# diff in paramedic and intermediate



## medic 4-2 (Jul 5, 2005)

what are the differances in being a paramedic and an intermediate? 
what are the scope of practice for both?
are there anythings that a medic can do that an intermediate cannot do? 
- thanks alot


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## rescuecpt (Jul 5, 2005)

In NY we have 2 levels of intermediate:  intermediate and critical care.  I's can do barely anything.  CC's can do almost as much as the medics with one exception (needle crych's  -sp?)  except that medics have more under standing orders than CC's do.  Some protocols, however, we have the same.  But the big difference is the amount of time spent in school and clinicals, and the fact that medics know WHY they do stuff (as they were trained to know why) while CC's know what to do when, but weren't taught the why's in as much depth (or any depth) as the medics.  Although good CC's will learn the why's through CME's and extracurricular learning.


(how'd I do Seb?  any better?)


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## usafmedic45 (Jul 5, 2005)

> _Originally posted by medic 4-2_@Jul 5 2005, 08:32 AM
> * what are the differances in being a paramedic and an intermediate?
> what are the scope of practice for both?
> are there anythings that a medic can do that an intermediate cannot do?
> - thanks alot *


It varies wildly across the states and even from service to service within some states, but at least where I worked at EMT-I's could administer most ACLS drugs and a few others (epinephrine, atropine, lidocaine, naloxone, D50, thiamine, glucagon, nitrous oxide (when we carried it), albuterol, ipratroprium bromide, nitroglycerin, aspirin, etc), intubate, needle decompress, IV, IO, manually defibrillate and a few other assorted procedures.  This however is the exception to the rule- most EMT-I services are far more limited in scope and require far more online medical control authorization for what they can do than we did.

We didn't have medics available so we were the top of the food chain as far as EMS providers go, so I can't get into specifics as to what medics could do locally since we don't have them, but the general rule is "everything else" 

By the way, most medics are just as clueless about the reasoning for what they do as most EMT-I's.  It's just a matter that medics have a wider expanse of topics to know about. But then again, a lot of medics are still not too swift on the mechanisms underlying what they do (but neither are most RN's, a lot of RT's, and a frightening number of MD's).


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## medic 4-2 (Jul 5, 2005)

yeah i am from virgina and i just got my emt-b and i am looking to further my education. are you are to go from emt-b to paramedic? i am looking into trying to get a paid career. do you have any suggestions i am a ff/emt right now. i prefer the ambulance better. i dont mind riding the fire truck. i just like riding the ambulance. do you have any sugestions on what certs i should have to get on a paid medic unit


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## usafmedic45 (Jul 5, 2005)

If you can, go straight for your paramedic certification.  I'd recommend obtaining ACLS and PALS instructor certs if you can, as these look very nice on a resume.


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## medic 4-2 (Jul 5, 2005)

thanks i was definatly looking into pals. acls sounds like a good class. how about ce hrs i know medics in va have to have 72hrs in 2 yrs. is it tuff to get all of the ce credits.  what about evoc i was thinking about level 1 and 2


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## TTLWHKR (Jul 5, 2005)

Going off the original subject, you can pretty much ask "What's the difference" with all branches of EMS, since there is no true national standard.

There are so many DIFFERENT variations of EMT and First Responder, the list is literally too long to remember. At one point I recall there being at least 20 different certifications among the FR & EMT.


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## TTLWHKR (Jul 5, 2005)

Since I have nothing better to do at the moment, I made a list.
EMT-ADVANCED 
EMT-AMBULANCE 
EMT-BASIC 
EMT-CRITICAL CARE TECH 
EMT-CARDIAC TECH 
EMT-DEFIBRILLATION 
EMT-ENHANCED 
EMT-INTERMEDIATE 
EMT-I85 
EMT-I99 
EMT-MAST 
EMT-PARAMEDIC 
EMT-SHOCK TRAUMA TECH 
WILDERNESS EMT 
ECA (EMERGENCY CARE ATTENDANT) 
CAA (CERTIFIED AMBULANCE ATTENDANT) 
FR (FIRST RESPONDER) 
MFR (MEDICAL FIRST RESPONDER) 
PHRN (PREHOSPITAL REGISTERED NURSE) 
ETT Emergency Trauma Technician 
EMT I 
EMT II 
EMT III 
MICP Mobile Intensive Care Paramedic
LP - Licensed Paramedic 
NREMT-P - Nationally Registered Paramedic 
NREMT-B
NREMT-I
CCEMT-P - Critical Care Paramedic 

I compiled the list from several commercial sites that I didn't write down.


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## Jon (Jul 5, 2005)

CCEMT-P is Critical Care Emergency Medical Transport - Provider

Supposedly anyone can pay the money and take the class


Also - EMT-MST - local TI offers it - EMT-B + Phelbotomy and some other BS stuff to create an ED tech.


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## 911 DJ (Jul 5, 2005)

> _Originally posted by MedicStudentJon_@Jul 5 2005, 05:23 PM
> * Also - EMT-MST - local TI offers it - EMT-B + Phelbotomy and some other BS stuff to create an ED tech. *


 Wouldn't it maqke more sense to hire a EMT-I or EMT-P in the ED? I work as a Emergency Care Tech. (ERT, EMT-I/85) in a ED, and believe it or not, without taking a phlebotomy class.... (drumroll).......... we all collect blood without killing patients!      I guess it all depends on medical direction.


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## TTLWHKR (Jul 5, 2005)

But Why?

When you can be a Certified EMT-ABCDEFGHIJKLMNOPQRSTUVWXYZ?


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## medic03 (Jul 6, 2005)

> _Originally posted by TTLWHKR_@Jul 5 2005, 12:25 PM
> * Since I have nothing better to do at the moment, I made a list.......
> *


You forgot FP-C = flight paramedic-certified   
     (the only reason I knew this is cuz I have my cert    )


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## Jon (Jul 6, 2005)

> _Originally posted by 911 DJ+Jul 5 2005, 09:31 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (911 DJ @ Jul 5 2005, 09:31 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MedicStudentJon_@Jul 5 2005, 05:23 PM
> * Also - EMT-MST - local TI offers it - EMT-B + Phelbotomy and some other BS stuff to create an ED tech. *


Wouldn't it maqke more sense to hire a EMT-I or EMT-P in the ED? I work as a Emergency Care Tech. (ERT, EMT-I/85) in a ED, and believe it or not, without taking a phlebotomy class.... (drumroll).......... we all collect blood without killing patients!      I guess it all depends on medical direction. [/b][/quote]
 I never said it wouldn't.... that school is notorious for passing anyone who will pay the outragous fees and can pass the state exam after LOTS of coaching... they love to charge 20 grand to make you a medic from NOTHING, with NO street time experienc except school...

Jon


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## shorthairedpunk (Jul 13, 2005)

> _Originally posted by 911 DJ+Jul 5 2005, 08:31 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (911 DJ @ Jul 5 2005, 08:31 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MedicStudentJon_@Jul 5 2005, 05:23 PM
> * Also - EMT-MST - local TI offers it - EMT-B + Phelbotomy and some other BS stuff to create an ED tech. *


Wouldn't it maqke more sense to hire a EMT-I or EMT-P in the ED? I work as a Emergency Care Tech. (ERT, EMT-I/85) in a ED, and believe it or not, without taking a phlebotomy class.... (drumroll).......... we all collect blood without killing patients!      I guess it all depends on medical direction. [/b][/quote]
 Blood draw is a monkey skill for the most part. The ER receptionists took an in ER informal training and can do them, and they arent even medically trained. Its not hard, since it doesnt stay in and if its a complicated case, then lab gets called, which is a rarity. when you get to use a small needle, with no catheter to advance, its easy, even with tiny lil veins. Arterial draws on the other hand, only get done by lab.


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## Ridryder911 (Jul 13, 2005)

Most states have developed their own criteria above the national standard curriculums recommendation. 

Unfortuantely, I feel like many of the employers are using the EMT/I as a excuse to get ALS coverage, without paying for it, more scarrier is EMT/I are allowing this to occur. I have read how " we almost do everything.. or .. samething except"

A couple of things come in mind... 
1) You are being used. If you are treating the patient as a Paramedic, & not recieving compensation.. is that fair ?  I am sure they are billing at ALS rate, & thus recieving compensation as such.

2) Really you are not a Paramedic.. short & simple.. the same a LPN is not a RN. Sorry, until you have completed the full program & credentials, you are not sorta-or almost. Either you are or you are not.....

Be safe,
Ridryder 911


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## Summit (Jul 13, 2005)

> _Originally posted by ridryder_
> *Unfortuantely, I feel like many of the employers are using the EMT/I as a excuse to get ALS coverage, without paying for it, more scarrier is EMT/I are allowing this to occur.*


Our system has begun doing this due to a shortage of P's (inability to retain P's and attract new P employees). They have even started to assign some I's "Medic" callsigns and place them in ALS fly cars, and assigning them as ALS coverage for districts.



> *I am sure they are billing at ALS rate, & thus recieving compensation as such.*


Yep


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## rescuecpt (Jul 13, 2005)

> _Originally posted by Ridryder911_@Jul 13 2005, 10:57 AM
> * A couple of things come in mind...
> 1) You are being used. If you are treating the patient as a Paramedic, & not recieving compensation.. is that fair ?  I am sure they are billing at ALS rate, & thus recieving compensation as such. *


 WHAT?!?  I'm supposed to receive compensation?????  WOW, I wonder what 5 years of back pay will add up to........   :lol:

Oh wait, you were talking paid services, lol, nevermind.  


Seriously though, around here, as far as I know at paid services intermediates can only perform BLS, not ALS.  I know a couple I's (or CC's as you may) who work in private and are not allowed to perform ALS and are paid as basics because that is what they do.


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## KEVD18 (Jul 13, 2005)

round here, if my information is correct(thin ice here) i's can start line, but cant push anything but ns, intubate, depib plus all the bls stuff of course

we're trying to get rid of the i's in the boston metro area. pointless rating that causes more harm than good. not too long ago, there was a pair of newly minted i's on a truck. they responded to a c/p call. the nearest er was maybe 10 away. they sat on scene for *THIRTY* trying to establish a line, unsucessfully at that. they ruind every vein he had and took forty minutes to get him to the er, ALL TO PUSH SALINE!


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## ffemt8978 (Jul 14, 2005)

I don't see the benefit of I's in a metro area, but in a rural area I think they can be a good thing.  Given our long transport times around here, we can prep the patient for our ALS intercept and save the P's precious minutes that would be wasted by establishing a line.  Of course, we don't start our lines on scene but do them during the transport.  After all, BLS before ALS.


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## usafmedic45 (Jul 14, 2005)

I don't care what level of training you are- you're still a moron if you sit on scene trying to get an IV on a patient like that.  There are very few (maybe 1 in 10) that I will sit around after I get them in the back of the rig.  We might not be time sensitive in terms of what the case is, but there is still no point in delaying transport, even if it is just going to be a nicely non-emergent transport.


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## shorthairedpunk (Jul 14, 2005)

narco overdoses and diabetics are about the only on scene IVs I do, the rest can get em enroute

I dont put anybody in the bus unless I know they arent going to sign a refusal on me


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## rescuecpt (Jul 14, 2005)

Depending on how the call gets EMD'd, I'll usually spike a bag enroute - that way if it's something like chest pain or OD I'm ready to rock when I walk in the door.  Stick and run.  

Then I can start pushing all my yummy drugs (medical control wants an IV in place for nitro).


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## Jon (Jul 16, 2005)

> _Originally posted by ffemt8978_@Jul 14 2005, 01:38 AM
> * I don't see the benefit of I's in a metro area, but in a rural area I think they can be a good thing.  Given our long transport times around here, we can prep the patient for our ALS intercept and save the P's precious minutes that would be wasted by establishing a line.  Of course, we don't start our lines on scene but do them during the transport.  After all, BLS before ALS. *


 From a -P student standpoint.... -I's are nice, as a partner for a -P.... That way the -I can start a line and help the medic on a code or bad call. (Not that a lot of the BLS -P Drivers don't do that, unofficially  ). 

I've also heard of I's being able to push all drugs, under the orders of the medic onscene (giving Narcan or Epi while the medic intubates).

I's are good to have, to suplement medics, but shouldn't replace them.

But, if an -I can give ASA, NTG, Combivent, Epi, lidocane, Atropine, Narcan and d50, read a monitor and cardiovert/defib they could easily handle the 75%+ of "BS" ALS calls, leaving a fly-car medic free to respond on another call....


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## Jon (Jul 16, 2005)

> _Originally posted by shorthairedpunk_@Jul 14 2005, 09:34 AM
> * narco overdoses and diabetics are about the only on scene IVs I do, the rest can get em enroute
> 
> I dont put anybody in the bus unless I know they arent going to sign a refusal on me *


 I see it from another angle....

I'd rather get the patient into my rig, where I am "at home" and they are on "my turf" - espicially a drug overdose - less risk to me and my crew, espicially with weapons.

As for a diabetic, it is one thing I like to rule out onscene before transport, even if for no other reason than it helps me figure out a treatment plan.... just do a fingerstick while you partner is getting the litter ready - then you know if D50 is getting pushed when you get a line, or not.

Usually, the pt. is on the monitor, O2, IV'd and 1st round of meds given before transport.... the driver usually hops in the back and makes sure the medic has everything under control, then walks around and drives to the ED.

Jon


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## emschicksrock (Jul 27, 2005)

Back to your original question, I think the difference depends on what state you live in. Even if you are Natonal Registry certified. In addition individual private companies and municipalities may have their own protocols and limitations.

I-85 is what they call Intermediate when you go to take your National Registry test. A lot of people around here still refer to the level by its old name of "Specialist".  The level here is considered "Limited Advanced" depending on the level of licensure of the crew. If I run with a Paramedic, it is an "Advanced" rig. If I run with a fellow Intermediate, or with a Basic, it's "Limited Advanced".

Where I'm from we can intubate, start iv's, administer glucagon, ASA, oxygen, and assist pt. in taking their own nitro and albuterol without 'permission' from medical control. With med. control permission we can also push Epi, Albuterol, and Nitro. We can transport a patient with additional Paramedic non-narcotic drugs in the IV, but we can't start the IV. We can't transport if the IV is piggy-backed with serious stuff.

I think that there is a place for all levels, depending on where you run and what your patient demands are.  Not all runs need advanced care. Why make people pay for it?


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## Jon (Jul 28, 2005)

> _Originally posted by emschicksrock+Jul 27 2005, 09:02 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (emschicksrock @ Jul 27 2005, 09:02 PM)</td></tr><tr><td id='QUOTE'>With med. control permission we can also push Epi, Albuterol, and Nitro.[/b]_


_

not to be a smart-a**, but I think it is kind of hard to "push" albutorol.... (Isn't terbutaline IV, though?)...

<!--QuoteBegin-emschicksrock_@Jul 27 2005, 09:02 PM
*We can transport a patient with additional Paramedic non-narcotic drugs in the IV, but we can't start the IV. We can't transport if the IV is piggy-backed with serious stuff.
*[/quote]
So... you are saying that you can start an IV lock or NSS, but not durgs... but if the patient has a lidocaine drip, you can transport them with it running.. I think....


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## emschicksrock (Jul 31, 2005)

Yes,  those are the transport protocols. I can start D5 or NS without permission.

You're right about pushing the Abuterol, I'm new to this Board, I guess I better carefully edit before I post again.

Unless that was sarcastic humor, in which case I'll add that you may not push Albuterol, but when they need it the pt. is usually a pushover.

Edited to add/clarify:  Albuterol is via Nebulizer


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## Jon (Aug 1, 2005)

> _Originally posted by emschicksrock_@Jul 31 2005, 03:52 PM
> * Yes,  those are the transport protocols. I can start D5 or NS without permission.
> 
> You're right about pushing the Abuterol, I'm new to this Board, I guess I better carefully edit before I post again.
> ...


 I was just being picky... that's all.... I HOPE none of us have tried to give albutorol IV....


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## usafmedic45 (Aug 1, 2005)

I'm guessing someone has done it- given albuterol IV- because on the side of most albuterol bullets it says "NOT FOR INJECTION- INHALATION ONLY"

And yes, terbutaline can be given IV, but it can also be given as a neb treatment (although I've only seen it given as a neb once).


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## Jon (Aug 1, 2005)

> _Originally posted by usafmedic45+Aug 1 2005, 01:01 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (usafmedic45 @ Aug 1 2005, 01:01 AM)</td></tr><tr><td id='QUOTE'>I'm guessing someone has done it- given albuterol IV- because on the side of most albuterol bullets it says "NOT FOR INJECTION- INHALATION ONLY"[/b]_


_

Probably. How many of your co's rigs say "Gasoline" and "Deisel"??? Anyone here every made that oops before???

<!--QuoteBegin-usafmedic45_@Aug 1 2005, 01:01 AM
*And yes, terbutaline can be given IV, but it can also be given as a neb treatment (although I've only seen it given as a neb once).*[/quote]
Yeah. My instructor is an RT as well, so he was very big on it. "Yeah, it is old, but it is in code carts and drug boxes to give IV, as it is more Beta II specific then Epi" and that sometimes Grandma/Grandpa would get terbutaline nebs, because they've worked for 20 years, and why mess with success.


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## usafmedic45 (Aug 1, 2005)

One service I used to work for had terbutaline as a backup for wheezing not broken by albuterol.  It's good stuff.....it definitely has it's place.


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## Ridryder911 (Aug 5, 2005)

Not to say the least on that premature labor patient as well.....

Be safe,
Ridryder 911`


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## rescuejew (Aug 7, 2005)

lets see, in Durham heres what I's can do (without med control or supervision from a Paramedic...)  

IVs
12 leads
AED
Epi, Narcan, D50, Thiamine, SubQ Epi, IV benadryl, ASA, NTG, Albuterol, Atrovent 
ET intubation 
EJs
All the BLS stuff and we have been trained on Sternal IOs and Quick-Trachs.

I's function independently here, as we do not hire EMT-Bs.  Most I's ride with a medic, but we take turns on calls and rotate unless the call requires Paramedic skills.  We have been known to ride I trucks and call for a medic if necessary.


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## Jon (Aug 7, 2005)

> _Originally posted by ridryder 911_@Aug 5 2005, 10:37 PM
> * Not to say the least on that premature labor patient as well.....
> 
> Be safe,
> Ridryder 911` *


 Tebutaline for premature labor???

I always thought that was Mag...


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## medicNsand (Aug 9, 2005)

> _Originally posted by TTLWHKR_@Jul 5 2005, 12:25 PM
> * Since I have nothing better to do at the moment, I made a list.
> EMT-ADVANCED
> EMT-AMBULANCE
> ...


 No Disrespect Sir, but you forgot the " Black-Ops" medic community. Working with  LE/Federal agents/CIA/SWAT/Counter-Terrorism Groups and such.


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## Flight-LP (Aug 9, 2005)

> _Originally posted by MedicStudentJon+Aug 7 2005, 06:42 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Aug 7 2005, 06:42 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-ridryder 911_@Aug 5 2005, 10:37 PM
> * Not to say the least on that premature labor patient as well.....
> 
> Be safe,
> Ridryder 911` *


Tebutaline for premature labor???

I always thought that was Mag... [/b][/quote]
 Terbutaline is wonderful for pre-term labor as its B2 relaxant properties work directly on the uterus. Usually the only occasion it is given IV, it is infused at 10 - 25 Mcg/min..............


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## trauma1534 (Oct 18, 2005)

This is for medic4-2

Which region in VA are u in?  I work in Western Virginia EMS region, I volunteer in ODEMSA, and work part time for another squad in ODEMSA.  I used to be a member of a squad in BREMS.  I would suggest to you that you take time to get aquainted with EMT-b before you move up.  I have met quite a few providers who have gone zero to hero in 2 years and they are clueless in the back of the truck.  As far as getting into EMS for a career, I would suggest that you find a Transport service.  That is a great place to start.  Get used to that, put a couple years in, move up to ALS and go for a squad.  Most Squads want nice resume's.  Get your Firefighter 1 also, alot of areas are starting to combine it.  Chesterfield County pays pretty well, and the want you to have both certs.  You deffinatly need your EVOC and why not go for the highest EVOC you can get, that way there are no limits in what you can drive.  That is more bargining power for a good job.  Another thing too, I don't know how close you are to North Carolina, but thier Paramedic is much cheeper than VA, and you can still get your regestry and cert in VA.  That is what I am doing.  I am taking Paramedic in NC.  I stayed BLS for 8 years before I moved up to ALS, I have been ALS since May of this year.

As for what the diference between EMT-I and Paramedic is... in ODEMSA in Virginia, there are none... except for RSI and surg. crychs (spelling).  I's can do everything a Paramedic can do.. they even needle crych.  I's give all drugs in the box except for paralytics/RSI drugs.  Our OMD is pretty cool.  He let's us do alot at each level.  In Western Virginia EMS councel, I's have to call for alot of orders.  They are limited in which drugs they can use for what.  

BREMS, EMT-B's can open the drug box and give glucagon, ASA, and a few others.  They have an EPI pen they can use in the box too.  

Just in VA, there are many differences in what each level can do, and not far apart on the map.  I live almost on the line between 2 EMS councels or regions.  I still can't get used to the difference in protocols.  I work in both regions.


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## ResTech (Oct 29, 2005)

Just to add to the terbutiline comments, a second B2-agonsist is nice to have on board for those COPD'rs that get a tolorance to albuterol. Sometimes when albuterol isnt working terbutiline will.. both are B2-agonsist but chemically different.


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## Jon (Oct 30, 2005)

> _Originally posted by ResTech_@Oct 29 2005, 04:33 AM
> * Just to add to the terbutiline comments, a second B2-agonsist is nice to have on board for those COPD'rs that get a tolorance to albuterol. Sometimes when albuterol isnt working terbutiline will.. both are B2-agonsist but chemically different. *


What about Xopenex????

Although, I think it is Terbutaline, there is a B2 agonist that is IV injectable... VERY GOOD thing to have.

Jon


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## ResTech (Nov 16, 2005)

Terbutiline is usually given IM for exacerbations of obstructive pulmonary diseases. Epi would be a B-2 agonist that can be given IV.


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## Jon (Nov 17, 2005)

> _Originally posted by ResTech_@Nov 16 2005, 03:44 PM
> * Terbutiline is usually given IM for exacerbations of obstructive pulmonary diseases. Epi would be a B-2 agonist that can be given IV. *


 My understanding is that there was a drug that can be given IV that is "somewhat" Beta specfic, and dosen't have the Alpha effects of Epi.

Jon


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## Medic38572 (Nov 17, 2005)

It is also used to slow contractions in pregnant woman but has to be used cautiously.


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## trauma1534 (Dec 5, 2006)

medic 4-2 said:


> what are the differances in being a paramedic and an intermediate?
> what are the scope of practice for both?
> are there anythings that a medic can do that an intermediate cannot do?
> - thanks alot



Ok... well here in Virginia, in our region ofcourse, Intermediates can do everything that a Paramedic can do with the exception of RSI, and even then they can assist.  Everything is on standing orders for every level here.


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## akflightmedic (Dec 5, 2006)

trauma1534 said:


> Ok... well here in Virginia, in our region ofcourse, Intermediates can do everything that a Paramedic can do with the exception of RSI, and even then they can assist.  Everything is on standing orders for every level here.



Strictly out of curiosity mind you, but why is there even an intermediate level if they are the same?


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## trauma1534 (Dec 5, 2006)

akflightmedic said:


> Strictly out of curiosity mind you, but why is there even an intermediate level if they are the same?



They are cheaper paid, and can do basicly the same as a Paramedic.  It's an economical thing in this state.  Believe it or not, they make only a thousand dollars less than a Paramedic in a certain county I know of here in Virginia.  They can needle cric, some can even surg. cric if the OMD signs off on them.  They have standing orders for everything in the protocol.  They are even refered to as "medics".  At the agency where I work, if the truck leaves the building with an I onboard, they sign on as "Medic 31" or whatever the truck number is.  If it is a paramedic onboard, it is signed on as "Paramedic 31", if it is Enhanced, it is "trauma 31", and Basic is "Rescue 31".

I don't know anyother way to explain it, maybe someone else can pick up and continue this for me.


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## jeepmedic (Dec 5, 2006)

ResTech said:


> Terbutiline is usually given IM for exacerbations of obstructive pulmonary diseases. Epi would be a B-2 agonist that can be given IV.



We used to give Terbutiline 0.3cc SQ then 0.7cc mixed with 3cc of Saline Neb. for asthma attacks


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## captoman (Jan 24, 2007)

usafmedic45 said:


> If you can, go straight for your paramedic certification.


 
Bad idea in my experience. Most medic school washouts are EMTs with no street experience. Remember, BLS before ALS, so a good medic must first be a GREAT EMT! 

 As for the difference in I vs P, in MN there is a world of difference, varying on were you work. The arguement that the diff is small, consisting of a list of drugs and procedures, is missing the larger point. In a cookbook world of paramedicine,
it's OK to look at it like that. But if we are to advance the profession, we must be thinkers. Were I work, there are no protocols, just guidelines and lists of meds and procedures. A medic should be able to work towards the problem at hand, and the totality of the pt. condition. This requires a strong knowlegde base, heavy in A&P, and well versed in critical thinking. How many EMT-I's can explain to me the different treatment modalities of rt vs Lt AMI or heart failure? how many can articulate the pathophysiology affecting treatment of a STEMI in a CHF pt? The ramifications of end stage renal failure 
in a pt whom missed dialysis? I cant tell you the times when my EMT-I partners questioned my judgement becuase they did not understand the back story. One even wrote me up for not starting a STEMI alert, and not flying a pt to the cities' heart hospital becuase of mild chest pn, with global st elevation in a otherwise healthy 33 yo male. I had to explain to all that it was strongly suspicious for pericardititis, not stemi  . By no means am I stating that EMT-I's are not smart, but they lack the intense education that I would like to see in our medics. Good Luck!


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## Ridryder911 (Jan 25, 2007)

I compare the difference similar to LPN versus RN's. Yes, both can perform some of the same procedures, however LPN are more task or technical nurses not understanding why or educated in detail of patient care. The same as Intermediates. They have accomplished a portion of the paramedic program and as of yet should not be considered as one, since completion has not occurred. The same as a P.A. attempting to compare themselves as a Physician, same classes for the most part without the completion and detailed needed to be at the highest level.

One has to remove the "emotional" part and realize what ever level or EMT____ (fill in acronym). One, is still being compared to gold standard of the Paramedic. 

Unfortunately, administration usually sees this as a "cheap paramedic, commonly called placebo medic" and hopefully the dice does not roll for the patient requiring Paramedic procedures. 

If the management only pays a differential of only a thousand dollars, shame on them for not either paying a larger differential or paying to get the real deal. Again, displays of poor management techniques which runs amuck in EMS. 

Personally, I believe EMT Intermediate level should be encompassed into the basic program. Thus allowing two levels. We have way too many multiple levels in this industry. 

R/r 911


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## Medic2891 (Jan 29, 2007)

medic 4-2 said:


> thanks i was definatly looking into pals. acls sounds like a good class. how about ce hrs i know medics in va have to have 72hrs in 2 yrs. is it tuff to get all of the ce credits. what about evoc i was thinking about level 1 and 2


 
It is so easy to get these hours.  In NJ we are required to do more than 440 hours in about a year.  We have a year of class time and depending on where you are getting that depends on whether or not you can start your clinical time in the second half.  If not then you have 2 years to get your time in or you have to start over from the beginning.


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## firemedic1563 (Mar 10, 2007)

First of all, glad I found this site.

I wanted to add my thoughts. In my state I's are titled Cardiac Rescue Technician- Intermediate, only as a matter of ease of changing laws to the national Intermediate standard. They are generally compensated between and EMT-B and a Paramedic. By state protocols, they can perform about every procedure as a Paramedic (minus NTT, NG, and surgical crich). They can administer all but Haldol, but have to consult for about twice what Paramedics do. They are not widely used to replace Paramedics for cheaper though. Some of the rural departments use volunteer I's as their standard ALS. 

Larger departments utilize I's as a quicker access to ALS, but have Paramedics on the calls as well. My own department has I's with a Paramedic at all times, although Paramedics may be on their own with a Basic. This allows the Intermediate to have a Paramedic to administer med's we would otherwise have to consult for. We are actually in the process in my department of phasin out all the I's and training all new hires to the Paramedic level straight from Basic.

Similarly, private companies (which I do PT) still need the paramedics. I's in my state cannot transport vent patients or Heparin or Morphine drips interfacility. So the private companies need paramedics for critical care. They mostly utilize I's for basic monitor, IV, Nitro patch, etc patients.

I think Intermediate is a good idea in theory, but departments should not replace the training and education of Paramedics, rather support the care with higher than Basic training. I am currently completing my Paramedic licensure (done the training). Luckily I work for a department that believes Paramedic should be the standard of care for all patients, even though the downside is we have to run all the BLS too.


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