# Does anyone know why Florida doesn't have EMT-I?



## txquty (Aug 18, 2011)

I start EMT-B school in September 2011.  I am super excited about it and plan to go further.  I was hoping to do EMT-I next, however Florida only recognizes EMT-B & EMT-P.  Anyone know why?  

I would have liked to train gradually as I will not be leaving my full-time day job and once I have my NREMT plan to register as a EMS Reservist for my county. I won't be able to go right into medic school right away due to my current schedule.  I will be burning the candle at both ends from September to December to complete school.


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## Chimpie (Aug 18, 2011)

txquty said:


> I start EMT-B school in September 2011.  I am super excited about it and plan to go further.  I was hoping to do EMT-I next, however Florida only recognizes EMT-B & EMT-P.  Anyone know why?



Cause Florida recognizes the need to keep things simple.  Two levels of training.  Nice and easy.


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## usalsfyre (Aug 18, 2011)

I could see three, but only two for transporting EMS. 

Texas is bad enough with Intermediate and two levels of paramedic. Places like Colorado with all the various different endorsements are just confusing.


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## medicdan (Aug 18, 2011)

Essentially because the I-level is pointless. If we educated all intermediates as paramedics we would have more skilled, better educated and better equipped field staff.


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## JPINFV (Aug 18, 2011)

emt.dan said:


> Essentially because the I-level is pointless. If we educated all intermediates as paramedics we would have more skilled, better educated and better equipped field staff.



Depends if you view EMT-Is as a replacement for paramedics or as a replacement for EMTs. The base level provider (lowest level legally allowed to man an ambulance, generally the EMT is the US) needs to have a higher scope of practice, and a significantly higher level of education to go along with it, if for no better reason than to increase the efficiency of the emergency medical system. What point is there when a provider can generally do no more than provide oxygen and drive to the hospital?


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## Aprz (Aug 18, 2011)

JPINFV said:


> Depends if you view EMT-Is as a replacement for paramedics or as a replacement for EMTs. The base level provider (lowest level legally allowed to man an ambulance, generally the EMT is the US) needs to have a higher scope of practice, and a significantly higher level of education to go along with it, if for no better reason than to increase the efficiency of the emergency medical system. What point is there when a provider can generally do no more than provide oxygen and drive to the hospital?


I agree with JPINFV. Replace B with I, and you won't have to worry about 3.


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## Cup of Joe (Aug 18, 2011)

Aprz said:


> I agree with JPINFV. Replace B with I, and you won't have to worry about 3.



agreed....100%.  I would be all for it.


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## hyperlyeman1 (Aug 18, 2011)

Cup of Joe said:


> agreed....100%.  I would be all for it.



agreed as well... but then why not have all medics? very slippery slope:wacko:


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## JPINFV (Aug 18, 2011)

hyperlyeman1 said:


> agreed as well... but then why not have all medics? very slippery slope:wacko:


 There's a legitimate argument that some paramedic level interventions are perishable and should be performed only by a limited number of providers (the archetypical one is endotracheal intubation). So the ultimate question is, "How can we ensure that a limited number of providers are allowed to perform the perishable interventions while ensuring that everyone gets an appropriate minimum level of care?" Now the trick is defining, "What's an appropriate minimum level of care?" and "Which interventions are perishable and at risk?"


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## usalsfyre (Aug 18, 2011)

hyperlyeman1 said:


> agreed as well... but then why not have all medics? very slippery slope:wacko:



Because medics are not needed on 95% of calls. Let's face it take an Intermediate with say one year of in-depth education, replace intubation with 12-lead acquisition and interpretation and add decent options for pain and NV management (including narcotics) and you can now run 95% of the "ALS1" calls in the nation. Put the paramedics in fly cars and have them run high acuity intercepts.

However, due to many, many factors it's not gonna happen.


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## Shishkabob (Aug 18, 2011)

I've been saying trucks should be I/P for years.


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## usalsfyre (Aug 18, 2011)

Linuss said:


> I've been saying trucks should be I/P for years.



I'd go one step farther and say that I/I with P intercept would be fine, assuming decent education and scope for both.


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## Sasha (Aug 18, 2011)

Because Florida sees the ridiculousness in a million different levels and certs of training.

Basic. Medic. Very plain and simple.


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## hyperlyeman1 (Aug 18, 2011)

usalsfyre said:


> Because medics are not needed on 95% of calls. Let's face it take an Intermediate with say one year of in-depth education, replace intubation with 12-lead acquisition and interpretation and add decent options for pain and NV management (including narcotics) and you can now run 95% of the "ALS1" calls in the nation. Put the paramedics in fly cars and have them run high acuity intercepts.
> 
> However, due to many, many factors it's not gonna happen.



Ah... true. But who is to decide before they arrive on scene who gets those paramedics? Before you get to the call there is no way to definitively know if a medic is needed. IF you dispatch an EMT-I to a call and all of a sudden the patient requires a skill that requires a EMT-P, do yous it and wait? Load and go? Every ALS rig should have at least one paramedic on it, and in my opinion an EMT-I wouldn't hurt for when the :excl: hits the fan. But hey, I'm not the one doing the county requirements for rig staffing.


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## usalsfyre (Aug 18, 2011)

hyperlyeman1 said:


> Ah... true. But who is to decide before they arrive on scene who gets those paramedics? Before you get to the call there is no way to definitively know if a medic is needed. IF you dispatch an EMT-I to a call and all of a sudden the patient requires a skill that requires a EMT-P, do yous it and wait? Load and go? Every ALS rig should have at least one paramedic on it, and in my opinion an EMT-I wouldn't hurt for when the :excl: hits the fan. But hey, I'm not the one doing the county requirements for rig staffing.



The same thing places like SA, AUS and NZ are doing now. You get an ETA of an advanced provider, if your closer to the ED you transport. If not you get an intercept. 

Very, very few patients require paramedic level interventions "right now". Probably less than 0.1% (completely pulled that number out of my rear). Most people can wait 5 or 10 minutes with good management.

Things like county staffing requirements are one of many reasons it won't happen.


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## Hunter (Aug 18, 2011)

Hasn't EMT-I been phasing out? And one reason florida does thing on its own is because florida has no reciprocity, Unfortunatly you wont be able to take your EMT-P license from here to any other state unless you pass the National Medics test after you have your State license.


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## JPINFV (Aug 18, 2011)

Hunter said:


> Hasn't EMT-I been phasing out? And one reason florida does thing on its own is because florida has no reciprocity, Unfortunatly you wont be able to take your EMT-P license from here to any other state unless you pass the National Medics test after you have your State license.



Technically yes, it's now Advanced EMT instead of EMT-Intermediate. However states are free to use, abuse, or make up their own levels on their own accord.


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## Hunter (Aug 18, 2011)

JPINFV said:


> states are free to use, abuse, or make up their own levels on their own accord.


 
which is why I'm really glad Florida only has B and P =D


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## JPINFV (Aug 18, 2011)

Hunter said:


> which is why I'm really glad Florida only has B and P =D




...which is technically abusing the level because there isn't any "EMT-B" level now.


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## Hunter (Aug 18, 2011)

JPINFV said:


> ...which is technically abusing the level because there isn't any "EMT-B" level now.


 
First Responder... lol...


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## JPINFV (Aug 18, 2011)

Hunter said:


> First Responder... lol...




First responder isn't a level anymore either according to the national model. It's emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic. Any deviation from that is a [fatherless child]-ization of the system (not that that's necessarily a bad thing though). 

So don't be happy that Florida doesn't 'use, abuse, or make up their own levels' (my words, which you agreed to) when Florida does make up their own levels, even if in name only.


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## Hunter (Aug 18, 2011)

JPINFV said:


> First responder isn't a level anymore either according to the national model. It's emergency medical responder, emergency medical technician, advanced emergency medical technician, and paramedic. Any deviation from that is a [fatherless child]-ization of the system (not that that's necessarily a bad thing though).
> 
> So don't be happy that Florida doesn't 'use, abuse, or make up their own levels' (my words, which you agreed to) when Florida does make up their own levels, even if in name only.


 

No one recognises First Responders <.<... there was sarcasm in my original statement doesn't translate that well over text I guess.


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## usalsfyre (Aug 18, 2011)

Actually, Texas has a state certification that's equivalent to EMR.


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## Hunter (Aug 18, 2011)

usalsfyre said:


> Actually, Texas has a state certification that's equivalent to EMR.


 
Sorry... no agency in florida recognises first responder, at least not down here in south florida since most companys don't hire just drivers.


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## the_negro_puppy (Aug 18, 2011)

usalsfyre said:


> I'd go one step farther and say that I/I with P intercept would be fine, assuming decent education and scope for both.



Thats essentially what we do here.

Our Paramedic level is in between your EMT-I and EMT-P. We have two of these on a truck. For extra skills and drugs (intubation, cardioversion, TCP, ketamine, thrombolysis etc) we have Intensive Care Paramedics who intercept when called.

Needless to say, only a small percentage of calls need ICP's.


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## pa132399 (Aug 18, 2011)

JPINFV said:


> Depends if you view EMT-Is as a replacement for paramedics or as a replacement for EMTs. The base level provider (lowest level legally allowed to man an ambulance, generally the EMT is the US) needs to have a higher scope of practice, and a significantly higher level of education to go along with it, if for no better reason than to increase the efficiency of the emergency medical system. What point is there when a provider can generally do no more than provide oxygen and drive to the hospital?



very well stated and is the one of the reasons i'm going to medic school


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## usalsfyre (Aug 18, 2011)

the_negro_puppy said:


> Thats essentially what we do here.
> 
> Our Paramedic level is in between your EMT-I and EMT-P. We have two of these on a truck. For extra skills and drugs (intubation, cardioversion, TCP, ketamine, thrombolysis etc) we have Intensive Care Paramedics who intercept when called.
> 
> Needless to say, only a small percentage of calls need ICP's.



It's really a much more cost efficient system that make more sense medically. Unfortunately, the reimbursement system and demand for "the more medics the better" makes it tough to pull off in the US.


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## Handsome Robb (Aug 18, 2011)

Linuss said:


> I've been saying trucks should be I/P for years.



You'd like the system here. Decently progressive, we rarely have to call for orders, in fact I've never seen it done on any of my rides. No RSI, it's not in the Nevada Paramedic scope, but the medical director is working on getting around that for the CCEMT-Ps, possibly all of the medics. Usually there's 13-15 I/P trucks on the road and 1-2 P/P trucks. The integrated flight service runs CCEMT-P/CCRN, the flight crew uses a ground unit for CCTs.

I agree with abolishing Basic and only having Intermediate and Paramedic.


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## txquty (Aug 19, 2011)

*Thanks for the input*

The only issue I foresee with being a Basic in Florida, is really there isn't much else we can do but give oxygen and transport.  As far as reciprocity if I move and I do plan on moving in the next 3yrs, I am more than willing to take the state's licensing test.  In Florida, once we complete our course we take the NREMT.  This is according to the admissions ppl at the school I will be attending in September.

Plus since I am not affiliated with any FD or anything, it's out of pocket so I have to keep my full time day job and take classes/clinicals at night.  Wish me luck! 

Thanks!


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## Hunter (Aug 19, 2011)

txquty said:


> The only issue I foresee with being a Basic in Florida, is really there isn't much else we can do but give oxygen and transport. As far as reciprocity if I move and I do plan on moving in the next 3yrs, I am more than willing to take the state's licensing test. In Florida, once we complete our course we take the NREMT. This is according to the admissions ppl at the school I will be attending in September.
> 
> Plus since I am not affiliated with any FD or anything, it's out of pocket so I have to keep my full time day job and take classes/clinicals at night. Wish me luck!
> 
> Thanks!


 
yes once you finish your basic you take the NREMT-B, with that you can go anywhere. But the reciprocity was reffering to your EMT-P. Sorry if I didnt explain the apropriately, good luck by the way! I'm sure you'll do great.


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## MrBrown (Aug 19, 2011)

txquty said:


> The only issue I foresee with being a Basic in Florida, is really there isn't much else we can do but give oxygen and transport.



And it is somehow different in other states? 

Oh look you might be allowed to ring up on the ambophone to "medical control" and ask if you can "assist" this person with their GTN?

/taking the piss


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## fortsmithman (Aug 20, 2011)

Aprz said:


> I agree with JPINFV. Replace B with I, and you won't have to worry about 3.



Here in most of Canada the lowest level provider is the Primary Care Paramedic which is equal to EMT-I.  The other level is Advanced Care Paramedic which is equal to EMT-P.  Some province and the number is shrinking use Emergency Medical Responder which is equal to EMT-B.  Our EMR is mainly used by rural areas that have limited financial resources to train their members.  For the most part its either PCP/PCP or PCP/ACP or ACP/ACP.


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## jjesusfreak01 (Aug 20, 2011)

MrBrown said:


> And it is somehow different in other states?
> 
> Oh look you might be allowed to ring up on the ambophone to "medical control" and ask if you can "assist" this person with their GTN?
> 
> /taking the piss



Hah, if I were in that situation, I would say take it if you want, I can't stop you. One thing EMT-Bs (in NC) are legally allowed to administer is any oral medications prescribed to a person by their private physician, so if someone expresses a desire to take some prescribed medication, I think it will likely help, and I can't think of a good reason to stop them, then they can go ahead.


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