# New EMT Questions



## stethoscope (Apr 1, 2015)

Hey all,

I'm approaching the half way marker in my training. So far, I love this, and I'm excited to get real world experience. I have some questions that I figured you guys may be able to answer?

1) We are going to need patient contact experience soon. I have a company that I would love to work for who is willing to take me along in a time-slot. Are there any companies that will do an "internship" in some sort? Such as maybe going in volunteer on a single shift each week to get some real world practice? How would I go about asking for that? Is it possible / likely?

2) As far as a stethoscope, I bought a $20 MDF Acoustica. It came with a lifetime warranty on _everything_ but the tubing. I figured this is all I needed. Should I have purchased a more "branded" Littman? I likewise bought a cheap but rugged watch that tells military and analog time.

3) We took our AHA BLS / CPR course, and I passed. Are we going to be receiving the cards in the mail? How does that work? I want to make sure that I receive it.

Thanks


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## STXmedic (Apr 1, 2015)

1) There are services that take volunteers, but that depends on your area. Call around to your local services and ask.

2) If you can hear from it, you're fine. I use a littmann, but I've had good luck with some off-brand steths also.

3) They should have given you your card CPR card. It typically is not mailed, but provided at the completion of the course.

4) Clinicals should be both in the ER and ambulance. Both are equally important.


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## grind time medic (Apr 1, 2015)

STXmedic said:


> 1) There are services that take volunteers, but that depends on your area. Call around to your local services and ask.
> 
> 2) If you can hear from it, you're fine. I use a littmann, but I've had good luck with some off-brand steths also.
> 
> ...



100% fact on those responses.... Take this to the bank.


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## Aprz (Apr 1, 2015)

*Observation in ER vs Ambulance*

If I had to pick one over the other, I would pick the ER. The unfortunate thing about doing your observation on an ambulance is that even if it's busy, you will still probably see less patients than what you would have in the ER. Because you'll probably see more patients in the ER, you'll probably see a better variety of complaints too. Another unfortunate thing on the ambulance is that there are only two people and both of them are either an EMT or paramedic. In the ER, there will probably be more than two people and multiple different disciplines: could be an EMT/paramedic or CNA working as an ER/floor technician (who may have prior experience on an ambulance), phlebotomist, x-ray technicians, LVN/LPN, registered nurse, PA, and physicians. If you don't get along with the EMT/paramedic on the ambulance or they aren't in the teaching kinda mood then tough luck. Since there are more people working in the ER, the odds are higher that you will find somebody that you will connect with or who will be in a teaching kinda mood. In my area, paramedics don't do a lot for most patients other than transport, get vital signs, and establish an IV. When we respond to calls on an ambulance, I feel like most of what we see either happened prior to us arriving (syncope, seizure, etc.) or it is a continuous problem (chest pain, shortness of breath, stroke-like symptoms, etc.). Some of these problems the paramedic might be able to treat and it will look totally different to the ER (eg I have had shortness of breath patients that are speaking 1-2 word sentences when I arrive on scene, treat them with albuterol and oxygen, and they'll practically be doing kart wheels into the ER), but in my limited experience, they'll have a problem that I'll attempt to treat, but it the change is minimal, if any (eg I frequently get chest pain and shortness of breath patients who don't change even after treatment). What I am trying to paint to you is that most of the time the problem is subjective and changes minimally, if at all, and the paramedic info that he reports to the ER is just relaying what the patient or witnesses has told him so therefore you probably won't miss a lot if you are doing your observation in the ER.

The great thing about doing your observation on an ambulance is first making yourself a familiar face to the company if you plan on applying there. If you connect well with the EMT/paramedic you are observing then they might be able to help you get in. You'll probably get to learn some operational stuff such as their posting locations, terminology they use, and observe their interaction with the fire department. When you are new, lights and sirens might make you feel pumped. It's fun. In between calls, it is mostly relaxing if you aren't the one driving to different posts. Like I said earlier, there are some calls where we do get to see the patient not looking too hot and by the time they get to the ER, the patient is practically doing kart wheels into their room while the ER staff asks us "Why did you bring them to the ER???" but I consider those calls somewhat uncommon (not rare).

I 100% agree that you should do both. I don't think people should do it just once or twice on the ambulance and/or in the ER. It's too few to really be that useful.

*Stethoscope*

At your level, you might be using your stethoscope for lung sounds and blood pressures. I feel like fancier stethoscopes (like Littmann)  are more targeted for listening to heart tones, which most people don't even do. We had a discussion on it here. In regard to listening to lung sounds and korotkoff sounds (blood pressure) using a fancy stethoscope vs a cheap one, it sounds the same to me. Maybe other people have better hearing than me? I wouldn't pay the extra $100 for a minimal difference that is hardly noticeable. I've tried listening to heart tones. Knowledge wise, I can describe the sounds, document it, and associate it with a condition, but listening wise in real life... Maybe other people have better hearing than me? I haven't heard too many murmurs. Even when I did hear a murmur, it was difficult for me to describe unfortunately. I think it is a pretty difficult skill.

*CPR Card*

Talk with the place where you did your CPR training at. Ask them about how are you gonna receive it. Like STXMedic said, they usually just give it to me immediately after I finish the class. We online folks don't know how your educational institution works so it is probably best to go to them and not us in regard to this issue.


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## RefriedEMT (Apr 2, 2015)

No choice for my clinical's, I was on a fire engine with a medic, emt and a emt captain, if I had a choice I would have wanted to run a shift or two on the engine, ambulance and at least one in the er.


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## NomadicMedic (Apr 2, 2015)

I still think a fire engine responding to a medical call (outside of a cardiac arrest or MVA) is a ridiculous waste of resources.


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## Nestor (Apr 2, 2015)

I did 5 ED clinicals, and 2 ambulance ride alongs with different companies. I got to do more skills in the ED, and had a lot of patient contacts on my own. Taking vitals for the nurses, cleaning wounds and shadowing the techs around. 
During my ambulance ride outs I had the chance to watch the medics and ask important questions after a call.

If you're able to do both I suggest that you do.


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## samsbgm (Apr 3, 2015)

I did one clinical on an ambulance and one ED rotation. This was required. If I was you I would see if you can sign up for more shifts than that. Emt class teaches you the very basics.  I felt like I didn't really learn to be an emt until I was working. The more exposure you can get the better.


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## RedAirplane (Apr 3, 2015)

DEmedic said:


> I still think a fire engine responding to a medical call (outside of a cardiac arrest or MVA) is a ridiculous waste of resources.



If they're in station, why not?

All firefighters nationwide need a minimum level of medical training. It can't hurt, only help.

(Now if you have fires and car crashes simultaneous, this is obviously less of a priority)


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## RefriedEMT (Apr 3, 2015)

Ishan said:


> If they're in station, why not?
> 
> All firefighters nationwide need a minimum level of medical training. It can't hurt, only help.
> 
> (Now if you have fires and car crashes simultaneous, this is obviously less of a priority)



I would have to say that they have helped me on occasion, primarily with lifting 300-700lbers.


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## chaz90 (Apr 3, 2015)

RefriedEMT said:


> I would have to say that they have helped me on occasion, primarily with lifting 300-700lbers.


Right, but lift assists can be called when the need is recognized rather than assuming every run of the mill medical call needs a $700k piece of fire apparatus with 4 FF/PM staffing in addition to the ALS ambulance. It's about efficient use of resources.


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## RefriedEMT (Apr 3, 2015)

chaz90 said:


> Right, but lift assists can be called when the need is recognized rather than assuming every run of the mill medical call needs a $700k piece of fire apparatus with 4 FF/PM staffing in addition to the ALS ambulance. It's about efficient use of resources.



Exactly why some departments are looking into outfitting brush fire rigs as sprinter units instead of sending the big engines.


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## RebelAngel (Apr 3, 2015)

Clinicals are part of the course I took. They required 12 hours in ED or 12 runs or mix of the two. I figured since I would be working in ambulance I wanted to do clinicals on ambulance and I would only do ED time if I didn't meet my 12 runs just BC in the ED we're fighting with nursing students and this person going through that training and that person going through other training. We had a preapproved list of paid and volunteer organizations to run with as EMT students. 

I suggest checking with your local FDs for volunteer opportunities. Most paid companies around here prefer a year of experience before hiring anyway and a lot of volunteer squads are hurting for members.  

I understand places are different but for us, when we're on Clinicals for BLS call the student runs the show. It's not just sitting back and watching. You get watched and graded by the preceptor. If it's ALS the Paramedic runs the show but you can still be graded on what you do (ie, take vitals, splint, load pt.).

I spent a lot of time going over steths. I ended up buying a littman cardiology III. One of the main reasons is because it had great reviews for all ages and saved me the trouble of buying peds/neonate steths. Over a year from purchase and I don't regret the purchase. Plus I got my name inscribed on it so it can't be stolen.

During class last year I bought a watch for $25ish dollars from Dakota that was digital, had 24 hour time, and seconds on the face. I also got a $5 watch with same features just because it was $5.00

Our AHA CPR cards came to out course instructor and were distributed to us by him.


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## RebelAngel (Apr 3, 2015)

My squad is part of a volunteer FD and we do not auto dispatch fire apparatus on EMS calls. We call for lift assist as needed and usually it's FD peeps that drive to scene in their own vehicles, not apparatus. 

We do have a rescue, but that usually goes only to mvas and fire scenes...unless we don't have a driver than an EMT or EMR could potentially  drive it to call as first responder until transporting agency can get there. 


chaz90 said:


> Right, but lift assists can be called when the need is recognized rather than assuming every run of the mill medical call needs a $700k piece of fire apparatus with 4 FF/PM staffing in addition to the ALS ambulance. It's about efficient use of resources.





RefriedEMT said:


> Exactly why some departments are looking into outfitting brush fire rigs as sprinter units instead of sending the big engines.


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## chaz90 (Apr 3, 2015)

RefriedEMT said:


> Exactly why some departments are looking into outfitting brush fire rigs as sprinter units instead of sending the big engines.


I don't want to get too off topic here, but why is even this necessary? We don't run many time sensitive calls. Of the calls that are time sensitive (cardiac arrests), I agree that sending the closest available resource of any type (police, fire, and EMS) should be common practice. Otherwise, the patient with chest pain is not going to have a different outcome if any piece of first responding apparatus gets there to hold their hand 2 minutes before the transporting ambulance. My biggest problem with it is I don't think you need more than two or three people on the vast majority of EMS calls. If more are needed after arrival on scene or anticipated during dispatch they can be added as needed.


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## RebelAngel (Apr 3, 2015)

Our rescue has Aed and CPR equipment on it so it may make a big difference. We also have trauma bag, burn kit, etc. On rescue. 

As far as number of people, my department usually runs with a driver and 1 EMT. We do have a couple EMRs that hop on here and there. We call for lift assistance as well as ALS, if necessary.


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## RedAirplane (Apr 3, 2015)

I'm not suggesting having more fire engines just so they can all go to medical calls. Staff the fire engines for fires/rescues/full arrests...

But if a medical call happens and the fire guys have nothing else to do, why not let them respond? Aside from the gas used in the fire engine, what resource is wasted?


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## medichopeful (Apr 4, 2015)

Ishan said:


> I'm not suggesting having more fire engines just so they can all go to medical calls. Staff the fire engines for fires/rescues/full arrests...
> 
> But if a medical call happens and the fire guys have nothing else to do, why not let them respond? Aside from the gas used in the fire engine, what resource is wasted?



If a pipe breaks in my house and the electricians have nothing to do, why shouldn't I give them a call?

In addition to the gas, there's also wear and tear on the apparatus, in addition to the increased risk to everybody with multiple units responding.  For something truly time sensitive, absolutely send the closest available unit (cardiac arrest, respiratory arrest, major trauma, etc).  Otherwise, just send the resources that are needed.  More can always be requested later.

Now, if the firefighters are dispatched to assist with carrying my bags, that's a legitimate use of resources!

Firefighters are great people and are incredibly helpful when they're around.  But giving them stuff to do in a different specialty just because they aren't doing something doesn't make much sense to me!


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## RedAirplane (Apr 4, 2015)

medichopeful said:


> If a pipe breaks in my house and the electricians have nothing to do, why shouldn't I give them a call?
> 
> In addition to the gas, there's also wear and tear on the apparatus, in addition to the increased risk to everybody with multiple units responding.  For something truly time sensitive, absolutely send the closest available unit (cardiac arrest, respiratory arrest, major trauma, etc).  Otherwise, just send the resources that are needed.  More can always be requested later.
> 
> ...



I guess the other part I was pointing out is that firefighters have to have medical training first. So they are all at least Emergency Medical Responder (EMR), and most are Emergency Medical Technician (EMT) or higher.

So the analogy would be more like: if a pipe breaks in your house and an electrician who is also a licensed plumber is across the street, should you give them a call?


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## chaz90 (Apr 4, 2015)

Most calls don't need any first responding unit, medically trained or otherwise. If grandma has been feeling sick with diarrhea for a few days and has now decided to call an ambulance to go to the hospital, how does a piece of fire apparatus responding 2 minutes early help the situation? Most EMS calls simply require a transporting unit to arrive and treat the patient as best as they can before/during transport to the hospital. I'm a fan of the tiered response system ALS/BLS, but ALS ambulances with EMT partners would work as well.


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## NomadicMedic (Apr 4, 2015)

proper dispatch pre screening can determine the need for additional resources. They don't send three companies to a trash fire, do they?

A cardiac arrest or a motor vehicle accident should certainly have a 1 engine response, but a sick call receiving a fire engine with 4 people, quickly followed by a BLS unit and an ALS unit is simply overkil. 

Wait, you say. It doesn't happen like that. Of course it does. Look at Seattle. That is the response model their system is built on.


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## EpiEMS (Apr 4, 2015)

For OP:

 Clinicals should, ideally, be in a busy ALS 911 system. However, even then, you may not see a lot of (legitimate) patients. Thus, I strongly suggest taking your clinicals in the ER, where there is generally going to be "good" patient volume of mixed acuity and full follow-up by a cross-professional team. Regarding your steth, an MDP is fine, maybe consider a Littman when you start working, but for BLS providers, the MDP is plenty good (in my fairly limited EMS experience).



DEmedic said:


> I still think a fire engine responding to a medical call (outside of a cardiac arrest or MVA) is a ridiculous waste of resources.



+1000 EMS points (my entire stock of EMS points)



Ishan said:


> If they're in station, why not?
> 
> All firefighters nationwide need a minimum level of medical training. It can't hurt, only help.
> 
> (Now if you have fires and car crashes simultaneous, this is obviously less of a priority)



The first argument, sure, ok, but it poses a fundamental question: why have so many firefighters?
Regarding the second, "it can't hurt," that's not necessarily true. Patient outcomes aren't necessarily better with more providers -- and, indeed, are subject to negative returns from additional providers at a certain point (several studies on this, esp. regarding the number of paramedics on scene and in a system, I will have to locate the sources...).


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## Tigger (Apr 4, 2015)

Ishan said:


> I'm not suggesting having more fire engines just so they can all go to medical calls. Staff the fire engines for fires/rescues/full arrests...
> 
> But if a medical call happens and the fire guys have nothing else to do, why not let them respond? Aside from the gas used in the fire engine, what resource is wasted?


Have you ever run calls with six people? It sucks.


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## RedAirplane (Apr 5, 2015)

Tigger said:


> Have you ever run calls with six people? It sucks.



Really? I guess I'm not introduced to the bliss of running calls alone. Even in my role in standby medicine, someone wanting to go lie down for a bit will get a second team to respond for a total of four people. 

In my first response role, the principle was send as many resources that are not otherwise occupied (they could be peeled off if another call came in). 

Example: I witness a syncope and call it in. Two other first responders arrive to help, and then they keep piling in from all areas of campus, until you have a huddle of about 12 people (BLS). Then we get one engine company (ALS) and eventually one ambulance (ALS) and they all also come on scene. So for any medical call that needed transport, you typically had a cluster of about 18 people hanging around.

That's a bit extreme. It tended to frighten patients and draw onlookers.

I don't know if I'd feel more comfortable with just me and my partner, but I never really felt uncomfortable with 4-6 people. 

Also, OP, sorry for hijacking the thread. I did one ride along with BLS IFT ambulance and one with ALS 911 ambulance, but I haven't been in this long enough to say what will be best for you. I will say that I learned a lot more out of BLS than I thought I would, albeit it was less "exciting."


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## Flying (Apr 5, 2015)

Having 4-6 people is fantastic for maintaining consistent compressions in CPR, but is detrimental for most other situations.


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## Jim37F (Apr 5, 2015)

6 responders is standard here. One paramedic is leasing the assessment, the second paramedic is the radio man, he's filling out the ePCR, looking at the meds/SNF paperwork/etc and will then be making base contact if/when needed. The two EMTs are helping with the assessment, basically the medics leave all the BLS stuff such as splinting and bandaging to us, but for our run of the mill medical calls one EMT will be hooking up the monitor while the other gets blood pressure. The engineer is standing by to fetch any additional equipment from the ambulance  (usually stair chair, or the scoop or splints bag) while the captain is in overall charge of the scene, most often keeping extraneous family/bystanders out of our hair, having them fetch meds, paperwork etc or even keeping the "green" crewmembers on task if we find ourselves standing around doing nothing after getting a BP lol


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## NomadicMedic (Apr 5, 2015)

That's called "justifying your existence"

See also: Kool aid.


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## Tigger (Apr 6, 2015)

Jim37F said:


> 6 responders is standard here. One paramedic is leasing the assessment, the second paramedic is the radio man, he's filling out the ePCR, looking at the meds/SNF paperwork/etc and will then be making base contact if/when needed. The two EMTs are helping with the assessment, basically the medics leave all the BLS stuff such as splinting and bandaging to us, but for our run of the mill medical calls one EMT will be hooking up the monitor while the other gets blood pressure. The engineer is standing by to fetch any additional equipment from the ambulance  (usually stair chair, or the scoop or splints bag) while the captain is in overall charge of the scene, most often keeping extraneous family/bystanders out of our hair, having them fetch meds, paperwork etc or even keeping the "green" crewmembers on task if we find ourselves standing around doing nothing after getting a BP lol


Just because you can divide a call up so that six people have something to do (and even as presented here that's a stretch), does not mean it's necessary, and it certainly does not improve care.


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## Angel (Apr 6, 2015)

I agree. It's too many cooks in the kitchen  I did my internship in a busy urban area where at least 3, usually 4 medics responded on all calls (both on the medic itself. 1, sometimes 2 on the engine, or 3 if the captain kept his cert). 
And while it's nice to stand back and delegate (i guess) I get to use my skills and critical thinking less, and all for things that don't NEED another medic.


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## Bruno (May 19, 2015)

stethoscope said:


> Hey all,
> 
> I'm approaching the half way marker in my training. So far, I love this, and I'm excited to get real world experience. I have some questions that I figured you guys may be able to answer?
> 
> ...


Congrats and welcome 
I'm unaware of any internship -
Get experience where you can- I did volunteer hrs in an ER b4 taking the nremt, and it was ok but nothin like riding along and running calls. 
Don't waste any more $ on scopes. You'll have them on board -just wipe them b4 using and btwn pts.  The expensive scopes will walk away if you happen to forget one in a rig. Keep the $20 one for now   
You should get the card on site if not shortly after. Ask the place you took course.


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