# EMT-B/BLS care is there a point??



## LE-EMT (Jun 13, 2008)

My new thread..... This may bring the proverbial pot to a boil but well I am curious.... 

After reading several posts in several different threads I have developed a new question to pose to all of you.... It would seem that some of you ( not all ) higher level care givers Medics and up seem to believe that EMT-B/BLS's aren't needed.  Now personally being a pre-student I don't really know all the logistics and everything that comes with being a basic, so I can't really say what is needed.  That being said and the cya being taken care of.  

Is it that you individuals think that there is no need for the basics' or is it just that you are so arrogant.  I can not and will not name names because well as many of you know I have already walked that fine line in the past.  These attitudes of medics are gods and the rest are mindless peons running a muck in your wakes just dumb founds me.  I understand many of you take your jobs and lives seriously, I respect you all for that.  What I don't understand is how you can completely belittle these future medics of tomorrow.  Is this something that is seen in the field or is it just egos running wild on the internet?  To me it seems like it would be a vast waste of time and money to enter a field knowing I was going to be treated like crap by my peers and mentors.  

I understand there is a hierarchy in every field.  Its what keeps everything running smoothly.  So when you treat the lower level guys like crap doesn't that effect the upper level guys???? Hell if EMT-B's are just glorified lift assists and drivers then why bother? Why not just employ joe blow bum from the corner at least that way we are all making a difference.  He isn't gonna care how you treat him as long as you give him a sandwich, a warm place to sleep, and a 40 oz at the end of the day.  Would be a hell of a lot cheaper then an EMT as well.

Ok in the end there really was no question it turned out to be more of a rant.....LOL oh well.  comment if you like.  I suspect I will be attacked for something or another some where along the lines.  Which will only validate my point.  I guess my thoughts are we should all try and treat each other a little better especially those who are lower on the totem pole.


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## snaketooth10k (Jun 13, 2008)

Inb4 attacks on anyone at all, I would like to say that medics and basics are team mates. They should act as such. While I enjoy a good argument, dying patients can really ruin everybody's day. Try to remember that medics are full of medical knowledge, but basics are the ones who have to assist them and make sure everything that isn't a medic's job goes smoothly. BLS is also much more prevalent than ALS. ALS takes more time, energy, and sometimes money to learn, but BLS has to know about as much (except drugs and advanced airway and other minors) to get the job done right. 

Instead of fighting, join forces to form ILS: Incredible Life Support!


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## Ridryder911 (Jun 13, 2008)

snaketooth10k said:


> Inb4 attacks on anyone at all, I would like to say that medics and basics are team mates. They should act as such. While I enjoy a good argument, dying patients can really ruin everybody's day. Try to remember that medics are full of medical knowledge, but basics are the ones who have to assist them and make sure everything that isn't a medic's job goes smoothly. BLS is also much more prevalent than ALS. ALS takes more time, energy, and sometimes money to learn, but BLS has to know about as much (except drugs and advanced airway and other minors) to get the job done right.
> 
> Instead of fighting, join forces to form ILS: Incredible Life Support!



Now let's all hold hands & sing Kumbaya!.. Seriously, love to where rainbows are daily too but let's be realistic ... Dying patients do not "ruin" my day.. it is just part of the business, when you see one or two day, you understand very fast it is just a part of life just like living. In fact sometimes it is a blessing... 

As well, do not know where you see BLS more prevelant than ALS.. except in EMS. NO where else is BLS even defined in medicine other than EMS, because we have had to make excuses for continuing to have Basic Life Support instead of ALS.

Are you sure that BLS has to know as much as ALS? Want to compare the curriculum? Again, 150 hours is not even as long as my communication(s) module on understanding radio communications... 

So yes, work together for the patient's sake but let's be realistic and understanding on the divisions so each other can perform at the fullest. 

R/r 911


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## hitechredneckemt (Jun 13, 2008)

I have stated this before " To be a good Medic a person has to be a good Basic first". I do not know any one on her personally. This is no way an attack on anyone,but all the good medics i know where good basics. I do know a few medics that that where not good basics and they have not made good medics.
Once again this no way an attack on anyone on this forum. I form my opinions on medics in the truck not by what i read because we all can be arrogant from time to time, myself included.


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## Ridryder911 (Jun 13, 2008)

LE-EMT said:


> My new thread..... This may bring the proverbial pot to a boil but well I am curious....
> 
> After reading several posts in several different threads I have developed a new question to pose to all of you.... It would seem that some of you ( not all ) higher level care givers Medics and up seem to believe that EMT-B/BLS's aren't needed.  Now personally being a pre-student I don't really know all the logistics and everything that comes with being a basic, so I can't really say what is needed.  That being said and the cya being taken care of.
> 
> ...



I will tell you why. Basic levels have held EMS back for decades now! The curriculum was watered down in the mid 90's to not to have teach "too much medical & technical" reading. Even now, the Basic EMT text is written at a 6'th grade level. NO where else in medicine does one read about BLS vs. ALS because MEDICINE is MEDICINE. There is NO levels.. You deliver PATIENT CARE!. Period! 

As well, all the levels EMT-I, EMT/CC, EIOU, etc.. ALL are again in lieu or being compared to the gold standard of the Paramedic. Excuses and that is it! Seriously, it has been over 40+ years and many communities still do not have the advanced care provided by TV's Johnny & Roy Emergency from the 70's. Why? Because the public assumes EMT's & Paramedics are the same.. the same comparison as one comparing CNA & RN's.. ludicrous. The public is usually duped assuming one that has taken a little more than a 150 hour advanced first aid class is actually administering medical care. Misleading. 

Look at other countries.. Yes, we started the ball in the early 70's unfortunately we dropped it in the early 90's. We should had eliminated the Basic Level altogether except for MFR, as they are solely designed for. Yes, keep the Basic Level for those that are going to first respond, very remote areas where skill deterioration and ALS is nil to none. Again, don't confuse the public and medical community though, it is medical care. Look at our neighbors towards the North and other countries such as Australia & South Africa. 

Unfortunately, we teach EMT's that after a 150 course that is much more than what it is . It is only & only a ENTRY level. The very basics.. anything less would never be considered anything related medically. 

I believe what aggravates most professionals on this site (if you notice, very few stay here) is for some reason many posts that they are already experts in this profession, just after taking the entry level course.. and some have not done that!  When in reality they have less than 5 years experience or less than a thousand patient contacts, in which most professional EMS services consider being a novice. 

We will always have Basic Levels... what and where they are used is currently changing. We need to emphasize in the EMT curriculum, this is ONLY the beginning. One can have an opinion about EMS, but in reality until you have became educated, experienced then you research instead of basing upon emotions.  

Am I mad? You bet! Communities are placing their patients in jeopardy. Communities that could have ALS but place BLS instead. Placing BLS units where ALS should be. Patients having AMI's without proper diagnostics and treatment, fractures without analgesics, vomiting with aspiration, eclampsia deliveries without magnesium, etc... 

Only in EMS and EMS forums will you find posts on how we should lowering our standards or attempting to justify lower care. 

R/r 911


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## mdkemt (Jun 13, 2008)

I think it is finially time for me to have my rant!  I am tired of reading that EMT-Basics are not as important...or not as respected by ALS...or this that and the other thing.  That is the BIGGEST load of @#$% I have heard.  How many can actually tell me they *ONLY* took the EMT-Paramedic course.  Oh wait!  You have to be a basic first before you can go advanced!

The levels were created to help in bringing emergency care to communities that would not otherwise have this.  It created a route for safe transportation.

As for levels being a diluted curriculum I think that is a arrogant comment to make.  It is not about diluting the curriculum it is about allowing a person to grasp the knowledge being handed down to them.  Any good medic knows you use your basic skills before your advanced skills and a lot of the time basic is what is needed.  LOC!  ABC!

And there being no levels in the medical field...That is again an arrogant comment to make.  Here is a list of levels in the medical field (I am sure I will miss a few):
EMR
EMT-Basic
EMT-Advance
EMT-Paramedic
EMT-Critical/Fligh Medic
LPN
RN
RPN
NP
Doctor-General Practictioner
Doctor-Surgeon/Specialist

All these levels require different amounts of training and even more when you specialize.  So before you say there is no levels in the medical field maybe ask around.

My problem is that everyone always picks on the litle guy.  We are all equal!  Sure we have a different knowledge base but that doesn't mean you are a better medic then me.  Just means you went and got more education that I have and can provide different medical treatment then me.  That is a good thing.

In my community we are lucky to have EMS.  EMS just started up 7 years ago and started with first responders.  Now we are just in the process of bringing in ALS.  I can sit here and think about how many people would have died in this town alone if it wasnt for EMT-Basics.  Maybe 1/4 of those patients would have needed ALS but still survived and some it would have made things easier if ALS was here.

I am going back to get my Advance Care Paramedic.  But I needed to work as a basic for 2 years at fulltime hours before they let you back in.  There reasoning behind it is to make sure you have your basic skills down pack so you always start basic and move to als when needed.  Now maybe our Primary Care Paramedic program is a bit different then that in the states but still Basic Medics are essential!

MDKEMT


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## Vizior (Jun 13, 2008)

MDK, the thing I think you're missing is this:

RNs don't need to be LPNs before they get their certification.  MD's don't need to be PAs before they get their license.  

You're right, EMT-B does bring a level of care to a community that may otherwise not have EMS, but in some many cases there's no reason for it.  There are communities that spend tons of money per year to pay for a volunteer corps to exist, with huge ambulances and lavish things, however, they still contract another service to provide ALS for them.  For less they could easily provide an EMT-B/-P ambulance, which, while probably not quite as effective, provides the highest level of care currently accepted in the US prehospitally.  I don't know much about Canada's system, so I can't really comment on how that relates.

At what point do you accept that only BLS care is sufficient?  I only use terms of BLS/ALS because that's the standard used by the national standards.  If you dispatch a -B/-P ambulance you always have someone trained in Advanced Life Support measures available to you, however can release it to BLS to give the basic experience.  And to take it one step further, if you already have an ALS unit being staffed, you can just replace the -B with a -P for whatever the difference in wage is.

Furthermore, you always talk about how you need a good basic, and BLS before ALS, etc etc etc.  However, why can a Paramedic not provide the same, if not better utilization of those skills.  It's not like Paramedic school teaches someone to forget ABCs, if teaches the physiology behind why you're doing things.  Such as how to use EtCO2 detectors to aid in your consideration in the adequecies of ventilation and oxygenation.

You're saying that EMT-B is necessary, however, why can't you just learn all the material of a paramedic, and learn how to utilize all the skills throughout your clinical rotations?  I've seen medics become medics straight out of Basic class, and they strived on it, and some of them have received the best reviews from supervisors.


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## mdkemt (Jun 13, 2008)

I am not saying the ALS is useless.  I am merely trying to state thst BLS is not useless and that I still feel they are essential.  Some places do not have the funding to have ALS.  Difference in pay is significant.  Where I work it would be a $10/hr increase.  That is a lot for some services.

You are correct ith RN's and LPN's however you do have to be a doctor in order to become an anesthesiologist.  Is this not another level in the medical field?

I am all for having a BLA/ALS on each care.  I don't think tht is a bad idea in the least.  And yes...sometimes BLS care is sufficient enough and sometimes it isnt.  But I do not think that BLS is useless or not needed.  If I could have just finished my training from the get go I would have.  Does that make more sense?  Yes!  But it isnt the way it works.  I don't think gaining experience is a bad thing either.  I feel it gives a person some background in the field.

I work as BLS.  I work on car and in the emergency department.  I have two different protocol I follow pending where I am.  I have a different skill set in each place.  I cannot begin to explain the vast amount of experience I have gained working in the emergency department.  It has allowed me to understand and apply my knowledge base.  It has also gained me more knowledge in which I can now apply to my ALS education.  There are somethings you can't learn in a class room.  Being BLS for 4 years has allowed me to realize that I enjoy my choice in career and that I want to accel in this field.  I also feel better prepared to go back to school because I have the experience behind me.

I am in no way saying that being able to go do your ALS from the get go is a bad thing.  I just don't think it is a fair assuption to make that BLS can't give sufficient care to people.  I think in some situations they can when they can't they need to recognize that and ask for ALS.  That is how we operate here.  If you are riding a BLS car and need ALS you call for an interept!  That simple.

MDKEMT


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## Ridryder911 (Jun 13, 2008)

mdkemt said:


> I think it is finially time for me to have my rant!  I am tired of reading that EMT-Basics are not as important...or not as respected by ALS...or this that and the other thing.  That is the BIGGEST load of @#$% I have heard.  How many can actually tell me they *ONLY* took the EMT-Paramedic course.  *Oh wait!  You have to be a basic first before you can go advanced!*
> 
> The levels were created to help in bringing emergency care to communities that would not otherwise have this.  It created a route for safe transportation.
> 
> ...



In your country maybe?.. Wait, I was never a Basic EMT.  Yes, I have 4 Paramedics that NEVER were a Basic EMT either. 

Now, really inform me what "*medical* care  you provided? What difference did you make, that a common laymen with good advanced first aid training could not? Splinting?.. No Hmm maybe controlling hemorrhaging? No ..Okay, how about CPR? No.. Assisting in administration of NTG, EpiPen? No. Wow! A common laymen can give much more than a Basic EMT, they are far more restricted. Okay, maybe taking a set of vitals? That it's it ! Oops that is not treating, rather assessing.. Begin to see a trend? 

Sure, I will say Basic EMT's are essential.. and they are GREAT!.. As their role and educational allows.. as a Medical First Responder and that's it! Stabilize, seriously injured and ill patients until ALS arrives. No, there is not enough education to assess what is serious and what is not nor to transport critical patients and definitely not to perform advanced and invasive procedures. 

Again, this is NOT against a particular person. It is again, just the facts.. something many EMT's do not want to face. 

Don't like the system, then either go to school or change it! Increase the required EMT educational requirements and or accept the level that it is. 

This would be similar to a nurses aide complaining about the nursing profession. That they should be recognized more, allowed to do more, etc.. What would you expect the answer to be? .... Like I tell you, that they are appreciated but they are suited for that job & functions for a reason. Otherwise, their arguments are unfounded and if they want to personally change, then change within the system... there is a way.

R/r 911


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## Ridryder911 (Jun 13, 2008)

mdkemt said:


> You are correct ith RN's and LPN's however you do have to be a doctor in order to become an anesthesiologist.  Is this not another level in the medical field?.
> 
> MDKEMT



No, one can become an Nurse Anesthetist.. both anesthesiologist & anesthetist is a specialty not a level... Both are considered either nurses or physicians. There is not a Dr. Dr. .. etc.

R/r 911


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## Hastings (Jun 13, 2008)

Very simply, I'd rather have a great basic over a mediocre medic any day.


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## mdkemt (Jun 13, 2008)

Ridryder911 said:


> In your country maybe?.. Wait, I was never a Basic EMT.  Yes, I have 4 Paramedics that NEVER were a Basic EMT either.
> 
> Now, really inform me what "*medical* care  you provided? What difference did you make, that a common laymen with good advanced first aid training could not? Splinting?.. No Hmm maybe controlling hemorrhaging? No ..Okay, how about CPR? No.. Assisting in administration of NTG, EpiPen? No. Wow! A common laymen can give much more than a Basic EMT, they are far more restricted. Okay, maybe taking a set of vitals? That it's it ! Oops that is not treating, rather assessing.. Begin to see a trend?
> 
> ...



To be honest with you I *Resent* the fact you undermine my abilities to provide medical care to those in need.  I find it *repulsive* and *appauling*.  What medical care do I provide?  What kind of question is that?

There are many different procedures and medications...yes medications that *I* can administer.  Where do you get off undermining anyone who has taken BLS training?  Oh wait because you have more education!  No I am sorry that doesn't fly with me in the least bit.  You are no better then anyone in this field!  You may have more education then some of us but that doesn't make you better then anyone.

As for beginning to see a trend...yeah I see the trend.  You are entitled to your own opinion.  I can respect that.  But if you are not educated in the abilities I have as a Primary Care Paramedic then you need to do the appropriate research or ask.  You are as good as your education allows to an extent.  I have done a lot more studying after school and also work closely with doctors and gain more experience and knowledge.  Oh but wait yes I am BLS...

There are lots of things I am able to do to help patients...wait not help...*TREAT*.  You said medicine is medicine and patient care is patient care...then anything under a doctor is obsolete isnt it?  With this logic you are saying everyone needs to be a doctor in order to give care.  I don't agree!

As for not being suited for that job...I do not think this is a correct assumption in the least.  It has nothing to do with being suited for a job.  For some people they dont have the grades to get into school but they have the practical knowledge.  Not everyone is book smart.  Along with some people do not have the money to get them to school.  This is in no way anyones problem but their own but it still gives no one the right to say they are not suited becasue they choose a level lower.

Yes here in Saskatchewan you have to be a Primary Care Paramedic or an Intermediate Care Paramedic for a min of 2 years with full time hours before you can enter the Advance Care Paramedic program.  So please before you try and belittle the education I have received and try and tell me I cannot do this that or the other thing...please do your research.  I am a Primary Care Paramedic and deliver the *Best Patient Care* I can to every patients I have.

MDKEMT


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## triemal04 (Jun 13, 2008)

MDKEMT-

1.  You've got to remember, the EMS systems for the US and Canada are extremely different; an EMT-B is nowhere near the same as a PCP; you know more, and can do more (I believe).  As well, the amount of training is much different; 150 hours versus...I've heard some say around 800-1000 for a PCP.

2.  Saying "basic skills before medic skills" is just another way to say "basics save paramedics."  Either way, it's crap.  Sure, everyone assess the airway and breathing, but as a paramedic I'm thinking of other things than an EMT-B and will be going down a different path than them most of the time.

3.  There are lot's of levels, but the point still stands that to be an RN or MD you don't have to have a lower licence first.  And an anesthesiologst is just a doctor's specialty; like being a pediatrician or cardiologist, they are still MD's, just trained in one specific area.

4.  We are not all equal, I'm sorry.  I've never walked into the OR and told the surgeon exactly what needed to be done and how they needed to do it just because I saw the patient first.  Why?  They know a hell of a lot more than me and I know nothing about how to do their job.  As well, a paramedic will know a hell of a lot more than an EMT-B and a EMT-B will not be able to do the job of a paramedic.

5.  It's not that EMT-B's and BLS is useless; they aren't, it's just that people all to often think they can do more than they can, that they are more important than they are, and that, for some reason, just working in the field makes them special.  Let EMT-B's be first responders.  Even let them work on an ambulance with a paramedic, but they shouldn't be running calls on their own; the education and knowledge for that isn't there.  As well, they really can't do much for a patient other than drive faster.  It is an entry-level position in EMS; if this is your profession, then why stay there?  Move on.

6.  There is always a way to get to being a higher level care provider, if you are suited for it.  Grants...loas...scholarships...scrimping and saving...there is always a way.  And by suited I mean you can understand the material taught, retain that material and apply it in the field, and actually perform at that level.  If you can't do that...then you aren't suited for it.


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## Ridryder911 (Jun 13, 2008)

I'm sorry, you are not understanding the post. Again, in the U.S. the Basic CANNOT administer medications other than to assist, or simple med.'s such as the Epipen, NTG & ASA. If you are able to administer medications then *YOU ARE NOT PERFORMING BLS*, you are performing ALS (i.e advanced life support=medications, advanced airway, etc.). Sorry, you did not know the differential. I find that repulsive as well. 

Being, better than anyone else.? You bet! I am better because I strive and study to be better. I never sat on my arse or had any   excuse not to progress upwards. Everyone has the chance if they *really* want to. 

You keep attempting to compare your system with the U.S. system, and if you *read* my posts I keep referring that the system in Canada is far more advanced than the U.S. Again, there is NO comparison in your levels and those in the U.S., the Basic EMT in the U.S. can be as short as 2 weeks in length and is just a few hours more than a Advanced First Aid Course..

So when you refer to BLS.. that is NOT a level that is able to provide ALS care. .otherwise they would be ALS.. okay? 

Also, I never said they are useless.. again, used as they should be as a MFR. Would you entrust a nurses aide to be the sole provider of care in a ICU?... think about it..

R/r 911


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## mdkemt (Jun 13, 2008)

triemal04 said:


> MDKEMT-
> 
> 1.  You've got to remember, the EMS systems for the US and Canada are extremely different; an EMT-B is nowhere near the same as a PCP; you know more, and can do more (I believe).  As well, the amount of training is much different; 150 hours versus...I've heard some say around 800-1000 for a PCP.
> 
> ...



Alrighty:

1) Yes our program is longer.  I did 13 weeks in school fulltime and then I did 5 weeks in the field and hospital.  Classes went from 8am-5pm Monday to Friday.  But I am still BLS and my point is do your research before making a generalzed assumption and opinion.  Be *Informed*!  Not all of us in this community are from the states!

2) Once again...my basic skills are obviously different from the US.  Do your research because it is basic before advance no matter what even if your thinking is going in a different direction and needs to go into ALS skills.  I am trained to recognize when I need ALS.

3) Reguardless of if it is specialized or not it is the same idea.  They still have to be licensed with the College of Physicians before they can specialize.

4) We are all equal.  Your missing the point.  When I say we are al equal I am saying we all had different education and we all bring different thought and idea to the table.  You bring different skills to the table.  But we are all still human and we are all still doing the same thing...Patient Care.  The level is different at which we provide this but your not better then me just because you education is higher.  You just bring a different approach to the game.

5) Sometimes that is easier said then done.  But I can say I am *NOT* a glorified ambulance driver.  I have the ability to do much more then that.  And I use this ability daily.

6) And I do not disagree with this point in the least.  But I can say sometimes it is easier for others to get the appropriate funding.

MDKEMT


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## Hastings (Jun 13, 2008)

Basic/Basic < Medic/Medic < Medic/Basic

And the reason why the partnership of a medic and a basic is better than two medics is because while it's nice to have someone to bounce ideas off of, to have one person who specializes on basic calls and one who specializes on advanced calls just lets things flow better. 

As for the topic though, 90% of all calls are BLS. It's nice to have someone specifically trained for BLS there, because I have to admit, paramedics can forget the basics and make things much more complicated than they need to be. It's always nice to have that basic to ground them. Plus, they'll do all those things paramedics think they're so far above, and do it will. I don't know, but I'd always prefer riding with a basic over another paramedic.


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## mdkemt (Jun 13, 2008)

Ridryder911 said:


> I'm sorry, you are not understanding the post. Again, in the U.S. the Basic CANNOT administer medications other than to assist, or simple med.'s such as the Epipen, NTG & ASA. If you are able to administer medications then *YOU ARE NOT PERFORMING BLS*, you are performing ALS (i.e advanced life support=medications, advanced airway, etc.). Sorry, you did not know the differential. I find that repulsive as well.
> 
> Being, better than anyone else.? You bet! I am better because I strive and study to be better. I never sat on my arse or had any   excuse not to progress upwards. Everyone has the chance if they *really* want to.
> 
> ...



Rid,

Regardless of Canada vs. US in this matter my point is I am *BLS* even though I give medications.  The meds I give are not considered ALS.

*I will clarify what I can do as a PCP:*
Monitor V/S
Oxygen
OPA insertion and suction
Cardiac Monitoring
CPR
Spinal Immobilization
Fracture Immobilization
P.A.S.G. Application
Glucose Monitoring
SaO2 Monitoring
Defibrillation
I.V. insertion (only in the hospital)
I.V. Monitoring - can monitor with Antimicrobials, Blood/Blood products, Heparin, KCL
NT Monitoring
Foley Insertion and Monitoring
CT Monitoring
Central Venous Lines

*Medications I can administer:*
ASA
Activated Charcoal
Amyl Nitrate
Epi SC
Epi-Pen
NTG
Oral Glucose
I do not need orders from a physicians to give this unless I have ran into any of the contrainications.

So does this mean I cannot do anything for a patient?  You find it repulsive I didn't know the differential.  LOL  What differential?  Medication administration doesn't mean you are ALS.  If that is the case then every person who has ever give tylenol to someone is ALS.  Like really!

My point is simple.  You cannot make a generalization unless you are directing it to a specific place in which then you should state that.  Other wise it leave a *HUGE* area for interpretation.

MDKEMT


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## curraheemed (Jun 13, 2008)

This thread is rapidly becoming one of those who's better threads... so... here are my two cents.

There is a valid need for everyone in EMS. Everyone from the MFR to the doctors and nurses in the Hospital. Granted when I went through my EMT-B course we were given the standard "O2, Reassurance, Transport" routine. Over the years though I have had the opportunity to get some advanced training. Yes, I am still and EMT-B in the civilian sector, and I am a Combat Medic on the military side. As one of the lead medical instructors for my Battalion I can honestly say that there is a need for the whole shebang!

With the advanced training the military has given me I can see where some of the EMT-I and EMT-P guys are coming from saying there is no need for BLS, but something that a lot of people are overlooking is that sometimes all that a patient really needs is the basics... someone with a broken leg from falling off a porch (yes I've seen it from a 3ft porch) doesn't need to have an EKG, two large bore IV's, and a slew of pain meds. Sometimes all that they need is a splint, and a ride to the hospital. BLS works on BLS situations. ALS works on ALS situations. 

Yes, the advanced training does make you look down some other paths that a basic mght not see, but I have met Paramedics who need to have their license taken from them for being stupid, and I've met some Basics who need to go for their "P". 

What it all boils down to is that there are good guys (and gals), and there are idiots. It doesn't matter the level of your license... just remember... when TSHTF level of license doesn't matter... your ability to do what you are trained to do does.


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## Ridryder911 (Jun 13, 2008)

Hastings said:


> Basic/Basic < Medic/Medic < Medic/Basic
> 
> And the reason why the partnership of a medic and a basic is better than two medics is because while it's nice to have someone to bounce ideas off of, to have one person who specializes on basic calls and one who specializes on advanced calls just lets things flow better.
> 
> As for the topic though, 90% of all calls are BLS. It's nice to have someone specifically trained for BLS there, because I have to admit, paramedics can forget the basics and make things much more complicated than they need to be. It's always nice to have that basic to ground them. Plus, they'll do all those things paramedics think they're so far above, and do it will. I don't know, but I'd always prefer riding with a basic over another paramedic.



Okay, how can someone forget the basics? Really C'mon..! What happens when a Basic EMT forgets the basic? What do they do then? Seriously, if one forgets the basics then they are not really worthy to be advanced level, they are really lousy medics period. If one is truly advanced level, then basics will be automatically. How can one be specialized in basics? ..Would that not be general care? Again, there is not really such a thing in medicine as advanced and basic.. it is all patient care. Again, only in EMS we * have* to make differentiate the two.. again, in real medicine there is not such critter. 

Bouncing off ideas? .. I do ride with a Basics occasionally, the ideas is usually teaching them. Very few of the Basics I ride with appreciate discussing in-depth ALS care or even understand in-depth pharmalogically. Especially in treating a patient, other than providing the core care, what are they or can they bring to the table? If they can, chances are they are not at a U.S. Basic level. Many of our basics we use are Paramedic students awaiting to test for their Paramedic, so they can get some experience. 

R/r 911


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## Ridryder911 (Jun 13, 2008)

curraheemed said:


> g!
> 
> With the advanced training the military has given me I can see where some of the EMT-I and EMT-P guys are coming from saying there is no need for BLS, but something that a lot of people are overlooking is that sometimes all that a patient really needs is the basics... someone with a broken leg from falling off a porch (yes I've seen it from a 3ft porch) doesn't need to have an EKG, two large bore IV's, and a slew of pain meds. Sometimes all that they need is a splint, and a ride to the hospital. BLS works on BLS situations. ALS works on ALS situations.
> 
> .



Are you certain that they do not need that EKG? Really, what if they had a history of vertigo prior to fall? Ever heard of Sick Sinus Syndrome? IV's.. pain med.'s.. Really, you maybe a tough one but Granny might like that analgesic for a comminuted fracture, and yes I am sure they would like it IV in lieu of I.M..... yes, even just 3' in height. Again, the reason why ALS should be on each every call to assess and treat. The reason many basics assume calls are so simple, is because they have not been taught it might NOT be as simplistic as it seems... 

R/r 911


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## JPINFV (Jun 13, 2008)

mdkemt said:


> however you do have to be a doctor in order to become an anesthesiologist.  Is this not another level in the medical field?



Apples and oranges. You complete medical school and you specialize. The era of the 'GP' (no speciality and just completing an intern year to become fully licensed) is essentially long gone and most primary care physicians practice a sub-specialty of internal medicine (which *is* a specialty in itself) or the specialty of Family Medicine. In general you won't see a physician go through an IM or FP residency and then after practicing for 10 years go through a second residency to become a surgeon, anesthesiologist, other other specialty. . So, no, anesthesiology is a specialty, not another "level" of care.


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## curraheemed (Jun 13, 2008)

Ridryder911 said:


> Are you certain that they do not need that EKG? Really, what if they had a history of vertigo prior to fall? Ever heard of Sick Sinus Syndrome? IV's.. pain med.'s.. Really, you maybe a tough one but Granny might like that analgesic for a comminuted fracture, and yes I am sure they would like it IV in lieu of I.M..... yes, even just 3' in height. Again, the reason why ALS should be on each every call to assess and treat. The reason many basics assume calls are so simple, is because they have not been taught it might NOT be as simplistic as it seems...
> 
> R/r 911



How about this for the scenario? It was a five year old girl who was pushed off the porch by her 7 year old brother! You automatically assumed something worse. 

I've read multiple posts from you, and it seems like you think that everyone who is not the same level of training as you must be an idiot. There are reasons that some of us start out where we do. I can't currently get any advanced training. I am stuck at this level due to the bureaucratic BS that is the military. I fully agree that there should be ALS at all calls, but that doesn't mean that there is no need for basics.


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## CFRBryan347768 (Jun 13, 2008)

curraheemed said:


> How about this for the scenario? It was a five year old girl who was pushed off the porch by her 7 year old brother! You automatically assumed something worse.
> 
> I've read multiple posts from you, and it seems like you think that everyone who is not the same level of training as you must be an idiot. There are reasons that some of us start out where we do. I can't currently get any advanced training. I am stuck at this level due to the bureaucratic BS that is the military. I fully agree that there should be ALS at all calls, but that doesn't mean that there is no need for basics.



What if the girl sustained an undected head wound and SHTF in the rig (sorry I cant be more specific I couldn't come up with any severe condition, that would most likely occur) and their were no ALS providers on board then what? I think in EMS you HAVE NO CHOICE but to assume the worse, it is your rear end on the line if YOU fault some where. 

Secondly, because you can't obtain a higher level of training right now what gives you the right to assume that their is nothing wrong? Shouldn't you be trying to learn from people like Rid who have so much more knowledge? If the ALS providers had cleared and said she will be fine in BLS care then that would be a diffrent story.


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## curraheemed (Jun 13, 2008)

CFRBryan347768 said:


> Secondly, because you can't obtain a higher level of training right now what gives you the right to assume that their is nothing wrong? Shouldn't you be trying to learn from people like Rid who have so much more knowledge? If the ALS providers had cleared and said she will be fine in BLS care then that would be a diffrent story.



What gives me the right is the fact that I was on this call, I am very close with the family, and I got to read the doctors reports from the ER where she was given a CAT scan, and was cleared from any head injuries. The treatment that they gave her was nothing more than a cast, and a sticker.

P.S I was on a BLS/ALS combined rig


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## JPINFV (Jun 13, 2008)

mdkemt said:


> As for levels being a diluted curriculum I think that is a arrogant comment to make.  It is not about diluting the curriculum it is about allowing a person to grasp the knowledge being handed down to them.  Any good medic knows you use your basic skills before your advanced skills and a lot of the time basic is what is needed.  LOC!  ABC!





> "*Preface*
> ...
> _The EMT Basic curriculum is a core curriculum of minimum required information, to be presented within a 110-hour training program_.  It is recognized that there is additional specific education that will be required of EMT Basics who operate in the field, i.e. ambulance driver training, heavy and light rescue, basic extrication, special needs, and so on.  It is also recognized that this information might differ from locality to locality, and that each training program, or system should identify and provide special training requirements.  _This curriculum is intended to prepare a medically competent EMT Basic to operate in the field_.  Enrichment programs and continuing education will help fulfill other specific needs for the EMT Basic's education.





> *Curriculum
> 
> History*
> ...
> ...


-NHTSA National Standard Curriculum
http://www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pdf

Is it really that arrogant to believe that there's something wrong with thinking that you can teach someone to provide competent emergency care in 110 hours? Is it really that arrogant to think that if the goal of a curriculum rewrite was to trim it down to 110 hours that something was going to be diluted?


> And there being no levels in the medical field...That is again an arrogant comment to make.  Here is a list of levels in the medical field (I am sure I will miss a few):
> EMR
> EMT-Basic
> EMT-Advance
> ...


EMS levels are irrelevent as 'evidence' since the entire point of the discussion is about those levels. Nursing is not medicine, but nursing. Sorry, both very related and intertwined, but not the same thing. Finally, as I mentioned in my prior post (I'm replying out of order), 90+% of GPs are specialists and most physicians don't practice for a while and then go back to residency. Thus you can't say that one speciality is higher than another. There are just different skill sets that are used to treat different diseases. This is not the case in EMS where paramedics have the *entire* EMT-Basic skill set and education (regardless of if they went through EMT-B or not) plus additional education and skills. 


> My problem is that everyone always picks on the litle guy.  We are all equal!  Sure we have a different knowledge base but that doesn't mean you are a better medic then me.  Just means you went and got more education that I have and can provide different medical treatment then me.  That is a good thing.


1. This isn't about "picking on the little guy"
2. If there are different knowledge bases and one knowledge base contains all of the information in the second plus additional information, then how is it equal?


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## JPINFV (Jun 13, 2008)

Hastings said:


> As for the topic though, 90% of all calls are BLS.



How many of those calls don't even need an ambulance?


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## CFRBryan347768 (Jun 13, 2008)

curraheemed said:


> What gives me the right is the fact that I was on this call, I am very close with the family, and I got to read the doctors reports from the ER where she was given a CAT scan, and was cleared from any head injuries. The treatment that they gave her was nothing more than a cast, and a sticker.
> 
> P.S I was on a BLS/ALS combined rig



Last time I checked we can't perform CAT scans, so that was done AFTER our care. What is done AFTER our care is nolonger my problem once the forms have been signed.


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## hitechredneckemt (Jun 13, 2008)

First NREMT does not include any level of nursing.The last time i checked national curriculum  stated that a person could not become a paramedic with out being at least a basic. I dont understand why Rid is so against basic EMTs. Im a basic and am very proficient in my skills. All of my EMS training has been trough a state accredited school. I get very offended when people say that basics are not necessary in the EMS field.


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## Hastings (Jun 13, 2008)

JPINFV said:


> How many of those calls don't even need an ambulance?



Many 911 calls in general don't need ambulances. Nature of the job.


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## JPINFV (Jun 13, 2008)

hitechredneckemt said:


> First NREMT does not include any level of nursing.The last time i checked national curriculum  stated that a person could not become a paramedic with out being at least a basic. I dont understand why Rid is so against basic EMTs. Im a basic and am very proficient in my skills. All of my EMS training has been trough a state accredited school. I get very offended when people say that basics are not necessary in the EMS field.



1. Don't get offended, especially if you don't defend EMT-Basics. What does a basic bring to an emergency scene that isn't done better by a paramedic?

2. Plenty of states allow health care professionals to challenge or take truncated classes. For example, California:
http://www.emsa.ca.gov/paramedic/faq.asp See question/answer 10. 

3. Knowledge is more important than skills and most EMT-Bs and EMT-B programs are very ignorant of biology and medicine, in large part because it is neither expected or required of them.


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## JPINFV (Jun 13, 2008)

Hastings said:


> Many 911 calls in general don't need ambulances. Nature of the job.




So isn't saying that EMT-Basics are good for 'BLS' calls kinda of misleading since someone with zero medical training/education can handle them just as easily?


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## triemal04 (Jun 13, 2008)

MDKEMT-
Come, get the chip off your shoulder, really, why is it there in the first place?  This is a US-based site with 99% of the people here being US providers.  So when a level of care is talked about, it's the US level of care, not Canadian.  Just keep in mind that the Canadian PCP is well beyond what an EMT-B is, not neccasarilly in skills, but in what you get taught.  The assumptions are not really assumptions, just what most of us have seen of US EMT-B providers.  Seriously, nobody is talking about anyone north of the border, so calm down.

For MD specialties...no no and no.  The original point is that if you want to be a doctor, you go directly to that level, you don't have to be a PA first; same for RN's...no need to be an LPN or CNA.  RT's are the same.  Once you are there you may choose a specialty, but you got to that level without any initial training to speak; directly from Joe Blow on the street to Dr. Joe Blow.

Sure, you can say we are all equal as people, that's fine, but not applicable.  As patient care providers, we are NOT all equal, we are NOT all the same, and education IS one of the things that makes a higher level provider better than a lower one.  (granted, not all the time, but the majority of the time...yes)  A paramedic does not just have a different thought process than an EMT-B (US system here, take note), they do almost an entirely different job.  Is a CNA equal to an RN?  Nope.  PA to MD?  Nope.  Why should there be a difference in EMS?

In the US, an EMT-B really can't do much that a well-trained Boy Scout can't.  Really, that's the case.  Hell, they can't do much more than a certified first responder can.  

It definetly can be hard to get the funding and time to advance to the next level.  But, if this is your choosen profession, and you really care about it and your patients, you find a way (not you in particular, just a general you).  How long it takes doesn't matter, it the doing it that counts.


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## Vizior (Jun 13, 2008)

OK, there are way too many people here, who are basics, talking about being very advanced basics, and therefore good providers.  That is an awful attitude to have, I don't care how much you've studied in addition to the curriculum, there is absolutely no excuse to not pursue advanced training.  If you are not happy that people only want to entrust patients to a higher level of training, either leave the profession, or work to pursue the higher level of training.  If you have to wait a time period, and work, and that basically means driving, I feel bad about your situation, however, just study hard and you'll eventually reach your goal.

I'm not gonna argue the BLS vs ALS argument, I just don't understand why someone would take it personally that there are individuals out there that would rather have ALS on every ambulance.  At least at that point every patient is seen by an ALS provider prior to transport.  If you wanna BLS a call, by all means, I mean after all, not every patient gets an IV and monitor at the hospital.  

But tell me, aside from COST, what is an argument towards having a purely BLS ambulance running emergency calls, as opposed to an ALS ambulance?


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## Jon (Jun 13, 2008)

Ok folks.

We all know that this is a real hot-button issue. Please keep it civil... you are doing an OK job so far.


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## Jeremy89 (Jun 13, 2008)

Unlike Rid, I chose to skip the Medic until I can master the basic skills.  For some people, jumping right into the Medic is fine but I'd rather take my time, go for the nursing, and get the medic later.  I heard from my instructor and some other guys in my class that preceptors and others in the field do not like medic students who came straight from basic school and in fact look down on them for doing so.  How would it feel to be in an ambulance for the first time on your medic clinicals?  What do you do when your preceptor asks you to perform a basic skill but you've never actually done it before?

Like I said, it works for some people but not for me.  Just some food for thought.


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## Vizior (Jun 13, 2008)

Jeremy89 said:


> Unlike Rid, I chose to skip the Medic until I can master the basic skills.  For some people, jumping right into the Medic is fine but I'd rather take my time, go for the nursing, and get the medic later.  I heard from my instructor and some other guys in my class that preceptors and others in the field do not like medic students who came straight from basic school and in fact look down on them for doing so.  How would it feel to be in an ambulance for the first time on your medic clinicals?  *What do you do when your preceptor asks you to perform a basic skill but you've never actually done it before?*
> 
> Like I said, it works for some people but not for me.  Just some food for thought.




That's why you're a 3rd rider, as opposed to the sole provider.  You are there to learn... most of your opportunities for clinicals do not bar you to only do the bare minimum.  If you're having trouble with skills, basic or advance, you can normally keep working at it until your preceptor says that you are well trained in it.  Most medic classes involve a lot of clinicals for a reason, it ensures that you are a competent provider, because some employers don't want to take the time to ensure that you learned what you needed to in-class, thats why you got certified by the state.  

I hate to keep going back to the RN analogy, but it's one of the few available to us:  is an RN student expected to have already mastered the techniques behind moving a patient, and caring for a person's basics needs(such as placing someone on a bed pan) before starting his or her clinicals?  However, to completely the analogy:  yes, someone who has done the skills before will spend less time working on the basic techniques, and spend more time focusing on the more advanced skills, possibly cutting down on the amount of time it takes to be proficient, however, it does not make the student who never worked as a basic any less proficient as a provider.


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## Ridryder911 (Jun 13, 2008)

curraheemed said:


> How about this for the scenario? It was a five year old girl who was pushed off the porch by her 7 year old brother! You automatically assumed something worse.
> 
> I've read multiple posts from you, and it seems like you think that everyone who is not the same level of training as you must be an idiot. There are reasons that some of us start out where we do. I can't currently get any advanced training. I am stuck at this level due to the bureaucratic BS that is the military. I fully agree that there should be ALS at all calls, but that doesn't mean that there is no need for basics.



I call BS... If you really wanted training it is available. There is private institutions is there not? You chose to be in the military (which I honor you) but that again was your choice and no one else's. So yes, there is always always o get education and training. It is again, how much sacrifice and desire one wants to pursue to get it. 

I worked full time (72 & 96 hr. work week) when I went to Paramedic & Nursing school, and was married with a newborn.. never not worked during school. If I can do it, anyone can... Now, if you want the military to pay for it or it to be a military sanctioned course that is something entirely different... but again, the training and educations is available. 

I never called EMT's idiots. People assume that because you describe the facts and challenge to break the myths that has been ingrained in them, you are wrong. Compare  advanced first aid courses, even the official medical first responder course curriculum with the EMT Basic level. Now, tell me the difference in a EMT & a MFR. ... Again, as a *medical professional*, one needs to understand medicine and the required knowledge in providing care to an acute illness or injured patient. Something they do not teach in the Basic EMT curriculum. Yes, I am *very* aware of it.. 

Again, nothing personal... just the EMT level is not qualified enough, with the current training. Unfortunately, most do not understand that because they again do not understand true medical care.

To your scenario.. your darn right I assume the worse. That is what they pay me for and what I went to school for. Any EMT that does not is worth their weight. You acclaim to be trauma specialist.. so here is one for you. Do you know how to perform a thorough neurological exam on a child? ... What is unique in the neuro test & trauma of a cervical spine in a child < than 7 years old? And why do physicians not even trust X-rays? ... Yes, I assume the worse, I have seen the worse.. You know what they call EMT's that don't?... Defendants...

R/r 911


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## emtsteve87 (Jun 13, 2008)

I agree with Rid, even as a Basic. I know that there is a lot that I need to learn to give proper care to patients. I'm not content knowing advanced first aid, I want to and will learn all that I can in regards to this field. Which is why I'm a medic student and eventually a nursing student. 

In regards to the scenario, why wouldn't you assume the worst? Even if it is a family that is close to yours, I would *still* assume the worst so then I know that EVERY base is covered.


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## mdkemt (Jun 13, 2008)

Alrighty,

This is the last I will speak on this topic because I feel we have nit picked at every angle.  From now on I will *assume* you are referring to US standards.  I also understand that my level of training is higher then the basic in the states.

I still feel it is important that we do not discourage people from becoming EMT-Basics and seeing if this is a career they can do.  I do not in Canada only drive.  That is not a standard of practice here.  Sure some people may want ALS but when you are injured and need help you will almost all the time take what you can get.  If ALS is available and I feel there is a need I will call.

I do have extensive A&P from school.  Something they stress on in our curicculum here.  And yes they do have work requirements here before you can go to the next stage in training.  I think this is a great thing because I think it is important to make you know your basic skills and not forget to use basic skills first and then move into your advance skills once you get them.  Our instructors here say that is the best system they have seen.  That is their view.  I agree because so easily do we get tunnel vision and go only one direction.  Often we find one problem and ignore the rest.  It happens.  I am not saying anyone on this community chat does this but it happens.

I am looking forward to taking my advance training and here when you complete it you can challenge the RN in which I also plan on doing.  To all those EMT-Basics keep up the good work!

MDKEMT


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## Jon (Jun 13, 2008)

Jeremy89 said:


> How would it feel to be in an ambulance for the first time on your medic clinicals?  What do you do when your preceptor asks you to perform a basic skill but you've never actually done it before?
> 
> Like I said, it works for some people but not for me.  Just some food for thought.



Jeremy,

This is a problem with several local paramedic programs... they are run as for-profit operations that don't care what the student's history is... so long as the school is getting money for having the student in class

Some of these schools run students from "Zero to Hero"... they start as nothing, get a fast-paced EMT-B class, and then on to medic school. At least one of the schools has Paramedic students preform ride time functioning at the *BLS *level.

I think that although a rare person can come out of that program and be successful... many, many more drop out and fail to complete the course.


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## enjoynz (Jun 13, 2008)

Well what does the patient think about all this?????

I bet you a large percentage of them wouldn't have a clue what the difference between a EMT-B, I or P is! Unless we were to say to them, we need a person with a higher skill level to give them pain relief, etc,etc.
They are just pleased to see you pull up, in the hope that you can help them!
If the call is one that a BLS can't control, they call for back up or load and head for the back up!
It's a waste of resources, time and money sending a ALS to a ETOH that has fallen over and needs a help up, or little Johnny with a cut finger, when they should be heading towards say, a Cardiac Arrest in the opposite direction!

Cheer Enjoynz


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## Ridryder911 (Jun 13, 2008)

enjoynz said:


> Well what does the patient think about all this?????
> 
> I bet you a large percentage of them wouldn't have a clue what the difference between a EMT-B, I or P is! Unless we were to say to them, we need a person with a higher skill level to give them pain relief, etc,etc.
> They are just pleased to see you pull up, in the hope that you can help them!
> ...



Again, are you sure? Sorry, do you really know how to perform a detail neuro exam on a drunk, ever heard of that "drunk" turning out to be a diabetic? Of course you realize 20% of alcoholics have some form of chronic illnesses, & that they have a 15% chance of having a head bleed because alcoholism causes blood vessels to rupture more easier? Ever see a physician not order a CT on a drunk that fell & struck their head?  .. Johnny with a cut finger does not need EMS or an ambulance, they need to be telephoned triaged by proper 911 communications dispatcher, and if necessary send a squad to place a band-aid on them. But every true patient needs to be evaluated by a Paramedic to determine injuries. 

Yes, EMT's can handle majority of the calls after it is determined that there is no indication for ALS intervention or in need of more intense intervention. Yet it is the Paramedic that needs to make that determination. Sorry folks; a 15 page chapter of A & P  (U.S.) is not enough knowledge to know about the body. Would you really would want your hospital staff to only have that much.. really think about it. 

Would you want a nurses aide to perform the assessment of your child in a ER to determine if you need a Dr. or not? The same applies here... 

In regards to the public will take what they can get & don't care is total bologna.! People assume they get a Paramedic on every call. That is what they see on t.v. They do not know the difference & from what I have seen most EMT's sure do not attempt to clarify either. You don't think they expect more then read the EMS News web site where they are suing everyday because a Paramedic did not do this or that...

Two EMS units instead of one, talk about wasted of resources. Now you have two EMS units for one patient? A roving Paramedic unit.... yeah been there, done that & it too was a waste of money. If I had just been initially on the truck, I could assess, treat, and transport all at one time. Don't sacrifice the patients health because the system is too weak to provide enough coverage. It is all in regards to money, not the patients health. ..something we all agree on. 

R/r 911


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## mikeylikesit (Jun 14, 2008)

Ridryder911 said:


> Again, are you sure? Sorry, do you really know how to perform a detail neuro exam on a drunk, ever heard of that "drunk" turning out to be a diabetic? Of course you realize 20% of alcoholics have some form of chronic illnesses, & that they have a 15% chance of having a head bleed because alcoholism causes blood vessels to rupture more easier? Ever see a physician not order a CT on a drunk that fell & struck their head? .. Johnny with a cut finger does not need EMS or an ambulance, they need to be telephoned triaged by proper 911 communications dispatcher, and if necessary send a squad to place a band-aid on them. But every true patient needs to be evaluated by a Paramedic to determine injuries.
> 
> Yes, EMT's can handle majority of the calls after it is determined that there is no indication for ALS intervention or in need of more intense intervention. Yet it is the Paramedic that needs to make that determination. Sorry folks; a 15 page chapter of A & P (U.S.) is not enough knowledge to know about the body. Would you really would want your hospital staff to only have that much.. really think about it.
> 
> ...


Hence the fact that you see this quote in all the Basic books "call ALS immediately after arriving on scene." now i am not a basic hater i think that it is great that you want to help and that you do have skills that help injured people and people that need help in general. however like Rid stated if you want to be respected for having a skill and a profession then go out and get your training! You will never understand why medics will defend to the death the fact that EMT's are no where as important then medics unless you have paid your dues and went through medic school. the funny thing is that medic school wasn't even that bad. so if you want to get up on a high hoarse like you all of said then preach from it...but don't go through less intense training and expect room to complain. to answer the original question, Yes i think that BLS is important in the EMS field but not for the reason that *some EMT's* think and that is that EMT's and medics are the same or that actually believe that they save medics who don't remember their basics cause "their all full of that advanced stuff". No, we remember how to splint and apply gauze don't worry. you guys do help when a patient needs care and help and we can't attend to them because were loading drugs or reading a rhythm or have another patient that were working on while your doing CPR or Dfibing another patient. In the end though i still like having BLS or EMT-B or even FR around.


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## Hastings (Jun 14, 2008)

Ridryder911 said:


> Again, are you sure? Sorry, do you really know how to perform a detail neuro exam on a drunk, ever heard of that "drunk" turning out to be a diabetic? Of course you realize 20% of alcoholics have some form of chronic illnesses, & that they have a 15% chance of having a head bleed because alcoholism causes blood vessels to rupture more easier?



Just to jump in for a second, those actually ARE things that EMT-Bs here, in the US, and trained to do. They can perform a detailed neuro exam, as well as check their blood sugar. They have the knowledge and ability to, for instance, differentiate between a CVA and a diabetic emergency. The difference isn't in the assessment, but in treatment. Just treatment.

And while EMT-Basics may lack the education to know that drunks have a higher chance of having a head bleed, they have the skills to recognize where the problem is, and how serious it is. And really, when it comes down to it, that's what matters. The medic can't do any better, as diagnosis and treatment of that is impossible in the field.


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## enjoynz (Jun 14, 2008)

Well as far as NZ goes, we don't follow the same protocols as the States.
Maybe if I was a little younger and had a spare $40.000, I would have looked at going to university for 3 years to become an Advanced Paramedic (EMT-P).
In New Zealand, most of our EMT-P's have been trained from the bottom of the field, and have had on-road experience, and many have started as volunteers. Either that, or they have done their advanced trained in other countries like England and South Africa for instance, and decided to come and live in NZ.
I don't know the figures, but there is only a small pertcentage of them compared to the majority of Ambulance personal in New Zealand.
So when they are needed for a job, you'd better really need them.

As far as the scenario I used before, we had a Etoh patient to deal with a few weeks ago. If we had called for ALS or even transported this person, we would have been in for a severe butt kicking. Of course the patient was assessed to ensure they were ok to stay at home.
We could split hairs all day over hear say.
I will say one thing though, about a case I heard about of a patient that ER hospital staff thought was Etoh. They left him sitting in the waiting room. He was having a hypoglycemic episode, which was picked up by a passing FR who thought he looked pretty sick and went to question him!

We all serve a purpose in EMS, in one way or another. 
I couldn't see an EMT-P wanting to sit on station in a rural town with 4 calls a month. That would be a waste!!! 

Cheers Enjoynz


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## LE-EMT (Jun 14, 2008)

wow I don't show up for 24 hours and everyone goes crazy...... LOL

Ok I am not sure you all understood what I was going for or really ranting about.  It was not a who's better then who and it sure as hell wasn't for all medics to jump on the bandwagon ( even some basics ) and start belittling the lower level of care.  I was not looking to draw the lines and start an all out war here.  although it makes me giggle a little because of all the heated back and forth.  

Is it not true that Basics are needed?  I am going to explain something with my limited knowledge and you all can retort.  
I can almost assure you most of your als/medics aren't going to want or need to do an interfacility transport for a doctor visit, return from said doctor visit, returning to a nursing home from a higher level of care with no EQ or special precautions.  
EMS- Do you medics want to or need to respond to every sick person, headache, and runny nose that gets a 911 call.   
I am a dispatcher and I know for a fact that I have sent units on "BS" calls but I am not allowed to make that designation professionally because every call we receive we dispatch and as we should.  I also know that working for one of the largest ambulance companies if not the largest in the greater southwestern region how short on medics we are.  Which would lead to me to believe this is a nation wide trend. 
I posed this same question to my trainer and supervisor and his answer went as fallows.... It would be impractical to send ALS on every call.  Considering cost and man power its just impossible.  It is far more expensive to equip a ALS unit then it is a BLS.  the equipment and Meds alone are extremely expensive.  Not to mention then you need the Medics to fill the units.  You can see how many ALS units we have and how we are often short.  There are times when BLS will suffice and ALS would be better posting for the next call we can utilize their abilities.  

I agree with rid the standards are far to low for basics,  especially considering the  profession.  I agree that education and the continuing of it should be very important to everyone in the profession.  
Maybe its just the softy in me saying that we should all sit around the camp fire holding hands and singing kumbya.   But I do believe that if there was a better relationship between all of us these issues would reach a conclusion.     I also do agree there are numerous people out there making themselves out to be more then they are with their limited titles.  Giving everyone a bad reputation and making it difficult to close these gaps.


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## Ridryder911 (Jun 14, 2008)

Hastings said:


> Just to jump in for a second, those actually ARE things that EMT-Bs here, in the US, and trained to do. They can perform a detailed neuro exam, as well as check their blood sugar. They have the knowledge and ability to, for instance, differentiate between a CVA and a diabetic emergency. The difference isn't in the assessment, but in treatment. Just treatment.
> 
> And while EMT-Basics may lack the education to know that drunks have a higher chance of having a head bleed, they have the skills to recognize where the problem is, and how serious it is. And really, when it comes down to it, that's what matters. The medic can't do any better, as diagnosis and treatment of that is impossible in the field.




I am sorry, but I do doubt that your Basics were trained to do a detailed neuro exam.. even your Paramedics if you describe it is the same. I am not talking about PEARL & grips, etc. I am discussing nystgmus differential, cranial nerves II-VII with EOM, Cardinal Movements, ataxic movements,  etc. 

If your Paramedics are not performing any more detailed assessment than you Basic EMT's your program or Paramedics are lacking a lot. Especially when Basic EMT neuro assessment is barely one paragraph to a chapter long. 

This is getting more scary!...

R/r 911


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## firecoins (Jun 14, 2008)

Ridryder911 said:


> People assume they get a Paramedic on every call. R/r 911



I generally agree with your point but most people don't know what a medic is. People's impression ranges from ambulance driver to doctor.  I have seen people tell us (includedes responding medic units) they had no previous medical hx but all of a sudden they have AIDS/cardiac when they speak to the triage nurse.  

When I work as an an EMT-B some patients may not see medics but all see doctors.  Or at least a PA.  Medics are not always available or the hospital is closer than the medics.


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## Littlebit (Jun 14, 2008)

*A perfect world*

In less populated areas if you want ALS plan on waiting 20-40 minutes.  In the meantime BLS is the answer.  They are trained to respond to emergencies- and most competent EMT-B's can recognize a critical or life threatening injury just as quick an EMT-P.  Then the EMT-B begins his/her training with the ABC's.  With no ALS available - what do they do- they contact the rural hospital to inform them- the hospital is then ready - and if a helicoptor needs to be called thats done.  Or they could wait and say " we aren't educated and trained enough so we'll wait for ALS"  
In a perfect world lets put an Ortho in the ambulance if dispatch states "broken leg" or a neuro on board if dispatch states "head injury" or a geratric specialist on board if the call comes out "elderly individual who does not feel well or is not acting right" 
Also in the perfect world - all volunteer ambulance members will be "educated to the highest level- the citizens or if owned by the city will pay for all that education.  Meanwhile the employers will allow the volunteers to leave work early to attend clinicals and school and someone will pay those volunteers top notch wages for providing ALS skills.


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## MMiz (Jun 14, 2008)

Lets remember to keep the discussion on topic and keep the insults and name-calling to a minimum


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## VentMedic (Jun 14, 2008)

firecoins said:


> I generally agree with your point but most people don't know what a medic is. People's impression ranges from ambulance driver to doctor.



One would have to have been living in a cave for the last 30 years not to have some idea about what a paramedic is.   The public may not know the exact job description but do know paramedics are capable of providing life saving therapies.   We've also have to cut the public some slack if they are not up to speed on all 48 different EMS certification or the varying scopes of practice from one region to another such as EMT-Bs intubating.   I think it is obvious by just the posts on this forum that the education, training, skills and abilities are all over the map even within one title in one state.  

EMS has been in the public eye for over 30 years starting with Johnny and Roy.  We have had a Paramedic, EMT and/or ambulance appear on almost every show.  My old ambulance company even made guest appearances on Miami Vice.   Jessica McLure put Paramedics in the public eye with the numerous news articles and a movie.  It was even relived years later in the hearts of many when the Paramedic, Robert O'Donnell, committed suicide attributed to PTSD. 

Even the recent Air Medical transport crashes have put Paramedics on the national and international news giving the public another view of the profession.   

No other profession has gotten so many leading roles and many are positive.  Nurses have been stereotyped in Soap Operas and X-Rated movies.  While they may cringe, they don't constantly whine even when some read the very negative posts on EMS forums bashing them.   Most EMS providers have no clue what a nurse or any other health care professional does and what type of education they must complete to just get an entry level position.   Even on the medical shows, you don't see all the healthcare workers that make a hospital run efficiently and are vital to the resuscitation/recovery of every patient the comes into the hospital.    

What other profession watches the news almost daily to see if they are shown at any scenes or mentioned?   And then, they critique every little thing the reporter says as the story is all about them and not the actual news item.   How many articles have we had critiqued on the forums and most probably can not remember what happened to the patients or persons rescued.  They just know someone called them an "ambulance driver" or "fire fighter".  Who cares if some toddler was shot dead in the street when there is a "bigger story".  



firecoins said:


> I have seen people tell us (includedes responding medic units) they had no previous medical hx but all of a sudden they have AIDS/cardiac when they speak to the triage nurse.



You actually find this hard to believe?   In the still very macho world of EMS and the FD, discrimination against people with some diseases is still alive and well even against our own.   I suppose some would say that is a very sexist thing for me to write.  I would be happy to debate that on another thread. 

How much privacy are you giving the patient when asking very personal questions?   Usually an ambulance attracts a crowd.   If it is just loved ones and friends, has the patient disclosed their health problems to them?   Even in the hospital for a routine nebulizer tx or PFT, I have to be careful and not mention anything about the patient's medical condition if family is present.   The patient may be familiar with the healthcare system which stresses privacy and does not want the world to know their health problems.  The patient may also be hesitant to disclose something that is not related to the what they have called you for.  They may also know that you ARE AN EMT-B and know that you will not be giving meds or doing invasive procedures.   You may also have been asking the wrong questions.


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## firecoins (Jun 15, 2008)

VentMedic said:


> One would have to have been living in a cave for the last 30 years not to have some idea about what a paramedic is.


There must be a lot people living in caves.  They have little interest in our profession until they need us. 



> EMS has been in the public eye for over 30 years starting with Johnny and Roy.


  I have never seen whatever that show was with Johnny and Roy.  I suspect most other people haven't.  




> What other profession watches the news almost daily to see if they are shown at any scenes or mentioned?   And then, they critique every little thing the reporter says as the story is all about them and not the actual news item.


  We pay attention to the stories. That doesn't translate into the general public doing so. 



> You actually find this hard to believe?


where did I say I found this hard to believe? I just mentioned it happens.

Despite perceived public eye, many people have little interest in what a paramedic or emt do until they need one.

All I am saying is that there is a range of perceptions.  To some we ambulance drivers and to some we are doctors.


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## mikeylikesit (Jun 15, 2008)

Littlebit said:


> They are trained to respond to emergencies- and most competent EMT-B's can recognize a critical or life threatening injury just as quick an EMT-P.
> 
> 
> 
> ...


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## VentMedic (Jun 15, 2008)

firecoins said:


> There must be a lot people living in caves.  They have little interest in our profession until they need us.



I don't give surgeons, plumbers or electricians much interest either even though I might need one some day.  People should live their lives to the fullest without thinking about "the day they'll need a Paramedic".  Of course, most of us tax payers are usually reminded about EMS and Fire services at least once a year for some election.  The campaigns for those elections will bombard us with "What paramedics, ALS services, enhanced 911 and trauma systems do" for months prior to that election.   



firecoins said:


> I have never seen whatever that show was with Johnny and Roy.  I suspect most other people haven't.



Too bad.  But, in all fairness to you that was over 30 years ago.  You were probably too young to remember that show even though it was on some stations throughout the 80s.

You didn't comment about the other examples I mentioned.  Did you not know anything about them either? 



firecoins said:


> We pay attention to the stories. That doesn't translate into the general public doing so.



Most people watch the news to see the current events and not if the reporter photographed the EMT's good side and used the correct title.



firecoins said:


> Despite perceived public eye, many people have little interest in what a paramedic or emt do until they need one.



Do you actually care what nurses, RRTs, RTs, OTs, PTs or even MDs do unless you need one?  


You complain about your department, your city, the pay and the patients.  You also complain that no one knows what you do, the public doesn't recognize you're an EMT, and you feel you get no respect from the public. 

Why do you stay in EMS?   You don't have that much EMS education time invested in the job.  There are probably a lot more jobs that pay better where you don't have to worry about patients in any way.  You might even find the respect you think you deserve doing something else. 

There are some of us that know we make a difference one patient at a time.  We don't need our pictures on the evening news every night to know what we do and who we are.   There are hundreds of different health care providers who all have an important job but don't expect to be recognized at the donut shop or even in the halls of their own hospital by many of the patients they have taken care of.  They know what their contribution was to that patient's recovery and don't need a news reporter to announce it to stroke their egos.


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## MJordan2121 (Jun 15, 2008)

*Good Quote*

I've heard many Medics I work with say... ""Medics save people and basics save medics..."  I think its a partnership and you work together for a unified team effort to help save another's life or to help improve their quality of life.  Let's all be friends


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## JPINFV (Jun 15, 2008)

MJordan2121 said:


> I've heard many Medics I work with say... ""Medics save people and basics save medics..."  I think its a partnership and you work together for a unified team effort to help save another's life or to help improve their quality of life.  Let's all be friends



Name me one thing that a competent basic can do that a competent medic can't. You know, I wonder if there's a saying in the emergency room that goes, "Emergency physicians saves lives. Emergency PAs save physicians." I honestly doubt it.


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## firecoins (Jun 15, 2008)

> Too bad.  But, in all fairness to you that was over 30 years ago.  You were probably too young to remember that show even though it was on some stations throughout the 80s.


yes I am too young for that show.




> Most people watch the news to see the current events and not if the reporter photographed the EMT's good side and used the correct title.


you brought it up.





> Do you actually care what nurses, RRTs, RTs, OTs, PTs or even MDs do unless you need one?


 People have different perceptions of them too.  I am not sure people even know what RRTs, RTs, OTs and PTs are. 



> You complain about your department, your city, the pay and the patients.  You also complain that no one knows what you do, the public doesn't recognize you're an EMT, and you feel you get no respect from the public.


Your reading waaaaaay to deep into my comments.  The public reconizes different thinks depending on their perceptions.  Some think I am doctor and some an ambulance driver.  Nothing your saying is going to change that. Its just the way it is.   



> Why do you stay in EMS?   You don't have that much EMS education time invested in the job. [There are probably a lot more jobs that pay better where you don't have to worry about patients in any way.  You might even find the respect you think you deserve doing something else.


=Its very simple you seem to complicate things way too much. I am a medic student. I have enough education to stay in this. And I get more than enough respect from my patients.  Patients aren't the problem reguardless of their good and bad perceptions they may have. Your taking this WAY too personally is more of a problem. You need to chill.  



> There are some of us that know we make a difference one patient at a time.  We don't need our pictures on the evening news every night to know what we do and who we are.   There are hundreds of different health care providers who all have an important job but don't expect to be recognized at the donut shop or even in the halls of their own hospital by many of the patients they have taken care of.  They know what their contribution was to that patient's recovery and don't need a news reporter to announce it to stroke their egos.


Again I have no clue where you get this from.  All I said was the pubic has range of perceptions. I have been called doctor and ambulance driver in the same shift.  I do my best with both.


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## mdtaylor (Jun 15, 2008)

Ridryder911 said:


> Now, really inform me what "*medical* care  you provided? What difference did you make, that a common laymen with good advanced first aid training could not? Splinting?.. No Hmm maybe controlling hemorrhaging? No ..Okay, how about CPR? No.. Assisting in administration of NTG, EpiPen? No. Wow! A common laymen can give much more than a Basic EMT, they are far more restricted. Okay, maybe taking a set of vitals? That it's it ! Oops that is not treating, rather assessing.. Begin to see a trend?



What I am beginning to see is an entirely different side of a forum member that I had respected...


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## el Murpharino (Jun 15, 2008)

MJordan2121 said:


> I've heard many Medics I work with say... ""Medics save people and basics save medics..."  I think its a partnership and you work together for a unified team effort to help save another's life or to help improve their quality of life.  Let's all be friends



Many medics say that to make the basics feel like they aren't completely useless in the realm of EMS.  Most basics complete their class with this bravado that quickly diminishes once they realize how little they can actually do.  Of course they do serve a purpose in the grand scheme of things and their assistance is very useful, especially in bad patients.  But I can't think of one instance in the last 5 years that I have been "saved" by a basic....but I can think of multiple times where the opposite could be true.


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## CFRBryan347768 (Jun 15, 2008)

> Originally Posted by Ridryder911
> Now, really inform me what "medical care you provided? What difference did you make, that a common laymen with good advanced first aid training could not? Splinting?.. No Hmm maybe controlling hemorrhaging? No ..Okay, how about CPR? No.. Assisting in administration of NTG, EpiPen? No. Wow! A common laymen can give much more than a Basic EMT, they are far more restricted. Okay, maybe taking a set of vitals? That it's it ! Oops that is not treating, rather assessing.. Begin to see a trend?





> Originally Posted by mdtaylor
> What I am beginning to see is an entirely different side of a forum member that I had respected...



I think you have to look at it from the point that what Rid is saying is that to provide the absolute best care to your pt's you need more then just an EMT-B class. I don't think hes trying to discourage any one but show people that basic skills just dont cut it, you need more EDUCATION to provide better care.


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## triemal04 (Jun 15, 2008)

mdtaylor said:


> What I am beginning to see is an entirely different side of a forum member that I had respected...


Why?  That's one person who has never been shy about pointing out the shortcomings of EMT-B's, the lack of education for them, their inability to render anything more than the most basic care, and the false feeling that many have that they provide so much care for their patients.

In all honesty, there really isn't anything taught in an EMT-B class that's that spectacular; the majority of the things a well-trained Boy Scout could do.  The problem is that so many Basics, (and this is partially the fault of instructors who don't make it clear that what they are learning is a bare minimum and they NEED to know more to adequately care for people) think they can do so much when they can't.  So many think that they bring a lot to offer to the table, when in reality, they don't.

The first time I had to care for a patient as an EMT-B, the first thing that crossed my mind was "Holy crap!  I don't know anything about what's going on!  I can't do anything for this person!  Holy crap!  I need to get my butt back to school, and fast!"  It's a fairly common reaction...for people who actually belong in this field and will move to a higher level.  The problem is that many don't, and won't, and will go on believing that what they do is all that needs to be done.

And our culture let's them keep believing these lies.


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## Flight-LP (Jun 15, 2008)

LE-EMT said:


> wow I don't show up for 24 hours and everyone goes crazy...... LOL
> 
> Ok I am not sure you all understood what I was going for or really ranting about.  It was not a who's better then who and it sure as hell wasn't for all medics to jump on the bandwagon ( even some basics ) and start belittling the lower level of care.  I was not looking to draw the lines and start an all out war here.  although it makes me giggle a little because of all the heated back and forth.
> 
> ...



You present a clear point, one that as a medic, I appreciate. There is a major over abuse of the system nationwide, but just as every ER RN out there can attest, you just have to deal with them. Just as ER's are starting to do more medical screening exams and getting people who have no business consuming ER resources out the doors, EMS can and in some places will follow. I actively inform pts. of the MSE possibility and have no hesitation dispelling the rumor of faster service by calling 911. This education alone has shown me a personal decrease in the number of unneccessary transports. But despite the call volume, I strongly believe, as do many others here, that each and every patient deserves a thorough assessment and diagnostic check utilizing all available resources in the pre-hospital environment. That cannot be performed proficiently by an EMT-B, sorry. 

I have stayed out of this thread until now, because I have the definite ability to carry my stick to the pot and start stirring, but this needs to be addressed, because apparently some folks just don't get it. 

First off, Interfacility transports to physician appointments, dialysis, and discharges back to the nursing home ARE NOT EMS CALLS. They are private transportation services. There is no medical service required and the only reason they are being taken by ambulance is due to an inability to sit upright unassisted. Or supposibly having that inability! I see very few dialysis patients actually lying in a bed during their treatment, yet hundreds of them are transported in Houston every single day by ambulance. Why? Because, these private companies fraud Medicare to pad their pockets. In reality, even bed confined patients can be transported by an non medical driver, even if they are on oxygen. Bottom line, probably a good 85% of these patients have no business in an ambulance (or vehicle the private company calls an ambulance). Drs. appts., same criteria. discharge from the ER, send 2 EMT's. Again, these calls are not EMERGENCY MEDICAL SERVICES calls, they are taxi calls with modified positioning for passenger transport.

Second, I realize the frustration of sending an ALS unit to a known B.S. call or frequent flyer, but the next time you are dispatching, take a look around you and ask yourself a question...............

Would you trust the person sitting next to you to make the official triage call as to what ambulance they send to you when your buddies call and say that you have been drinking and fell down? What do you think they would do? My guess would be send the BLS truck for the fallen down drunk, who in actuality has a closed head injury and starts seizing just seconds after the arrival of EMS.

 See the problem? Now we aren't asking an EMT-B to make a triage and transport decision. We are asking a dispatcher who is not on scene, cannot make any objective observation, and has minimal if any EMS education. That doesn't work that well. You are blessed from the standpoint that you have some EMS knowledge, most dispatchers dont. Now through in the fact that you dispatch for multiple agencies, and if there is any police agencies involved in that dispatch center, I will guarantee that something WILL be overlooked and a poor decision made. Remember, a law enforcement officers duties and life will come before any issue an ambulance has on scene. It is for good reason I agree, but bottom line is that mutli agency dispatch is Darwinism at is best!

EMT-B's are needed, just not at the helm of a 911 truck. Sorry, but people deserve the best capabilities available. They deserve definitive interventions following a proficient assessment. An EMT-B cannot perform this, period, end of story. For all of you EMT-B's out there arguing this point, you can cry until you are blue in the face, you're preparatory training is insufficient to effectively delivery proficient pre-hospital care. In an assisting role, yes you all can be a priceless assest, but leading a crew on a 911 truck creates limitations to care that is and should be reasonably expected by the public. Sorry, can't sugar coat it any better than that............

Yes, that means a higher premium and price, yes that is difficult in some areas, impossible in few. However, I see so many agencies that use the "we can't afford it card", yet do not tax or bill. Sorry, you can't have your cake and eat it too!

It is expensive. Its only going to get worse. But it can be done. Community education and political action is key. We have to get out there and air our dirty laundry a little. Public perception is everything. Let them know the limitations and constraints. You would be surprised what Joe Q. Public is willing to pay for!

In the meantime, lets take 'em to the ER!

Keep it safe!


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## Ridryder911 (Jun 15, 2008)

Why is this so confusing? Would would one think if they went to Nurses.com and read discussion that nurses aides were claiming & complaining that they should be able to do such and such, voiced opinions on how & what the nursing profession should be, just how much credibility would one give it.. Now in comparison to those of RN's or higher level nursing professionals? Do you think that the RN's would just naturally agree?

Would you consider it belittling if the RN's informed them that they lacked the education and knowledge to perform anything else that they were trained in... again emphasizing that it was a starting position.. the very Basics, nothing more should be expected or performed. That their opinions are valuable but in reality they lack the understanding of the profession as a whole to really be able to voice an educated opinion.

Would you not also agree that they should not be speaking on behalf of the profession? That they lack the knowledge, professional growth & clinical experience to debate or give any advice other than what their current level is? Would you entrust a volunteer nurses aide at a nursing home to give you advice of the nursing profession? 

This is NOT belittling, just the facts. EMT is an entry point, not the finale or even half way point. The care of the EMT is just above common laymen. Again, this is the facts. We do not train or educate those to be much more. Again, because it is an entry point. The first step of many.. 

Why would one expect anything else? Why is their any confusion? It is even confusing that there is even a confusion? Why would anyone consider it belittling when that is what the curriculum is designed and taught as. The very bare minimum. Sorry, again this is the facts based upon those that make up professional EMS standards of care and educational organizations such as NEMSP, NAEMSE, NAEMT, NREMT, AMA, ACEP and on and on... Where their opinions matter the most.. they make the National & State Rulings to be judged and followed by. 

What I find very frustrating on this site is so many assume that they are an EMS expert because they have just entered the profession or just finished an entry point. Again, ignorant (which is not the same as stupid) of the EMS as a Profession and delivery of medical care. I would be outraged that such programs still exist if I was a basic level. If I had just paid hard earned money and did not receive anymore education than what was delivered. Again, most of those do not understand and what it is entitled and requires to deliver true medical care. 

Maybe instead of arguing of what they "we are" and cannot do, maybe the effort and strength could be better channelled into requiring more education for the EMT level. By doing so increasing the chances of better pay, better benefits and actually making it a profession so we can attract and keep well educated professionals that want to deliver excellent care.

Now, with that being said.. I ask how many really do understand EMS as the profession? Outside the "box".. How one can work in a system without knowing the system? Every health profession studies their history and professional standards except EMS. How can one know the future of EMS if we do not know the past (Johnny & Roy, James Page, Nancy Caroline, etc) or study EMS as a system? How serious is one about their profession if they are not willing to know more than than an entry point level? 

Read the posts, how many really know about the billing process, medical documentation, professional EMS standards and the ethics of medicine? All that make up EMS. How much anatomy & physiology, different diseases and illnesses are discussed, or better yet not covered?  Again, EMS is much more than performing a very minimal assessment and history, splinting, applying oxygen and obtaining a set of vital signs. Is it essential to understand more than the "basics" yes..! 

So instead of getting feelings hurt about the facts place the energy in increasing your knowledge, participating in increasing EMS as a profession. Anyone can whine but it takes a real professional to change things... 

R/r 911


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## Zeke (Jun 15, 2008)

Ridryder911 said:


> EMT is an entry point, not the finale or even half way point. The care of the EMT is just above common laymen. Again, this is the facts. We do not train or educate those to be much more. Again, because it is an entry point. The first step of many..
> 
> 
> R/r 911



I remember halfway through my clinicals, I was shocked to find that after all the hours I had put into the course (in actuality about 180 at that point, I had a veeery long course) I still didn't feel adequately prepared. I came into it expecting a comprehensive knowledge and understanding of what to do and how to do it, yet all I seemed to know was how to stay calm, ABC's, assess, and transport.  It seemed that a basic should've been no more than the EMS equivalent of a CNA; a Certified Paramedic Assistant.


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## JPINFV (Jun 15, 2008)

^
There will never be a level called Certified Paramedic Assistant because CPA has already been claimed...


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## mikeylikesit (Jun 15, 2008)

JPINFV said:


> ^
> There will never be a level called Certified Paramedic Assistant because CPA has already been claimed...


LOL good point.


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## LE-EMT (Jun 15, 2008)

Valid point Flight-LP.  I completely understand that there isn't as much of a need for Basics in EMS especially with the policies that are in place.  Policies that are ever changing.  With the need for on the spot accurate assessments.  but I feel  interfacility transports are completely acceptable for basics.  It also may be some deeper plan from corporate America to suck us all dry.  

I also understand and note that on a known "bs" frequent flyer call we do not make judgment calls.  We dispatch on what we are told not what we think is happening.  We do not make assessment calls other then whether we send ALS or BLS.   I dispatch EMS so I really don't have to worry about interfacility.  We have a list of ALS specific calls. coincidently they are most calls.......   If I question any thing I send ALS.

That took me about an hour to type cause I got side tracked........ so yeah


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## Raf (Jun 16, 2008)

Basics are mostly used for transfers around here. Do you think it would be a good idea to have ALS trucks do transfers all day? Does dropping grandmas off at doctor appointments all day sound fun? Talk about a waste of money. Yeah most of these patients should probably take a cab or be driven by a friend or family member, but some of them are unstable and can croak on the road. If so, advanced first aid is all you need for that small period of time. Ambulances have lights and sirens for a reason, because they cannot deliver definitive care. Lights and sirens let you get to a hospital where they can get real medical assistance asap.


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## Ridryder911 (Jun 16, 2008)

Raf said:


> Basics are mostly used for transfers around here. Do you think it would be a good idea to have ALS trucks do transfers all day? Does dropping grandmas off at doctor appointments all day sound fun? Talk about a waste of money. Yeah most of these patients should probably take a cab or be driven by a friend or family member, but some of them are unstable and can croak on the road. If so, advanced first aid is all you need for that small period of time. Ambulances have lights and sirens for a reason, because they cannot deliver definitive care. Lights and sirens let you get to a hospital where they can get real medical assistance asap.



Please oh please, don't tell me you really think lights & sirens saves lives! OMG. did you just leave the 60's? Seriously do you even understand EMS?  The most one saves is maybe two to five minutes by going with lights and sirens, definitely not enough to "save a life".. Really, do you understand it is 2008 and the same treatment can be given in an EMS unit (they are no longer hearses or Cadillacs either). There is NO difference in the majority of care be it in an EMS or in a ER! .. Please, understand that!  

Personally, take off those L/S.. they usually do no good. Better be good at what you supposed to be doing .. patient care!

If an ambulance is dropping off Grandma at a Dr. Office then and charging it to Medicare, then it is fraud as Flight-LP described. Sorry, so called EMS-Ambulance Services abused Medicare & Insurance and now everyone has to pay the consequences. If they can "croak" on the road, then they need an ER not a clinic!

p.s. frogs croak.. not patients!

R/r 911


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## phunguy (Jun 16, 2008)

Wow... I feel lucky here in Arizona. All the paramedics I have met actually respect us BLS types. We work together and everyone is there for the patient care. A EMT-b can not start the paramedic program until they have 1 year of service under thier belt. So maybe the respected attitudes come from being in the basics shoes at one point. Maybe some others who never did BLS and jumped right to medic should try this approach...


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## Clibby (Jun 16, 2008)

Heres my 2 cents, take it or leave it. All the medics here, for some reason which I have yet to find anywhere in my area, believe basics are useless in 911. Really? You don't need them? At all? I think you need to take a second look.

I'm not saying you need them to save patients' lives because honestly we can't do all that much. But you know what, if there is a hospital within 10 min and a level 1 trauma in 13, such as my area, as long as the patient is AOX4 and has no life threatening injuries, that drunk or that fender bender victim or the broken bone patient will get to the ER before a medic can do all that much, especially before he develops a complication that wasn't visible to police on scene. Now for those bad calls or complicated calls, do you really need to pay a medic to drive? At the same time do you want someone who has not had basic training arriving on scene with you?

 Last night, for instance, we responded to a difficulty breathing. Turns out the pt was in cardiac arrest. We had 2 basics and a medic. As soon as we saw the pt, the medic gave us the look and went to the truck to set up. We had him short boarded and in the truck in under one minute while the medic set up his ET tube and got his meds ready. The police drove for us while one of us basic bagged him, post intubation, and the other set up the IV, EKG, and performed compressions when he crashed. This freed up the medic to do his job. By the time we got to the hospital, we had him go from respiratory arrest/cardiac arrest to fighting to take the tube out. Granted this doesn't happen often, if we only had medics then the police probably would have still drove, but the medics would have to perform CPR instead of doing their job saving his life. 

Do you really think it is effective to have 3 medics. That is at least twice the money and you now have at least 2 chiefs in one tribe. In a perfect world with no money and enough medics for every 911 truck who get along and all have the same right ideas, then every truck should have 3 medics, but this isn't a perfect world. While its nice to have someone to bump ideas off of, if a medic isn't confident in his own abilities then he shouldn't be allowed to run his own truck, period. He should be a junior and ride with another medic who runs the truck. A medic shouldn't need another medic to know what to do. Its nice to have another medic who can start IVs for you, but thats really not going to make enough of a difference to save a life, its more of a convenience for the hospital. If you think you need to waste a medic on those basic jobs, then you are beyond arrogant. At the same time, not anyone can perform those tasks. Granted they are not hard and any bozo who can keep a calm head and read can do it, legally you need someone with the basic training who has done it before and it helps tremendously if a person can anticipate what the medic is going to need. 

Basics saving medics doesn't mean that we remind the medics of their ABCs and try and push our knowledge on them; it means that we do our job so they can do theirs. Medics shouldn't have to tell anyone to control bleeding, perform compressions, have an IV hung and spiked with flushes set up, set up EKGs, or ventilating a pt; these are jobs for basics. We don't save lives, we help medics save lives, neither of whom can do so without the other.


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## firecoins (Jun 16, 2008)

Is there a point to this thread?  No


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## Ridryder911 (Jun 16, 2008)

phunguy said:


> Wow... I feel lucky here in Arizona. All the paramedics I have met actually respect us BLS types. We work together and everyone is there for the patient care. A EMT-b can not start the paramedic program until they have 1 year of service under thier belt. So maybe the respected attitudes come from being in the basics shoes at one point. Maybe some others who never did BLS and jumped right to medic should try this approach...



I respect Basics. That is NOT the point, the point is that the current curriculum is ineffective and piss poor. As well, why do I want an EMT with poor or bad habits prior to entering a Paramedic program? Now, I have to re-teach and attempt to break them.. There has not been any validity that proves or improves a person to be an EMT first. Really, how much are you bringing to the program? There is quite of bit of difference between advanced care and basic.. again, it is usually those that are not educated to attempt to prove different. Ironic huh? 

R/r 911


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## Flight-LP (Jun 16, 2008)

Clibby said:


> Heres my 2 cents, take it or leave it. All the medics here, for some reason which I have yet to find anywhere in my area, believe basics are useless in 911. Really? You don't need them? At all? I think you need to take a second look.
> 
> I'm not saying you need them to save patients' lives because honestly we can't do all that much. But you know what, if there is a hospital within 10 min and a level 1 trauma in 13, such as my area, as long as the patient is AOX4 and has no life threatening injuries, that drunk or that fender bender victim or the broken bone patient will get to the ER before a medic can do all that much, especially before he develops a complication that wasn't visible to police on scene. Now for those bad calls or complicated calls, do you really need to pay a medic to drive? At the same time do you want someone who has not had basic training arriving on scene with you?
> 
> ...



Yet again, another EMT-B attempting, unsuccessfully, to justify their position. I'm sorry and please do not take this personally, but your examples, especially the "broken bone" one, are completely incorrect. Two words, PAIN MANAGEMENT. I don't care if the ER is pissing distance away, the patient deserves comfort. Preference being in the medicinal form, an act that a BLS provider again cannot provide.

But that is not what bothers me.................

Just as Rid mentioned, the overall system is broke. Experience prior to entering medic school paves the way for horrible habits. Like having the belief its o.k. for a medic to walk away from a cardiac arrest patient and go to the truck to set up his intubation equipment instead of being prepared in the first place. Not to mention that intubation is the LAST think you should be worrying about during a code. Sounds like a half arsed C.F. to me, yet when you typed it, I bet you had no idea that it was remotely incorrect. Right?

Again, its the blind attempting to lead the blind. Notice that throughout the NUMEROUS threads of BLS vs. ALS, never once has there been a Paramedic that agrees with the crap you guys are believing. Every time its an EMT-B. Honestly, a few of you are making the overall BLS population look bad. There are some very talented and educated Basics running around. Many that I would work with in a heartbeat, and be proud to do so. They are easy to identify, they are the ones not feeding into this nonsense. You call us egotistical, arrogant, and having "Paragod" syndrome. But you have yet to have one Medic agree with you. Are we all wrong, or is it possible that you just are not educated enough to really know the truth? The answer lies within this forum, stop trying to illude yourselves otherwise.


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## Littlebit (Jun 16, 2008)

*apples vs oranges*

In one of the posts we're now comparing CNA's vs RN's.  Not sure what that has to do with the topic going on.  My comment regarding CNA's vs RN's is "try running a nursing home without the CNA's and it'll crumble!"  Granted the RN's have the knowledge and education but I doubt if the RN's would stay if the CNA's were not longer available.  But to me this really has nothing to do with the topic at hand. 
this topic could go on forever with no resolution.  If EMT B's are uneducated then maybe the Department of Public Health EMS should be notified.
At any rate:  it may be an entry point and maybe its all that EMS individual wants.  Not everyone wants to be educated to the fullest extent possible- thats why there are different levels out there. 
No matter what a person's education level is they are deserve respect until proven otherwise. 
EMT-PS


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## mikeylikesit (Jun 16, 2008)

Why are there so many people out there that feel they are fully trained after only one semester of college though. i had to take a year of English comp to get my AAS in paramedic's does this make me a professional in writing? I don't think it comes down to medics not respecting basics, but respect is still earned not given. Do basics do jobs that medics can't do...no. do basics do jobs that medics don't want to do or can't get to due to triage...yes, but heaven forbid that you bring that up less you get a whole " you don't respect me thing". Can we have 2 attendants on a rig that are both medics...i do. Not everyone can afford two medics per rig, but that is not our problem. Basics should continue to get their education and not just stop at the cert and call it a career...if you want my respect.


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## triemal04 (Jun 16, 2008)

Clibby said:


> Basics saving medics doesn't mean that we remind the medics of their ABCs and try and push our knowledge on them; it means that we do our job so they can do theirs. Medics shouldn't have to tell anyone to control bleeding, perform compressions, have an IV hung and spiked with flushes set up, set up EKGs, or ventilating a pt; these are jobs for basics. We don't save lives, we help medics save lives, neither of whom can do so without the other.


This isn't so bad...not anywhere near completely right, but not completely wrong either.  It's a start, and probably the most acccurate thing to come from an EMT-B in this thread so far.

A Basic isn't useless...it's just that the bring extremely little to the table, especially when they have never worked with a paramedic before.  In all honesty, ask yourself, if you were alone with a patient that needed ALS care, what could you do for them?  Answer:  next to nothing.  While Basic's can assist on calls, they shouldn't be in charge, and shouldn't be taking patients on their own except in very controlled circumstances; your broken leg scenario proves that.  

The amount of education that goes into learning to be an EMT-B is so minimal it's laughable; if you continue on to a higher level this will become more and more clear to you.  The problem is that the majority of basic's don't know this, aren't willing to admit it, aren't willing to admit that they cannot adequately care for most patients, or all of the above.  And when this get's pointed out they automatically get defensive about it.

Basic's can have a role in EMS (and I don't mean transfers to/from a Dr's appointment; that's not EMS) but it's a very small role that, in the vast, vast majority of cases will be that of an assistant, not a primary care giver.  Until the educational standards change, that's all that's appropriate.  Unfortunately, the culture we have is one that allows, and even encourages people to think otherwise.



Littlebit said:


> If EMT B's are uneducated then maybe the Department of Public Health EMS should be notified.
> At any rate:  it may be an entry point and maybe its all that EMS individual wants.  Not everyone wants to be educated to the fullest extent possible- thats why there are different levels out there.
> No matter what a person's education level is they are deserve respect until proven otherwise.
> EMT-PS


Department of Public Health EMS?  Do you even know who sets the standards for EMS education and enforces it?  And I'm not talking about at the local level.  A bit more education for you is in order I think.

If someone doesn't want to know how to appropriately care for their patients then they shouldn't be in this profession.  And you can't do that as an EMT-B.  End of story.  Far as respect goes...everyone get's treated appropriately until they do something to change that, but's that not respect.  You want my respect?  Earn it.


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## Littlebit (Jun 16, 2008)

"Basics should continue to get thier education and not stop at cert and call it a career...if you want my respect."
Can you clairfy- does this mean unless they are certified at your level they don't have your respect?  I hope I am reading it wrong.  What gets my dander up and makes me respond to this post is way it is presented.  
We've probably all had experiences in our life in which an individual in a position of authority is disrespectful just because of thier position or level of education.  If you have a higher level of certification that is an opportunity to encourage and teach.  
If I work with an individual who does an exceptional job or displays the potential to advance thier education I will encourage however there are individuals who do not have the potential to advance- that does not mean I have less respect for them.


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## Jeremy89 (Jun 16, 2008)

phunguy said:


> Wow... I feel lucky here in Arizona. All the paramedics I have met actually respect us BLS types. We work together and everyone is there for the patient care. A EMT-b can not start the paramedic program until they have 1 year of service under thier belt. So maybe the respected attitudes come from being in the basics shoes at one point. Maybe some others who never did BLS and jumped right to medic should try this approach...



Not sure if you're referring to a specific company/FD but where I went, you could go straight to Medic school from Basic...


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## Flight-LP (Jun 16, 2008)

Whoops, wrong thread................nevermind


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## mikeylikesit (Jun 16, 2008)

Littlebit said:


> "Basics should continue to get thier education and not stop at cert and call it a career...if you want my respect."
> Can you clairfy- does this mean unless they are certified at your level they don't have your respect? I hope I am reading it wrong. What gets my dander up and makes me respond to this post is way it is presented.
> We've probably all had experiences in our life in which an individual in a position of authority is disrespectful just because of thier position or level of education. If you have a higher level of certification that is an opportunity to encourage and teach.
> If I work with an individual who does an exceptional job or displays the potential to advance their education I will encourage however there are individuals who do not have the potential to advance- that does not mean I have less respect for them.


Not my level just enough continuing education that is not required just to keep their cert up, I'm talking like A&P IV ECG things that show that they have some interest in furthering their knowledge.


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## Clibby (Jun 16, 2008)

Flight-LP said:


> Yet again, another EMT-B attempting, unsuccessfully, to justify their position. I'm sorry and please do not take this personally, but your examples, especially the "broken bone" one, are completely incorrect. Two words, PAIN MANAGEMENT. I don't care if the ER is pissing distance away, the patient deserves comfort. Preference being in the medicinal form, an act that a BLS provider again cannot provide.



Really? Then why are they BLS calls in every district in the state where I live? Medics don't grow on trees, which is what I think you guys don't get. (And please don't take that personally) They are needed on the trucks running the ALS calls. Would I rather have one on those types of calls? Yes, absolutely, they can make the patient feel better and there should be one in every 911 truck in a perfect world. But on the same note, would I want to have our only medic for the night tied up with a broken arm when a call for chest pain comes out. Now we have to wait 20 min for mutual aid or if we are running a BLS truck, we can tone for a medic who won't be on scene before we are long gone. All so a broken arm feels better. Its about prioritizing with limited resources. Again, I would love to have a medic for every call, and that's what we do during the day, but we don't have the personnel to do so. There are about 4 basics for every medic where I live. It would be fantastic if everyone could be medics, but they just aren't. Saying they should be doesn't do anything for the next call. You have to do the best you can with what you have until things change. 



> But that is not what bothers me.................
> 
> Just as Rid mentioned, the overall system is broke. Experience prior to entering medic school paves the way for horrible habits. Like having the belief its o.k. for a medic to walk away from a cardiac arrest patient and go to the truck to set up his intubation equipment instead of being prepared in the first place. Not to mention that intubation is the LAST think you should be worrying about during a code. Sounds like a half arsed C.F. to me, yet when you typed it, I bet you had no idea that it was remotely incorrect. Right?




Maybe I didn't explain it correctly. We responded to a difficulty breathing and the officer on scene said he was on a cannula and would most likely need to be transported. We had no reason to believe it was anything worse especially when the officer on scene told us everything seemed fine. When we saw him he was cyanotic, still breathing but was getting worse, and alert to verbal. There really isn't much a medic can do in a crowded room when he was on the couch. In the time it takes for him to run to the truck for a bag of meds and the monitor, we can have him in the truck and then transporting 20 sec later. Should he have had his bag? Yes he should have, but he was givin information that made it seem like he just needed the ALS bag, not the Med bag. He wasn't going to start an IV on him on scene or intubate someone who was still breathing at 6 respiration per minute anyway. Also for clarification, he was intubated because the airway could not be maintained with the OPA and his breathing got worse to the point where it stopped entirely in the truck. He had a pulse when he was put in the ambulance and it fell when he went into shock. He was not coding on scene, but  his heart slowly failed from when we started the EKG. I looked over the EKG today and apparently it wasn't full arrest; he just had very low electrical activity and it looked like arrest to us at the time. We were going to push the atropine, it was actually already assembled, but his EKG and HR improved enough with just O2 that it was unnecessary. (When I say improved, I mean that when we were at the hospital he was back to being responsive to verbal and kept motioning to get the tube out.) The medic is one of the few I have worked with who knows exactly what he is doing all the time, and I have alot of respect for him. I just don't ask questions of a medic who has been doing this for 28y in the middle of a true emergency call. He knows his stuff and is very good at what he does. If you would like to read the call step by step, I can type it up, but it was just meant as an example of the things a basic can do for a medic.




> YA Basic isn't useless...it's just that the bring extremely little to the table, especially when they have never worked with a paramedic before. In all honesty, ask yourself, if you were alone with a patient that needed ALS care, what could you do for them? Answer: next to nothing. While Basic's can assist on calls, they shouldn't be in charge, and shouldn't be taking patients on their own except in very controlled circumstances; your broken leg scenario proves that.



I don't disagree with a word you have said. Basics can cannot do anything, really. Its frustrating, annoying, and for the most part its just a tease for those who are hoping to go on to medic school. (Especially those like me who will be starting medical school next semester^_^) Also basics should never be in charge if there is a paramedic available. That would just be backwards and I don't even see how that is possible. The only BLS calls that we send are either calls when ALS is unavailable, or when the call is dispatched as being a basic call, which there are very few of. We don't like having BLS trucks, but we also don't  have the resources or medics around to run ALS all the time on two trucks at night. 



> The amount of education that goes into learning to be an EMT-B is so minimal it's laughable; if you continue on to a higher level this will become more and more clear to you. The problem is that the majority of basic's don't know this, aren't willing to admit it, aren't willing to admit that they cannot adequately care for most patients, or all of the above. And when this get's pointed out they automatically get defensive about it.



Again, I know, I know, I know! My state is actually trying to get rid of EMT-I and make the requirements for EMT-B higher so we can run IVs, intubate, and push some more meds; but then again we have been hearing this for years and it still won't be enough. (But that's what is great about the field, nothing is ever enough, and I mean that in a good way. We constantly better ourselves in the field or in con-ed. We try to do more and more, but its never enough for me at least.) To be honest, I learned more first aid and emergency response as an Eagle Scout than in EMT-B class, which has helped me in the field. If someone cannot see how little we can do then they have never worked with ALS or on a true emergency.

The reason I am saying all this in our defense is that I've worked with medics before who brush off basics on calls as if they can't do anything. They can do things for the medic, a whole lot at that and we want to otherwise we wouldn't be there. (I work volunteer) They're not hard to do and to be honest it doesn't require much training other knowing how things work. *The good basics are the ones who know their medic and know their truck more then anything. When a medic asks for something and you don't know where it is, guess what, you fail and your off the truck. The medic might as well have a FF with him.*

Like I said before, basics do their job so medics don't have to worry about the little things. We know its not that much to do, hell  a 12 yo can do it, but they are necessary. So when a medic doesn't think we can check glucose or ventilate with a BVM, it is disrespectful to us. That is why many of us get defensive; most of us are more intelligent than most 12 year olds. That's why we are there; use us! You have more important things to do.


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## Flight-LP (Jun 17, 2008)

Clibby said:


> Really? Then why are they BLS calls in every district in the state where I live?



Because your state, or more specifically its EMS services, are doing it wrong!






Clibby said:


> Maybe I didn't explain it correctly. We responded to a difficulty breathing and the officer on scene said he was on a cannula and would most likely need to be transported. We had no reason to believe it was anything worse especially when the officer on scene told us everything seemed fine. When we saw him he was cyanotic, still breathing but was getting worse, and alert to verbal. There really isn't much a medic can do in a crowded room when he was on the couch. In the time it takes for him to run to the truck for a bag of meds and the monitor, we can have him in the truck and then transporting 20 sec later. Should he have had his bag? Yes he should have, but he was givin information that made it seem like he just needed the ALS bag, not the Med bag. He wasn't going to start an IV on him on scene or intubate someone who was still breathing at 6 respiration per minute anyway. Also for clarification, he was intubated because the airway could not be maintained with the OPA and his breathing got worse to the point where it stopped entirely in the truck. He had a pulse when he was put in the ambulance and it fell when he went into shock. He was not coding on scene, but  his heart slowly failed from when we started the EKG. I looked over the EKG today and apparently it wasn't full arrest; he just had very low electrical activity and it looked like arrest to us at the time. We were going to push the atropine, it was actually already assembled, but his EKG and HR improved enough with just O2 that it was unnecessary. (When I say improved, I mean that when we were at the hospital he was back to being responsive to verbal and kept motioning to get the tube out.) The medic is one of the few I have worked with who knows exactly what he is doing all the time, and I have alot of respect for him. I just don't ask questions of a medic who has been doing this for 28y in the middle of a true emergency call. He knows his stuff and is very good at what he does. If you would like to read the call step by step, I can type it up, but it was just meant as an example of the things a basic can do for a medic.



I still don't think you are explaining it well, I am actually more confused now. "looked over the EKG today and apparently it wasn't a full arrest". Are you kidding me?!?!? It either is or is not a cardiopulmonary arrest and the EKG has ZERO to do with it. Did your patient have a pulse or not? There lies your answer.

"He wasn't going to start an IV on him on scene or intubate someone who was still breathing at 6 respiration per minute anyway". "he was intubated because the airway could not be maintained with the OPA and his breathing got worse to the point where it stopped entirely in the truck" "but his EKG and HR improved enough with just O2 that it was unnecessary"................ So he did need to be intubated after all! 

Sorry but your example has no relevence on this thread. It only proves the deficiency described in your partner. Bottom line is your medic was lazy and complacent and instead of relying on his own objective assessment, took the word of someone else with minimal (if any???) medical training. And it bit him in the arse.............. 





Clibby said:


> Again, I know, I know, I know! My state is actually trying to get rid of EMT-I and make the requirements for EMT-B higher so we can run IVs, intubate, and push some more meds



This has been beaten to death already. If the current educational system is piss poor (which you agreed with), then why on earth would any educated person allow an EMT-B to start an IV, intubate, or even look at medication. Heck, most Paramedics couldn't tell you a thing about pharmacology at a cellular level, so do you honestly think that you as an EMT could? Not a chance.

Believe it or not, you can meet higher requirements and do all of these thing. In all 50 states. Its called becoming a Paramedic.



Clibby said:


> So when a medic doesn't think we can check glucose or ventilate with a BVM, it is disrespectful to us.



Considering you didn't with your patient in respiratory failure, it brings questions and doubts.............

Sorry to pi$$ in your Wheaties, but enough is enough. You do not have a leg to stand on with this topic. Nothing more really needs to be said. 

God, I have a headache now....................................

Goodnight all, keep it safe!


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## Amill (Jun 17, 2008)

I believe it is good for someone to gain some experience as a basic before getting their 2 year paramedic degree.  I would want to make sure it was the field I wished to be in before I get the degree and decide I couldn't handle it or burn out quickly.  But I definitely don't see EMT-B as a career or the level we should all stay at.  We definitely need to keep expanding our skills and knowledge and continue towards a paramedic degree.

I'm also betting that most providers don't see the need to make every rig an ALS rig.  Now I know we're supposed to always error on the patient but I doubt hospitals, private companies, and fire departments always think that way.  Even on what seem to be simple calls that don't need ALS skills, the knowledge of paramedics should always be preferred over basics....But ALS costs more than BLS, and companies don't like to waste money when they don't feel they need to.  Basics are cheap and easily dispensable.


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## mycrofft (Jun 17, 2008)

Ridryder911 said:


> Are you certain that they do not need that EKG? Really, what if they had a history of vertigo prior to fall? Ever heard of Sick Sinus Syndrome? IV's.. pain med.'s.. Really, you maybe a tough one but Granny might like that analgesic for a comminuted fracture, and yes I am sure they would like it IV in lieu of I.M..... yes, even just 3' in height. Again, the reason why ALS should be on each every call to assess and treat. The reason many basics assume calls are so simple, is because they have not been taught it might NOT be as simplistic as it seems...
> 
> R/r 911



Oh, excremento, I'm stepping right into it, but my first post was sort of about this so let me throw in my perspective from the 'long time at it' RN and former street and military EMT perspective:
1. In the Beginning, the EMT was created by the NHTSA, and it was good. (That's right, boys and girls, the pedigree is from the Department of Transportation, not Health, and contracting with America's ORTHOPAEDIC surgeons, not internists, to write the text) the accent was upon the survival of MVA victims despite primitive means of extrication, non-treatment, and a paucity of dedicated Emergency "rooms".
2.  Seeing as how the EMT was alone, and due to crying and haranguing by the medical profession, the EMT was split in twain: EMT-A (ambulance), and EMT-P (paramedic). And it was good.
3. The State of California, and other entities, immediately created nationally unrecognized subvarieties such as "EMT-IV"; as the NAEMT was in its infancy and had no teeth, as infants are wont to lack, this sort of unseemly administrative gerrymandering created a plethora of titles with lots of varying duties, enabling employers to finely shave their personnel budgets and keep EMS providers divided.

 Bad or nonexistent first aid does much more harm than an EMS response does good (e.g., a bad first aider can kill your patient, which is why they were taught to refer to their subjects as "victims", not "patients"). Most MI's resulting in the actual need for EMS response result in death, whether it is in the living room you walk into, or a week later in the ICU. Absolute airway embarassment will cause brain damage before you can arrive in most cases. We aren't God, and we aren't a hospital; we will hit the wall running full tilt to do what we can and learn/do whatever will make a difference, but waving letters after your name lacks humility before these facts and makes us look like the three stooges trying to pull rank on each other based on seniority. Shaving the apple to see who has the most appeal and trying to construct a hierarchy/family tree is a fool's errand, your local medical and EMS culture will have its own. We have to be a team. FONT]


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## mycrofft (Jun 17, 2008)

*Holding my nose and jumping in...*

Mea culpa, press on...


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## WuLabsWuTecH (Jun 17, 2008)

Is the EMT-B a watered down course?  From what I have deemed so far, yes!  It is a far cry from the Biology Classes i take in college (studying premedicine and Biomedical Engineering) and some things they teach are flat out wrong, but will work for the purposes of an EMT-B or sometimes even paramedic.

What I do believe is that EMT-B's are still critical componts of the EMS system.  In my area, every single fire department run by the city of more than 700k and most (>95%) of the 1.7 million people in the metro area are covered solely by Fire Departments that have personnel trained as a FF/EMT-P.  I find this to be a crude waste of resources.  Of the 1600+ firefighers that work just for the city departments, there is absolutely NO NEED for all of them to be trained to that level.  while i agree that an ALS unit in each district is something worthwhile if it is affordable for the city, making EVERY unit an ALS unit is a waste of money.  Personally I like the 2 EMT-P/EMT-B trucks per station combination as it provides you with the ability to run 2 EMT-P's for those tougher calls, and otherwise run 1 of each during a routine call.

Being a realist, I realize that in the more rural areas, a tiered system works better as most calls can be handled by Basics and I'd rather have a basic at my doorstep in 5 minutes starting to assess vitals and take immediate interventions with ALS backup on the way in 15-20 minutes than to wait 15-20 for the ALS unit to get here with no treatment until then and them having to start at square 1 when they do get here.

(Disclaimer, those numbers ar ewhat I have heard in school for response times and are just used as an example.  Sinec I live in the suburbs, our district's average response time is 3 minutes and the city's is 4 minutes)

Lastly, Rid mentioned earlier that EMT-B's are more or less just providing First Aid.  This I HAVE to respectfully disagree with.  When was the last time a first aid class taught you how to deliver a baby?  Contraindications of giving nitro or epi?  Identifying head trauma and holding a C-spine and securing the head onto a backboard?  Use a CPAP machine?

Would you like me to obtain a history while you start assessing the patient?  Take some vitals maybe?  Setup the IV for you?  Attach the leads to your EKG?  Intubate the patient while you're getting the drugs ready?  Provide CPR while you prep your cardiac drugs?  (Do realize that they are teaching compressions only CPR to laypersons now!)  Take a glucose reading?

Would a FR be able to do all of this?  No!  But do you really need another Paramedic to do this?  No!  I feel if used properly, Basics can really be an asset and provide not only ASSESSMENT but TREATMENT to patients in greater care than an FR


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## Clibby (Jun 17, 2008)

> Because your state, or more specifically its EMS services, are doing it wrong!


What's your suggestion? You have 5 basics and one medic on your night shift, you don't need to use them all. There are no other medics who can work nights, but two have their radios in town (hopefully on). Mutual assist is 13 min away to one side of town and about 15 from the other side. You try and hire more medics but the private companies steal a lot of them. We could pay the medics even more, but then we have to get more money to pay for them. Training more is cheating because it just doesn't happen at the rate of EMT-B. I'm all ears!!!



Flight-LP said:


> I still don't think you are explaining it well, I am actually more confused now. "looked over the EKG today and apparently it wasn't a full arrest". Are you kidding me?!?!? It either is or is not a cardiopulmonary arrest and the EKG has ZERO to do with it. Did your patient have a pulse or not? There lies your answer.



On scene, yes he had a pulse and he was breathing. In the truck, he started with one and it fell to no pulse and he stopped breathing. His bp and hr dropped too low to feel a carotid pulse, but the monitor showed severe bradycardia mistaken for artifacts (looks very similar to asystole in a moving truck, but has beats when the truck stops) which sped up as he was ventilated. IDK if the medic knew or not, but I thought it was asystole for awhile. What I mean is that his heart never actually stopped, but we lost his pulse. I had never seen a pt come back like that before without meds nor did we have the time to figure out why he went into respiratory arrest. 



> "He wasn't going to start an IV on him on scene or intubate someone who was still breathing at 6 respiration per minute anyway". "he was intubated because the airway could not be maintained with the OPA and his breathing got worse to the point where it stopped entirely in the truck" "but his EKG and HR improved enough with just O2 that it was unnecessary"................ So he did need to be intubated after all!



I never said he didn't, I just said that the medic wasn't going to do it in front of a panicked family especially when an OPA hadn't been inserted yet.



> Sorry but your example has no relevence on this thread. It only proves the deficiency described in your partner. Bottom line is your medic was lazy and complacent and instead of relying on his own objective assessment, took the word of someone else with minimal (if any???) medical training. And it bit him in the arse..............



First all police and FF are first reponders, the guy should have known better than to just NRB him. Second I don't see how he was lazy. The pt was in the truck with EKG lines, intubated, and was having an 1 IV inserted in less than 3min on scene instead of setting up flushes and holding a bag and doing all that was done in the truck in the living room with a panicked family in the way, then getting him in the truck. The truck 20 steps from the door has flushes set up, bags hung, the monitor, and most importantly no family.




> This has been beaten to death already. If the current educational system is piss poor (which you agreed with), then why on earth would any educated person allow an EMT-B to start an IV, intubate, or even look at medication. Heck, most Paramedics couldn't tell you a thing about pharmacology at a cellular level, so do you honestly think that you as an EMT could? Not a chance.



...well... the whole point of such a program is to educate them to a higher level with more training. Do you think they would just wake up one day and allow basics to intubate, push a few meds, start some IVs? Come on now; I hope they are a little smarter than that. If such a program ever does comes into existence it would have to involve more upgrade courses for current basics so they do know what they are doing. Those medics you speak of who don't know their stuff should take the course too. Many states still have extinct levels because people refuse to take the upgrade courses. I would think you would be all for more education, but now I'm just confused as to what you are looking for; obviously its not a solution.



> Believe it or not, you can meet higher requirements and do all of these thing. In all 50 states. Its called becoming a Paramedic.


I really don't think you get it. You point out the obvious without looking at the what we have. Not everyone can afford the $$$ or time for medic school which is why there are basics. Without them the field would lose more that half the workforce, and in my area they would lose more than 75%. Your argument is similar to saying R.N.s are not needed in a hospital; if they want to treat patients to the highest care and understand everything then they should become and M.D. or D.O. Granted the situation is different, but an EMT-B is sort of to a paramedic in a truck what a R.N. is to an M.D. in a trauma room. They assist so the paramedic can do the best job he can; they just operate at different levels.

For me medic school would just be a waste of time. In 4 years I will hopefully be an M.D. and I don't have the time in between to go to medic school.




> Considering you didn't with your patient in respiratory failure, it brings questions and doubts.............


 What do you mean, the OPA not working? Idk if it was because the pt was too large and the fat on his throat put too much pressure on his trachea or if the basic just wasn't ventilating correctly, but the pt wasn't getting the ventilation necessary. He was tubed and ventilated and it worked. (BTW that basic was fired from our volunteer organization today b/c he didn't know his stuff, so I wouldn't put it past him.)



> Sorry to pi$$ in your Wheaties, but enough is enough. You do not have a leg to stand on with this topic. Nothing more really needs to be said.
> 
> God, I have a headache now....................................
> 
> Goodnight all, keep it safe!


I agree I don't really feel like talking about it any more. Just know that I hate it when people question my intelligence without knowing me. I know my stuff, and I know more about how things work in the body than most people I work with. Just because I haven't trained as a paramedic doesn't mean I am incopetent nor does it mean I won't figure out how things work. Your tone is why so many basics get defensive and sometimes abrasive. To assume we are below you because we aren't paramedics is a paragod syndrome. We know you can treat pts, can interpret EKGs, push meds, and have had far more training in more areas than we do, but those of us who are intelligent can do our job assessing and assisting. I am very surprised to see this tone on this forum.

I hope your headache gets better.


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## daedalus (Jun 17, 2008)

As some of you may know, I recently made the switch over to 911. As an objective observation, I have so far not seen a single patient benefit from ALS level care. Im still very new mind you, but the only treatment I have thus far seen make any difference in a patient's condition was lots of oxygen. I do not argue that paramedics are needed for most 911 calls because of their "advanced assessment" skills. However, from my calls so far, the only thing the medics do is start an IV, and by the time I open it up for them, we are always already in the hospital bay. 

If you as an EMT educate yourself in medical terminology, and read up on assessment, you will gain the respect of the ED doctors and nurses for sounding professional, taking accurate assessments, and writing good reports. The ability to put in airways, administer oxygen, use an AED, and know when a patient truly needs an ALS intervention that will make a difference before the hospital is all that you will need for most emergency calls. So what if a patient has sick sinus syndrome? What are you going to do in the 5-10 minute transport that will make this patients life better? Put in a pacemaker? Or push a drug that the hospital cannot? No. In fact, the EMT can diagnose brady or tachycardia. The doc can run the strip. Patient can get better. If anything I have found ALS slows down most calls.

Please don't confuse my post with a intent in saying EMTs do not need more education. I do not agree with that statement. Im saying a good EMT BLS provider is almost always, from my experience, all the patient needs. We need to push for more training. I also realize the important role of ALS level care. An EMT is NOT as educated as a paramedic. But thats no excuse to waist time in the field providing useless procedures, or saying that an EMT who has a good education cannot provide good prehospital care.


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## LE-EMT (Jun 17, 2008)

If the system is so broken why don't you/we fix it?????? what would it take to fix it?  I am sure there are many people here that don't want to fix it because I am sure they don't believe that it is broken or just don't want to/cant afford to up grade.  But seriously what would it take to fix this system that many don't believe is broken??  This is directed mainly to rid because well you are the who in almost every bls related post has not much to say other then they are in your mind useless.  I am paraphrasing sir not putting words in your mouth.  I don't disagree this is an objectionable question.  Any others feel free to answer but I want educated answers not nonsense.


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## Ridryder911 (Jun 17, 2008)

[





daedalus said:


> As some of you may know, I recently made the switch over to 911. As an objective observation, *I have so far not seen a single patient benefit from ALS* level care. *Im still very new* mind you, but the only treatment I have thus far seen make any difference in a patient's condition was lots of oxygen. I do not argue that paramedics are needed for most 911 calls because of their "advanced assessment" skills. However, from my calls so far, the only thing the medics do is start an IV, and by the time I open it up for them, we are always already in the hospital bay.
> 
> If you as an EMT educate yourself in medical terminology, and read up on assessment, you will gain the respect of the ED doctors and nurses for sounding professional, taking accurate assessments, and writing good reports. The ability to put in airways, administer oxygen, use an AED, and know when a patient truly needs an ALS intervention that will make a difference before the hospital is all that you will need for most emergency calls. So what if a patient has sick sinus syndrome? What are you going to do in the 5-10 minute transport that will make this patients life better? Put in a pacemaker? Or push a drug that the hospital cannot? No. In fact, the EMT can diagnose brady or tachycardia. The doc can run the strip. Patient can get better. If anything I have found ALS slows down most calls.
> 
> Please don't confuse my post with a intent in saying EMTs do not need more education. I do not agree with that statement. Im saying a good EMT BLS provider is almost always, from my experience, all the patient needs. We need to push for more training. I also realize the important role of ALS level care. An EMT is NOT as educated as a paramedic. But that's no excuse to waist time in the field providing useless procedures, or saying that an EMT who has a good education cannot provide good prehospital care.



I would attempt to argue with you, but it very obvious you do not have the knowledge or understand emergency medicine nor cardiology yet. Not to be condensining but really who are you to determine what is needed or not? What medical expertise can you even base to make such opinon as such? 

Just alike so many here believe their Basic Entry level couse automatically makes them eligible to know so much about emergency medicine, what is needed, what is not, on what & how things shoud be performed.. Wow ! A lot is offered in that 150 hour course.... So it must be the vast clinical exposure and in-depth praticum of clinical skills.. Oh.. What? You had how many clinicals?.. A week, two weeks... month.. a year? No? Oh, it must be all those areas you gained that knowledge in.. burn unit, surgery, pediatric ICU, CCU, Pysch hospitals.. No ? Wow!  Yet, you are able to inform a higher licensed person that does have such, on what should and how it should occur? ... See the irony? 

Yes such illness as Sinus Arrest (that occurs in Sick Sinus Syndrome) can be treated alike several hundred illnesses and injuries that can be performed and tx. in a Wal-Mart, a pasture, an EMS Unit, or that 3 million dollar CCU. Medicine is medicine. The same treatment is given for that Sick Sinus/ Arrest be it in the field, ER or CCU. External pacing takes about 30 seconds.. I use the same pads in the field, ER, ICU, CCU. Again the same for many things. 

What is the rush to get to a hospital? I do the same thing. Are you aware your chances of living from a code is better outside a hospital than inside one? .. The only reason people rush back to a hospital is for two reasons.. they don't know what to do.... or they know there is nothing else they can do.... 

Seriously, what authority does a Basic EMT even have to base an opinion on what ALS is, how it is performed? Remember in medicine there is no such thing. ALS = Medical Care with medicine, treatments & medical interventions. So, I ask are you able to be more informed than those with more education and those that have a higher licensed? You can determine what is appropriate care? Wow! That Basic EMT course must be one heck of a course.. And yet, the text is written at sixth grade level and all of the information is contained in one paper back book. 

I have not read where anyone called a basic any names, or even belittled except when they have made unrealistic even ignorant or potential dangerous opinions. 

Does anyone else notice that those that have a higher education, more experience and higher medical license usually have the same focus? Again, I use the analogy of what would one think of a nurse aide attempting to tell a RN with a DnSc or Nursing Professor all about nursing or what is appropriate nursing interventions. One would think it would be it be strange and not realistic.... the same could be said here and the EMS profession.  

Just FYI there are courses that teach C-Spine immobilization, delivering babies, even administering ASA.... it's called Basic First-Aid. Something ARC has been doing for decades. 

R/r 911


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## JPINFV (Jun 17, 2008)

LE-EMT said:


> If the system is so broken why don't you/we fix it?????? what would it take to fix it?  I am sure there are many people here that don't want to fix it because I am sure they don't believe that it is broken or just don't want to/cant afford to up grade.  But seriously what would it take to fix this system that many don't believe is broken??  This is directed mainly to rid because well you are the who in almost every bls related post has not much to say other then they are in your mind useless.  I am paraphrasing sir not putting words in your mouth.  I don't disagree this is an objectionable question.  Any others feel free to answer but I want educated answers not nonsense.



Why won't it be fixed any time soon? As you said it, it's not in some people's best interests. You can't make an omelet without cracking a few eggs. A good start would be requiring an actual degreed education and not this 9 months BS with a 10 day A/P course (Example!. 10 days, and claims to be "comprehensive"). EMS can't honestly expect respect in a field where just about every other major player has a real college education. Heck, the lab tech in the lab that's training me for my thesis has a BS and the procedures she follows doesn't even allow for deviation at all.

Who cares about the people who 'can't afford it?' I don't hear too much of an out cry for a 1 year physician program or 120 hour PA program because 'people can't afford it.' No, people take out loans just like every other student under the sun. 

Another reason it's not broken is because the public is just too ignorant of the profession. I have not talked to one person who was not shocked that I became a "paramedic" (Yes, I do clarify that I am an EMT-Basic and not a paramedic when this happens) with 120 hours of training. Of course they aren't exactly relieved when they learn that real paramedics still have less than a year of actual training with the prospect of no real education.  

Is the system broken? Sure. Unfortunately, half of EMS is suckling from the tit of an EMS system that allows mediocrity and ignorance to flourish more than France was scamming the Oil for Food program pre-Iraq war while the general has no clue what the requirements are in the first place. 

Seriously, how many people here have heard someone go, "AND you can do all that?" right after telling them how "long" an EMS course is?


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## mycrofft (Jun 17, 2008)

*Someone sorth the threads please*



JPINFV said:


> Why won't it be fixed any time soon? As you said it, it's not in some people's best interests. You can't make an omelet without cracking a few eggs. A good start would be requiring an actual degreed education and not this 9 months BS with a 10 day A/P course (Example!. 10 days, and claims to be "comprehensive"). EMS can't honestly expect respect in a field where just about every other major player has a real college education. Heck, the lab tech in the lab that's training me for my thesis has a BS and the procedures she follows doesn't even allow for deviation at all.
> 
> Who cares about the people who 'can't afford it?' I don't hear too much of an out cry for a 1 year physician program or 120 hour PA program because 'people can't afford it.' No, people take out loans just like every other student under the sun.
> 
> ...



 Rich discourse, spreading out into multiple channels. I'm hearing expostulation about the "structure" and heirarchy of EMS, appropriate measures, and still folks trying to climb on one anothers' shoulders.
To be brutally honest, given the pay rates versus cost of living for *field* EMS workers, the strict rules and constant exposure to top-down pressure as well as patient initiated complaints (initiating top-down pressure), you are going to have a field mostly composed of transients (newbies, med students, etc); firefighters; and a cadre of folks who have found their niche and will stay with EMS n matter what for emotional and personal reasons. Grocery workers with the teamsters make more money and may be getting better benefits. 

If you want to be taken seriously and make a contribution, learn as much as you can, show interest, know when to just listen, get a professional outlook and appearance, and remember that at each echelon of care the patient passes up through what poeple are looking for is concise information passage, not miraculous diagnoses and elegant treatment. As Mike Perry (and others) say, air in and out, blood around and around, all else is gravy; as my EMT instructure Lance said, "unless you have xray vision and a radiology certificate, it ain't a fractured tibia, fibula,etc, it's a 'broke leg'; 'broke' is 'broke', treat the break and get 'em in".


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## Ridryder911 (Jun 17, 2008)

LE-EMT said:


> If the system is so broken why don't you/we fix it?????? what would it take to fix it?  I am sure there are many people here that don't want to fix it because I am sure they don't believe that it is broken or just don't want to/cant afford to up grade.  But seriously what would it take to fix this system that many don't believe is broken??  This is directed mainly to rid because well you are the who in almost every bls related post has not much to say other then they are in your mind useless.  I am paraphrasing sir not putting words in your mouth.  I don't disagree this is an objectionable question.  Any others feel free to answer but I want educated answers not nonsense.




I am trying to. I work almost weekly with legislative, EMS educators, administrators, EMS medical directors. I speak at conventions attempting all to be aware of the problems.. as many has pointed out are quite unaware or do not have time, money or resources to change things.. and of of course some do not want to change, because salaries would have to increase, increase competition and accountability would occur. 

Why fix something, if it is was working to your advantage? 

Start at the beginning. Look at your instructor. Do they have a formal degree? Even maybe an associate? Okay.. how about experience? Okay, they became one because it was an easy moonlight job & one only has to take a 40 hour EMS Instructor Course.. Wow! 
Amazing, we require little 5 year old Johnny teacher/educator to have a Bachelor's Degree (preferred Master/Graduate) to teach a 5 year old to color within the lines, but to learn about life threatening injuries & illness... A person that attended a 2 week course (150 hours) and then a 1 week instructor course.. Bingo! They can teach! .. Now, think about that.. across the nation, most instructors have not a clue about adult education, very little about emergency medicine.. but they teach it? Worse you believed it!

Levels.. The only reason for multiple levels is an excuse for a Paramedic. Sorry, that is a fact! This level is almost, or can do similar, etc. Yadda, yadda.. B.S. Town & cities do not want to pay for the level, so the state invents titles/excuses. Amazing every nursing home has a RN, every hospital has at least one RN per floor & division.. Amazing they can find the money to pay for that... again unlike EMS, nursing focuses more on patient care and education... how sad. They joined forces with organizations to ensure that their profession will always be in demand, that patients will somehow have access to them. When was the last time you found a volunteer nurse position at a hospital? 

Again, it amazes me the arrogance that someone that barely knows the names of the bones in the body, (definitely not the names of the bone markings) that their anatomy course was a whopping 10 pages long.. to determine if a person is ill or not! Then to tell me that know they know when ALS is taking to long, needed, and or even how to perform and treat better!! That they would not even know pancreatitis if it bit them.. and definitely not aware that it is life threatening illness... yet, I am supposed to trust them to screen patients? C'mon what arrogance and how pompous! .. And they call us Paragods? When in fact, the EMT has very tiny amounts of training and assume they are aware of emergency medicine...that is simply dangerous.

We need to place the EMT's for what they are trained for. Medical first responder.. that's it. Sorry the lame excuses of "saving ALS for real stuff" is just that. Seriously, ER's are full with lame stuff all the time, and very often that so called lame is not really lame after all. The cramp in the leg, is diagnosed as a DVT, the nausea & vomiting is really an AMI or undiagnosed DM w/DKA. Then alike what was mentioned, analgesics/pain control. Really, how can someone say they are for patient care when they would allow a patient to suffer  in pain? How inhumane! You would actually rather have someone tolerate manipulation of a fracture for splinting and movement while bone ends ripping tissue and nerve endings rather than have someone administer pain control?.. Yep, that is a BLS call.. Ever had a fracture? Wanted something for pain? .. 

Again, there is no such thing in medicine as BLS or ALS. It is patient care. Only in EMS did have to invent such terminology because to make things so simple minded. You do not find treating an acute appendicitis, BLS perform this and ALS perform that.. No, you only find to do the following.. period. Again, only in EMS we continue to allow sub-standard care and actually feel good about ourselves. 

The mind set has to be increased from the first day of class of what limitations the EMT has, not so much what they can do. The encouragement of wanting to obtain a deeper more involved education to be able to deliver better and more proper care. Something that we are not apparently doing .. or EMT would be just a phase. Nearly everyone would be expanding their education level immediately. 

So why do we have so many excuses of not continuing? Simply; because we allow it. Some complain the costs, the time, the what-ever! What other profession (especially medical) costs so little, so little time is involved that can immediately get a job and perform? Why do EMT's feel that they do not need get a student loan, but can seem to find money for l/s for their vehicle? See something here?  Even manicurist that rubs and trims toenails goes to school longer than a EMT, more sadly event a beautician that cuts your hair usually goes longer in school that many Paramedics... Now, that's scary!

So what to do? 

Join a organization that is promoting EMS and increasing standards.. NAEMT, NEMSE, etc.. 
Local associations, demand better legislation for funding, increasing reimbursements, and demand increase level of care.. State wide. Instead of attempting to defend yourself recognize that you do not understand the system or patient care enough, but promote and educate yourself to realize there is a problem. (one cannot fix the problems, until one recognizes them)

Quit whining about what you can do and do the right thing. Go back to school and get an education to understand & know what and to how to treat appropriately..Anyone can do it. That is if it is a priority in their life. Don't allow excuses for poor care.. seriously, if you are a humanitarian enough one would not poor care. 

Basically get involved!


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## Alexakat (Jun 17, 2008)

JPINFV said:


> A good start would be requiring an actual degreed education and not this 9 months BS with a 10 day A/P course




I've said this before, but I strongly believe an EMT-B should be educated to  an associate's degree level & a paramedic should be educated to a bachelor's degree level!


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## mikeylikesit (Jun 17, 2008)

Alexakat said:


> I've said this before, but I strongly believe an EMT-B should be educated to an associate's degree level & a paramedic should be educated to a bachelor's degree level!


LOL you would spend more time on generals than you would the whole damn program.


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## Ridryder911 (Jun 17, 2008)

mikeylikesit said:


> LOL you would spend more time on generals than you would the whole damn program.



Yeah, what we could learn from all that reading and writing stuff!... Seriously, it is because the Paramedic does not have the general education they cannot understand most medical regime. 

One surely would not disagree being educated would be a bad thing would they? Or in other words it is okay to be ... ignorant? 

R/r 911


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## BossyCow (Jun 17, 2008)

It seems to me that the two camps on this discussion, as usual are addressing different issues. While I can understand and respect the frustration that a Medic feels when there are not enough Medics to adequately serve their response area and the EMTs are undertrained and/or unprofessional. I don't think any EMT-B here is going to say that ALL basics are highly professional in their appearance, training and skills. There are bad apples spoiling the barrel. 

On the other hand, to say that there is no need, ever in any situation for an EMT-B and that all of them should be replaced with Medics, is also inaccurate.
There is not one solution that will work for every district, agency and demographic. 

I do not believe that EMT-B's save Medics. I do not believe that all Medics need to be EMT-Bs first. But I also do not believe that all EMT-Bs need to be Medics. I think its perfectly acceptable to take pride in my role in EMS. I can get to a patient before ALS. By the time ALS arrives, the medic has a full set of vitals, an IV set up, the scene is controlled, a history has been taken, ABCs assessed and if needed, CPR in progress, Major bleeds controlled and a monitor in place. This doesn't replace ALS but certainly assists it.

Can all of that be done by a medic? Certainly it can, but why should my pt wait the 20 minutes that it takes for a medic to arrive before those interventions are begun? In many areas of the country, the understaffing of ALS units is a serious problem. Trashing EMT-Bs for stepping up to help mitigate the impact to patients is I believe, the wrong approach. 

I admit that some areas of the country and some agencies within my own area of practice seem to be against any sort of quality control or improvement. But I'm not sure that over regulation is the key to eliminating that. There will always be schlock agencies doing the minimum of what is required. 

I would love to see the EMT-B curriculum include A&P, Medical Terminology and a ton more clinical time, perhaps even a probationary period of assisting on calls before being fully certified. I paid for and took those classes myself because I wanted to know the information. I include that information in the classes I teach to the EMTs I am responsible for. I also do my fair share of hair pulling and ranting about the quality of EMT-Bs that my state gives permission to treat pts. But I do not believe that eliminating EMT-B is the solution. 

There are many reasons why someone may want to limit (yes folks, its a limitation) their certification to EMT-B. Understanding the priorities within our lives is not a character flaw. Part time employment doesn't mean that we are unable or incapable. The economic reality of some areas requires people to work more than one job. A family with children may have to work around a childcare schedule. Should we remove entry level or technical jobs from the job pool? All those currently doing those jobs can do what? Either upgrade to more '_professional_' careers or simply go on welfare? 

Assisting in the delivery of quality patient care is admirable. Respect of our fellow human beings, regardless of what they do for a living is simple courtesy. Elitism has no place in society and is not a prerequisite to personal pride or integrity. While we all have our ideas of what we would do if we ruled the world, fortunately for society, none of us do. In the meantime, can't we just treat each other with respect?


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## mikeylikesit (Jun 17, 2008)

Ridryder911 said:


> Yeah, what we could learn from all that reading and writing stuff!... Seriously, it is because the Paramedic does not have the general education they cannot understand most medical regime.
> 
> One surely would not disagree being educated would be a bad thing would they? Or in other words it is okay to be ... ignorant?
> 
> R/r 911


Hell no, I’m saying an associate’s degree for an EMT-B. 
I have a Bachelor in Paramedics like he stated above so that I can teach one day. Between the English Comp. Psychology, Sociology, Kinesiology, Microbiology, and all sorts of other good things I feel it helps a ton.


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## JPINFV (Jun 17, 2008)

mycrofft said:


> To be brutally honest, given the pay rates versus cost of living for *field* EMS workers, the strict rules and constant exposure to top-down pressure as well as patient initiated complaints (initiating top-down pressure),


Do you think nothing will change without disturbing the status quo? The strict rules, top down pressure, and lack of respect will not change on its own. Otherwise it would be like getting dessert before eating dinner.


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## daedalus (Jun 17, 2008)

Ridryder911 said:


> [
> 
> I would attempt to argue with you, but it very obvious you do not have the knowledge or understand emergency medicine nor cardiology yet. Not to be condensining but really who are you to determine what is needed or not? What medical expertise can you even base to make such opinon as such?
> 
> ...


Make no mistake Rid, I do not claim medical knowledge or authority from my Basic class. My Basic class was just that, Basic. What I am saying is that I have met some EMTs here that know a hell of a lot, and do a fantastic job in assessing their patients. I understand the need for ALS, and more to the point, actually riding out on 911 calls has caused me to change my opinion that a paramedic should always be in charge of patient care. Some, if not most, patients really don't need it (after checking out the patient, the paramedics frequently BLS the patient and get back into their squad and leave). Its a waste of ALS resources for the surrounding community. And I know more cardiology than you might think I do. And most of my knowledge comes from the traditional classroom. Try me.


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## Alexakat (Jun 17, 2008)

mikeylikesit said:


> LOL you would spend more time on generals than you would the whole damn program.



Which would be a good thing!

In a traditional BA or BS program, you take all the generals before you take the courses specific to your major anyway!  EMS professionals could greatly benefit from courses like technical writing, interpersonal communication, psychology, biology/chemistry, a foreign language (all usually considered "general education" requirements).

Then, the junior & senior year - A&P, pharmacology, pathophysiology, clinicals, ride time, etc.

And it would certainly help "professionalize" the profession!


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## mikeylikesit (Jun 17, 2008)

Alexakat said:


> Which would be a good thing!
> 
> In a traditional BA or BS program, you take all the generals before you take the courses specific to your major anyway! EMS professionals could greatly benefit from courses like technical writing, interpersonal communication, psychology, biology/chemistry, a foreign language (all usually considered "general education" requirements).
> 
> ...


Indeed it would. But like said most people can go through the 10 credit hour course and then take 50 credit hours of generals. By the time I was done with my medic schooling I had about 145 Credit hours...56 of which were didactic. I learned a ton of stuff from taking my generals that made me an overall better medic than most medics I know who just got the CERT.


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## VentMedic (Jun 17, 2008)

I was reply to another thread and referenced the Phlebotomy certification which at the national level, it is about 150 hours. 

This program popped up on a quick web search.  I also did a few more searches with similar results in other parts of the country.

https://www.terra.edu/PDFs/Lcc/Phlebotomy_Certificate_info_sheet_-_Semesters_12-17-07.pdf

EMT-Bs, notice the pre and co-requisites to do venipuncture as a phlebotomist.


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## mycrofft (Jun 17, 2008)

*Howdy JPIN et al*

I understand your question (although for things to change, literally the status quo would shift, by definition, no? 
1. Field emergency medical workers need not only to have a professional organization but also a recognized labor organization. As weak as nursing unions are (as opposed to, say, the UAW), I am thankful for mine daily when I see how unorganized healthcare workers are treated. 
2. I also think that there will always be a steady stream of young enthusiasts, winnowing down to a thinner stream of older workers who have found a niche, to keep up with demand as long as standards are kept low and educational requirements for paid companies as low.
3. Too damned many artificial types of field emergency medical workers. RN-dom has suffered because of the existence of certificate and degree nurses, field EMS workers have many more than that.
4. And quit kicking each other in the shins, will ya?
Sheesh!....


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## daedalus (Jun 17, 2008)

VentMedic said:


> I was reply to another thread and referenced the Phlebotomy certification which at the national level, it is about 150 hours.
> 
> This program popped up on a quick web search.  I also did a few more searches with similar results in other parts of the country.
> 
> ...


a few hours of anatomy? two hours of first aid? nice. B)


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## mikeylikesit (Jun 17, 2008)

daedalus said:


> a few hours of anatomy? two hours of first aid? nice. B)


Credit hours! full semesters.


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## Jon (Jun 17, 2008)

I think... scratch that.. I HOPE he's joking!


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## VentMedic (Jun 17, 2008)

daedalus said:


> a few hours of anatomy? two hours of first aid? nice. B)





mikeylikesit said:


> Credit hours! full semesters.



Exactly!

Look again daedalus.  That is almost two full semesters of college credits not the "hours" that EMS is unfortunately so familiar with.


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## Ridryder911 (Jun 17, 2008)

If it was two full semesters that is usually one year.. and to think some Basics complain of a two to three week course...


We need to clarify for those that not aware, college hours is *NOT* the same as clock hours...

R/r 911


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## daedalus (Jun 18, 2008)

In my state a few weeks course at an adult school is all one needs for a Phlebotomy card. I was not aware of "credit hours", my college uses "units", usually correlates to the number of hours each class contains.


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## daedalus (Jun 18, 2008)

"California Department of Health Services, Division of Laboratory Science, approved *42-hour program*"

And the pre reqs?
"Prerequisites: 18 years or older; speak, read, write English."

From the Phlebotomist class description, Simi Valley Adult School. http://www.simi.tec.ca.us/files/medprog.htm

Hardly comparable to a good EMT class


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## VentMedic (Jun 18, 2008)

daedalus said:


> "California Department of Health Services, Division of Laboratory Science, approved *42-hour program*"
> 
> And the pre reqs?
> "Prerequisites: 18 years or older; speak, read, write English."
> ...



You are still  trying to go for the lesser education by the numbers.  Your data is referring to yet another entry level into the world of phlebotomy.  Most phlebotomists move on past the "Limited" cert.  If not, that would be like staying at the First Responder level in EMS.  

Doing the math on this description of the program from the school you quoted, there are almost 42 hours even if the class met only 2 hours/week.  I would say that is not the case.  


> The course consists of a Basic 10-week class, an Advanced 7-week class and a two-week unpaid externship.



Did you also miss the 1040 hours of on the job experience in the California statutes when you did your research for phlebotomy?  

https://secure.cps.ca.gov/cltreg/Phlebotomy_Requirements.pdf


The 18 y/o and English speaking requirements are often the same prerequisites to enter many other educational programs in the United States.

BTW, the Phlebotomy Cert in California is a state certification and not the usual county to county mess for EMTs in that state.


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## Ridryder911 (Jun 18, 2008)

daedalus said:


> In my state a few weeks course at an adult school is all one needs for a Phlebotomy card. I was not aware of "credit hours", my college uses "units", usually correlates to the number of hours each class contains.



One better be used to college hours.. those are what are transferable. Sorry, clock hours usually does not represent upper level or formal education. 

Let's just face it. EMS is one of if not the easiest profession to enter and get through to get a job in.

R/r 911


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## JPINFV (Jun 18, 2008)

daedalus said:


> In my state a few weeks course at an adult school is all one needs for a Phlebotomy card. I was not aware of "credit hours", my college uses "units", usually correlates to the number of hours each class contains.



By correlates, do you mean correlates like a 4 unit class meets for 4 hours a week (at my undergrad, this generally meant 3 hours of lecture and 1 hour of discussion)?


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## daedalus (Jun 18, 2008)

JPINFV said:


> By correlates, do you mean correlates like a 4 unit class meets for 4 hours a week (at my undergrad, this generally meant 3 hours of lecture and 1 hour of discussion)?



Exactly, as my next Chem is 6 units I believe, 4 lecture and 2 laboratory, and is part of the "IGETC" which mandates transferability. 

Vent, I am not a supporter of hours of education. I am a supporter of college degrees. I do not contest the idea that I am under educated.


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## VentMedic (Jun 18, 2008)

College units and credit hours are essentially the same. 

One credit hour of college work is approximately three hours of lecture, study or laboratory work per week throughout a term of 16 weeks. Where a term is more or less than 16 weeks, more or less than one credit hour shall be allowed in the same ratio that the length of the term is to 16 weeks. 

Each unit of credit (credit hour) requires approximately 48 hours of student learning time. As a matter of standard higher education practice, in traditional academic disciplines (such as English, history, mathematics, etc.), it is expected that one third of these hours will occur in the classroom (lecture), and two-thirds of them will occur outside the classroom ("study" or homework). Thus, for a one unit academic course, the following hours would normally be expected: 

16 hours of classroom time
32 hours of homework
48 hours total student learning time

Many traditional academic courses award three units. The number of hours expected for such a course would be:

48 hours of classroom time
96 hours of homework
144 hours total student learning time

In the California Community College system, the number of hours per unit is often expressed as slightly higher than the figures I mentioned above. That is because, although the controlling regulation describes a 16-week semester, California finance laws require that California's semesters average 17.5 weeks rather than 16. 

Now, does anyone see why the degree system of learning is better designed for academic (and training) achievement than the "hours" system?  When one argues before legislators the amount of time a professional has spent in preparation for their profession, there is a measurable standard in the education world.  

Even if the EMS instructor says you should put in 3 hours of study for every hour of classroom, that still may not translate accurately since many of the hours listed in EMS are actual contact clinical hours.  Whereas, the units (credits) for clinic hours can be broken down in a method that still reflects hands-on and study time to compare with other similar programs.


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## mikeylikesit (Jun 18, 2008)

Ridryder911 said:


> Let's just face it. EMS is one of if not the easiest profession to enter and get through to get a job in.
> 
> R/r 911


Enter yes....get a job in as a basic.....hahaha. ^_^Like you always say rid when you're a dime or dozen type it is inherently more difficult to land a job in small areas anyways.


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## Lyss (Jun 18, 2008)

I don't know where most of you are from, but here BLS is essential.  I work with both an ALS and BLS crew.  And yes, its quite safe to say that I have made a difference in several people's lives.  Perhaps at times just as an extra pair of hands, but hey, it still counts and I've got the awards to prove it.  Whether the medics like to acknowledge it or not (I don't think most of them were hugged enough as children) we all make a difference.  Thats right, each and every one of us.  

When working for the BLS station (yes, its paid) I rarely call for a medic.  We only have one for the entire mountain-top area, and they're generally in a fly car.  There's not much I can't handle, MVAs, environmental issues, etc., and don't feel it necessary to take a medic out of service.  I've never had any complaints.

I'm quite happy being a BLS provider.  Would I like to upgrade?  Some day, but right now I'm focused on finishing college and getting my Master's.  Medic school is expensive, and I just don't have the time.  Also I'm in love with my job, no where near burned out, and don't really feel like becoming a medic and having to associate day after day with people who have their heads permanently lodged in their asses.  

So, even if at times we are just an extra pair of hands, we do help out and we do matter.  Just be thankful for those extra hands at times.  Because when we're gone, you'll be *****ing because we're not there.


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## Free-B-EMT (Jun 19, 2008)

*Fuel for the Fire*

There seems to be quite a few people with very strong and varying opinions on this subject. There was an independent study carried out in Canada over a 3 year period that addressed the patient's survivability when treated ALS vs. BLS in a prehospital setting. Try googleing OPALS Major Trauma Study to read the results. A lot of people may be surprised. You can also take the link below to see a full write up.

http://www.cmaj.ca/cgi/content/full/178/9/1141


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## JPINFV (Jun 19, 2008)

*Trauma? So what?*

Your point is? To be fair, any prehospital care might not decrease mortality rates of trauma patients either. 

http://www.ncbi.nlm.nih.gov/pubmed/8611068


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## Free-B-EMT (Jun 19, 2008)

The point is, and by the way it's not my point but the study's, is that it doesn't really seem to make a difference to the patient's outcome whether you are ALS or BLS in the long run. If we take it one step further, according to your link, all we need for the best patient care is a car.


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## VentMedic (Jun 19, 2008)

Free-B-EMT said:


> The point is, and by the way it's not my point but the study's, is that it doesn't really seem to make a difference to the patient's outcome whether you are ALS or BLS in the long run. If we take it one step further, according to your link, all we need for the best patient care is a car.



The other point that was also made in that study was the provider to have enough education to determine whether ALS or BLS *intervention *was needed.  It was not intended to mean ALS or BLS service or provider.  The study does not promote BLS *services* over ALS services, just the type of procedures done for the trauma patient.   You can not base the EMS system on some trauma calls when it is the providers education and training that should be deciding the level of care needed.  An ALS provider can always reduce the amount of ALS procedures they do.  A BLS provider can not step up to ALS procedures as needed. 

http://www.cmaj.ca/cgi/content/full/178/9/1141



> We believe that emergency medical services should carefully re-evaluate the indications for and application of prehospital advanced life-support measures for patients who have experienced major trauma.





> The relative effectiveness of community-based advanced life-support programs for major trauma patients has not been clearly established, and there have been calls for larger and more rigorously designed studies.


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## JPINFV (Jun 19, 2008)

Apparently it doesn't make a difference if your a private citizen or an EMT-Basic either. The simple fact is that there is very little that an ambulance can provide to most trauma patients outside of a ride anyways. On the other hand, what exactly can a basic do for a CHF patient suffering from pulmonary edema besides oxygen?  

Oh, by the way, you are making an argument and using the study as support for that argument. Otherwise you wouldn't be posting it.


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## BossyCow (Jun 19, 2008)

JPINFV said:


> what exactly can a basic do for a CHF patient suffering from pulmonary edema besides oxygen?



I'm thinking that having a basic provide oxygen is better than just a car ride. Sure its not going to be as good as ALS. I don't think anyone is going to say that ALS is not going to do more for a patient than BLS. But the point I repeatedly try to make is that in many areas, BLS is all they can afford or support. Statements like BLS is just a car-ride, are not accurate. 

That said, I'm going to go to my meeting, where I'm going to hear the sad news that I have just lost access to another ALS provider for my district. Tell me again about how ALS is the future!  Nice to know its so wonderful, now if I could just have it available to me!!!!!


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## Ridryder911 (Jun 19, 2008)

Free-B-EMT said:


> There seems to be quite a few people with very strong and varying opinions on this subject. There was an independent study carried out in Canada over a 3 year period that addressed the patient's survivability when treated ALS vs. BLS in a prehospital setting. Try googleing OPALS Major Trauma Study to read the results. A lot of people may be surprised. You can also take the link below to see a full write up.
> 
> http://www.cmaj.ca/cgi/content/full/178/9/1141



Everyone like to refer to Canada's OPAL study, that found to be heavily flawed. Although there were some good points, but over all really not informative and unrealistic. For example the primary recommendation was to correct measures was to have BLS within 4-8 minutes on every response.. Yeah, that will happen!.. 

This is why it is hardly used or recognized anymore... 

R/r 911


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## Ridryder911 (Jun 19, 2008)

This is really becoming humorous. Lower levels attempt to justify their existence, at the job they have. Now, describing how "advanced" does not do this or that.. again, take a deep breath and figure out there is no such thing as advanced life support; only patient care. Now, state that "there is no good in patient care".. doesn't sound right huh? ... 

No one is saying Basics should be done away with.. rather their job description and usage should be changed. What is amazing is everyone agrees that the educational level is piss poor but then they refuse to agree that should changed from those to that deliver primary care? This makes no sense.. Shooting out of both sides of the mouth. 

Why would EMT's be threatened to be a MFR?  I ask what advantages does running the so called "BLS" calls have for you? Why would anyone be defending a position of this? Is it the best for the patient or... just for you? 

I agree the Paramedic training is so inconsistent it is horrible, but appears to be much better than what I continue to read about the Basic courses that are being taught. For example one day of scenarios and usage of a stretcher & your qualified for what? ... Do you really even realize what points you are attempting to make? 

I ask if most felt that their education was adequate or difficult. or was it easy and not to hard or even a joke, read the numbers. Sorry, I have a problem that if one believes a 6'th grade level text is hard and as well if it is so easy, then apparently the material was not detailed enough. 

So let's propose this... a change in the material. Make the Basic Level at least 650 clock hours long with at least 150 clinical hours. All agree it was too short, not enough material, so increase it. Now .. what would be the problem? ... 

Bossy, your situation is not unique. All levels of EMS are closing due to poor funding. Even metro areas. What is going to have to change is the perception of EMS being not being a luxury that it is an essential service. Amazing, communities will have F.D.'s with haz-mat, thermal imaging, etc.. all nice but in comparison the EMS will run 75% more responses. No, it does not make sense... 

R/r 911


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## Lyss (Jun 19, 2008)

RidRyder... you make a hell of a lot of sense.  Want to come be my boss?  Mine is senseless.


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## BossyCow (Jun 19, 2008)

Rid, well, my fears were justified. I just left a meeting where I found out that I will only have ALS available from 8am to 8pm. After that time, a medic will be toned out from his/her home, go to the station to pick up a rig, then proceed to my critical pt. By that time, I will be pulling into the hospital parking lot with an ALS pt in a BLS rig. 

As to a name change, I could give a rat's patootie what lable they hang on my uniform. I just wish the discussion could take place without adjectives such as 'worthless', 'pointless' and 'ignorant' being applied to what I do. As long as the discussion takes place in that tone, nothing is going to be resolved and we will never work together to improve the whole of EMS. It shows a lack of professionalism on both sides when the issues can't be addressed without acrimony and insults. 

I too wish that EMS could be seen as essential service and funded as such. I believe it has to happen federally, because too many local districts, agencies and businesses have other agendas. My husband's ALS agency just doubled their response area and added around 40-60 additional calls per month without any increase in staff, pay or equipment. The ripple effect of this move was to eliminate ALS support availablity to the unicorporated areas of the county because it took those 40-60 calls per month away from a local private ambulance company. The city saves money, and the only cost is to the health and safety of my critical pts. But how can I compare that to the resume of the local city mangler(manager) who will show his future employers how he cut the budget to the city he used to work at? 

So, I'm working on my SAFER grant, working on a multiple scenario solution for my little rural fire district, preparing to face my board of commissioners who will in no way implement the movement of our agency into ALS and are forbidden by charter to authorize any charge for services. 

And oh yeah.. meetings, meetings, meetings..... where suits attending will discuss the impact, the financial repercussions, the liability issues, the required language changes to protocols, SOPs and district responsiblities.. and none of them will ever have to face the family of a critical pt. at 2am and tell them that we're going to do the best we can. Knowing full well, that it will not be enough.


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## JPINFV (Jun 19, 2008)

BossyCow said:


> Rid, well, my fears were justified. I just left a meeting where I found out that I will only have ALS available from 8am to 8pm. After that time, a medic will be toned out from his/her home, go to the station to pick up a rig, then proceed to my critical pt. By that time, I will be pulling into the hospital parking lot with an ALS pt in a BLS rig.



I know it's a tad off topic, but if they're running an on-call type service, why not just have the on-call medic take a fly car home?


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## Ridryder911 (Jun 19, 2008)

Bossy's predicament is an unusual & not unusual one. Her location is unique so the chances of becoming more advanced will always be hard. There is no right answer. AS well, her predicament in shortage of funding, employees, is not unusual from any EMS. 

As the costs of fuel increases, we will see shifts in operations to save money. This as well will ripple from those that live outside areas where employees no longer want to commute, and the operating costs to prohibit raises to offset costs. A viscous circle called recession. 

I wish I had the answer for you Bossy, but if I did , I doubt I be here on a forum. As I would be a much wealthier man not saving lives but business such as  EMS, hospitals, etc.. Unfortunately, those much smarter & wiser too are at a dilemma. Many EMS are having to   consolidate with other EMS services making districts or chance being placed into a Fire Service that only really wants them to be able keep the FTE they have. Both can have drastic measures. 

Until the public sees that we are an integral part of a healthcare system, nothing will change. Next to requiring education, marketing is one of the poorest areas we failed at. Unlike Fire Services projection of being hero's, we never have promoted ourselves enough and now it has bit us and we are paying for it. 

R/r 911


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## mycrofft (Jun 19, 2008)

*The missing ingredient is personal excellence.*

Example: we pull up on a scene where the driver of the car t-boned by a van is trapped by the firewall being curled up around his left foot by the lateral impact. (Yeah, that hard). I'm a former firefighter with rescue school, other firefighters on scene are extrication oriented, they're revving up the Jaws and the K-12 saw but don't see how they can be of use short of cutting the front off this early Sixties tank of a station wagon. My senior partner, an EMT-A with a tour in Nam with the Rangers, finishes splinting the driver's broken arm (while I moved his DOA wife out the other side), looks at the floorboard, opens his Buck knife, cuts the carpet and, voila, out comes the miraculously uninjured foot and, with it, our victim. He was excellent, we were not, despite our creds and experience; he was the better man.
Give me an experienced EMT-B who is good, versus a green and arrogant anything else, anyday.
(Ask me about the podiatrist at the accident scene sometime).


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## JPINFV (Jun 19, 2008)

mycrofft said:


> (Ask me about the podiatrist at the accident scene sometime).



Regardless, it doesn't matter. A podiatrist telling a medic what to do unless it involves feet would be like a paramedic telling a radiologist how to read a CT scan.


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## GeekMedic (Jun 19, 2008)

Ok, just so I can understand the issue with EMT-Bs, Don`t they have to be under medical control with in their agency?, What about the registration process?  Do the EMT-Bs have to do continuing education to keep thier certification?
  If there are such disreputable companies out there, why aren't they getting blacklisted, or put out of business by the state regulatory body?
 If you have state colleges, they should be pushing for increased training standards, registration standards, and a more relevant scope of practice.

I profess ignorance of the american system, please educate me.


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## CFRBryan347768 (Jun 19, 2008)

Their is no point what so ever to this thread any more, nothing more productive will come from this both sides have argued their point, and yet no happy median occured. And to the new members please read the previous pages before posting so you can atleast understand what the entire discussion was about, yes ALL 14 pages.


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## Ridryder911 (Jun 19, 2008)

mycrofft said:


> Example: we pull up on a scene where the driver of the car t-boned by a van is trapped by the firewall being curled up around his left foot by the lateral impact. (Yeah, that hard). I'm a former firefighter with rescue school, other firefighters on scene are extrication oriented, they're revving up the Jaws and the K-12 saw but don't see how they can be of use short of cutting the front off this early Sixties tank of a station wagon. My senior partner, an EMT-A with a tour in Nam with the Rangers, finishes splinting the driver's broken arm (while I moved his DOA wife out the other side), looks at the floorboard, opens his Buck knife, cuts the carpet and, voila, out comes the miraculously uninjured foot and, with it, our victim. He was excellent, we were not, despite our creds and experience; he was the better man.
> Give me an experienced EMT-B who is good, versus a green and arrogant anything else, anyday.
> (Ask me about the podiatrist at the accident scene sometime).



That is not in regard to any level, that is using common sense or as known now as "Critical Thinking Skills" to be able to think and rationalize outside and prioritize things more than just what was taught. 

CFRBryan is right, now people are posting just to post. Still nothing has been proven that as I described until EMT's has more education then they are still in comparison like a nurses aide. Until Paramedic education level increases nothing is going to change,  Don't expect to get professional recognition and pay until you meet professional standards. 

R/r 911


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## Jeremy89 (Jun 19, 2008)

With that being said, I move for forum closure.  Do I hear a second?


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## mycrofft (Jun 20, 2008)

*Seconded.*

---------------


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## mycrofft (Jun 20, 2008)

*Deep breath, not an argument, an anecdote.*



JPINFV said:


> Regardless, it doesn't matter. A podiatrist telling a medic what to do unless it involves feet would be like a paramedic telling a radiologist how to read a CT scan.



We were sent to a two car accident out in the sticks, fire dept was ther but no business, guy identifies himself as a doctor, says the girl in the red Mustang just bumped her head so he had her lie down in the back seat, then he drives off. She has a goose-egg on her forehead then says her posterior neck hurts. Instead of easing her out of the front seat , we had to weasle her out of the back seat of a 66 
Mustang. We heard the next day she had a cervical sprain, and he was a podiatrist.
Had to cut the Tony Lama boots off the other driver. He was crying, and it wasn't his ankle causing it.


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## Tincanfireman (Jun 20, 2008)

Interesting thread with many good, valid points. Now for my .02.  For the record, I'm an EMT-I 85, working full time at a fire department and part time with a 911 county EMS provider, putting me in EMS purgatory in this state. I can start lines, but little else above a basic level.  That said, I think -I's get a bit more respect for the simple reason that we have taken the initiative to increase our skill set, even if ever so slightly. -B is just that, a basic level to get you started, not the final destination for someone interested in EMS as a profession. I still think the hours spent in Intermediate class were well spent, because it gave me a new mindset regarding EMS. it opened my eyes to the possibilities of care beyond Basic, and it gave me a new curiousity about human physiology, anatomy, and the effects of injury and illness on the body.  Will I ever advance to Medic? Probably not, as I love my job in the fire department and cannot juggle the two for the amount of classroom and clinical time that medic would require.  I agree completely with Rid's often stated position that -B's need to understand that they must advance in their skills (and certifications) to grow in our chosen field, and also that Basic should be much more than a few dozen hours in a classroom.  We need to recognize that without the building blocks of A&P, medical terminology, biology and chemistry, Basic EMT will forever be considered little more than a good first aid course. Even in the fire service, recruit class involves building construction, fire science and behavior, a smattering of physics, and other topics totally unrelated to applying 2/1 mixtures of hydrogen and oxygen to rapidly carbonizing cellulose.  Anyone who is content to stand in the yard with a hoseline in their hands will have a career in the fire service that can be measures in weeks, if not days.  Accept your Basic patch with the understanding that it comes with an inherent challenge to learn and grow, and not to stagnate at the lowest level possible. To my brethren and sisters in the fire service; I'm certainly not tossing darts at you, we have a different role as firefighters first, and medical professionals second. However, if you desire even a part time position in EMS, I would hope that you take the time to advance beyond the -B level. I did, and it has paid off in ways I never imagined.


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## JPINFV (Jun 20, 2008)

mycrofft said:


> We were sent to a two car accident out in the sticks, fire dept was ther but no business, guy identifies himself as a doctor, says the girl in the red Mustang just bumped her head so he had her lie down in the back seat, then he drives off. She has a goose-egg on her forehead then says her posterior neck hurts. Instead of easing her out of the front seat , we had to weasle her out of the back seat of a 66
> Mustang. We heard the next day she had a cervical sprain, and he was a podiatrist.
> Had to cut the Tony Lama boots off the other driver. He was crying, and it wasn't his ankle causing it.



You just illustrated my point. A podiatrist instructing paramedics on the scene of a call (provided it isn't foot related) is about as stupid as a paramedic telling a radiologist how to interpret a CT scan.


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## JPINFV (Jun 20, 2008)

GeekMedic said:


> Ok, just so I can understand the issue with EMT-Bs, Don`t they have to be under medical control with in their agency?, What about the registration process?  Do the EMT-Bs have to do continuing education to keep thier certification?
> If there are such disreputable companies out there, why aren't they getting blacklisted, or put out of business by the state regulatory body?
> If you have state colleges, they should be pushing for increased training standards, registration standards, and a more relevant scope of practice.
> 
> I profess ignorance of the american system, please educate me.




The problem isn't necessarily the companies, but the structure. Sure, companies tend to hire on the cheap side and you get the "Requirements: cert and pulse. pulse optional" routine, but how the levels are structured enable that action. Yes, there's "medical control" (my area didn't have online medical control as an option to EMT-Basics) and yes there's CME requirements. Unfortunately, a lot of what counts for CMEs are embarrassing. When a CME ("Sick/Not Sick Patient Assessment) essentially dumbs down assessments to 'position, pulse, respirations, LOC, skin signs and if there's more in the sick column than in the not sick column, then your patient is serious,' it's a sure sign that the system is doing something drastically wrong. 

If you want a good illustration of the reading level (someone show this author "Conjunction Junction" of School House Rock fame) and level of understanding expected of EMT-Basics, see this column and the associated comments. http://www.jems.com/news_and_articles/columns/Edgerly/Lets_Talk_Shock.html Pay particular attention to comments 7 and the authors reply in comment 7.


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## daedalus (Jun 20, 2008)

JPINFV said:


> The problem isn't necessarily the companies, but the structure. Sure, companies tend to hire on the cheap side and you get the "Requirements: cert and pulse. pulse optional" routine, but how the levels are structured enable that action. Yes, there's "medical control" (my area didn't have online medical control as an option to EMT-Basics) and yes there's CME requirements. Unfortunately, a lot of what counts for CMEs are embarrassing. When a CME ("Sick/Not Sick Patient Assessment) essentially dumbs down assessments to 'position, pulse, respirations, LOC, skin signs and if there's more in the sick column than in the not sick column, then your patient is serious,' it's a sure sign that the system is doing something drastically wrong.
> 
> If you want a good illustration of the reading level (someone show this author "Conjunction Junction" of School House Rock fame) and level of understanding expected of EMT-Basics, see this column and the associated comments. http://www.jems.com/news_and_articles/columns/Edgerly/Lets_Talk_Shock.html Pay particular attention to comments 7 and the authors reply in comment 7.



The sad part is that I learned none of this in my Basic class, but this is on par with Mosby's paramedic text, Mosby seems to go into more detail but its negligible.


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## rmellish (Jun 20, 2008)

After reading 12 or so pages of this I think I'm ready to jump in. 

The whole Basics save paramedics is wishful thinking. I'm a basic in Indiana. I'm currently finishing clinicals for EMT-BA which is BLS + IV access and 3-5 lead ECG monitoring involving 7 very basic rhythms. IMHO, EMT-B should be the BA scope, *with further training.* Without IV access or any form of monitoring, EMT-Bs are really just glorified first aiders. 

Is a good, experienced and calm EMT-B an asset on scene? You bet. Should they be the standard of care? Hell no. In counties with limited ALS availability they work as first on scene responders who can perform a basic assessment on the patient, perform basic interventions, O2, simple adjuncts, maybe a NVA, AED, bandaging, splinting, etc. Package the patient, and possibly transport to reduce time to ALS. Should ALS be first response on every scene, yes, however that is more an issue of funding and politics, and not so much the responders themselves.


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## BossyCow (Jun 20, 2008)

JPINFV said:


> I know it's a tad off topic, but if they're running an on-call type service, why not just have the on-call medic take a fly car home?



They have decided that their bread and butter are the transports, not 911 response. A review of call volume showed that the best use of the available rig was for transporting pts the Civil ALS has downgraded to BLS. So, the only available rig will be BLS. This means that the rig will be in service at the station, and the medic will have to go to it. I asked if it were possible to have the medic respond directly to the scene, because we generally transport in our rig with their medic, but was told that the liability for a medic responding in the middle of the night, POV to an ALS call was cost prohibitive.


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## Free-B-EMT (Jun 20, 2008)

Rid,

I'm a volunteer EMT-B and I will agree with you 100% that the training is wholly inadequate for the job we are expected to do. Even though it goes beyond the 150 hours that you mention because of on-going education requirements, it is still severely lacking. I personally would love to be able to be trained to the Paramedic level but, as a volunteer, I just can't justify it financially. Thousands of dollars and thousands of hours are hard to come by when you are working full time, supporting a family and dealing with the rest of life just to give it all away at the end. So what is the answer? Raise the training level requirements of EMT-B to allow them to provide better care? That would be a workable solution as long as the State training funds for volunteers could support it, but I'm not sure that's possible. Drop the volunteer municipal BLS - paid regional ALS system that my area now uses and force all municipalities to implement their own ALS systems? I don't think this could be done without major tax increases. That is something that probably won't happen either since we already pay some of the highest property tax rates in the country. Or do we just keep going on, status quo, because there doesn't seem to be a good answer? It's a question that has been debated around here for a long time and so far no good answers. I would love for someone to come up with a better way, that is realistic, that could remove the whole question of who gives better care, ALS or BLS and bring us all to the same level. For now, it is what it is and we do the best we can with what we have.


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## Jeremy89 (Jun 20, 2008)

Tincanfireman said:


> Interesting thread with many good, valid points. Now for my .02.  For the record, I'm an EMT-I 85, working full time at a fire department and part time with a 911 county EMS provider, putting me in EMS purgatory in this state. I can start lines, but little else above a basic level.  That said, I think -I's get a bit more respect for the simple reason that we have taken the initiative to increase our skill set, even if ever so slightly. -B is just that, a basic level to get you started, not the final destination for someone interested in EMS as a profession. I still think the hours spent in Intermediate class were well spent, because it gave me a new mindset regarding EMS. it opened my eyes to the possibilities of care beyond Basic, and it gave me a new curiousity about human physiology, anatomy, and the effects of injury and illness on the body.  Will I ever advance to Medic? Probably not, as I love my job in the fire department and cannot juggle the two for the amount of classroom and clinical time that medic would require.  I agree completely with Rid's often stated position that -B's need to understand that they must advance in their skills (and certifications) to grow in our chosen field, and also that Basic should be much more than a few dozen hours in a classroom.  We need to recognize that without the building blocks of A&P, medical terminology, biology and chemistry, Basic EMT will forever be considered little more than a good first aid course. Even in the fire service, recruit class involves building construction, fire science and behavior, a smattering of physics, and other topics totally unrelated to applying 2/1 mixtures of hydrogen and oxygen to rapidly carbonizing cellulose.  Anyone who is content to stand in the yard with a hoseline in their hands will have a career in the fire service that can be measures in weeks, if not days.  Accept your Basic patch with the understanding that it comes with an inherent challenge to learn and grow, and not to stagnate at the lowest level possible. To my brethren and sisters in the fire service; I'm certainly not tossing darts at you, we have a different role as firefighters first, and medical professionals second. However, if you desire even a part time position in EMS, I would hope that you take the time to advance beyond the -B level. I did, and it has paid off in ways I never imagined.




See, I never really understood the I.  I'm just curious- If you're gonna go that far, why not go for the medic?


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## jfd347 (Jun 21, 2008)

Ridryder911 said:


> I'm sorry, you are not understanding the post. Again, in the U.S. the Basic CANNOT administer medications other than to assist, or simple med.'s such as the Epipen, NTG & ASA. If you are able to administer medications then *YOU ARE NOT PERFORMING BLS*, you are performing ALS (i.e advanced life support=medications, advanced airway, etc.). Sorry, you did not know the differential. I find that repulsive as well.
> 
> Being, better than anyone else.? You bet! I am better because I strive and study to be better. I never sat on my arse or had any   excuse not to progress upwards. Everyone has the chance if they *really* want to.
> 
> ...



Alright I was going to try and NOT get in on this because I am very opinated but you set me off.

I am an EMT-Basic in Indiana and under my protocol I can carry an Epipen in my back pocket and ADMINISTER it to anyone I see needs it. That doesn't mean I'm going to walk up to Joe-Schmo and nail him in the leg though. I know the signs and symptoms of anaphalaxis because of my MEDICAL training. Oh and what do yuo call oxygen? It's a medication. I can administer it. AND Activated charcol AND ASA. And all that is a BLS skill set.

I don't know where you are from for an EMT-Basic class to be 2 weeks long. Mine was 6 months 3 nights a week  and we did almost 100 clinical hours. I know that's nowhere near what a medic does but don't go telling me that I don't know what I'm doing. Yes on a scene you are better than me BUT with out a basic you wouldn't get to the scene. Ever medic I have worked doesn't know jack about where things are. Medics without basics are lost.

As for the "I'm better than you because I'm better trained" bull crap. Your cert is EMT-P mine is EMT-B. What are the same 3 letters? We all do the same thing. Why does a medic need to respond to most calls. Do you start an IV on EVERY run? Do you print an EKG strip EVERY run? Do you administer meds EVERY run? No. Most responses don't need a medic. I'll admit that some do. I've done a BLS response and called a medic before but they are not ALWAYS needed. Hell.... I've even done a few BLS codes. You know what?? I actually brought one of them back. I'd like to see a medic do that. The other codes I've worked with a medic we never brought the pt back.

Ok I'm done ranting for now.


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## VentMedic (Jun 21, 2008)

jfd347 said:


> Alright I was going to try and NOT get in on this because I am very opinated but you set me off.
> 
> I am an EMT-Basic in Indiana and under my protocol I can carry an Epipen in my back pocket and ADMINISTER it to anyone I see needs it. That doesn't mean I'm going to walk up to Joe-Schmo and nail him in the leg though. I know the signs and symptoms of anaphalaxis because of my MEDICAL training. Oh and what do yuo call oxygen? It's a medication. I can administer it. AND Activated charcol AND ASA. And all that is a BLS skill set.
> 
> ...



http://www.in.gov/dhs/files/emscertlevels.pdf

According to the Indiana statutes your class may not be the norm as far as EMT-B goes which states it as 144.5 hours.  Your state does have  a "plus" cert to add on which is still "hours" and "skills" without much solid education.

So, did you go straight through the "plus" course as well as the EMT-B?  Judging by the "skills" you listed I would say that is the case.  If so, that is not a fair comparison.  The EMT-B for your state is in line with many other states that require 150 hours or less. 

As far as the length of the class, 3 hours per night x 3 nights x 24 weeks is still only 216 hours.  The number 24 is used since there are holidays that must be taken into consideration.   At the standard EMT-B minimum for your state, 144.5 hours could be easily done in just a little over 3 weeks by most "mills".  There's probably as intensive class like that in your state. You can also stretch out any class based solely on "hours" to as many months you want to make it seem impressive but it is still "hours". 

To judge a call by just the number of procedures and meds pushed is a very good illustration that more education is needed to understand what and why procedures are being done and not because one can according to certification. There are times based on a Paremedic level of assessment that agressive treatment is not appropriate.  If this is your argument for your "skills" abilities, then you may have missed the what and why to clinical assesment and treatment.

Your statements about medic codes and BLS codes have left me speechless.  I have no words for your remarks.


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## JPINFV (Jun 21, 2008)

jfd347 said:


> I don't know where you are from for an EMT-Basic class to be 2 weeks long. Mine was 6 months 3 nights a week  and we did almost 100 clinical hours. I know that's nowhere near what a medic does but don't go telling me that I don't know what I'm doing. Yes on a scene you are better than me BUT with out a basic you wouldn't get to the scene. Ever medic I have worked doesn't know jack about where things are. Medics without basics are lost.



EMT-Basic, per NHTSA, is a 110 hour course. There are plenty of 2 week accelerated courses around the country (I can link one if you'd like) and they all get the same license as someone who takes 2 years to finish their basic. 


> As for the "I'm better than you because I'm better trained" bull crap. Your cert is EMT-P mine is EMT-B. What are the same 3 letters? We all do the same thing. Why does a medic need to respond to most calls. Do you start an IV on EVERY run? Do you print an EKG strip EVERY run? Do you administer meds EVERY run? No. Most responses don't need a medic. I'll admit that some do. I've done a BLS response and called a medic before but they are not ALWAYS needed. Hell.... I've even done a few BLS codes. You know what?? I actually brought one of them back. I'd like to see a medic do that. The other codes I've worked with a medic we never brought the pt back.



Every response requires a paramedic response because you don't know the severity of the call till you arrive. It makes zero medical sense to send someone who can later call for paramedics while doing minimal interventions. A medic should be on every call simply because of the increased education. Does an IV need to be started on every call? No. ECG? No. Heck, I'd even bet that you don't really need an EMT-B on most calls either. Why not just start sending MFRs to calls who can then, if need be, call for an EMT-B who then can, if need be, call a paramedic? That's absurd, especially when systems who value their residents could just send a paramedic in the first place. 

As far as codes? Congrats on using probably the worst metric for system efficacy possible. Just wondering, though, are you defining as "brought back" as "return of spontaneous circulation" or "survival to neurologically intact discharge?" Also, are we talking witnessed vs unwitnessed arrest? Bystander CPR?


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## mdtaylor (Jun 21, 2008)

JPINFV said:


> Every response requires a paramedic response because you don't know the severity of the call till you arrive.



Why don't we just create a new level? EMT-D sounds like the minimal necessity under your theory.


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## mikeylikesit (Jun 21, 2008)

mdtaylor said:


> Why don't we just create a new level? EMT-D sounds like the minimal necessity under your theory.


There is an EMT-D level. it stands for EMT Defibrillator. it is very common to see in NJ.


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## Ridryder911 (Jun 21, 2008)

jfd347 said:


> Alright I was going to try and NOT get in on this because I am very opinated but you set me off.
> 
> I am an EMT-Basic in Indiana and under my protocol I can carry an Epipen in my back pocket and ADMINISTER it to anyone I see needs it. That doesn't mean I'm going to walk up to Joe-Schmo and nail him in the leg though. I know the signs and symptoms of anaphalaxis because of my MEDICAL training. Oh and what do yuo call oxygen? It's a medication. I can administer it. AND Activated charcol AND ASA. And all that is a BLS skill set.
> 
> ...




That is all it is .....ranting. You did not prove any point. Again NO one here disclaimed the need of EMT's rather the education and responsibility level. God forbid, some one challenge the current systems that everyone agrees is failing. 

I almost find it humorous on some of the responses, thank you for responding. Usually such posts just point & proves my facts even more. Thank-you. 

Now, consider this. An RN still has to go through an extensive triage training program to be able to perform triage. In fact most prefer not to work the "tree'... because it is one of the most hardest and difficult positions. Determining that the N & V was really not an AMI or pancreatitis that can be lethal, or that so called abdominal pain that was no big deal was really an perforated bowel or incarnated hernia.. Now, really let's be serious. Do you really &honestly think that your 240 hour didactic course & those whopping 100 hour of clinical's trained you well enough? .. you, yourself is not aware what is currently required or is taught within your own local region, yet.. you acclaim to be knowledgeable about EMS? Again, what is partly wrong with EMS... assumptions is made, that everything and everyone else is the same or that their class was the best.. yet they have nothing to compare it to. My nutrition class alone was longer than that. Just to tell people on what to eat. As well check your state on the length to be a beautician and compare class hours ... I'll be awaiting your response. 

All those "medicines" that you described can be administered by the common laymen without any special training. That is why the EMT Basic can give them too. Seriously, within reason it is hard to screw up oxygen and ASA.. and Epi-Pen is no brainer. 

Now in regards to your save.. I am impressed. Do I doubt that they were in special circumstances yes.. and as well would you like to compare save rates? ... 

This has never attempted to be a measuring contest, rather an attempt to educate and enlighten & to recognize some of our problems in EMS. If you do not think there is a problem then that itself is a problem. Discussion with other EMT's their view of their EMT training almost all have agree that it was very lacking. 

Do we actually believe that the current curriculum is adequate enough and responsible enough to properly assess and treat those with acute illnesses and injuries. Then to be able to stabilize and continue treatment en route to the appropriate facility? 
Hopefully, we have discussed this to death as the answer is no. Again, it nothing personal but as a profession as a whole we to be unified enough to say enough is enough. Review the new curriculum, is there really that much difference for their to be a change so professional benefits can be achieved such as increased knowledge in patient care, or professionalism? What I have read and interpreted ... no. 

Does this mean we raise our arms up and surrender? Heck no! Again, part of our problem is we give up too easy and allow others to mandate for us. A little effort for a positive change can & could occur, *if* we all participated. 

If you are not currently supporting local & national organizations to support change, or working locally with local, state & federal regions, then you are part of the problem as well. 

R/r 911

p.s. Here is how you correctly spell anaphylaxis and charcoal, of course the word "you". Next time you are going to tell fellow peers on how smart you at least check your spelling.


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## mdtaylor (Jun 21, 2008)

mikeylikesit said:


> There is an EMT-D level. it stands for EMT Defibrillator. it is very common to see in NJ.



Well then let's not confuse the current levels of care.... make that EMT-MD.


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## JPINFV (Jun 21, 2008)

mdtaylor said:


> Well then let's not confuse the current levels of care.... make that EMT-MD.



Why? There's already EMS fellowships available to emergency medicine trained physicians.


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## Flight-LP (Jun 21, 2008)

jfd347 said:


> Alright I was going to try and NOT get in on this because I am very opinated but you set me off.
> 
> I am an EMT-Basic in Indiana and under my protocol I can carry an Epipen in my back pocket and ADMINISTER it to anyone I see needs it. That doesn't mean I'm going to walk up to Joe-Schmo and nail him in the leg though. I know the signs and symptoms of anaphalaxis because of my MEDICAL training. Oh and what do yuo call oxygen? It's a medication. I can administer it. AND Activated charcol AND ASA. And all that is a BLS skill set.
> 
> ...



For anyone out there who is still second guessing the pressing issue present, you just cleared up any and all confusion. Your post was the perfect epitomy of why there is a need for change. After 15+ pages of posts, you decide to puff your chest out and make some of the most ignorant statements I have read in recent times. Not only do your comments not hold water, a couple are flat out not true.

I'm so glad you are proud of your ability to administer an Epi pen, Oxygen, and Aspirin. Guess what???? So can any lay person, hell they are personally prescribed them. So what did that comment prove? Nothing!

You should be more sure of yourself before making assumptions. Not all Paramedics are EMT-P's. Some are Licensed. Some are Practitioners (predominantly outside of the U.S.).

Why does a medic need to respond on every call. Because everyone deserves a thorough and proficient assessment by someone with the ability to utilize some critical thought processes', not an attribute found routinely at the EMT-B level.

Just as the others are awed by the comment about codes, I for one will comment. You are so far wrong on every account. There are services in the U.S. that have a statistically significant survival rate. Now, I am not talking ROSC (which by the way, my agency's current rate is around 75%, not bad for an ALS system). I am referring to being discharged neurologically intact. The national average runs about 5%. Some agencies are achieving near 20% for all codes, not just the ones meeting Upstein criteria. ALL OF WHICH EMPLOY ALS PROCEDURES AND PROVIDERS. So sorry speedy, your wrong!

Don't let your passion for EMS cloud your better judgement, read before you post..........


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## Ridryder911 (Jun 21, 2008)

You know I would say to lock this thread, but in retrospect apparently there is still a lot of confusion. I have to say I have seen some that are beginning to understand that *none* of this is at a personal level. This is at a professional level within our system and the problems it is facing. 

Debate is good, being ignorant and throwing emotions into something before really making an *informed* decision is not. 

Again, what I have seen (and that is a lot) is pure unawareness and ignorance on what many people assume. I know I thought my first EMS instructor was great until I started learning more & more, then one day in an informal setting I really listened to what he said. How surprised I was to realize what a dufus he was! Did he have a stroke, was it Alzheimer's? Sadly, someone pointed out to me that he had always been stupid and that I had nothing to really compare him to so he came across as brilliant and well diverse. Earlier he could had said anything and I would had believed him.. !

Even those that have worked in the field for years still prescribe to what they were supposedly taught as correct and become chiseled into stone as "pure facts". After 31+ years in EMS, I have learned there is no such thing. Most of what we assume is an assumption based upon .._"this is they we always done it"_ mentality. Something many in EMS (i.e. Bledsoe) has attempted to remove. 

Many do not realize that the "older" EMT program was more in-depth and detailed. One learned types of fractures, more anatomy & physiology.. yes more but did not cover as many materials as needed now. Part of the problem, we watered it down to make "everyone" feel special. Something they (those that had the contract) felt that was lacking. They actually described people were "scared" of the equipment. Suggestions of  holding hands around the stretcher and touching each piece of equipment could lessen tension & anxiety.  I do wish I was joking...

So when many of us criticize the programs (again NOT the individual itself); we know what should be taught, what is NOT effective & what IS effective. Again, you have to be above to see below. 

Now, I as well believe before anyone makes flaming remarks one should at least attempt to consider the other side (yes, I have) and not remove doubts about your credibility by spouting erroneous comments.

R/r 911


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## daedalus (Jun 21, 2008)

Flight-LP said:


> For anyone out there who is still second guessing the pressing issue present, you just cleared up any and all confusion. Your post was the perfect epitomy of why there is a need for change. After 15+ pages of posts, you decide to puff your chest out and make some of the most ignorant statements I have read in recent times. Not only do your comments not hold water, a couple are flat out not true.
> 
> I'm so glad you are proud of your ability to administer an Epi pen, Oxygen, and Aspirin. Guess what???? So can any lay person, hell they are personally prescribed them. So what did that comment prove? Nothing!
> 
> ...



A little off topic, but after reading an article by Bryan Bledsoe, it seems that care for cardiac arrest will soon be "drugless" and defibrillation and good CPR will become the AHA guidelines for treating an arrest. This will come with the advent of induced hypothermia...It would be very interesting for me to see a comparison of ALS vs. BLS (w/ AED) codes with survival to neurologically intact discharge.  

It is very cool to see evidence based medicine show that some of the things we do in the field are not necessary of even beneficial to patient outcome. In the future, hopefully all 911 response will at least initially include paramedic response, although I still advocate for BLS as an acceptable level of care after a patient has been examined by the paramedic.


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## Ridryder911 (Jun 21, 2008)

Part of becoming educated is to understand the scientific process. As I have also been on the other hand reading great controversy of hypothermia induced resuscitation measures. That maybe we are not gathering enough data to even suggest changes. In fact some of the new literature suggests that simply it is too new and that not enough is known. 

As well alike anything else not all facilities will be equipped to perform such type of measures, if and after success occurs. 

Yes, it will be interesting to see the outcomes..and possible treatment changes. Yet, as one that has seen many, many, studies that was going to "be the one".. I will not hold my breath. Alike the saying: "_Remember the Alamo"_; I say :_remember Bretylium!_".. the drug that was going to stop all needless arrhythmias and convert v-fib.. yeah, still waiting.

That is why medicine is an endless shuffle of ideas and research.. continuously moving.. sometimes reverting to the original treatment... 

R/r 911


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## jfd347 (Jun 21, 2008)

Ridryder911 said:


> you, yourself is not aware what is currently required or is taught within your own local region, yet.. you acclaim to be knowledgeable about EMS?



First I do know what is required. It is a 120 hr course and about 16hrs clinical time. My instructor was a NAZI so we had to do much more.




Ridryder911 said:


> p.s. Here is how you correctly spell anaphylaxis and charcoal, of course the word "you". Next time you are going to tell fellow peers on how smart you at least check your spelling.



Second I'm sorry my fingers move faster than I think. I'm not perfect and I'm so glad you are. Please oh great master teach me to be perfect! And also I am new here so I'm still figureing out all the controls so the "spell check button" wasn't first priority on my list to find.


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## daedalus (Jun 21, 2008)

jfd347 said:


> First I do know what is required. It is a 120 hr course and about 16hrs clinical time. My instructor was a NAZI so we had to do much more.
> 
> 
> 
> ...


Fingers move faster than you think? Its not a good "quality" to have while providing medical care. In fact, it worries me. Jfd347, you may want to be careful insulting Rid/ryder. Your entire EMT program was probably the same amount of time Rid spent learning the histology of a blood vessel.


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## jfd347 (Jun 21, 2008)

daedalus said:


> Fingers move faster than you think? Its not a good "quality" to have while providing medical care. In fact, it worries me. Jfd347, you may want to be careful insulting Rid/ryder. Your entire EMT program was probably the same amount of time Rid spent learning the histology of a blood vessel.


I only have that problem typing. Providing pt care I do fine. 

As far as "insulting" rr... I don't really care. I don't care how much he knows. He doesn't have to treat emt's like that.


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## Littlebit (Jun 21, 2008)

Time to hop in again....
There are some highly educated trained individuals on this forum that I would be very relieved to see arrive if I were in need of ALS care, however, if I were a brand new EMT-B they would be the last person I would want to see - cause talk about bursting a bubble. 
This may be redundant but where I am from if it weren't for the volunteer EMT-B's we would not have anything.  
When I was an EMT-B I would ask questions of the ER staff if I felt I needed to understand more, I would look it up, and I read any and all articles related to EMS.  I"m sure others do the same.  In any profession learning more than is required is an asset. 
It's such a shame that some peoples arrogance comes before knowledge and causes other to percieve them that way.   In some of the posts I'm reading it seems that because a person stops at EMT-B they shouldn't be proud of what they have accomplished.  
On the squad I"m on we have 2 paramedics and the rest are EMT-B's and if the paramedics told the EMT-B's that they could do what a layperson can do I doubt if there would be any B's left.


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## Vizior (Jun 21, 2008)

jfd347 said:


> I only have that problem typing. Providing pt care I do fine.
> 
> As far as "insulting" rr... I don't really care. I don't care how much he knows. He doesn't have to treat emt's like that.



He's not treating emt's badly, he's insulting you because you came on here with an arrogant attitude and proved that you don't have any clue what you're talking about.  You just spewed the same argument as other emt's in triplicate.  

You're still not answering my question:  WHY, other than MONEY should we have EMT-Bs(and no paramedics) on a 9-1-1 ambulance?  

Let me guess... you cancel an ALS interface a lot, don't you?  Because you're too busy stroking your own stupid ego as opposed to worrying about patient care.  You've already proved it here:  


> "Yes on a scene you are better than me BUT with out a basic you wouldn't get to the scene. Ever medic I have worked doesn't know jack about where things are. Medics without basics are lost."



I'm STILL scratching my head at how you can POSSIBLY think that EMT-Bs have some kind of super awesome driving/navigating skills that make them irreplaceable on an ambulance.  


Guess what... you're whole argument is the same thing:  I already got one certification, there's no reason for me to learn anything else, what I do is good enough as it is.  If you think you're patients deserve the best care, go and get your paramedic.  If you can't afford it, get student loans.  If you're system is all volunteer BLS, work to change the system.


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## jfd347 (Jun 21, 2008)

Vizior said:


> He's not treating emt's badly, he's insulting you because you came on here with an arrogant attitude and proved that you don't have any clue what you're talking about.  You just spewed the same argument as other emt's in triplicate.
> 
> You're still not answering my question:  WHY, other than MONEY should we have EMT-Bs(and no paramedics) on a 9-1-1 ambulance?
> 
> ...



I never said there should not be medics. I worked for a company that regularly sends bls trucks on 911 calls. If I have a medic enroute already I never cancel. Sure I'll take the extra opinion on what's going on. I only cancel if it is an obvious BS run. Yes I came on arrogant and I have that flaw unfortunatly. I never said that we have super awsome skills but alot of medics have no clue how to get anywhere because all they do is ride shotgun. they never drive. Yes that was arrogant to say. You are right. I have one cert. I honestly don't want another. call it what you will but I have no real desire to be a medic.


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## ffemt8978 (Jun 21, 2008)

jfd347 said:


> I only have that problem typing. Providing pt care I do fine.
> 
> As far as "insulting" rr... I don't really care. I don't care how much he knows. He doesn't have to treat emt's like that.



Then maybe you need to go back and read the first rule of this forum.

He's not treating EMT's bad...he's trying to question how much they really bring to the table in EMS.  If you can't handle that, then maybe you're in the wrong field.

All of the Community Leaders have watched this thread with interest (you can tell because we haven't really posted in it) and we've had several discussions amongst ourselves about it.  We decided to let this one run it's course despite repeated requests to close this thread and requests to issue infractions to another member because somebody didn't like what was posted.  

But since people have decided to not be polite in this discussion, this thread is now closed.


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## Jon (Jun 22, 2008)

Let's try this again. The thread was closed for 24 hours as a "cooling off" period. Everyone has calmed down a little, I hope.

We all have strong opinions... and I enjoy discussions like this. We need to remember to be courteous and kind at all times, even if we are having an argument. Remember... he who loses his temper first, loses the argument.

Jon


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## LE-EMT (Jun 23, 2008)

I don't know that reopening this thread was the best of decisions.  I mean I have had my run in/s with the administration of this here web site and I will be the first to say that i don't always agree with decisions made buttttttttttt I do abide by them and I believe they are for the best of the site.  this thread has been way off topic for some time.  the only reason why I didn't mind is because well I enjoy a good heated debate.   But as I just stated a good heated debate NOT arguing about crap that isn't even the topic at hand.  This thread was taken out of context and beaten to death and then beaten again.  there is no need to reopen this thread.  So that we can argue about what it is that EMT-B's do.  


I propose we move on, hug, kiss, and sing coombyia while roasting smores.


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## daedalus (Jun 23, 2008)

A thread closure cannot be undone. This thread is dead.


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## Ridryder911 (Jun 23, 2008)

jfd347 said:


> ..."alot of medics have no clue how to get anywhere because all they do is ride shotgun. they never drive." ....



I know of some services the Paramedic is not allowed to drive, that is what they have a 'driver" or EVO for. Seriously, anyone really can drive if they are safe and can read a map book or now as many have GPS units. 



jfd347 said:


> I honestly don't want another. call it what you will but I have no real desire to be a medic.



That is your personal business, but do not come across condemning upper level positions. Personally, I would not know why anyone would be in a healthcare business and not want to deliver more patient care? Why one would not want to advance and be able to perform and the best patient care possible. But, again that is a personal choice.. yet, should we not be promoting one should advance upwards in the profession?

Again, everyone has the personal choice to advance in this profession and of course with that increases the responsibility. Certification levels is irrelevant, as in some states there is no such thing as certifications. As well, many EMS is now only allowing some to be an EMT for an X amount of time. Even at mine, one has to advance up within two years to maintain their position. Something, I have mixed feelings upon. I don't know if forcing someone is going to deliver the best person, and as well many become complacent with being a "driver" with little responsibility. Then there are those that should NEVER be a Paramedic or never could be able to fully understand the material other in a cookbook form, wanting to only deliver care in a recipe format. Knowing patients one really is aware that patients never fit a recipe. 

So now I will start a new thread.. regarding advancing your career. 

R/r 911


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## mark111 (Jun 23, 2008)

I believe that Basics are need , hell that how we all started out . iv beeen a flight medic for twenty yesrs now and i still learn every day.....


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## Ridryder911 (Jun 23, 2008)

mark111 said:


> I believe that Basics are need , hell that how *we* all started out . iv beeen a flight medic for twenty yesrs now and i still learn every day.....



Not *all* of us. I and know of several hundred others that were NEVER a Basic EMT, that started as a Paramedic. Yet, we too agree we are still learn something everyday as well. 

R/r 911


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## JPINFV (Jun 24, 2008)

mark111 said:


> I believe that Basics are need , hell that how we all started out . iv beeen a flight medic for twenty yesrs now and i still learn every day.....



How does learning something new every day have anything to do with being/requiring someone to be a basic?


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## Ridryder911 (Jun 24, 2008)

mark111 said:


> I believe that Basics are need , hell that how we all started out . iv beeen a flight medic for twenty yesrs now and i still learn every day.....



Now if we could only get that spelling down.. (just joking, welcome to the forum!)


R/r 911


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## firemedic7982 (Jun 26, 2008)

Ridryder911 said:


> In your country maybe?.. Wait, I was never a Basic EMT.  Yes, I have 4 Paramedics that NEVER were a Basic EMT either.
> 
> Now, really inform me what "*medical* care  you provided? What difference did you make, that a common laymen with good advanced first aid training could not? Splinting?.. No Hmm maybe controlling hemorrhaging? No ..Okay, how about CPR? No.. Assisting in administration of NTG, EpiPen? No. Wow! A common laymen can give much more than a Basic EMT, they are far more restricted. Okay, maybe taking a set of vitals? That it's it ! Oops that is not treating, rather assessing.. Begin to see a trend?
> 
> ...



Alright Rid.

i agree with you on about 98% of the things you say. But... You're being a bit arrogant here. you're saying one thing, and say you mean another. The minute you start to devalue those around you, the sooner you get left in the dark. All by yourself.


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## Ridryder911 (Jun 26, 2008)

No actually, I say what I mean. EMT's are considered in the same arena and level as a Nurses Aide, yet we allow them to have autonomy? The only reason of "devaluing" is because the role and the responsibilities do NOT match the education requirements. Again, stop placing false ideas in the EMT course, and teach what that minimum level is designed to do .. provide first response first aid and initial medical care. 


Arrogant? .. I have been called worse, and don't mind as long as is it in being in the best interest and being a patient advocate. To ensure safety, and proper medical care is delivered. 

R/r 911


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## wolfwyndd (Jun 27, 2008)

Why don't we just do away with the EMS system all together and just staff the ambulances with Doctors?  They get more training then any of us.


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## firemedic7982 (Jun 27, 2008)

rid, your saying then, as a basoc it is impossible for me to know , or be educated outside of my skill set? the only thing i should do is first aide? it sounds to me like this is a situation where yoou feel like you are on a plateau above others. you have reminded us several times that you were never a basic. you are always quick to tout how much education you have, and act like some sort of martyr on a quest to protect the purity of medicine. 

i agree with you on 98% of things. you are an eloquent, educated, well mannered individual, for that you should be applauded. conversly you have used this thread to make it painfully clear that in your eyes basics are of no more use than the common layman. you are stereotyping all basics. im sure my partner flight-lp would have to disagree with you on all basics being lowly educated, and just a bunch of first aiders.


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## mikeylikesit (Jun 27, 2008)

You can be the most educated individual in the world as far as medicine is concerned. You can know more than a MD. The thing is that as long as you have a Basic cert you can only provide basic life support and care legally. I know a ton about medicine, more than a few nurses that I know...but as a medic I can only do what the state and other regulatory group’s state that I can do.


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## Ridryder911 (Jun 27, 2008)

wolfwyndd said:


> Why don't we just do away with the EMS system all together and just staff the ambulances with Doctors?  They get more training then any of us.



You don't know the history of EMS very well do you? Actually that is what the first idea in the _"White Papers_ suggested. In France & several other countries that is exactly what they do... Also, there has been three separate physician groups that just started advertising to make "house calls".. so it may not be funny. 

Anyone that would even suggest Paramedic is even near the same caliber of an emergency physician has not been exposed to medicine, the same as trying to justify that Basic Life Support is anywhere near emergency medicine, it is just that.. Basic Care= First Aid
.. hence the reason it is called B-A-S-I-C. 




firemedic7982 said:


> rid, your saying then, as a basic it is impossible for me to know , or be educated outside of my skill set? the only thing i should do is first aide? it sounds to me like this is a situation where you feel like you are on a plateau above others. you have reminded us several times that you were never a basic. you are always quick to tout how much education you have, and act like some sort of martyr on a quest to protect the purity of medicine.
> 
> i agree with you on 98% of things. you are an eloquent, educated, well mannered individual, for that you should be applauded. conversly you have used this thread to make it painfully clear that in your eyes basics are of no more use than the common layman. you are stereotyping all basics. im sure my partner flight-lp would have to disagree with you on all basics being lowly educated, and just a bunch of first aiders.



I don't care if you have a PhD, an M.D. (that is NOT a license, rather it is a Degree) or M.S. in Traumatology, unless your license or certification states that you can perform care or are expected to perform care at a certain level, one can not do above their license. 
Now, I have NEVER said knowledge is bad OR one should not exceed their knowledge, even suggesting demonstrates one has not read my post entirely. 

Sorry, if it offends persons, so be it. truth hurts. The EMT curriculum is just barely above common layman knowledge. It is written at a 6'th grade reading level, with skills that are classified as simplistic and repetitious. Sorry, that is from the National Curriculum Review and EMS Educators as verified by multiple studies on the EMT. This is why it is usually considered equivalent to a nurses aide training. Don't be pissed at the messenger, be angered at the system. Don't like it.. then change it!

Yes, I have had several partners that were Basic and were very highly educated, but it did not matter in regards to clinical care.. they could diagnose an "Widow Maker AMI" but could not do squat for it because they were not licensed to. In the same regards I am cautious for anyone that is supposed to be so educated not realizing this. 

If one does not like the perception or even the truth then there is an alternative, go to school and change it. Otherwise learn to acknowledge and be able to deal with the persona.

Me and Flight LP have had many discussions about this, and you might want to read his posts on other sites as well.


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## firemedic7982 (Jun 30, 2008)

Ridryder911 said:


> Yes, I have had several partners that were Basic and were very highly educated, but it did not matter in regards to clinical care.. they could diagnose an "Widow Maker AMI" but could not do squat for it because they were not licensed to. In the same regards I am cautious for anyone that is supposed to be so educated not realizing this.



Here you go making presumptions again. You presume that just because I state that Im educated beyond my patch that I dont recognize my clinical boundaries. My clinical boundaries are what frustrates me, and thus why we further our education, and our clinical certifications. I do not, nor will I practice beyond my patch. Its illegal, and it's unethical.


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## skyemt (Jun 30, 2008)

gosh... sooo many bruised Basic egos out here...

how about this... why don't we all just practice our skills, and advocate for the patient to the best of our abilities within the scope of our levels.

if we feel we want to do more, than we can get a higher level of certification.

all of the "worth less", "worth more", "first aid", etc comments are just a waste of time, and mean nothing to the patient.

if you take a step back, until the system changes, it is pretty simple.  be the best you can be at your level, and if you want to do more, move up, instead of trying to "redefine" the perception of what the level is in the first place.

just remember, the patient doesn't give a hoot about any of this... they just want the best care possible.


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## Ridryder911 (Jun 30, 2008)

firemedic7982 said:


> Here you go making presumptions again. You presume that just because I state that Im educated beyond my patch that I dont recognize my clinical boundaries. My clinical boundaries are what frustrates me, and thus why we further our education, and our clinical certifications. I do not, nor will I practice beyond my patch. Its illegal, and it's unethical.



No one was making assimptions, if you know you do not, then there will be no issue. Although, there has been numerous postings here and other forums that many do exceed and want to obtain the "skill" before obtaining the knowlege portion.

Not all in EMS is worried about illegal procedures or ethics. I wished I could say it was different. 

R/r 911


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## BossyCow (Jun 30, 2008)

Ridryder911 said:


> No one was making _assimptions,_ if you know you do not, then .........R/r 911



Now, if we could just get you to work on your spelling....... a-s-s-u-m-p-t-i-o-n-s


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## NREMT08 (Jul 1, 2008)

Ridryder911 said:


> I will tell you why. Basic levels have held EMS back for decades now! The curriculum was watered down in the mid 90's to not to have teach "too much medical & technical" reading. Even now, the Basic EMT text is written at a 6'th grade level. NO where else in medicine does one read about BLS vs. ALS because MEDICINE is MEDICINE. There is NO levels.. You deliver PATIENT CARE!. Period!
> 
> As well, all the levels EMT-I, EMT/CC, EIOU, etc.. ALL are again in lieu or being compared to the gold standard of the Paramedic. Excuses and that is it! Seriously, it has been over 40+ years and many communities still do not have the advanced care provided by TV's Johnny & Roy Emergency from the 70's. Why? Because the public assumes EMT's & Paramedics are the same.. the same comparison as one comparing CNA & RN's.. ludicrous. The public is usually duped assuming one that has taken a little more than a 150 hour advanced first aid class is actually administering medical care. Misleading.
> 
> ...



I used to think you were an intelligent person, I used to value your opinion, and I used to look forward to reading your replies, but now, not any more, I simply cannot believe you wrote this, have you forgotten where you came from? 

 you once were a EMT-B as well, you have to start from the bottom to get to the top, that is how skill and mastery are learned, from the bottom up, and this is true in everything, you don't start out a master carpenter, you start by building treehouses and bike ramps as a kid, see the point here? 

wherever you are and  whatever you are doing, you always learn the basics first, the people with more knowledge are the ones that teach and share their knowledge with you, and if there is no one to teach, then no one will learn, therefore, those people with greater knowledge; more is expected from, 

 you have a lot of letters behind your name, and someone had to "show you", so please do not look down on those of us who are young into our journey, I am not just an EMT, I am a damn fine EMT, as one of my instructors said, 

 and I will be attending Paramedic school after I complete my Fire cert. I did not get this far in my journey without people to "show me" I cannot learn this alone, and there are things that some of my FF/Paramedic friends can teach me that I could NEVER learn in a book,

 you can also be like that for someone, imagine all the experience and knowledge you could share with the "young ones" if you just softened your heart a bit and remembered, all of us start from the basics. 

                                                                 God Bless


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## mikeylikesit (Jul 1, 2008)

NREMT08 said:


> I used to think you were an intelligent person, I used to value your opinion, and I used to look forward to reading your replies, but now, not any more, I simply cannot believe you wrote this, have you forgotten where you came from?
> 
> you once were a EMT-B as well,
> 
> God Bless


 Rid has posted several times that he was never a basic i believe. yes most start from the bottom and thats one thing...but staying at the bottom just looking up and the top and not willing to take the journey is another.


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## VentMedic (Jul 1, 2008)

NREMT08 said:


> you once were a EMT-B as well, you have to start from the bottom to get to the top, that is how skill and mastery are learned, from the bottom up, and this is true in everything, you don't start out a master carpenter, you start by building treehouses and bike ramps as a kid, see the point here?
> 
> wherever you are and  whatever you are doing, you always learn the basics first, the people with more knowledge are the ones that teach and share their knowledge with you, and if there is no one to teach, then no one will learn, therefore, those people with greater knowledge; more is expected from,
> 
> ...



Rid and I are from the same generation where EMS was meant to be a higher education and we were encouraged to get our Associates degree. That was in the 1970s.  Nursing was as that time making the transition from diploma to degree.  It was actually thought that the Paramedic would emerge as the stronger profession for awhile.   In my degree program, the EMT was meant to be a certification like CNA so one could get some experience or extra money working on the ambulances while FINISHING their degree.  It was not to be an end all profession.   FFs were required to have EMT but initially Fire Fighting was the primary focus of their careers.  Later did it become a requirement to also have the Paramedic cert to be a FF in some areas as Fire Based EMS grew in popularity and many mergers occured. 

I believe that once you finish your Paramedic cert you will understand some of this.  

None of the comments made by those with "fancy letters" are meant to demean anyone in anyway.  Rather, one should see that there it is still alot of learning to do.  I've been practicing my education skills for over 40 years and plan to continue working on them for another 40.  150 hours is just one small drop in a large ocean of knowledge.


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## NREMT08 (Jul 1, 2008)

VentMedic said:


> Rid and I are from the same generation where EMS was meant to be a higher education and we were encouraged to get our Associates degree. That was in the 1970s.  Nursing was as that time making the transition from diploma to degree.  It was actually thought that the Paramedic would emerge as the stronger profession for awhile.   In my degree program, the EMT was meant to be a certification like CNA so one could get some experience or extra money working on the ambulances while FINISHING their degree.  It was not to be an end all profession.   FFs were required to have EMT but initially Fire Fighting was the primary focus of their careers.  Later did it become a requirement to also have the Paramedic cert to be a FF in some areas as Fire Based EMS grew in popularity and many mergers occured.
> 
> I believe that once you finish your Paramedic cert you will understand some of this.
> 
> None of the comments made by those with "fancy letters" are meant to demean anyone in anyway.  Rather, one should see that there it is still alot of learning to do.  I've been practicing my education skills for over 40 years and plan to continue working on them for another 40.  150 hours is just one small drop in a large ocean of knowledge.



I agree, and I have always planned on continuing my education, who knows, maybe some day I will be a Doctor,  but the point I was trying to make is that  everyone has to start somewhere, I would not stay an EMT, but I would like to practice as one for a while before I go and get my Paramedic, as I said before, it is just another step along my journey, and I will be a student for life , I am a master of NO skill and No trade, when I think I am, then I have a problem,   and I sincerely hope no one has taken offense to my previous post, because it was written in a non-hostile manner, at least thats what I was aiming for anyways.


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## NREMT08 (Jul 1, 2008)

mikeylikesit said:


> Rid has posted several times that he was never a basic i believe. yes most start from the bottom and thats one thing...but staying at the bottom just looking up and the top and not willing to take the journey is another.



Mikeylikesit, I have never, ever, in any post whatsoever, said anything to the effect of not wanting to continue my education, and I am definitely not the type of person who just looks up at the top and never takes the journey, thats not my style, I am a go getter, a survivor of many many things, and if there is something I want to know, a skill or whatever, I go looking for the answer,  I also would appreciate it if you would not cut my posts into pieces when you reply with a quote, as it defaces the meaning of the sentence, one single sentence taken out of a paragraph and re-posted can appear to have a very different meaning than what the writer originally intended, and this is how disagreements begin, when one persons thought is twisted into another meaning, therefore making it look like a person had said something that they have actually not.


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## CFRBryan347768 (Jul 1, 2008)

NREMT08 said:


> Mikeylikesit, I have never, ever, in any post whatsoever, said anything to the effect of not wanting to continue my education, and I am definitely not the type of person who just looks up at the top and never takes the journey, thats not my style, I am a go getter, a survivor of many many things, and if there is something I want to know, a skill or whatever, I go looking for the answer,  I also would appreciate it if you would not cut my posts into pieces when you reply with a quote, as it defaces the meaning of the sentence, one single sentence taken out of a paragraph and re-posted can appear to have a very different meaning than what the writer originally intended, and this is how disagreements begin, when one persons thought is twisted into another meaning, therefore making it look like a person had said something that they have actually not.



I do not think that Mikey was saying that directly to you, I think what he was trying to say, correct me if I am wrong Mikey is that from Rid's point of view you are supposed to provide the best care, and that a 150hr. class isn't cutting it. Like Vent explained, it was a diffrent time period when they started, which is where their opinions, and mine are coming from.


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## mikeylikesit (Jul 1, 2008)

CFRBryan347768 said:


> I do not think that Mikey was saying that directly to you, I think what he was trying to say, correct me if I am wrong Mikey is that from Rid's point of view you are supposed to provide the best care, and that a 150hr. class isn't cutting it. Like Vent explained, it was a diffrent time period when they started, which is where their opinions, and mine are coming from.


 Thanks Brian...exactly my point. no it was not directed at you but i did use your post as a referance point.


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## VentMedic (Jul 1, 2008)

I really wish EMS could have held its momentum from the 1970s.  It was an exciting time.  I may have noticed it more because Miami was part of the initial EMS movement.  It also had a large Diploma nursing school.  The talk was centered on education as degrees and professionalism were in the spotlight.  If the Paramedic degree had stayed its course to become the standard for entry into EMS, who knows what this profession could have evolved into.  Rid's Paramedic Practitioner model that he supports could have been a reality a decade ago.   

Many of the healthcare professions you see in the hospital today were not established at that time.  Most were OJT or nurses picked up radiology, RT and lab skills.  Respiratory Therapy was certified by a national organization but did not achieve licensure in many states until the mid-late 1980s. Radiology, Radiation, HBO and Nuclear Med Technologist were also part of the OJT movement that finally started to get recognition with licensure when their education levels increased.   They also realized that their weakest links by education and certification were harder to fit into a work schedule as technology and patient care demands increased.  People had to have advanced education and skills to work in many of the patient care areas.   

When you look at the big picture of healthcare and its advancements, EMS is not young when compared to other professions including nursing.  Yet, it has made the least advancements as a profession when compared to all the others.  One could even include Phlebotomy which is now getting its own certification and more states are pushing to make it the standard.   Massage Therapy has even become a recognized and licensed healthcare profession with solid reimbursement recognition. Massage Therapists have the option for a 2 year (Associates) degree complete with A&P, Microbiology, English and Math for prerequisites.  Many states are considering raising their entry requirement to at least 1500 hours  or eventually the Associates. And yes, they are strongly represented by State and National organizations for legislative power.


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## Ridryder911 (Jul 1, 2008)

BossyCow said:


> Now, if we could just get you to work on your spelling....... a-s-s-u-m-p-t-i-o-n-s


You got me! No excuse, I was working as Supervisor and on a truck and was typing in between calls and business.... as they now say..."my bad". 



NREMT08 said:


> I used to think you were an intelligent person, I used to value your opinion, and I used to look forward to reading your replies, but now, not any more, I simply cannot believe you wrote this, have you forgotten where you came from?
> 
> you once were a EMT-B as well, you have to start from the bottom to get to the top, that is how skill and mastery are learned, from the bottom up, and this is true in everything, you don't start out a master carpenter, you start by building treehouses and bike ramps as a kid, see the point here?
> 
> ...



As a veteran healthcare provider and educator, I have used many methods to attempt to change attitudes. In the past I used the "softer" approach and it has not worked. The new younger generation appears to have to have the more direct "in your face approach". Many will not respond unless they are motivated to change things. 

I know I have irritated many on this forum. *Good!* I do not so much care for one to see my exact point but to really *think!* Now, I hope you look and go beyond go past what you were taught and have been exposed to.  Again, look beyond your box! Examine other successful health care professions that have increased their role in patient care & outcomes, increased standards as well upward growth. 

Again, I have seen and studied many different approaches of EMS, not just in patient care but again as a *whole system*. In the way many of those in EMS do not approach or ever look at. Yes, patient care should be our utmost important goal, but just only one part and we should be looking towards ways that will developing and producing the best for not just the patient care, but the system as well. 

As Vent describes, we come from a different generation. I can tell you it was an exciting era; we where just coming out of the "ambulance driver" mode to oh they are just a "technician" phase to WOW they are educated and actually know what they are doing! Yes, as Vent described this is something we fought hard to overcome. We wanted more and we knew that they only way to do this was to keep striving for better and more improved standards. This meant more education. We looked at other professions and examined & seen that their role was increasing in patient  care, they were getting recognition in the form of respect from peers, patients and pay with benefits. We too wanted the same. We knew the only way to do so was change in our system and that was going forward through a formal education. 

One can be the "best" the "greatest" EMT, Nurses Aide, or Environmental Technician (Janitor) but it still does *NOT* change the current curriculum or the way you were taught. Nor does it change the limitations of this position because of the poor requirements and again the poor associated curriculum. Again, just because one has mastered this entry level does not make them or allow them to provide the needed and required care for the critical or those requiring emergency medicine. 

Again, I do wish readers would quit taking such statements personally and out of context. Again my opinions are based upon the "system" and the education or lack of in that system. EMT's should evaluate that their training was *only* the tip of providing care. Anything less would be considered non-medical, and with this minimal training, one does *NOT* have the education and knowledge needed to evaluate how EMS and details of what patient care should be delivered. Again using my analogy; one would not ask a nurses aide on how & what the nursing profession should consist of. Nor what type of interventional therapy methods should be sought also what type of educational standards should be in place. As one, I can assure you they probably would listen and then inform you that you lack the required knowledge to see the "whole picture"  as well lack the educational and clinical background needed to make such decisions. Which would be only correct. I feel the same only being that being in the EMS profession. 

Many fail to understand *the only reason *we ever had multiple levels was we were in the infancy of a profession. It was NEVER meant or intended to keep such lower levels. There was not many zero to Paramedic programs. In fact my practical testing was evaluated by specialized physicians in those areas because there were not Paramedics to evaluate. Yes, I took and became a NREMT Basic test after my Paramedic course. The NREMT Paramedic test was not developed until the early 80's. We naturally assumed the education process would continue upwards and the lower levels would finally be phased out or be abolished. Not ever considering we would or even want to continue to remain in our infancy mode. Don't believe me? Look other countries EMS systems. They took our ideas and proceeded and built upwards where we failed and did not.

Unfortunately, we have continued to install the same propaganda that is taught in almost all EMT courses. The same thing we have been doing now for nearly forty years. We want to encourage and motivate students therefore; we do install a false doctrine that they actually represent more a medical provider than they really are. When in fact, it should be stressed and emphasized over & over that they are *just* the entry point of the profession and have very limited knowledge in providing care to a patient. Again, just a little above first aid. Does this mean that position is less important or not have weight?* No*. Again the role needs to be changed.  In reality the Basic EMT is just one part of EMS (albeit an important part a very small part) and definitely not the role as an expert in care or the system. 

How much emphasis was placed in your training that your primary role was just to stabilize them until further help arrived or was it taught for you to be able to treat and transport the patient? Well, if your instructor was following the curriculum, it would be the later.. Again, not the fault of the instructor or student or even the text, rather the system. Yes, the current system needs to be eliminated and revamped. Apparently what we are doing is failing and will continue do so until it is changed.

I ask how much were you taught in your EMT class about EMS as a system? How much discussion of professionalism was taught, billing and compensation issues, what legal topics was covered, rules of certification processes versus licensure, managing personnel, and of course EMS research and development? Was this topic covered in one hour, one class, one semester, one year, four years...more?  

See where I am going?


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## Foxbat (Jul 1, 2008)

> How much emphasis was placed in your training that your primary role was just to stabilize them until further help arrived or was it taught for you to be able to treat and transport the patient? Well, if your instructor was following the curriculum, it would be the later.


This is what PA protocols say:
http://www.dsf.health.state.pa.us/health/lib/health/ems/bls_protocols_2004.pdf

_2. If transport time by BLS to an appropriate receiving facility can be accomplished before ALS
can initiate care, then the BLS service should transport as soon as possible and should not
request or should cancel ALS.
3. BLS services should not delay patient care and transport while waiting for ALS personnel.
If ALS arrival at scene is not anticipated before initiation of transport, arrangements should
be made to rendezvous with the ALS service. 
_____________________________________________
Notes:
1. BLS personnel should initiate patient care and transport to the level of their ability following
applicable BLS protocol(s).
2. In the case of a long BLS transport time with a nearby ALS service coming from the opposite
direction, it may be appropriate to delay transport for a short period of time while awaiting the
arrival of ALS if this delay will significantly decrease the time to ALS care for the patient. When
BLS transport time to a receiving facility is relatively short, this delay is not appropriate._


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