EMT-B Seeking Wisdom from Medics

[EMTinNEPA]

The problem is with your logic is this.. in order to be a good paramedic.. i feel that one should have a firm grasp on the BLS skills.. and a good level of experience dealing with patients and having patient contact.

All of which can be achieved during your paramedic clinical rotations.

Explaining to your students "limitations" of an EMT is doing them a dis-service. EMT is an important role, especially if one has plans to move on to paramedic, and should never be looked at as a "limitation".

Really? Because I go from functioning as a paramedic at clinical back to work as an EMT and feel awfully limited... "What's that? You're having chest pain now? Ok, let me call the paramedic..." or "Her mental status is altered... I'll be up front playing taxi slave..."

Ive worked for many agencies in my 12 years in EMS, and I have only ever encountered ONE agency that would not allow EMT's to attend solo on a patient. They were allowed to perform any skill they wanted on scene or with a medic in back, and that was an agency that wrote their protocols in blood, and mother-may-I'ed their medics to death. Every where else I've worked values the experience and knowledge you gain as an EMT, and plenty of places in the US still have BLS 911 trucks.

While I do believe that every patient deserves an ALS assessment, I don't believe that every patient needs ALS during transport. However, would I feel more confident with a paramedic in the back with me than an EMT if I were a patient? You bet your sweet butt.

True, your treatment options are not the same as a paramedic, and paramedics can provide an advanced level of care.. but being an EMT should NEVER EVER be looked at as a limitation... ever.

Adenosine for SVT, cardizem for a-fib with RVR, narcan for a opiate overdose, trancutaneous pacing for second degree type II or third degree AV block, synchronized cardioversion, needle decompression, D50, steroids, antidysrhythmics, 12-lead EKGs...

All potentially life-saving interventions or procedures, whether directly or indirectly. Yet in most states, none of these items listed are within an EMT's scope of practice. Seems kind of... I dunno... limiting.

As I said above.. shame on you for even putting that idea in your students head. You're doing yourself, your students, and the general public a major dis-service by spreading that line of thinking... and I'll tell you, if I EVER hear a paramedic sharing that type of sentiment with an EMT or another Medic for that matter, I'd be pulling that person aside for a serious heart to heart chat and refer them to administration for an attitude adjustment.

"Agree with me or I'll tattle to your boss on you!" Real mature... this is yet another problem with EMS... anybody who dares to speak out against "the way we've been doing it for (insert big number here) years" is shot down and blackballed.

Yes, EMT IS a limitation. There's a reason the paramedic isn't up front driving on critical patients.

I took a year off after EMT before going to paramedic school, because I was dumb enough to listen to people who said "Get some experience...", the same people I wound up working for who made my life a living hell for that year. And what did that year of experience do for me? Taught me bad habits that I had to fight to break because I saw the "experienced" EMTs doing so.

Bottom line: EMS seems to have an infatuation with this mystical gem called "Experience". The question you have to ask yourself is this: does the EMT going into a paramedic program who claims to have 20 years of experience really have 20 years of experience, or does he have 6 months of experience over and over again 40 times? It's not how much time you put in, but what you put in the time.

 

[medic417]

The problem is with your logic is this.. in order to be a good paramedic.. i feel that one should have a firm grasp on the BLS skills.. and a good level of experience dealing with patients and having patient contact. Explaining to your students "limitations" of an EMT is doing them a dis-service. EMT is an important role, especially if one has plans to move on to paramedic, and should never be looked at as a "limitation". Ive worked for many agencies in my 12 years in EMS, and I have only ever encountered ONE agency that would not allow EMT's to attend solo on a patient. They were allowed to perform any skill they wanted on scene or with a medic in back, and that was an agency that wrote their protocols in blood, and mother-may-I'ed their medics to death. Every where else I've worked values the experience and knowledge you gain as an EMT, and plenty of places in the US still have BLS 911 trucks. True, your treatment options are not the same as a paramedic, and paramedics can provide an advanced level of care.. but being an EMT should NEVER EVER be looked at as a limitation... ever.


As I said above.. shame on you for even putting that idea in your students head. You're doing yourself, your students, and the general public a major dis-service by spreading that line of thinking... and I'll tell you, if I EVER hear a paramedic sharing that type of sentiment with an EMT or another Medic for that matter, I'd be pulling that person aside for a serious heart to heart chat and refer them to administration for an attitude adjustment.

SHAME ON ME????????????????????? Your the one encouraging mediocrity. I am educating my emt's to go get educated. I give them the truth not a set of rose colored glasses like you do. They get there experience while in the Paramedic program. There is no reason any person cannot develop good basic level patient care while also developing their advanced patient care skills.

 

[denverfiremedic]

Crazy thoughts ! I know emt's that will make paramedics look like idiots.. Dont know where you guys work but in my state emt's do most of the work with a paramedic supervising ... But i do know we expect a lot more from our employees than most places

 

[DrParasite]

As an educator I explain to the emt students the limitations and work to get them started on the road to being successful Paramedics.

yeah, it's good to know what your limitations are.

And what did I say wrong? The majority of paid 911 services only allow the basic to be a gopher and a driver. Why do so many here like to try and blow smoke up the new emt's butt? Lying is the worst thing you can do to someone and probably another large reason for the high burn out rate seen in EMS.

yeah better tell all the 911 services in NJ that they are mostly drivers and gophers only. ditto New York City EMS, their entire BLS division (about 80% of all EMS units in the 5 boroughs) must not do much. I am sure there are other paid 911 systems, but I don't know where they are (because I have lived most of my life in NJ and NY).

 

[FLEMTP]

Bottom line: EMS seems to have an infatuation with this mystical gem called "Experience". The question you have to ask yourself is this: does the EMT going into a paramedic program who claims to have 20 years of experience really have 20 years of experience, or does he have 6 months of experience over and over again 40 times? It's not how much time you put in, but what you put in the time.

So using your logic... would you rather get the green new surgeon to do your open heart surgery.. or the surgeon with 30 years on the job?... you know.. since experience means nothing...

Your "bottom line" shows your lack of experience... and if you want to sit there and tell me you've been in ems for years and years and years.. then im going to feel awful sorry for you.. because you've obviously learned nothing.

Im sorry you guys disagree with me on this, but this "hurry up and become a paramedic" stuff is going to kill more people than its going to help. You dont see a medical student "rush" his way to becoming a doctor, because getting all those cool medications and monitors doesn't mean jack if you can't LOOK AT YOUR PATIENT and figure out whats going on. As an EMT i learned how to tell a sick patient from a not sick patient, and guess what? i never needed a paramedic, or an EKG machine, or medications to do any of that. I relied on my experience.. and now as a paramedic i use that same experience to fall back on to make my decisions on treatment and transports.

Something else i want to point out... your PARAMEDIC clinicals are NOT the time to "learn" your BLS skills you should have mastered before getting into paramedic school. Thats like trying to put the house up while the foundation slab is still wet.. you're gonna end up with a mess.. and that is exactly what I see time after time after time when someone who has never touched a patient is given the ability to kill someone with all those procedures you rattled off in your post and doesn't have a clue why they did it. Its also why paramedics are being forced into cookbook medicine.. because they dont have the experience or knowledge to make the right decision, so a doctor makes the decisions for them by literally giving you a recipe to follow.

It really scares me that people are setting up the future of our profession for failure.. and pushing us from professionals back to the days where we were just simply a technician without the ability to think for ourselves... congrats guys.. give yourselves a pat on the back... and while you're following your recipes for disaster... i'll be practicing medicine.

 

[JPINFV]

/me curious as to when he learns his BLS physician skills since he didn't have to be a PA first.

 

[denverfiremedic]

FLEMT: couldent have said it better myself.... it so funny people think its time to master there BLS skills after P school hahaha.. A million people on here think an EMT - B shouldent be IV certified lol .. a monkey can start an IV first off and you think a good time to start learning how to start lines is after P school!!! yea when your the one that has to push the drugs and do all the ALS the last thing you want is to be sitting there poking a lifeless body going darn i wish i had more practice!!! :::::

as for where do the Docs learn their BLS , maybe in their 4-6 years in med school then possibly a little bit in there 7 years of residency practicing under an experinced physician ohh and about a dozen RN's EMT-B's, EMT-P's and so forth..

 

[JPINFV]

EM residency isn't even half of 7 years in most programs and medical school is only 4 years, of which only 2 years is clinical. After all, when trying to decide between dactinomycin or methotextrate, who has time to figure out how to start an IV?

Edit: Oh, and residency should only count for 1 year (even if most residencies are 3-4 years long, more if a physician wants to complete a fellowship) since a physician in the US is fully licensed after 1 year of residency.

 

[EMTinNEPA]

So using your logic... would you rather get the green new surgeon to do your open heart surgery.. or the surgeon with 30 years on the job?... you know.. since experience means nothing...

Depends... is the heart surgeon with 30 years of experience educated in the latest techniques or new technology that has come out in the 30 years since he's started performing surgery, or does he perform it exactly the same way as he did 30 years ago?

Your "bottom line" shows your lack of experience... and if you want to sit there and tell me you've been in ems for years and years and years.. then im going to feel awful sorry for you.. because you've obviously learned nothing.

Ad hominem.

Im sorry you guys disagree with me on this, but this "hurry up and become a paramedic" stuff is going to kill more people than its going to help. You dont see a medical student "rush" his way to becoming a doctor, because getting all those cool medications and monitors doesn't mean jack if you can't LOOK AT YOUR PATIENT and figure out whats going on.

You also don't see doctors telling kids who wish to grow up to be doctors to become PAs first and get some "experience" before going to medical school. We are the only part of medicine that has this tiered system, and the disparity between EMT education and paramedic education is astounding. Oh, and even though I've "learned nothing" (as you put it) during my time in EMS, I can easily distinguish between "sick" and "not sick". It's not that difficult if you know what to look for... and guess where I spent an entire semester on the art of assessment? Certainly not in EMT school.

As an EMT i learned how to tell a sick patient from a not sick patient, and guess what? i never needed a paramedic, or an EKG machine, or medications to do any of that. I relied on my experience.. and now as a paramedic i use that same experience to fall back on to make my decisions on treatment and transports.

So you never utilized ALS once during your entire time as an EMT? What could you possibly do besides "scoop and run"? Oxygen? Whoop-de-doo, Basil! I don't need an EKG machine or medications to determine sick from not sick, but the EKG can help determine what type of sick I'm dealing with and (along with my assessment findings and the patient's history) determine my treatment modality.

Something else i want to point out... your PARAMEDIC clinicals are NOT the time to "learn" your BLS skills you should have mastered before getting into paramedic school. Thats like trying to put the house up while the foundation slab is still wet.. you're gonna end up with a mess.. and that is exactly what I see time after time after time when someone who has never touched a patient is given the ability to kill someone with all those procedures you rattled off in your post and doesn't have a clue why they did it.

I'm sorry, BLS skills are something that need to be mastered? If their airway isn't open, open it. If they're not breathing, breath for them. If their heart isn't beating, beat it for them. If it's broken, splint it. If it's bleeding, stop it. Seems fairly cut and dry to me. And that's what paramedic school is for... learning the how and why behind the treatments we perform. If a paramedic doesn't know the how or the why, then chances are they don't know because they didn't bother to learn it in paramedic school, not because they didn't wait one more year before going to get experience.

Its also why paramedics are being forced into cookbook medicine.. because they dont have the experience or knowledge to make the right decision, so a doctor makes the decisions for them by literally giving you a recipe to follow

And you think nurses don't have protocols to follow? Nobody in healthcare aside from physicians practice with any real autonomy.

It really scares me that people are setting up the future of our profession for failure.. and pushing us from professionals back to the days where we were just simply a technician without the ability to think for ourselves... congrats guys.. give yourselves a pat on the back... and while you're following your recipes for disaster... i'll be practicing medicine.

Our profession is in the midst of failure because of those who want to remain EMTs forever (read: volunteers and people who simply don't have what it takes to be a paramedic) lobbying to keep educational standards low. I say eliminate EMT entirely and make a two-year associate's the minimum entry level and the problem will be solved. That's two years in the classroom and two years worth of clinical time. Do away with the "BLS vs. ALS" nonsense and realize that IT'S ALL MEDICINE. THAT'S what trips people up. Instead of getting the whole picture from the start, all they get at first is the most very basic picture. Then when they go to paramedic school, they think "Oh, I'm ALS now" and forget about BLS. If there was no division, we wouldn't have that problem. And you do realize that by encouraging people to remain EMTs, you are pushing the paramedic profession back because that's all EMTs are... technicians. So while you're holding the profession back by encouraging old, out-dated, flawed ways of thinking, I will be advancing in my career and making my profession the best it can be.

 

[EMTinNEPA]

yeah better tell all the 911 services in NJ that they are mostly drivers and gophers only. ditto New York City EMS, their entire BLS division (about 80% of all EMS units in the 5 boroughs) must not do much. I am sure there are other paid 911 systems, but I don't know where they are (because I have lived most of my life in NJ and NY).

There is no New York City EMS. It was engulfed by the FDNY and broken into a shadow of its former self. And if you didn't notice, FDNY recently began seeking more personnel for their EMS... they're looking for paramedics... NOT EMTs.

 

[denverfiremedic]

EM residency isn't even half of 7 years in most programs and medical school is only 4 years, of which only 2 years is clinical. After all, when trying to decide between dactinomycin or methotextrate, who has time to figure out how to start an IV?

Edit: Oh, and residency should only count for 1 year (even if most residencies are 3-4 years long, more if a physician wants to complete a fellowship) since a physician in the US is fully licensed after 1 year of residency.

First off what the heck would I know... my dads been a Dr. for 25 years , my mom a ed RN for 20..... A of all medical school isnt even 4 years for all Doctors! "Podiatrist" 3 years! genearaly 4-6 years if having an advanced specialized field.. residency is 3-7 years budd! my dads was 7 at Vanderbilt HP.. depends on what type of physician your becoming. but again you probably know everything and your google bar is getting wore out!

 

[medic417]

yeah, it's good to know what your limitations are.yeah better tell all the 911 services in NJ that they are mostly drivers and gophers only. ditto New York City EMS, their entire BLS division (about 80% of all EMS units in the 5 boroughs) must not do much. I am sure there are other paid 911 systems, but I don't know where they are (because I have lived most of my life in NJ and NY).

Based on the NJ EMS reputation it is never a good way to defend any point except when showing the wrong way to do things.

 

[JPINFV]

First off what the heck would I know... my dads been a Dr. for 25 years , my mom a ed RN for 20..... A of all medical school isnt even 4 years for all Doctors! "Podiatrist" 3 years! genearaly 4-6 years if having an advanced specialized field.. residency is 3-7 years budd! my dads was 7 at Vanderbilt HP.. depends on what type of physician your becoming. but again you probably know everything and your google bar is getting wore out!

Sorry... there is no such thing as a 7 year EM residency. MD residencies are mostly 3 years (PGY 1-3) with a few 4 years and 3 year PGY 2-4 while DO EM residencies are 4 years (PGY 1-4). Technically, if you want to go into it that deeply, even things like cardiology is only a 3 year internal medicince residency followed by a 2-3 years of fellowship depending on which type of cardiology the physician is going into. Additionally, I'm not too concerned over the requirements for DPMs, ODs, DMD, etc. I'm in none of those programs and, as a whole, those fields have absolutely nothing to do with EMS.

Of course none of this touches the fact that the vast majority of states do not require physicians to complete anything more than 1 year of residency prior to obtaining an unrestricted license to practice medicine.

Of course what the hell does a medical student know about how medical education is set up.

 

[triemal04]

All of which can be achieved during your paramedic clinical rotations.
That is the worst advice and idea I've ever heard. If you are using your clinical time, the time that you are supposed to be spending in various units learning about different disease processes, illnesses, treatments, and so on, to master your BLS skills you are doing yourself, your school, and EMS as a whole a huge disservice. You are not put into an ICU to learn how to function as an EMT, you are there to learn how to treat your patients as a paramedic. The same goes for a burn unit, NICU, PICU, oncology ward, CCU, SICU, ER and on and on.

<snip>
I took a year off after EMT before going to paramedic school, because I was dumb enough to listen to people who said "Get some experience...", the same people I wound up working for who made my life a living hell for that year. And what did that year of experience do for me? Taught me bad habits that I had to fight to break because I saw the "experienced" EMTs doing so.
So because you are/were a bad EMT that means that everyone is? Not everyone picks up bad habits as an EMT, and not everyone works for a lousy system. (oh, and based on your personality here, there could be a reason you were treated so bad...just sayin') Don't make the mistake of thinking that your own experiences are what everyone will go through.

Bottom line: EMS seems to have an infatuation with this mystical gem called "Experience". The question you have to ask yourself is this: does the EMT going into a paramedic program who claims to have 20 years of experience really have 20 years of experience, or does he have 6 months of experience over and over again 40 times? It's not how much time you put in, but what you put in the time.
Oh boy. It's not EMS that has an infatuation with experience; it's everybody else who works in the medical field in every profession. There is a reason why many other professions spend a huge amount of time on their clinical/internships before they are allowed to practice on their own; you need that time and experience to learn and perfect your own abilities before you go out on your own. Unfortunately, EMS has NOT realized this; hence the relatively small amount of time spent on our clinicals and internship, and hence why some people say that experience as an EMT may be beneficial for some people. Granted, it also may not be beneficial for some people, but it is a decision that needs to be made by each individual, and only after thoroughly thinking it through, something that doesn't seem to ever get done here.

Replies in red. Why is it that people think that their own experience is so important that it trumps everyone else's? That they are so important that their way is the ONLY way? Sad really.

I'm not going to repeat myself in this thread; I said it all in my first one. There are reasons that working as an EMT can help someone when they go on to paramedic school. And there are reasons that it can be detrimental. But a blanket statement really can't be made one way or another at this point with the way EMS education is run. Like it or not, with the short amount of time that paramedic students spend on their internships, certain knowledge and abilities are needed before they start; for many people there is not enough time to learn EVERYTHING that a paramedic should know if you are starting from scratch. If things were different and a year was spent working in the field before getting certified then this would be a non-issue. But, unfortunately, that isn't how things are right now.

And some food for thought: The King County Medic 1 system (which encompasses Seattle, KCM1 the service and several other transporting fire departments) requires a minimum of 3 years of prior experience before entering into their paramedic program. Boston EMS requires all their new paramedics work at a BLS level for at least a year before working as paramedics. Why do these places (which are generally thought of very well in EMS and medical circles) do that if it's such a bad idea?

 

[medic417]

Boston EMS requires all their new paramedics work at a BLS level for at least a year before working as paramedics. Why do these places (which are generally thought of very well in EMS and medical circles) do that if it's such a bad idea?

To save money.

 

[JPINFV]

And some food for thought: The King County Medic 1 system (which encompasses Seattle, KCM1 the service and several other transporting fire departments) requires a minimum of 3 years of prior experience before entering into their paramedic program. Boston EMS requires all their new paramedics work at a BLS level for at least a year before working as paramedics. Why do these places (which are generally thought of very well in EMS and medical circles) do that if it's such a bad idea?

Weed out the patch mill medics.

 

[triemal04]

Weed out the patch mill medics.

It's possible, but if that were the case then why does King County have the requirement they do? After all, they send everyone through Harborview, so why require 3 years prior experience at any level? Is it because they've found that prior exposure and experience helps people perform at a higher level? Some other reason? Similar for Boston; given that the paramedic is only performing at the EMT level, it would be harder to determine the quality of their paramedic education; the things that a mill leaves out will be hard to assess in someone functioning at the lower level.

I'm not necessarily right and there are multiple reasons why it may be done, but the response from some of the more rabid..erm...uh...individuals who've posted here will be interesting to see.

 

[DrParasite]

There is no New York City EMS. It was engulfed by the FDNY and broken into a shadow of its former self. And if you didn't notice, FDNY recently began seeking more personnel for their EMS... they're looking for paramedics... NOT EMTs.

really.... so all those hospitals that are running ALS and BLS ambulances are just figments of my imagination?

there absolutely is NYC EMS; it is the EMS providers that provide EMS in NYC (thought it would be a duh, but I guess I need to clarify for some people). FDNY and the voluntary FDNY EMS system (those hospitals that answer 911 calls alongside FDNY EMS). Yes, it isn't called NYC*EMS, but there is still an EMS system in NYC, and it runs with BLS and ALS ambulances.

Based on the NJ EMS reputation it is never a good way to defend any point except when showing the wrong way to do things.

and who is that reputation from? people who actually work in NJ, and continue to still do so? or have just heard stories?

I guess your right, we could have the rep of California (where an EMT-P cert will get you a job flipping burgers until a FD offers you a job, or so I read on here) or florida (the land of a medic on every ambulance, fire truck, tow truck, and DPW vehicle). maybe you want to look at Philly, the capital of Pa? or DC? all shining examples of EMS

 

[DrParasite]

Boston EMS requires all their new paramedics work at a BLS level for at least a year before working as paramedics. Why do these places (which are generally thought of very well in EMS and medical circles) do that if it's such a bad idea?

Because they are smart enough to realize that an all ALS system is unnecessary, and most good systems use BLS as the backbone of a good EMS system, leaving ALS for the sick patients? Not only that, but they keep a relatively few paramedic units in the city (compared to BLS), to ensure their paramedics are highly trained and experienced because they only deal with sick patients. and not every BLS unit is staffed with 2 paramedics who are waiting for a paramedic spot, there are EMTs who are happy as EMTs (I know, amazing concept).

 

[MrBrown]

Well first off, the EMT-Basic should be seen as an advanced first aid certificate, because *gasp, that is what is!

Experience is required however, it must be the right kind of experience. This is where I think your education system sort of fals over because you get people out the door with sweet F/A knowledge and give them a little time to practice and then wowee they're off saving the world.

When one of the Ambulance Service Medical Officers told a class of Intensive Care Paramedics that in the US the EMT-Basic was around 100 hours with 1o or so hours of practical experience on an ambulance or in the ER the room let out a rousing laugh. That was in 1994. And look how far you've come in nearly two decades.

Taking a blood pressure and giving somebody oxugen is not the experience that new Ambulance Officers need. While that is important, I think you should be educating to a much higher level and then putting these people onto the street to cosolidate that knowledge into a package that forms a cognitive based for higher level learning.

If we take Ontario (Canada) as an example they educate Primary Care Paramedic's for two years full-time in micro level fundamentals of medical bioscience and ambulance practice then put them onto the street with an appropriate scope-of-practice (about 6 or 7 drugs) to allow them to solidify that knowledge with thier experience. This is quite simmilar to how our Bachelors Degree works.

So what experience do new Ambulance Officers need? Well first of all they need the education to support that experience, a 100 hour class or 600-1000 hours of training is not adequate. They need a prolonged, structured pathway to take them from graduate to Paramedic and beyond.

A Paramedic here will have around 3,500 hours of education and practical experience in the Bachelors Degree and spend another 1,000 hours (one year) consolidating that knowledge in the Graduate program.

An Intensive Care Paramedic will have around 6,000 hours of education and experience both in the Degree and on the street (around 2-3 years post-graduation) before undertaking another 12-18 months of study and internship to become an ICP.

Because they are smart enough to realize that an all ALS system is unnecessary, and most good systems use BLS as the backbone of a good EMS system, leaving ALS for the sick patients? Not only that, but they keep a relatively few paramedic units in the city (compared to BLS), to ensure their paramedics are highly trained and experienced because they only deal with sick patients. and not every BLS unit is staffed with 2 paramedics who are waiting for a paramedic spot, there are EMTs who are happy as EMTs (I know, amazing concept).

You may be onto something here. Those cities with less ALS such as Boston, Tulsa and Seattle with very strong first-response and BLS level care do have better cardiac arrest survival rates than say oh, Miami or Dallas where every Firefighter is a Paramedic. What a shocker!