EMT-B Seeking Wisdom from Medics

MusicMedic

MusicMedic

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Linuss said:
Wow, I could not see not having Albuterol as an EMT... then again I can no longer see not having all the tools I have now either :p
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haha welcome to Orange County,CA

here we can only help with albuterol inhalers that are prescribed to the patient, and even in that circumstance we still need to get an OK from Medical Direction


In orange county, ALS is king, they run pretty much everything regarding 911
 
JPINFV

JPINFV

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MusicMedic said:
here we can only help with albuterol inhalers that are prescribed to the patient, and even in that circumstance we still need to get an OK from Medical Direction
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Er... actually no. In fact, to the best of my knowledge (and unless something changed since 2007, but granted a lot has), there is no was for an EMT-B to contact medical control in Orange County. Nebulizers are not in the scope of practice for EMT-Bs.

Here's the Orange County BLS MDI guideline.
http://ochealthinfo.com/docs/medical/ems/treatment_guidelines/10 Procedures/BLS Procedures/B-20.pdf

Also, note that the 9/09 date is the date that this was introduced, and not a revision date.
 
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MusicMedic

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JPINFV said:
Er... actually no. In fact, to the best of my knowledge (and unless something changed since 2007, but granted a lot has), there is no was for an EMT-B to contact medical control in Orange County.

Here's the Orange County BLS MDI guideline.
http://ochealthinfo.com/docs/medical/ems/treatment_guidelines/10 Procedures/BLS Procedures/B-20.pdf

Also, note that the 9/09 date is the date that this was introduced, and not a revision date.
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hmm, i guess i might have been mis informed, is it the same with Nitro/epi?
 
firetender

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Will you settle for logic?

This debate is smeared all over this site.

From a broader perspective, look at the way systems are run. They are still geared toward "having those 2 bodies in the rig." You are never assured that you will have an experienced medic come to your door. Two partnered green paramedics can do much more damage than a couple seasoned EMTs.

Personally, I don't believe EMTs get enough credit. I don't think they get enough training, either. It's looked at as a stepping stone (as is paramedic to fire for many) and not given the attention it deserves, which could include training in proper use of community resources. (See "What is it a paramedic does?"

I think it's a whale of a job requiring a whole lot of sophistication in terms of scene, people, allied agency and resource management. I've worked with too many green paramedics fumbling around with the basics because they simply did not have enough exposure. I've also watched too many not have a clue as far as patient care goes, which is 80% of the work.

If being a PA before becoming a Physician could have an affect on Physicians developing sensitivity and a bedside manner; YES, I'd say let's go back to the system of Mentoring that helped people ease in to their professions under the guidance of the experienced.
 
medic417

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firetender said:
Two partnered green paramedics can do much more damage than a couple seasoned EMTs.
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LOL I don't think so. They have more education and also have more potential to do good for me or my family than the "experienced" but uneducated emt's. So I will take the the two green Paramedics any day over the 2 basics.

Sorry there is no way you can win or prove that it is better to be uneducated than educated, it is ludacris.
 
JPINFV

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I'm going to have to disagree with that. One cliche I do agree with is "EMTs let patients die, paramedics kill patients." To clarify before someone crucifies me on that one, it's commentary on the vast differences in scopes of practice between paramedics and basics. EMS is no different than nursing or medical education in the sense that competitant providers are not produced out of school Nurses go through new nurse programs, physicians have residencies, and hopefully new paramedics go through some sort of field training. Ideally, no new provider (paramedic or basic) is paired with another new provider until they have at least some experience in applying their education.
 
medic417

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JPINFV said:
I'm going to have to disagree with that. One cliche I do agree with is "EMTs let patients die, paramedics kill patients." To clarify before someone crucifies me on that one, it's commentary on the vast differences in scopes of practice between paramedics and basics. EMS is no different than nursing or medical education in the sense that competitant providers are not produced out of school Nurses go through new nurse programs, physicians have residencies, and hopefully new paramedics go through some sort of field training. Ideally, no new provider (paramedic or basic) is paired with another new provider until they have at least some experience in applying their education.
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So there you are in the middle of no where and up comes two EMT's. They can give you nothing but a ride. You die during transport though they claim you didn't because they did CPR the hour to the hospital. Your wife collects big insurance check and forgets about your ashes.

Now if instead the two green Paramedics show up they pull out a magic drug and correct the problem. You joke and laugh with them all the way to the hospital. You are prescribed meds and lead a full life depriving your wife of the life insurance for now.

Which would I want? The two Paramedics. At least in a life or death they might have a chance of doing something for me. I understand they have the potential to do the wrong thing but at least they are educated enough to try doing something rather than watching me die then start working.
 
JPINFV

JPINFV

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Ideally, at least one of those paramedics would have experience. If the question was "inexperienced basic vs inexperienced paramedic" or "experienced paramedic v experienced basic" I'd take the paramedic hands down. There's a reason why even residents (who are fully licensed physicians) who are moonlighting generally try to have at least double coverage.
 
medic417

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firetender said:
Just to be clear, this is what I said (emphasis mine):
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And they can do much more good, in fact they are more likely to do good than to kill the patient. Sorry no way I'd take 2 basics over 2 Paramedics.
 
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triemal04

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JPINFV said:
Ideally, at least one of those paramedics would have experience. If the question was "inexperienced basic vs inexperienced paramedic" or "experienced paramedic v experienced basic" I'd take the paramedic hands down. There's a reason why even residents (who are fully licensed physicians) who are moonlighting generally try to have at least double coverage.
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I really don't feel like typing the same, long post that I usually do for this topic, so I'll keep this brief.

Unfortunately, people tend to forget the above when this topic comes up, as well as forgetting, or being unable to accept, that EMS (and medicine in general really) has a lot more involved in it than just medical issues. This is where working as an EMT can be beneficial to some new providers. (though it may not be beneficial depending on the type of service the EMT works for; a NETS service will not be as helpful as a 911 service where they are working with a medic)

On average field internships in paramedic programs are woefully inadequate; for the amount of things we can do and are expected to treat and know, 200 hours of fieldwork (the national minimum) is ludicrous; that's less than a month of fulltime work. Not to single anyone out, but Linuss is nearing the end of his internship, and by his posts has done and experienced very little (this is just how it comes across and an example so don't get upset). Yet he'll be turned lose soon, and may be hired by a service that does little, if any initial training of their own (and there are many, many places that do that). Is that right? Will he be an experienced, fully-capable provider ready to head out on his own? Will he be capable of handling any oddball situation that comes up? Possible, but the odds are against him, and everyone else in that situation. I believe another poster here was actually dropped from their internship because they weren't proficient at the non-medical aspects of this job.

There is more to EMS (and medicine in general) than just medicine. There is more to being a good provider than just knowing something in your head. Being able to function during stressful situations, recall the needed information, apply the needed information, evaluate the results and apply more information as needed, all while under stress and in controlled to chaotic environments takes time to learn. Being able to control a scene and direct multiple personnel. Being able to communicate and interact appropriately with pt's (and this includes different cultures and sub-cultures, ages, socioeconomic groups) family (sometimes distraught and/or hostile family), bystanders, coworkers, nurses, doctors, other medical personnel, police, FF's, drunks, crazy people and everyone else we come across is not something that can be learned in a brief internship. Being able to recognize when someone is lying or holding something back. Being able to recognize when a scene is unsafe (and I don't mean the glaringly obvious times) or has the potential to become so, being able to take in everything that is happening while still maintaining your focus on the pt, being able deal effectively with the multiple, non-medical issues that we come across regularly...the list can go on and on, but for all the fact remains the same: becoming truly proficient at these things takes more than 200 hours.

There is more to medicine than just medicine.

Learning how to cope with, and perform the above is where experience as an EMT can be beneficial. If a person ends up on a NETS (non-emergency transport service; ie nursing home to MD's appointment and such) then there will still be some benefit, though much less. If a person ends up on a 911 ambulance, preferably working with a paramedic, the benefit can be much greater, and when their paramedic internship comes around they will be able to focus more on the medicine side of things, on less on the other aspects of our job.

Of course, this also depends on the school where you go and where you eventually end up working. If you have well upwards of 700 hours of field time, that's a good start, though still not enough by far. In that case experience as an EMT is less needed, though it still might help. Same goes for where you start working; if there is a good, comprehensive training program before you start working, followed by which you are paired with an experienced partner who continues to teach and evaluate you, then experience as an EMT is less needed, though it'll still have some benefit. Of course, many places do not do the above, or only a very watered down version of this...so what should the prospective paramedic student do?

Look at the program you are going to; how many clinical hours does it have, how many internship hours? Look at the services in your local (and non-local)area; what is their training program for new medics? Can you work as an EMT on a 911 ambulance? Take a look at yourself; how do you function while under stress? Do you pick things up rapidly? Are you used to abnormal situations? Have you been exposed to multiple types of cultures and situations? Have you been placed in situations where you had to rely soley on yourself? How did you do?

Not everyone needs EMT experience, and not all EMT experience will help. But there is a reason that MD's, PA's, and RN's all spend many more hours practicing their job before they are allowed to work on their own. Until EMS education is reformed and the internship is extended to 1 year in length, prior experience as an EMT is something worth considering.

Huh...guess that ran long after all.
 
Shishkabob

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Trirmal, no offense taken because I'm pretty much in agreement. I'm nervous too about being the lead/lone paramedic in a few months should I get my cert next month.

Then again if I had 700hr internship I'd feel the same way.


I don't get my white cloud. I get 1-2 calls in a station where my classmate gets 10+ the day before. It wouldn't be a problem if Dallas didn't have the CF they did which made us change where we do our internship for this class.



Luckily I got some decent experience during clinicals in the hospital... It's just being the lead medic in the rig that's getting me. And I do have some experience as a working EMT-B as well. Not much, but it's there.
 
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medic417

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8jimi8

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firetender said:
This debate is smeared all over this site.

From a broader perspective, look at the way systems are run. They are still geared toward "having those 2 bodies in the rig." You are never assured that you will have an experienced medic come to your door. Two partnered green paramedics can do much more damage than a couple seasoned EMTs.

Personally, I don't believe EMTs get enough credit. I don't think they get enough training, either. It's looked at as a stepping stone (as is paramedic to fire for many) and not given the attention it deserves, which could include training in proper use of community resources. (See "What is it a paramedic does?"

I think it's a whale of a job requiring a whole lot of sophistication in terms of scene, people, allied agency and resource management. I've worked with too many green paramedics fumbling around with the basics because they simply did not have enough exposure. I've also watched too many not have a clue as far as patient care goes, which is 80% of the work.

If being a PA before becoming a Physician could have an affect on Physicians developing sensitivity and a bedside manner; YES, I'd say let's go back to the system of Mentoring that helped people ease in to their professions under the guidance of the experienced.
Click to expand...


Ok jumping into the game late here. Emphasis bolded by ME


Why were YOU watching them, Firetender? Were YOU the experienced medic in those situations? Were YOU the leader of the ALS unit in those situations?

Sounds like a pretty safe pairing to me. Experienced medic, riding with a green medic. Sure ANYONE new on the job (including you. Were you as proficient in all of your skills when you started?) is going to fumble with things. That is why you send them out with the FTO. The FTO can evaluate and do some OJT, as well as make sure that the best patient outcomes are achieved. Where would we be in this world if people without experience couldn't get any? The paramedics would have died long long ago and there wouldn't be anyone left to replace them.

I realize that the direction that this is taking is the argument about getting experience as a basic first. I don't agree that it is necessary. And for those who in your estimation aren't even good at BLS when they start... tell me, in your organization, do they get the "Go" from your FTO's to start leading ALS ambulances?
 
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