emt-b meds

[Ridryder911]

Let's not confuse the issue. We again are trying to compare apples with oranges. Respectfully, Disaster I believe your analogy is not correct. Each of those professions, are a separate profession with separate requirements and expectations. Nurses and physicians are not the same as well as Dentist to become a maxillo-facial surgeon would have to re-attend medical school. There are no "advances within" since on its own is a separate profession.

More of analogy would be an LPN to RN level. Not to long ago, LPN's were allowed to provide the majority of the patient care in all areas of the hospital setting, from critical care to the emergency department. With the expansion and development of needed more intense education, the LPN/LVN now has a choice of either returning to school obtain their RN to work in those specific areas or go into another area of nursing. Either move up or leave.

Sorry, the Basic EMT is just a little more than advanced first aid. I did not write the curriculum, I just know it and teach it. The content has been diluted down over the past decade and if the program does have clinical time, it is more an observation than actually having set objectives in patient care that has to be met. Again, it is not the person or their intent that is wrong, rather it is the expectations and the ability to deliver better and more advanced care to patients. Which is in reality is better for the patient. Even the Paramedic curriculum barely meets the minimum to provide care for critically injured patients. Two years, should be the minimum.

Will there always be a need for Basic EMT's? You bet! It is their role needs to be redefined. There will always be remote areas, where the Basic is the highest trained individual available, until more advanced level can be obtained. Let's not promote maintaining or excusing the need of BLS levels because we have EMT's. Unfortunately, majority of U.S. still does not receive as much ALS care as was portrayed by the television show "Emergency" thirty years ago, this is horrible!

As the population age increases, the illnesses and injuries will as well. The role will be changing soon, it has to. The demand for increased education will be there, just as it was for the LPN. It will be expected and demanded. Again, there will be EMT's, just not in the role EMS providers other than first responders and non-emergency transport techs. Again, similar to the LPN role changed.

Respectfully, Disaster your role in an MCI for as medical will be based upon your medical license, no matter if you even had a PhD. I am enquiring, are you enrolled in the on-line Philadelphia Disaster Medicine and Management course? This type of program is more in risk management, developing policies and dealing with community response teams, and public issues, not specific treatment modalities. This should not be confused with a Disaster Medicine degree, that I have been familiar with. This one requires one to have a doctorate in medicine, and already be board certified in an emergency medicine or as surgeon. The Disaster Medicine program I have worked with is three years residency program after medical school and studies the medical treatment, scientific research of disaster programs and response teams, that is quite of bit of difference.

I have experience in developing policies, and state systems to respond to disasters. I can agree one needs to have as much specific education in this field as possible. Especially with the multitude of different events, types that now can occur. I wish you the best of luck in your studies and professional growth. We definitely need professionals specifically in this area.

R/r 911

 

[skyemt]

unstable airway!
possible MI!
unconscious diabetic emergency!
severe pain management!
hypevolemic shock!
status asthmaticus!
bradycardic emergency!


i could go on and on, but in all of these common emergent situations, the EMT-B can provide little or no treatment, other than handholding, monitoring ABC's, and transport, and of course, calling for ALS...

this is a silly debate... EMT-B's can render very little in the way of interventions...

they can do a great job within the small scope of what they do...

let's try not to be so defensive about (11 pages worth!)...
if you are not satisfied, get a higher certificate, or be the best you can be at the BASIC level...

 

[Rangat]

You know what?

Industries evolve.:huh:

Henry Ford evolved the motor vehicle industry- Did he have a masters degree in Mechanical Engineering?

Wright brothers evolved the airplane industry- Did they have a masters in Aeronautical Engineering?

Florence Nightingale- R/N?

Leonardo da Vinci- Masters in Anatomy?


These individuals were interested in their fields. They were very experienced in their fields.

Would you let Henry Ford develop the injection fractions of your W12 engine?

Wright bros, Airbus flap design?

Would you choose to Da Vinci teach 3rd year anatomy students?


They would be a lot better than no one.


Would you let an EMT-B manage your child with a GSW chest?

I'm sure you would, or your child will likely die.

Would you let your child be managed by an Emergency Care Practitioner with a Masters degree in Emergency Medical Care from an internationally recognized university, taking him at least 4 years full time, and 2 years part time study?


Industries evolve.:birthday:


I understand, that it is only a few fortunate enough to have a sufficient support system to educate themselves that far, but there aren't random people who only finish second year medical school and then go work somewhere in a hospital.


100 years ago, if you couldn't get a job, you could go connect some wires and help build a plane.

Now there are still people who couldn't get a job at the post office, so they go drive an ambulance.

I know this might be offensive, and I respect the care you rend, but around you has evolved a higher standard.

Pre hospital care is no longer just an extension of a REAL doctor. There are many countries where an MD contributes N O T H I N G to the emergency environment. Paramedics RSI, IC drain, everything. On-line permission is a thing of the past.h34r:


The MD's used to have us by the balls, because we couldn't assess and diagnose properly. That has changed. These courses include years of pathophysiology, diagnostics, and correct assessment techniques.


I am not suggesting that the experienced old school medics should go back to varsity, but it is a waste for fresh, motivated, and interested young adults to go do a couple of short courses and be satisfied. Never will they reach their full potential, or the potential of the industry.

Often will you find an EMT-B be burned out and become uninterested in the pre-hospital field.

Do you often see a fully educated person become bored with their field? No, maybe a certain job? But then they go to research, education etc.


Is it fair to the patient that because there are only short courses sent to his car crash, where he is in tetany gargling in his own blood, that the paramedic should first get permission from someone NOT ON THE SCENE before RSI?

"Sorry, we only had short course trained people to help you during your emergency- But no worries, here are educated graduates in Occupational Therapy to help you be rehabilitated-_-"

 

[DisasterMedTech]

this is a silly debate... EMT-B's can render very little in the way of interventions...

l

Speak for yourself. Im on a disaster response team and basics are trained to give atropine for nerve gas exposure plus about 100 other things that ambulance basics dont do. And yes, we can provide airways. Im going to get flamed but its called a Combi-tube and when you have 600 patients on a single scene it may go from the airway of last resort to the first line intervention. Careful of rash, unresearched generalizations.

 

[CutePolkaDot]

Rangat u have a thing for OT's don't you?

 

[Rangat]

Make 600 patients ALS?

Speak for yourself. Im on a disaster response team and basics are trained to give atropine for nerve gas exposure plus about 100 other things that ambulance basics dont do. And yes, we can provide airways. Im going to get flamed but its called a Combi-tube and when you have 600 patients on a single scene it may go from the airway of last resort to the first line intervention. Careful of rash, unresearched generalizations.

You're going to run around on scene, sink 600 DLA's (and then what? put them on T-Pieces and vents?), atropinize them, and then find at least 300 paramedics able to care for these 600 patients with advanced airways and atropine on board?:huh:

I know it's the greatest good for the greatest amount, but that's patient abandonment. :sad:

Is this plan based on a study that proves that there will be less mortality/morbidity, when BLS treats with ALS procedures, spread over dozens of patients per provider? As opposed to detailed, continuous care, focused on those with the best prognosis?:unsure:

It takes a while to assess, and then atropinize someone correctly, and continuous monitoring thereafter is important.-_-

I'm sure in any case, that skyemt did not mean additionally trained BLS in his statement. One cannot defend the majority by referring to specialized units.:blush:

 

[triemal04]

Speak for yourself. Im on a disaster response team and basics are trained to give atropine for nerve gas exposure plus about 100 other things that ambulance basics dont do. And yes, we can provide airways. Im going to get flamed but its called a Combi-tube and when you have 600 patients on a single scene it may go from the airway of last resort to the first line intervention. Careful of rash, unresearched generalizations.

So you're going to run around giving IM injections of atropine to people who may have been exposed to nerve gas? Good luck with that. Seriously. You're going to need it. Because normally it takes a lot of atropine to really help, and usually it means that it needs to be given IV. But, maybe they'll live long enough for someone else to take over.

And there are basic's in other areas that give atropine injections, so don't get to exited.

Same with the combitube. What are you going to do after you drop those 600 combitubes? Hook up 600 BVM's and run from one person to another ventilating them? Find 600 people off the street to do it?

Or follow your triage procedure and realize that some of those people are now black tags?

That is the biggest difference between a basic level provider and a paramedic; knowledge. You could give the same patient to a basic and a paramedic who could only operate as a basic, and guess who would be able to render better care, figure out what was going on, and then pass that info to the hospital so that care there could be started faster? The skills that we do don't always mean a lot, and it's not about who can do more. It's about who really knows how to assess and treat patients. Who knows when they should do something, and more importantly, when they should NOT do something.

 

[skyemt]

ok, it is quite an honor to be chosen for your disaster response team...
but really, what does that have to do with the EMT-B curriculum in this country?
unless they are all on disaster response teams, what you are talking about, while noble, is completely irrelevant to EMT-B's...

once again...
why do EMT-B's continue to fight what they are? B-A-S-I-C...

you could roll out all the bells and whistles you have to make it sound like you are some kind of medic, but at the end of the day... YOU ARE NOT!

there is nothing wrong with being a basic and having limited scope...

why fight it?

triemal04, in regards to your comment, i was just speaking to one of our paramedics last night, who was very happy to work on and perfect his basic skills as well... armed with the knowledge a medic has, you will have superior care even on a basic level...

 

[DisasterMedTech]

So you're going to run around giving IM injections of atropine to people who may have been exposed to nerve gas? Good luck with that. Seriously. You're going to need it. Because normally it takes a lot of atropine to really help, and usually it means that it needs to be given IV. But, maybe they'll live long enough for someone else to take over.

And there are basic's in other areas that give atropine injections, so don't get to exited.

Same with the combitube. What are you going to do after you drop those 600 combitubes? Hook up 600 BVM's and run from one person to another ventilating them? Find 600 people off the street to do it?

Or follow your triage procedure and realize that some of those people are now black tags?

That is the biggest difference between a basic level provider and a paramedic; knowledge. You could give the same patient to a basic and a paramedic who could only operate as a basic, and guess who would be able to render better care, figure out what was going on, and then pass that info to the hospital so that care there could be started faster? The skills that we do don't always mean a lot, and it's not about who can do more. It's about who really knows how to assess and treat patients. Who knows when they should do something, and more importantly, when they should NOT do something.

Read the previous post I wrote in response to Rangat. It answers your questions. And when your talking about a mass exposure to a chemical agent, the term to remember is austere care. Its fast, its ugly but it works. It has been proven to work. And the atropine to which you refer is often the answer. And in the cases such as I discuss it is not given IV, it is given IM via Mark 1 Auto Injector until the Sx I discuss in my other post stop. Thats your dosage. Until the symptoms stop. As a medic with what I assume is some knowledge of treating protocols for WMD attacks, I would assume you know that. It is the field of emergency medicine in which I practice and it is the subject of my graduate coursework. I'll recommend that you go with Rangat to Hadassah and let them give you some useful information. As is said so often in terror/disaster medicine "Thus ends theory. Let us begin the fact." Your nice, neat, in the box NREMT-P protocols are theory. The events I describe are the fact. Its a good idea to know the difference.

Because you are a paramedic doesnt mean you have experience in the types of emergency medicine i am talking about. It is entirely different from EMS. It is the type of mass casualty medicine that occurs when local EMS is immediately overwhelmed and rendered useless in scenarios such as the one I offer in my previous post. Put away the paragod complex. Its useless when dealing with a few thousand patients.

And for your further edification, triage tags for dead or death imminent patients are no longer called black tags after the racial unrest in the wake of the V2 Night Club fire in Chicago in 2002.

 

[triemal04]

triemal04, in regards to your comment, i was just speaking to one of our paramedics last night, who was very happy to work on and perfect his basic skills as well... armed with the knowledge a medic has, you will have superior care even on a basic level...

Yeah, that was my point. All the neat blinky thingies and pokey thingies we have don't mean as much as what you've got between your ears.

 

[BossyCow]

once again...
why do EMT-B's continue to fight what they are? B-A-S-I-C...

you could roll out all the bells and whistles you have to make it sound like you are some kind of medic, but at the end of the day... YOU ARE NOT!

there is nothing wrong with being a basic and having limited scope...

why fight it?

I don't think the issue is are basics and paramedics the same. I think its simply a matter of respect. Personally, in the field, I have always felt respected for the part I play in EMS. Occasionally on this forum, I have felt there is a bias on the part of some that those of us who remain basics do so because we lack the intellect, or just don't want to work hard enough to become 'real medics'.

My husband is a career ff/medic. I admire and respect the job he does and the amount of study and effort that still goes on to maintain his skills and certifications. I do not think of myself as certified at anywhere near the same level. I am painfully aware of the limitations a BLS provider is under. However, I do what I do as a volunteer for an area where it is us or nothing. To listen to constant diatribes about how everything we do is worthless or futile is insulting.

I am also embarrassed by those basics who respond to these posts with belittling comments about medics, nurses and doctors. We are all part of a system. We all work together. I may be just another set of hands on an ALS call, but since most of my ALS calls are answered by only one medic, I've never heard any of the medics complain about my saying "Sure" when asked to prepare the IV stuff for them, or put the leads on, lay out the airway kit, hand them the stylet, put cricoid pressure on a pt they are trying to tube, or whatever is needed. Could another medic do that? Sure.. where is he/she??? Not in the back of my ambulance!

If we are going to look at what is optimum, that would be for all of our patients to actually have their symptom onset in the waiting room of an ER. Life is messy. Humans are imperfect. In the meantime, we do what we can. That isn't an excuse, its not refusing to look at where we can improve, its simply doing what we can, with who we are and what we know at the time.

 

[triemal04]

So...guess let's start in an orderly fashion. And mods...I swear, there will be no personall attacks this time. Honest. I'll be a good boy. :angry:

Guess I was right and you do only give atropine IM. (you'll see where I mentioned that) We'll ignore the fact that at some point they're getting it IV since that is way way beyond your scope. Tell me, how much atropine will it take to reverse the effects? I've got a good idea, since this is part of the paramedic curriculum. Do you?

Guess what again...you don't have any experience in disaster mediciene either. You've got the book smarts. Pleasepleasepleasepleaseplease stop acting like you are some superdooper wonderful all-knowing specialist. It doesn't fit the facts as YOU'VE relayed them. It's very nice that you want to do some good, and for awhile there you were really doing good at asking questions and listening/learning. But now you're right back into the mode you where in before your chest pain. Stop being so confrontational. You aren't at the level where you can do that and get away with it.

Please, answer the question about combitubes and triage if you don't mind. Oh, and so so sorry about not being PC. Oops. :wacko:

And leave Rangat alone. For someone who has no experience to fall back on, you throw a lot of stones. Here and other places. Stop that. That guy at least is trying to learn, and from some of what I've seen him post ain't half bad either. So stop.

I don't know what else I can say that hasn't been said before. Maybe grow up. Cheers.

 

[DisasterMedTech]

ok, it is quite an honor to be chosen for your disaster response team...
but really, what does that have to do with the EMT-B curriculum in this country?
unless they are all on disaster response teams, what you are talking about, while noble, is completely irrelevant to EMT-B's...

once again...
why do EMT-B's continue to fight what they are? B-A-S-I-C...

you could roll out all the bells and whistles you have to make it sound like you are some kind of medic, but at the end of the day... YOU ARE NOT!

there is nothing wrong with being a basic and having limited scope...

why fight it?

triemal04, in regards to your comment, i was just speaking to one of our paramedics last night, who was very happy to work on and perfect his basic skills as well... armed with the knowledge a medic has, you will have superior care even on a basic level...

And once again, why do paramedics continue to fight what they are? E-M-T.

I also reiterate that the terms "medic" and "paramedic" are not interchangeable nor are the various individuals to who these terms apply all at the same skill, education or training level. A Medic is a military medical care provider. I believe this has been talked about on this very forum on more than one occasion. Specifically, the term medic refers to military personnel with the MOS of Combat Medic aka 68Whiskey or 68Whiskey1 (68W1) which is a Combat Special Operations Medic. The Army's MOS list can clarify this further for you

 

[skyemt]

BossyCow, i would never try to say that Basics and Medics were the same... that would be silly...

this thread has been just about the facts... compared to medics, basics can do much less, are less educated, less experienced, etc...
while time and money have often been cited as reasons, i have never felt like a medic has belittled the intellect of a basic.

but you can not argue the differences... the problems arise because many basics do argue them... and in fact, many have brought up studies, etc saying that there is no difference in care between basics and medics... you can review the threads if you like.

i appreciate your comments, you sound like an excellent EMT-B...
Respect the job you do, and don't worry about what others think...

you know as well as i do, that there are many emt-b's who frankly shouldn't be out there... and they are the root of many sentiments from medics, and in reality, i don't blame them...

however, if you know you do a good job, then the comments don't apply to you.

 

[skyemt]

"And once again, why do paramedics continue to fight what they are? E-M-T."

umm, DisasterMedTech, i am not a paramedic, i'm an EMT-B...
i am just not as insecure as you are about it...

 

[BossyCow]

i appreciate your comments, you sound like an excellent EMT-B...
Respect the job you do, and don't worry about what others think...

you know as well as i do, that there are many emt-b's who frankly shouldn't be out there... and they are the root of many sentiments from medics, and in reality, i don't blame them...

however, if you know you do a good job, then the comments don't apply to you.

I know, its just frustrating when the discussion gets so emotional!

 

[DisasterMedTech]

"And once again, why do paramedics continue to fight what they are? E-M-T."

umm, DisasterMedTech, i am not a paramedic, i'm an EMT-B...
i am just not as insecure as you are about it...

Oh...Im sorry. Where did I refer to you as a paramedic? If I misquoted your licensure or certification I apologize. The reference was intended, as I believe is perfectly clear, that paramedics are still emergency medical TECHNICIANS.

 

[ffemt8978]

And that's enough of this thread.

 

[ffemt8978]

This thread is now reopened provided everyone can remain civil.

 

[skyemt]

in an effort to get this thread back on track, i have a question about nebulized albuterol...

we are allowed to give it if the pt has an exacerbation of previously diagnosed asthma...

we can also assist with their inhaler, but usually they have done that and it has not been effective, or they have lost it and they now need more treatment...

my question is this... the contraindications are a pt older than 65, a pt unable to take adequate respirations, or a pt with heart history...

what is not mentioned is whether or how many times a pt may have taken albuterol with his own inhaler... no difference is noted between a pt who has lost his inhaler or has taken 5 puffs before we arrive...

is there no problem with overloading a pt with albuterol??

i would think, as it acts on the beta-1 receptors in some form, this may be an issue?