emt's are not medics" etc, "the public is being deceived...", blah blah...

PLEASE, as an emt, offer something useful out here...

your comments are about as tired and obvious as they get...

time for a new thread anyone?