# Emt-i



## Sasha (Sep 28, 2008)

What exactly is an EMT I allowed to do, that an EMT can't? Down here we only have B's and P's so I was generally curious as it came up in a discussion I was having with someone yesterday about how EMT-B's should recieve more training and be able to do more skills on their own.


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## EMT-P633 (Sep 28, 2008)

Check out the stickied posts at the top of this section. im sure you can find it there.


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## Sasha (Sep 28, 2008)

Or not. I'm looking for a general explanation of what EMT-I's can and can't do that sets them apart from EMT-B's, not the scope of practice for each state, links to each state's EMS office nor information on the duty to act.


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## KEVD18 (Sep 28, 2008)

in ma:

i's can start lines, however they can only run crystaloids(no meds)
they can intubate and insert ng/og tubes for decompression post intubation

thats pretty much it. -i trucks dont carry monitors, or any drugs above the bls drugs.


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## JPINFV (Sep 28, 2008)

It depends on the level of intermediate and location. An EMT-I (or any other _intermediate_ level between basic and paramedic) scope and education can vary wildly between states, and even locations inside of a state.


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## VentMedic (Sep 28, 2008)

One of the few things Florida has done right is NOT allowing the Intermediate level.


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## KEVD18 (Sep 28, 2008)

VentMedic said:


> One of the few things Florida has done right is NOT allowing the Intermediate level.



Bravo Florida!!!


its on its way out in ma. not by state mandate, but by the availability of the course. most emt schools arent teaching it. off the top of my head, i can only think of three -i courses in ma and by all reports they are underenrolled almost everytime. its my guess that within 5 years, there will be no more new -i's in ma.


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## bstone (Sep 28, 2008)

KEVD18 said:


> Bravo Florida!!!
> 
> 
> its on its way out in ma. not by state mandate, but by the availability of the course. most emt schools arent teaching it. off the top of my head, i can only think of three -i courses in ma and by all reports they are underenrolled almost everytime. its my guess that within 5 years, there will be no more new -i's in ma.



The availability should be expanded, EMT-I should become a pre-req for medic with 6 months field experience.


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## KEVD18 (Sep 28, 2008)

i realize that as an emt i, you have a certain amount of personal attachment to the rank. i know a few i's and they all feel the same way as you, so you're not alone. unfortunately, pretty much the entire national ems community disagrees.

lets take our situation. we both work(or in my case, worked until recently in the boston metro area. how many services in this area use i's? and i mean actually use them, not just hire them and let them work as basics or as a driver for a p/i truck. not very many. western ma and even real southern mass sure. maybe they get to work as an i. start a line once or twice a week, tube maybe twice a year(and thats being generous). 

lets face it, except in rare situations, -i's around here dont really do much in the way of actual als patient care. theres no actual practical evidence supporting your purposed pre req.

i personally think you should have experience in the field before going to medic school. not so much for the medical knowledge you gain, but for the actual experiences. by that i mean being face to face with the dead and dying, working 24 on 24 off, being in a truck for 16 straight hours with a partner who only know of two food groups, taco bell and dunkin donuts. all of the many facets of ems. these are things you cant be told, you actually have to do them. i know id persoanlly be pissed to find out that i hated my chosen career _after_ 2 years of schooling and at least 8 grand in tuition.


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## flhtci01 (Sep 28, 2008)

bstone said:


> The availability should be expanded, EMT-I should become a pre-req for medic with 6 months field experience.



I agree.  I was a B, then an I and now a P.  When I was taking P class, there were some students that finished B, had a few weeks off and then were in the P class.  Zero street experience other than clinicals.  They struggled and at least one didn't finish the class.


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## JPINFV (Sep 28, 2008)

flhtci01 said:


> I agree.  I was a B, then an I and now a P.  When I was taking P class, there were some students that finished B, had a few weeks off and then were in the P class.  Zero street experience other than clinicals.  They struggled and at least one didn't finish the class.



How many people with "experience" didn't pass the class?



KEVD18 said:


> i personally think you should have experience in the field before going to medic school. not so much for the medical knowledge you gain, but for the actual experiences. by that i mean being face to face with the dead and dying, working 24 on 24 off, being in a truck for 16 straight hours with a partner who only know of two food groups, taco bell and dunkin donuts. all of the many facets of ems. these are things you cant be told, you actually have to do them. i know id persoanlly be pissed to find out that i hated my chosen career _after_ 2 years of schooling and at least 8 grand in tuition.



So? There are plenty of other careers that require a much longer initial educational process prior to actually working and finding out if the prospective professional enjoys the career or not. Why should EMS maintain lower standards just because some people don't have a realistic (or, even worse, develop an unrealistic view in Basic class) view of the profession?


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## KEVD18 (Sep 28, 2008)

experience, ok. as ive said in this thread and many other times, im ok with that idea. my flag is firmly planted in that camp(for different reasons, but that irrelevant).

but intermediate as a requirement? thats just pointless.


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## bstone (Sep 28, 2008)

KEVD18 said:


> experience, ok. as ive said in this thread and many other times, im ok with that idea. my flag is firmly planted in that camp(for different reasons, but that irrelevant).
> 
> but intermediate as a requirement? thats just pointless.



Utterly disagree. Intermediate as a pre-req would help train and weed out those who can and cannot preform invasive procedures, handle total stress and actual emergencies. It's easy enough to transport, but try starting a line on someone who is in V-Fib while your partner is charging the paddles. That is a real test. Intermediate makes it a reality.


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## JPINFV (Sep 28, 2008)

And I've always stated that with proper educational standards (which EMS doesn't come close to having. Consider, for example, that when I took the MA exam on Saturday it asked me for the definition of "unprofessional") field experience wouldn't be needed as a prereq. Doctors and nurses don't require work at a lower level to show dedication or get experience afterall.


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## bstone (Sep 28, 2008)

JPINFV said:


> And I've always stated that with proper educational standards (which EMS doesn't come close to having. Consider, for example, that when I took the MA exam on Saturday it asked me for the definition of "unprofessional") field experience wouldn't be needed as a prereq. Doctors and nurses don't require work at a lower level to show dedication or get experience afterall.



That is only true due to the fact that doctors have a minimal of 5 years of clinical experience (2 in med school, 3 in residency) and nurses up to a year before they are allowed to be fully involved in their occupation. 

Requiring Intermediate before medic would provide for a similar situation to doctors in residency. It's an excellent idea and should be immediately implemented.


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## JPINFV (Sep 28, 2008)

Of course those professions still require getting an education prior to clinical training. You can't compare a 110 hour course to their educational requirments.


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## KEVD18 (Sep 29, 2008)

well its a theory. i thinks its bunk, but everybodies entitled to their opinion.


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## Hastings (Sep 29, 2008)

bstone said:


> That is only true due to the fact that doctors have a minimal of 5 years of clinical experience (2 in med school, 3 in residency) and nurses up to a year before they are allowed to be fully involved in their occupation.
> 
> Requiring Intermediate before medic would provide for a similar situation to doctors in residency. It's an excellent idea and should be immediately implemented.



No.

Nurses are getting clinical experience as nurses. Doctors are getting clinical experience as doctors. EMT-I is a completely different position than EMT-P. Paramedics should get experience as Paramedics. And they often do.  I rode as a third rider for a significant amount of time until they felt I was ready to move up, at which point I rode with another medic. It was only until I had a significant amount of experience that I was allowed to ride with a Basic partner.


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## bstone (Sep 29, 2008)

So what you're saying is you do not believe that mandatory clinical experience should be required before going to medic school?

Many professions have this requirement. PA is one of them. You must have clinical experience before becoming a PA. Many of them are former medics.


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## VentMedic (Sep 29, 2008)

bstone said:


> Requiring Intermediate before medic would provide for a similar situation to doctors in residency. It's an excellent idea and should be immediately implemented.


 
No.  Doctors are Doctors when they enter residency.  EMT-Is are NOT Paramedics.


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## VentMedic (Sep 29, 2008)

bstone said:


> Many professions have this requirement. PA is one of them. You must have clinical experience before becoming a PA. Many of them are former medics.


 
Your clinical experience can be as a CNA or EMT-B or none at all.  Your clinicals for PA will be done during the PA program.


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## Hastings (Sep 29, 2008)

bstone said:


> So what you're saying is you do not believe that mandatory clinical experience should be required before going to medic school?
> 
> Many professions have this requirement. PA is one of them. You must have clinical experience before becoming a PA. Many of them are former medics.



I had 700 hours of Paramedic (in the field, actively working as a paramedic) experience DURING medic school, plus 240 hours in an internship after medic school, followed by 200 patient contacts and another 240 hours training as a third rider when hired, plus 12 months riding with another paramedic after that.

No, you do not need clinical experience before going to medic school. You get plenty of experience as you go. You do not come out unfamiliar with how things work in the field.


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## bstone (Sep 29, 2008)

VentMedic said:


> No.  Doctors are Doctors when they enter residency.  EMT-Is are NOT Paramedics.



This is absolutely true. However doctors are required to have two years of clinical experience (aka clerkships/internships) before being graduated as doctors. Even then they are not independent physicians but must be under the supervision of a senior, attending physician until they take more exams (Step 3) and complete a residency. 

I am using EMT-I as a pre-req to medic in parallel to a resident physician becoming an attending physician. It's not a completely accurate one but indulge me if you will.


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## bstone (Sep 29, 2008)

Hastings said:


> I had 700 hours of Paramedic (in the field, actively working as a paramedic) experience DURING medic school, plus 240 hours in an internship after medic school, followed by 200 patient contacts and another 240 hours training as a third rider when hired, plus 12 months riding with another paramedic after that.
> 
> No, you do not need clinical experience before going to medic school. You get plenty of experience as you go. You do not come out unfamiliar with how things work in the field.



So you feel that direct entry from Basic school to medic school is appropriate?


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## Hastings (Sep 29, 2008)

bstone said:


> This is absolutely true. However doctors are required to have two years of clinical experience (aka clerkships/internships) before being graduated as doctors. Even then they are not independent physicians but must be under the supervision of a senior, attending physician until they take more exams (Step 3) and complete a residency.
> 
> I am using EMT-I as a pre-req to medic in parallel to a resident physician becoming an attending physician. It's not a completely accurate one but indulge me if you will.



Again, you're talking about a new Physician getting experience working under another experienced physician.

And as such, Paramedics are required to get experience with another experienced paramedic before being set out on their own.



bstone said:


> So you feel that direct entry from Basic school to medic school is appropriate?



Yes. I did it. Best decision I ever made.


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## VentMedic (Sep 29, 2008)

As an EMT-I, you will have a few more skills but without most of the knowledge.  Doctors do have MD behind their name before they start their residency.  As an EMT-I, you will not have all the education, knowledge, skills or title of EMT-P.


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## bstone (Sep 29, 2008)

VentMedic said:


> As an EMT-I, you will have a few more skills but without most of the knowledge.  Doctors do have MD behind their name before they start their residency.  As an EMT-I, you will not have all the education, knowledge, skills or title of EMT-P.



Yes, I think everyone will absolutely agree with your assertion that medics have more training and skills than an Intermediate. No debate or argument there, whatsoever, at all.


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## KEVD18 (Sep 29, 2008)

no, i agree(to a point) that one should have clinical experience before attending medic school.

what i disagree with is that that experience should be done as an I. i think the I rank is pointless, a waste of both time and money, and does not provide any significant preparation for medic school. i dont think being an i first will make someone a better medic. i dont think your argument that you should be an i so you can start code lines which will temper you for real emergencies has any validity whatsoever.

i also think that you're a very smart and proud man who is trying in vain to defend a bad position. i think your pride is getting in front of your brain. you're an i, so you cant understand why anybody wouldnt want to be an i. you dont get why it isnt a requirement because you used it as a stepping stone and think everybody should do the same. i get it. i dont agree with it, but i understand why you're still in that foxhole.


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## JPINFV (Sep 29, 2008)

bstone said:


> So what you're saying is you do not believe that mandatory clinical experience should be required before going to medic school?
> 
> Many professions have this requirement. PA is one of them. You must have clinical experience before becoming a PA. Many of them are former medics.



"Health-care experience is not required to apply, but is desirable and rewarded in the screening process"

-East Virgina Medical School-Master of Physician Assistant Admission Requirements


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## bstone (Sep 29, 2008)

KEVD18 said:


> no, i agree(to a point) that one should have clinical experience before attending medic school.
> 
> what i disagree with is that that experience should be done as an I. i think the I rank is pointless, a waste of both time and money, and does not provide any significant preparation for medic school. i dont think being an i first will make someone a better medic. i dont think your argument that you should be an i so you can start code lines which will temper you for real emergencies has any validity whatsoever.
> 
> i also think that you're a very smart and proud man who is trying in vain to defend a bad position. i think your pride is getting in front of your brain. you're an i, so you cant understand why anybody wouldnt want to be an i. you dont get why it isnt a requirement because you used it as a stepping stone and think everybody should do the same. i get it. i dont agree with it, but i understand why you're still in that foxhole.



As a preface, the first paragraph of what you wrote was fine. The second paragraph was unnecessarily personal and directed toward me, not at the issues at hand.

I believe that if a person knows how to start lines, calculate drip rates, do ACLS, 3 leak EKGs and is working every day with a medic on a P/I truck then, yes, they do indeed have a great deal of insight and head start in a medic program than a person who just completed Basic school. I firmly believe that we both can agree to this, right?


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## JPINFV (Sep 29, 2008)

bstone said:


> This is absolutely true. However doctors are required to have two years of clinical experience (aka clerkships/internships) before being graduated as doctors. Even then they are not independent physicians but must be under the supervision of a senior, attending physician until they take more exams (Step 3) and complete a residency.
> 
> I am using EMT-I as a pre-req to medic in parallel to a resident physician becoming an attending physician. It's not a completely accurate one but indulge me if you will.



Residency and clerkships are a direct comparison to medic school internships and clinical rotations. To compare it to being a basic before a paramedic would be like saying that physicians should start their clerkships before they start to take classes during their first year of medical school.


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## bstone (Sep 29, 2008)

Everyone does realize that if you do not believe that Intermediate should be a pre-req before medic school the it stands to reason that Basic should not be required either. Afterall there is at least one medic here who has said he has no problem with direct entry (and no field experience) into medic program after graduating from Basic. So then why not do away with Basic which obviously has less in common with medic than Intermediate?


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## VentMedic (Sep 29, 2008)

Ideally a 2 year Paramedic program would be the entry for EMS.  Realistically we still need EMT-Bs that do serve a vital link in some areas.  What we don't need is EMT-I or the 50+ other certs inbetween confusing legislators and the public.


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## KEVD18 (Sep 29, 2008)

it was without a doubt directed towards you. had we been in the same room, i would have been looking right at you when i said it. this is as close to an actual conversation as is possible on a message board.

you learn all those things in great detail(much more detail than in i school) in p school. knowing bits and pieces of that info prior to medics school will absolutely let you coast a teeny tiny bit. but i said make a _significant_ difference, which i dont think it does.

we had an nremt-i in my medic program. practiced in maine in a district where an i truck was als. medics were at least an hour away if you could get them. every time we we learning something he had already learned id say something like "this must be cake for you". you knwo what his response was? "dude, i thought i knew about this stuff before, but -i doesnt even begin to cover this".

we are never going to change each others minds on this one. you think i should be required, i think it should be abolished. it doesnt get more polar than that. 

at this point i think we should just let it go. our opinions are well documented.


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## bstone (Sep 29, 2008)

VentMedic said:


> Ideally a 2 year Paramedic program would be the entry for EMS.  Realistically we still need EMT-Bs that do serve a vital link in some areas.  What we don't need is EMT-I or the 50+ other certs inbetween confusing legislators and the public.



So we need people who cannot start lines, do EKGs and transmit to the ER, secure airways with an ET tube or use some ACLS drugs, but we don't need those who can?


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## KEVD18 (Sep 29, 2008)

yeah, you cant really dump the bls level.

what service could afford to pay medics to take granny in for her colo, or take freddie to and from dialysis 3 times a week.


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## VentMedic (Sep 29, 2008)

bstone said:


> So we need people who cannot start lines, do EKGs and transmit to the ER, secure airways with an ET tube or use some ACLS drugs, but we don't need those who can?


 
Instead of a Paramedic you want someone who can sorta do this but not really that?


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## bstone (Sep 29, 2008)

VentMedic said:


> Instead of a Paramedic you want someone who can sorta do this but not really that?



You do realize that the same can be said of medics on the bus instead of EM residents or emergency nurses?


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## KEVD18 (Sep 29, 2008)

having someone that can acquire(not interpret or treat) ekg's isnt incredibly useful. oh sure, advanced warning of the cath lab and what not but thats about it. and not a monumental benefit either.


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## bstone (Sep 29, 2008)

KEVD18 said:


> having someone that can acquire(not interpret or treat) ekg's isnt incredibly useful. oh sure, advanced warning of the cath lab and what not but thats about it. and not a monumental benefit either.



Wrong.

Bringing a PT with a confirmed STEMI to a hospital with a cath lab will save the PT's life. Not knowing and bringing the PT to the closest doc-in-a-box ER will likely kill 'em.


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## KEVD18 (Sep 29, 2008)

bstone said:


> You do realize that the same can be said of medics on the bus instead of EM residents or emergency nurses?



thats the most asinine thing thats been written on this thread, hands down.

theres no way you could ever have docs(100k+/yr) and nurses(75k+/yr) staffing _all_ ambulances. thats just not reasonable.

thats why there are paramedics. people with adequate(let it be, thats a topic for another thread) training to do the job.


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## VentMedic (Sep 29, 2008)

bstone said:


> You do realize that the same can be said of medics on the bus instead of EM residents or emergency nurses?


 
Are you comparing Paramedics to doctors? or even ER RNs? Yes, both of which may be required to go with the paramedics who can not do certain procedures or medications but what is your rational for that comparison? There are a few hundred hours of training difference for EMT-I and EMT-P and not a few years.


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## bstone (Sep 29, 2008)

KEVD18 said:


> thats the most asinine thing thats been written on this thread, hands down.
> 
> theres no way you could ever have docs(100k+/yr) and nurses(75k+/yr) staffing _all_ ambulances. thats just not reasonable.
> 
> thats why there are paramedics. people with adequate(let it be, thats a topic for another thread) training to do the job.



And now you understand the huge importance of a robust and expanded Intermediate program.


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## KEVD18 (Sep 29, 2008)

bstone said:


> And now you understand the huge importance of a *robust and expanded Intermediate program*.



yeah, a *paramedic* program!!


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## bstone (Sep 29, 2008)

KEVD18 said:


> yeah, a *paramedic* program!!



Yeah, those medic programs which are in places where there is no medic instructor, no medical school or ALS service. aka 80%+ of the USA.


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## KEVD18 (Sep 29, 2008)

wow, increase the scope of -i's? to what end?


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## VentMedic (Sep 29, 2008)

bstone said:


> Yeah, those medic programs which are in places where there is no medic instructor, no medical school or ALS service. aka 80%+ of the USA.


 
There lies the problems and making up band-aide cert fixes is not the answer.  Haven't you been paying attention to how EMS got into this mess?


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## bstone (Sep 29, 2008)

VentMedic said:


> There lies the problems and making up band-aide cert fixes is not the answer.  Haven't you been paying attention to how EMS got into this mess?



How can the answer possibly be to keep 80% of the USA only with BLS service and no possibility of ALS?


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## VentMedic (Sep 29, 2008)

bstone,

Do you plan to stay an EMT-I?   If so, why? It doesn't take that much more to get the Paramedic patch.


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## bstone (Sep 29, 2008)

VentMedic said:


> bstone,
> 
> Do you plan to stay an EMT-I?   If so, why? It doesn't take that much more to get the Paramedic patch.



I am quite happy with EMT-I. I simply haven't the time to sit through a full year of medic school when I shall soon be starting medical school. I am looking forward to the day when my NREMT card reads "bstone, NREMT-I, MD" (or possibly DO)


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## VentMedic (Sep 29, 2008)

bstone said:


> How can the answer possibly be to keep 80% of the USA only with BLS service and no possibility of ALS?


 
Show your numbers. States like Florida are nearly 100% ALS. California also carries high percentages. Major cities almost all have some ALS capabilities. 

Do you believe people shouldn't strive for something better and not just settle for something half-arsed?


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## bstone (Sep 29, 2008)

VentMedic said:


> Show your numbers.  States like Florida are nearly 100% ALS.  California also carries high percentages.  Major cities almost all have some ALS capabilities.



Major cities do not cover a huge geographical area. Recall, middle America (where I grew up) is *huge* and keeps going for many, many miles. It seems down right wrong to limit EMS service in those areas (which is heavily volunteer) to basically BVMs and driving fast. Especially when patients are having MIs, anaphylactic shock and bleeding out.


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## KEVD18 (Sep 29, 2008)

bstone said:


> Especially when patients are having MIs, anaphylactic shock and bleeding out.




and what is an i going to do? liter after liter of crystalloid, acquire a III lead and beam it to the H an hour away,  damn near kill the concious alert and orientated anaphylaxis patient with a gag reflex?


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## VentMedic (Sep 29, 2008)

bstone said:


> I am quite happy with EMT-I. I simply haven't the time to sit through a full year of medic school when I shall soon be starting medical school. I am looking forward to the day when my NREMT card reads "bstone, NREMT-I, MD" (or possibly DO)


 
If you aren't staying in EMS, why are you so insistent on keeping it at a less than optimal level? Keep your EMT-I but don't drag the rest of the system down which is striving for higher standards. 

Why go for your MD? Just get a PA certificate or degree.


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## bstone (Sep 29, 2008)

KEVD18 said:


> and what is an i going to do? liter after liter of crystalloid, acquire a III lead and beam it to the H an hour away,  damn near kill the concious alert and orientated anaphylaxis patient with a gag reflex?



I dunno, perhaps allow for interventions which save lives, use some SC/IM epi 1:1000 in a patient with full blown anaphylaxis and is on death's door. Ya know, that sort of stuff- the stuff that saves lives.


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## bstone (Sep 29, 2008)

VentMedic said:


> If you aren't staying in EMS, why are you so insistent on keeping it at a less than optimal level? Keep your EMT-I but don't drag the rest of the system down which is striving for higher standards.
> 
> Why go for your MD? Just get a PA certificate or degree.



You have a very interesting way of looking at things. I am arguing for higher standards of requiring medics to have ALS experience and high requirements of certification as a pre-req for medic school and you see this as harmful. Are you in favor of a 3 month medic mill? I surely am not.

I am not going for PA as I have always wanted to be and will be a physician. I plan on going into emergency medicine and focusing a great deal of my time on EMS related issues. I am your next medical director and I argue and work on behalf on EMS workers, not against them. I heavily in favor of expanding scope and autonomy but with that must come much higher standards of training, such as no direct entry into medic school after getting your Basic, and required ALS experience before being allowed into medic school. This also includes a heavily expanded and more robust Intermediate scope for 80% of America which lacks ALS service.


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## KEVD18 (Sep 29, 2008)

well you coverend one. not bad odds.

and this is direct from mass protocols. i dont see sub q epi listed anywhere. weird.

INTERMEDIATE PROCEDURES
1. INTERMEDIATE STANDING ORDERS
a. If patient presents in Severe Distress, as defined in Assessment Priorities, and if
patient age is between 5 and 65 years: administer epinephrine by auto-injection.
b. A second injection may be administered, if available, in 5 minutes if necessary.
2. Provide advanced airway management, if indicated.
3. Initiate IV Normal Saline (KVO) enroute to the hospital.
If patient’s BLOOD PRESSURE drops below 100 systolic: Administer a 250 mL
bolus of IV Normal Saline, or titrate IV to patient’s hemodynamic status


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## KEVD18 (Sep 29, 2008)

oh and basics can use epi pens, so waving that flag isnt really an argument now is it?


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## bstone (Sep 29, 2008)

KEVD18 said:


> well you coverend one. not bad odds.
> 
> and this is direct from mass protocols. i dont see sub q epi listed anywhere. weird.
> 
> ...



I am not licensed in MA nor will I be. I got my Intermediate training in New Hampshire in 2006 and have been duly certified by the NREMT since soon after. I did my clinicals in New Hampshire at the Elliot Hospital (Level 1 trauma center) and in Manchester and Nashua on ALS ambulances.


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## VentMedic (Sep 29, 2008)

If you are arguing to accept the EMT-I as a standard over the Paramedic, I hope you do not ever become a medical director in EMS. 

If you only going to get the job done half way, stay away!

Your ideas will set EMS back another 20 years. I guess you have not seen how healthcare has evolved or know how other professions became professionals. 

Good luck with your career as an EMT-I!


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## bstone (Sep 29, 2008)

KEVD18 said:


> oh and basics can use epi pens, so waving that flag isnt really an argument now is it?



Basics can use an epi-pen if the person has their own. If someone eats something or gets stung by something of which they have a new allergy (or they just plain forgot their epi pen, or it's broken, or it's expired, or the epi pen isn't enough) then it makes utter sense to have EMT-Is in areas where there is no medic service available and allow those EMT-Is to inject 0.3mg SC/Im 1:1000 Epi into the dying patient who has an hour drive to the ER.


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## KEVD18 (Sep 29, 2008)

mea culpa sir, mea culpa. i guess i went right ahead and assumed that since you're school in ma, you were practicing here.

im still not buying sub q epi though. we all have epi pens and they work pretty well.


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## bstone (Sep 29, 2008)

VentMedic said:


> If you are arguing to accept the EMT-I as a standard over the Paramedic, I hope you do not ever become a medical director in EMS.
> 
> If you only going to get the job done half way, stay away!
> 
> ...



Vent, do you have any idea of what you are posting? This is one of the most ridiculous posts I have seen in a long, long time. But for a moment I shall indulge you and say [sarcasm] I believe that medic should be disbanded and the highest level possible should be I-85 [/sarcasm].


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## KEVD18 (Sep 29, 2008)

bstone said:


> Basics can use an epi-pen if the person has their own. If someone eats something or gets stung by something of which they have a new allergy (or they just plain forgot their epi pen, or it's broken, or it's expired, or the epi pen isn't enough) then it makes utter sense to have EMT-Is in areas where there is no medic service available and allow those EMT-Is to inject 0.3mg SC/Im 1:1000 Epi into the dying patient who has an hour drive to the ER.



maybe in nh, but in ma we carry two adult and two pedi that we can use in the event of anaphylaxis regardless of the patients prior prescription.


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## KEVD18 (Sep 29, 2008)

bstone said:


> Vent, do you have any idea of what you are posting? This is one of the most ridiculous posts I have seen in a long, long time. But for a moment I shall indulge you and say [sarcasm] I believe that medic should be disbanded and the highest level possible should be I-85 [/sarcasm].



the sad part is that, while you try to make it a joke, im really under the impression that that what you actually believe, at least for "80% of the usa"


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## VentMedic (Sep 29, 2008)

bstone said:


> Vent, do you have any idea of what you are posting? This is one of the most ridiculous posts I have seen in a long, long time. But for a moment I shall indulge you and say [sarcasm] I believe that medic should be disbanded and the highest level possible should be I-85 [/sarcasm].


 
How many posts have you just spent arguing for the EMT-I? And not for advancing to EMT-P?

As KEVD18 just stated, at least for 80% of the US.


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## bstone (Sep 29, 2008)

KEVD18 said:


> maybe in nh, but in ma we carry two adult and two pedi that we can use in the event of anaphylaxis regardless of the patients prior prescription.



One of the very few areas which are that liberal for Basics.


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## JPINFV (Sep 29, 2008)

KEVD18 said:


> yeah, you cant really dump the bls level.
> 
> what service could afford to pay medics to take granny in for her colo, or take freddie to and from dialysis 3 times a week.



Your assuming that these patients need an ambulance and not a van that can hold a gurney and as an oxygen tank.


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## bstone (Sep 29, 2008)

VentMedic said:


> How many posts have you just spent arguing for the EMT-I?  And not for advancing to EMT-P?



Perhaps because this thread is solely for discussion of Intermediate. I am *also* heavily in favor of expanded scope and more autonomy for medics. But with that comes more training. I think that an associate degree is utterly minimal but it could be offered in some places as a 4 year clinical-didactic program leading to a B.S. degree.


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## KEVD18 (Sep 29, 2008)

no, im not. i know full well most of then dont need it. but medicare/caid wont pay for it otherwise.

this is a topic for another thread, but i have said many time that we should have medical transportation techs. people trainied to administer oxygen, use a stair chair and a stretcher and drive from a - b. take all the actual medical stuff, and the lights and woo woo's off an ambulance and stick two mtt's on it to do all those types of calls. charge a third of what a bls ride costs. everybody wins.


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## VentMedic (Sep 29, 2008)

bstone said:


> Perhaps because this thread is solely for discussion of Intermediate. I am *also* heavily in favor of expanded scope and more autonomy for medics. But with that comes more training. I think that an associate degree is utterly minimal but it could be offered in some places as a 4 year clinical-didactic program leading to a B.S. degree.


 
But only for 20% of the US?


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## bstone (Sep 29, 2008)

VentMedic said:


> But only for 20% of the US?



Considering roughly only 20% of the USA has medic service then, yes, only 20% of the country would benefit from this expanded scope. Even tho it's such a small percentage the patients would ultimately benefit and having better trained and educated providers never hurts. Unless you disagree with that?


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## KEVD18 (Sep 29, 2008)

id really like to see your data on the proportions of als v. ils v. bls services across the country.


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## VentMedic (Sep 29, 2008)

flhtci01 said:


> I agree. I was a B, then an I and now a P. When I was taking P class, there were some students that finished B, had a few weeks off and then were in the P class. Zero street experience other than clinicals. They struggled and at least one didn't finish the class.


 
I seriously doubt they struggled due to lack of "field experience as a B" but rather from a lack of study habits and prerequisites to understand the basic prinicples of medicine.  There was not knowledge or education to draw from and so it all had to be barfed up from memorization.


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## VentMedic (Sep 29, 2008)

bstone said:


> Considering roughly only 20% of the USA has medic service then, yes, only 20% of the country would benefit from this expanded scope. Even tho it's such a small percentage the patients would ultimately benefit and having better trained and educated providers never hurts. Unless you disagree with that?


 
Florida, for all of its faults, has shown that a state can become nearly 100% ALS. And, that is without the benefit of state employment taxes to fund the state's budget. 

California has also got an impressive ALS record and has achieved 100% accreditation for its Paramedic programs. 

What is holding your area back? People not wanting to advance to the next level?

Small percentages count if it is a life.


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## KEVD18 (Sep 29, 2008)

alright kids, ive been on my computer so long its actually starting to burn my lap so im going to head to bead. maybe if i cant sleep i'll pop back in a little later but for now good night and good hunting.


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## bstone (Sep 29, 2008)

VentMedic said:


> Florida, for all of its faults, has shown that a state can become nearly 100% ALS. And, that is without the benefit of state employment taxes to fund the state's budget.
> 
> California has also got an impressive ALS record and has achieved 100% accreditation for its Paramedic programs.
> 
> ...



What is holding people back? For one the counties are huge and the only EMS service available is volunteer. Those volunteers have VERY limited time available for class/study (they work full time in other jobs and have families) so getting Basics is amazing enough. Not a single one of them has the opportunity to sit through a year of medic classes (which are not offered within 100 miles). Even if by miracle some medic were to show up and want to volunteer, the service is BLS and thus this medic would have to work only BLS. If, however, there would be an Intermediate class offered which could work out to be one semester, decompressed and more flexible then it could greatly offer human services to thousands of counties around the USA. But of course I am not telling you anything you don't already know.


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## VentMedic (Sep 29, 2008)

Same here. Night all.

Especially since bstone is going to start blaming everything on the volunteers when he couldn't make his argument for EMT-I otherwise.


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## bstone (Sep 29, 2008)

Yup. Gnight all.


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## reaper (Sep 29, 2008)

bstone said:


> What is holding people back? For one the counties are huge and the only EMS service available is volunteer. Those volunteers have VERY limited time available for class/study (they work full time in other jobs and have families) so getting Basics is amazing enough. Not a single one of them has the opportunity to sit through a year of medic classes (which are not offered within 100 miles). Even if by miracle some medic were to show up and want to volunteer, the service is BLS and thus this medic would have to work only BLS. If, however, there would be an Intermediate class offered which could work out to be one semester, decompressed and more flexible then it could greatly offer human services to thousands of counties around the USA. But of course I am not telling you anything you don't already know.




This argument is always thrown out there. It does not hold water. As Vent has pointed out to you, FL is 100% ALS. There are counties in N FL that are has big as the counties you are in. These counties are also very poor, IE: very small tax base. Yet, they all have full PAID ALS services. Makes me wonder why they can do this, but 80% of the country still relies on volleys?

SC requires EMT-I as a prerequisite to medic school. It is ridiculous to do this. It provides no better education and half the time produces not so great medics. If they are mediocre EMT-I's with bad habits, then that is how they will be as medics. In this state, I's can not do much more then a Basic. They are allowed to intubate (except if working with me). They can not push any drugs. They can preform a 3 lead, but do not know how to read it. So how are they any better then an "B"?

The only thing they can help with is starting an IV. Where I used to work in FL, the basics could start Iv's, so there is no difference in help.

The reason why large percentages of the country does not have medics is because they can put an "I" on the truck and call it ALS. That is cheating the pt and will not change until they do away with the "I" cert. If it is not there to use, then these services will be forced to have medics on the trucks. This will greatly increase the care that the Pt's will receive!


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## Sasha (Sep 29, 2008)

KEVD18 said:


> the lights and woo woo's off an ambulance



That phrase made me choke on my gatorade!


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## Sasha (Sep 29, 2008)

bstone said:


> I dunno, perhaps allow for interventions which save lives, use some SC/IM epi 1:1000 in a patient with full blown anaphylaxis and is on death's door. Ya know, that sort of stuff- the stuff that saves lives.



Dont subQ injections take a looooong time to work? Wouldnt be the best option in a patient where their airway is closing.


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## Epi-do (Sep 29, 2008)

bstone said:


> Those volunteers have VERY limited time available for class/study *(they work full time in other jobs and have families)* so getting Basics is amazing enough.



Let me just say, I just finished medic class in August.  While going through class, I worked full-time and am married with a small child at home.  Furthermore, of the 7 in my class that did graduate, three others had families at home and the entire class worked full-time jobs.    While the majority did work for either fire departments or ambulance services, less than half of us were getting our class paid for by our employer.  Those that had to pay for class out of their own pocket had to figure out how to juggle class and work.  Some were fortunate that employers would adjust schedules to allow for class commitments, but others had to make sure they could get their shift covered, hours made up, take paid time off, etc., to be at class or clinicals.

It can be done, if one wants it badly enough.  It comes down to what sacrifices one is willing to make to get what they want.  In the end, I think it makes for a more dedicated provider to the profession.

I just have a hard time buying into this arguement.


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## bstone (Sep 29, 2008)

Epi-do said:


> Let me just say, I just finished medic class in August.  While going through class, I worked full-time and am married with a small child at home.  Furthermore, of the 7 in my class that did graduate, three others had families at home and the entire class worked full-time jobs.    While the majority did work for either fire departments or ambulance services, less than half of us were getting our class paid for by our employer.  Those that had to pay for class out of their own pocket had to figure out how to juggle class and work.  Some were fortunate that employers would adjust schedules to allow for class commitments, but others had to make sure they could get their shift covered, hours made up, take paid time off, etc., to be at class or clinicals.
> 
> It can be done, if one wants it badly enough.  It comes down to what sacrifices one is willing to make to get what they want.  In the end, I think it makes for a more dedicated provider to the profession.
> 
> I just have a hard time buying into this arguement.




I understand you were able to make the commitment and pass the course however you likely had a medic program within 50 miles. People living in utter rural America have all the issues as I listed above and, also, no medic program.


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## reaper (Sep 29, 2008)

Can we stop making excuses for it? When I went to medic school, I drove 85 miles one way. Just as Epi said, it is all in how much you want it and are willing to sacrifice for it!


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## bstone (Sep 29, 2008)

reaper said:


> Can we stop making excuses for it? When I went to medic school, I drove 85 miles one way. Just as Epi said, it is all in how much you want it and are willing to sacrifice for it!



And when there is no medic program within 200 miles? That is not an excuse?


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## BossyCow (Sep 29, 2008)

The reason the standards are so varied is because the areas covered are so varied. The statistics on ILS/BLS/ALS are going to be skewed because of the way some of us rural systems have to operate. 

I cannot justify 24/7 ALS with the salaries associated with it for a measly 200 calls a year. So my agency is BLS. We have mutual aid agreements for ALS support/intervention from a neighboring district but the availability of the medics has dropped considerably and we are no longer guaranteed an ALS response by those agencies. Economic downturns, mills closing, lowered tax base has caused a decrease in available personnel from those adjoining paid departments.

So, our agency, though BLS has in the past had volunteers with ALS or ILS certifications. This did not change the BLS rating of our organization but was viewed as an 'added benefit' to the citizenry 'as available'. Because we couldn't guarantee that either of those would be available at all times. 

When ALS is 15 minutes away, being able to start an IV, give sugar, or tube someone means that when they meet ALS they are in better shape than they would be had the ILS interventions not been done. 

While in an urban environment with multiple systems in place, and an assortment of services to choose from, ALS is of course the best, highest care and should be available. But to extrapolate that into an elimination of a stop gap service to the outlying areas is wrong. 

In my experience, more information and more education is a good thing. To put conditions on that knowledge will lower the level of knowledge and education to those unable to work towards EMT-P. 

EMT-I is more information. EMT-I knows more than an EMT-B. How is this not a good thing? To say it has to be an all or nothing EMT-P or nothing, will condemn the rural outlying districts to choose nothing. It's a lot easier to set that high standard when the achievement of that standard is do-able. 

Perhaps the language can be written making the EMT-I or BLS agencies only allowed in certain population densities. But to globally limit the education available because urban systems are misusing or abusing the levels is wrong.


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## reaper (Sep 29, 2008)

Well, since most medic programs are 12 months and most "I" programs are six months, why can't that dedication extend for six more months?

Why can't you request a medic class at a school close to you? Obviously they have "I"classes, so work to get a medic class done!

Just remember "Where there's a will there's a way"!


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## bstone (Sep 29, 2008)

reaper said:


> Well, since most medic programs are 12 months and most "I" programs are six months, why can't that dedication extend for six more months?
> 
> Why can't you request a medic class at a school close to you? Obviously they have "I"classes, so work to get a medic class done!
> 
> Just remember "Where there's a will there's a way"!



If only life were that simple. Unfortunately we live in the real world where it just isn't.


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## reaper (Sep 29, 2008)

And the reason is? 

Have you even tried?

 All you have given is excuses, why not figure out a way to get it done?


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## bstone (Sep 29, 2008)

reaper said:


> And the reason is?
> 
> Have you even tried?
> 
> All you have given is excuses, why not figure out a way to get it done?



When the closest medic program is a 200 mile drive in one direction and required showing up 3-4 times a week it quickly becomes evident that it's not realistic. That's 400 miles round trip, 8 hours of driving a day. The gas money alone would bankrupt some people. However you still feel this isn't a reason why someone cannot attend a medic program?


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## reaper (Sep 29, 2008)

Where did you go to "I" school?

Talk to them about having a medic class, even if they have one a year. This can be done if the effort is put forward.


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## bstone (Sep 29, 2008)

reaper said:


> Where did you go to "I" school?
> 
> Talk to them about having a medic class, even if they have one a year. This can be done if the effort is put forward.



I am not speaking personally. I am speaking to the 80% of rural America which is lucky to have a BLS ambulance. I have done internships in these areas as part of my field research. 

Establishing an Intermediate program in these rural areas is less intensive than a medic program. Once there is a good Intermediate program and the population is being served than a bridge Intermediate->Medic program is an excellent idea.


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## reaper (Sep 29, 2008)

bstone said:


> I am not speaking personally. I am speaking to the 80% of rural America which is lucky to have a BLS ambulance. I have done internships in these areas as part of my field research.
> 
> Establishing an Intermediate program in these rural areas is less intensive than a medic program. Once there is a good Intermediate program and the population is being served than a bridge Intermediate->Medic program is an excellent idea.



Agreed, but we were talking about areas that already have "I" programs. It can be worked to have a bridge program or a full medic class.

That is all I am saying, it can be done, if the effort is put forward.

This is why we are stating that in areas that have "I's", there is no reason not to have medics.


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## VentMedic (Sep 29, 2008)

bstone said:


> I am not speaking personally. I am speaking to the 80% of rural America which is lucky to have a BLS ambulance. I have done internships in these areas as part of my field research.
> 
> Establishing an Intermediate program in these rural areas is less intensive than a medic program. Once there is a good Intermediate program and the population is being served than a bridge Intermediate->Medic program is an excellent idea.


 
Forming another level just gives some another reason or excuse not to go to Paramedic. In other words, some of the cool stuff but yet not the full responsibility of being a Paramedic. 

Do you think any other healthcare profession has tolerated such excuses. 
Do the rural hospitals allow CNAs that can do IVs and EKGs replace RNs? What about those states with hospitals that insisted on the LPN advancing to RN? Believe it or not even those in the rural areas made the sacrific or found a new job. Yes it is a hardship for rural hospitals to staff with degreed and licensed professionals but they find a way because they know that is the quality expected of them. 

Only EMS has tolerated excuses to do less. If EMS wants to continue to be viewed as only a ride to the hosptial to where the professionals are, then settling for lower levels of certification by those in the EMS profession will achieve that. It is a good thing not all of the general public understands the differences in the level of care being provided or they would be p*$#ed. You want the public to know who and what you are but continue with the pseudo ALS crap to fool them.

It's not like it is "years" between the levels.


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## BossyCow (Sep 29, 2008)

reaper said:


> Agreed, but we were talking about areas that already have "I" programs. It can be worked to have a bridge program or a full medic class.
> 
> That is all I am saying, it can be done, if the effort is put forward.
> 
> This is why we are stating that in areas that have "I's", there is no reason not to have medics.



Apply that quote to my area. The closest EMT-P program is a full time, day classes with ride time and ER shifts on evenings and weekends. It is a full time program and cannot be done while working. It was created to provide training for Civic Programs who were sponsoring employees to the program and were paying their wages while they attended. It is a three hour drive (each way) from my home, which at $4 a gallon gas is not a commute. 

I can complete an EMT-I in 6 weeks at a station only 45 miles away. It is set up for evening and weekend classes since the program is designed for volunteers who are working full time in other jobs. 

I work full time in a job that pays me exceedingly well. I have no desire to work as a medic. My husband has been an EMT-P for 2O years so its not like I don't value the education or the cert. I am also over 50. It's not economically feasible for me to go to medic school unless I was going to do it as a career full time. At my age, in my area, the chances of being hired are pretty low given my age. My EMS experience is in a volunteer agency and as a BLS agency will not pay for EMT-P but will pay for EMT-I.

I'm currently waiting for the next class to be scheduled to get my EMT-I. It will give me an opportunity to learn more, and be able to do more for patients in my area. The local communities have been unable to pass EMS levies and are reducing the level of coverage rather than expanding it.  So why should this not be available to me?


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## ErinCooley (Sep 29, 2008)

I'm an EMT-I in the state of Georgia where EMT-i is pretty much the standard, bottom of the barrel person on the ambulance.  There are some EMT-B's, they are mostly a dying breed of first responders on the fire trucks.

The 8ish services that I am familiar with in metro atlanta have trucks w/ an EMT-i, ambulance driver and a paramedic who rides in the back of the truck. I'm sure there are loads of exceptions but I know from downtown Atlanta to Columbus all 911 trucks are ALS.

My scope of practice includes everything listed above, but we can also administer a few other drugs... nitro/asprin, glucose, and maybe a couple others that I cant think of.  It doesnt really apply to me, my paramedic partner usually does the drugs while I'm doing IV, vitals, Hx, etc. 

I saw the epi debate, we can only give a pt their own epi pen, we cant do sub-q epi. in Ga.

Personally, I think that an EMT-I should be lowest level of EMT, training hours wise.  In Ga its almost double the classroom hours (don't quote that, I dont remember how many more hours it is but its a full year of tech school) and I'm all about sending a person w/ as much education as possible into the field.

I will be persuing EMT-P,  however I personally felt that I needed to gain some experience in the field first.  I've been working just under 6 months on a 911 truck and still feel like I'm lost.  Hopefully I will begin paramedic school next spring... 1 year in the field before beginning.


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## reaper (Sep 29, 2008)

BossyCow said:


> Apply that quote to my area. The closest EMT-P program is a full time, day classes with ride time and ER shifts on evenings and weekends. It is a full time program and cannot be done while working. It was created to provide training for Civic Programs who were sponsoring employees to the program and were paying their wages while they attended. It is a three hour drive (each way) from my home, which at $4 a gallon gas is not a commute.
> 
> I can complete an EMT-I in 6 weeks at a station only 45 miles away. It is set up for evening and weekend classes since the program is designed for volunteers who are working full time in other jobs.
> 
> ...




As noted, I stated this can be done in an area that has an established EMT-I program.

I am to tired to even comment on a 6 WEEK EMT-I class!


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## KEVD18 (Sep 29, 2008)

my arms are getting tired......


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## reaper (Sep 29, 2008)

Me think the same thing!


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## VentMedic (Sep 29, 2008)

Unfortunately it is not a dead horse since more areas are adopting quick certs as a way to not address the real issue.  Too many do want this problem to just die just as all the EMS problems have been ignored.    So just do as you always have and continue to be at the bottom of the pit when it comes to recognition as a healthcare profession.


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## KEVD18 (Sep 29, 2008)

no, this issue itself isnt a dead horse.

the dead horse is this discussion. as i said two pages ago(expanded slightly), there are two camps here. the "i's are great and everybody should get their i" camp and the "-i's are of limited value. they should be eliminated" camp.

both are quite firmly entrenched and show no signs of ceasing hostilities or surrendering. now, we can spend a year debating the shape of the table for the peace talks, or we can all just pack up our camps and go home. but the back and forth of exactly the same information, just repainted and thrown out again is a waste of time, effort and paint.

y'all do what you will. i quit.


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## gillysaurus (Sep 29, 2008)

I just wanted to say that this thread has enlightened me a whole lot on why the "hells nah!" EMT-I camp thinks the way they do. I was very "EMT-I sounds great!" until I really got to read what both sides have to say.

I just had to add, I always thought EMT-I would be an excellent course to help someone really become good at *assisting* with ALS. Like, if you understood how to tube a patient, or what drugs should be given and when in cases an EMT-B wasn't taught, that sort of thing, you would really be an asset to your medic. You could set up tubes/drugs/anything during a cardiac arrest faster, you could assist in certain procedures if something went wrong. It would be more understanding of ALS than a basic has, thereby making it easier to help a paramedic with what is rightfully THEIR job. 

But then again, a great ALS assistant is nothing more than a very well trained and knowledgable basic. Thanks for teaching me something new today ^_^


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## triemal04 (Sep 29, 2008)

bstone said:


> Utterly disagree. Intermediate as a pre-req would help train and weed out those who can and cannot preform invasive procedures, handle total stress and actual emergencies. It's easy enough to transport, but try starting a line on someone who is in V-Fib while your partner is charging the paddles. That is a real test. Intermediate makes it a reality.


Gosh, this arguement gets made for being a basic too, and it still doesn't hold up.  
First, you have to assume that the EMT-I would actually be working on an ambulance where their new found "skills" would be used, and not on a NETS so called ambulance (more likely).  Which of course would mean that, if this were to happen, there would be a huge increase in the number of unqualified providers who are working in the field attempting to provide patient care.  How is that good?  
Second, you seem to  be going off the premise that all they will perfect is certain procedures...which they will also get done while in their internship.


bstone said:


> So what you're saying is you do not believe that mandatory clinical experience should be required before going to medic school?
> 
> Many professions have this requirement. PA is one of them. You must have clinical experience before becoming a PA. Many of them are former medics.


Actually, PA is not one of them.  While some schools may require it, not all do, nor is it mandatory.


bstone said:


> Everyone does realize that if you do not believe that Intermediate should be a pre-req before medic school the it stands to reason that Basic should not be required either. Afterall there is at least one medic here who has said he has no problem with direct entry (and no field experience) into medic program after graduating from Basic. So then why not do away with Basic which obviously has less in common with medic than Intermediate?


I'll go on record saying that I don't think that having your basic should be required for medic school.  All the concepts that are taught in basic school are also taught to paramedics, and in much, much greater detail.  All the procedures that are taught to basics are also taught to pramedics.  So why should in be a requirement?  Seriously, why?  It's a course that lasts all of 110-150 hours, what use is it?  Why not just add it into the paramedic curriculum, or realize that it's a redundant course?


bstone said:


> Yeah, those medic programs which are in places where there is no medic instructor, no medical school or ALS service. aka 80%+ of the USA.


Sure.  Let's see the numbers for this whopper of a lie.  Even if you are basing that 80% on geography and not population, it still doesn't add up to 80%.  And if it's population based it's so far off it's laughable.

There are many, many valid, justifiable arguements out there for why the EMT-I is a problem certification, and many more here for why it doesn't need to be required for paramedic school.  I do have one question for you though:  if you really are so passionate about EMS and advancing it, why are you such a proponent of a worthless measure like mandating having an I-cert prior to medic school?  Why not just advocate for increasing the length of paramedic school?  That would solve all the problems you've listed and more.


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## KEVD18 (Sep 29, 2008)

triemal04 said:


> Sure.  Let's see the numbers for this whopper of a lie.  Even if you are basing that 80% on geography and not population, it still doesn't add up to 80%.  And if it's population based it's so far off it's laughable.




go back an reread the three pages of this thread. he's been asked to back up his numbers a few times, to no avail.

in my extensive experience making poop up as i go along, ive found that when _*i*_ make up numbers, i have trouble backing up those numbers.

not saying thast whats going on here, just an anecdote from my past.....


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## triemal04 (Sep 29, 2008)

KEVD18 said:


> go back an reread the three pages of this thread. he's been asked to back up his numbers a few times, to no avail.
> 
> in my extensive experience making poop up as i go along, ive found that when _*i*_ make up numbers, i have trouble backing up those numbers.
> 
> not saying thast whats going on here, just an anecdote from my past.....


I know.  To be honest, he's been called out on pretty much everything I quoted.  But I had to get in my two cents anyway.


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## Anomalous (Sep 29, 2008)

You guys type faster than I can scroll.  Though I am only an EMT-I, I am smart enough to not join this thread.  

I smell a lock coming....


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## KEVD18 (Sep 29, 2008)

anomalous:

while i think you're probably right, theres no real reason to lock this thread. the discussion has always been and continues to be civil, adult and reasonable. no name calling or agressive posting. its all been very flowers and bunnies so far.


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## Jon (Sep 29, 2008)

KEVD18 said:


> anomalous:
> 
> while i think you're probably right, theres no real reason to lock this thread. the discussion has always been and continues to be civil, adult and reasonable. no name calling or agressive posting. its all been very flowers and bunnies so far.


I have to agree with Kev.

I read through the entire thread... and I'm not going to lock it... at least not now. Everyone has done a VERY good job at posting actual arguments... rather than reverting to ad hominem attacks.


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## KEVD18 (Sep 29, 2008)

Jon said:


> I have to agree with Kev.



well, i like the sound of that.


but i still wont go out with you.









j/k guys


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## Flight-LP (Oct 1, 2008)

KEVD18 said:


> well, i like the sound of that.
> but i still wont go out with you.



See Kev, that where your problem lies, you just not a team player. I think you hurt Jons feelings.......

Sorry to change to thread a bit, but this age old argument that holds ZERO WATER always comes up (usually by the same people!) and cannot be substantiated. An intermediate is not a paramedic, it is a half a$$ed excuse to make the most of something using as little as possible for as little money as possible. Experience is not needed before going to medic school and in all actuality reduces the learning pattern of bad habits which sooooo many EMT's develop quickly. Opinions are great, but if you come in here with the "this is the facts" talk and can't back it, then stop wasting the time of others who are actually looking for decent info. 11 pages of the same old crap is just utterly ridiculous.

BTW - Texas has a lot higher than 20% medic coverage as does most state's. Give me some time and I'll post it for you...............................


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