# ER Tech vs Rig Work



## Vetitas86 (Mar 19, 2012)

Ok, as you may know, I'm going to be starting EMT-B training this fall. What I'd like to know is this.

Those of you who've had experience in both or either, what's the pros and cons of ER vs ambulance?

I'm considering doing ambulance full time and ER PRN, so I can get clinical experience for med/PA school.


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## Chan (Mar 19, 2012)

Two different things but really ER-Tech is a difficult position to obtain as many who are working as ER-Techs are medics.


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## Vetitas86 (Mar 19, 2012)

Gotcha. I had heard that's how it was at our ER, but hadn't checked into it yet.


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## DesertMedic66 (Mar 19, 2012)

Based on my experience in the clinical setting during my EMT class it seems that the ER techs that are EMTs do: make and clean the beds, record but not read 12-lead EKGs, move patients to different areas in the hospital, and play babysitter for the psych patients.


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## DrankTheKoolaid (Mar 19, 2012)

Depends on the ED and its staff.  But depending on who your partenered with and area call volume I would say it would take a Field EMT 5 years to get the same experience 1 year as a ED tech would bring.  And thats only for a Full time 911 emt, not a bls IFT rig.  ED techs have the ability to pick the brains of experienced ED MD's and learn their assessment techniques.  And when a Tech doesnt pick up on suttle things he can chat with the MD later to ask what he saw that the tech did not.


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## Handsome Robb (Mar 19, 2012)

Our TC requires techs to be medics. A few are intermediates but they were on staff before the policy changed. With that said most tech positions require 6 months to a year of field experience before they even look at you. 

Techs at our TC record 12 leads, start IVs, some start EJs which is fun since most nurses can't do it  pt movement, stocking rooms, cleaning rooms, taking reports from EMS and can actually attend patients if the rooms are full. That's why they are medics, so the EMS medic can pass pt care off to them and move them to a temporary bed so they can get back into service. 

I've never worked as a tech but I have done quite a bit of time in the ER during medic school operating basically as a tech with the exception of being able to intubate and push medications. I like it but I would never do it full time, only PRN. It's totally personal preference.


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## Vetitas86 (Mar 19, 2012)

So its sounding to me that you sort of have the trade off of doing more complex things at the ER and getting more actual clinical experience vs getting more autonomy and advanced prodedure on rig. 

Does that about get it, generally speaking?

Sounds like the PRN idea for me would work well, since it'd give me the extra exposure.


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## Handsome Robb (Mar 19, 2012)

Vetitas86 said:


> So its sounding to me that you sort of have the trade off of doing more complex things at the ER and getting more actual clinical experience vs getting more autonomy and advanced prodedure on rig.
> 
> Does that about get it, generally speaking?
> 
> Sounds like the PRN idea for me would work well, since it'd give me the extra exposure.



Complex in what way? I'd say the field is more complex than tech work in an ER. Only paramedic techs in the ER can do EJs and they have to take a class through the hospital to enable them to place them. While techs do IVs and 12s in the ER they can't interpret them, place advanced airways and can't push meds. Also they don't have the power to make clinical decisions in the ER either.


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## DrankTheKoolaid (Mar 20, 2012)

What NV says is true to a point.  While you have little to no autonomy while working in a ED.  The skills and knowledge you pick up will help you and your patients in the field later.  In the ED you will learn more about wound management then you could ever wish for, Splinting and casting techniques and the whys of positioning.  You will read (and look up medication names and uses hopefully) so often you will have a understanding of home meds most paramedics dont even have, unless they had the initiative to learn them on their own.  While you wont be reading the 12 lead to the ED doc you will see each one and form your own assessment of it and can ask the MD's what they see.  Starting IV's in the ED is a null as it is nothing like doing it in the back of the rig while driving through potholes.  Once you master that, IV's on a veinless cabbage in a well lit room with the bed at whatever level you want it to be will be cake......


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## Handsome Robb (Mar 20, 2012)

Corky said:


> What NV says is true to a point.  While you have little to no autonomy while working in a ED.  The skills and knowledge you pick up will help you and your patients in the field later.  In the ED you will learn more about wound management then you could ever wish for, Splinting and casting techniques and the whys of positioning.  You will read (and look up medication names and uses hopefully) so often you will have a understanding of home meds most paramedics dont even have, unless they had the initiative to learn them on their own.  While you wont be reading the 12 lead to the ED doc you will see each one and form your own assessment of it and can ask the MD's what they see.  Starting IV's in the ED is a null as it is nothing like doing it in the back of the rig while driving through potholes.  Once you master that, IV's on a veinless cabbage in a well lit room with the bed at whatever level you want it to be will be cake......



I definitely do agree with this. You will learn a ton in the ER as well as get to assist with and watch some pretty cool procedures. My partner is a per diem tech and is a wealth of knowledge.

I just want to make sure I didn't come across as knocking working in the ER, it just isn't some I couldn't do full time.


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## SliceOfLife (Mar 20, 2012)

IMHO the biggest thing you will lose out on being in the ED is critical decision making.  It's all kinda academic untill your alone in the back of a truck.


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## Tigger (Mar 20, 2012)

SliceOfLife said:


> IMHO the biggest thing you will lose out on being in the ED is critical decision making.  It's all kinda academic untill your alone in the back of a truck.



For better or for worse, one of the few places that someone with only a 120 hour course will be responsible for clinical decision making is the back of an ambulance. As an ER tech, that power will not likely be given to you.


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## SliceOfLife (Mar 20, 2012)

Tigger said:


> For better or for worse, one of the few places that someone with only a 120 hour course will be responsible for clinical decision making is the back of an ambulance. As an ER tech, that power will not likely be given to you.



Yup.  But that's not to say you won't get some great experience and skills in the ED.  It's just a different animal.


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## DrankTheKoolaid (Mar 20, 2012)

Not only will you gain great skills in a ED, you will learn when to truely be concerned about a patients condition.  Instead of getting an adreniline rush during every call, which trust me is not a good thing.  After a while in an ED you will be able to spot a truely sick patient from half a block away.  If you can remain calm as the paramedic on scene, everyone else around you will be able to hopefully remain calm also.

Granted not all ED's are the same. I spent 10 years teching in a 6 bed 1 MD 1 RN, 1 Tech ER so I was fortunate to be able to do more then most once I had established trust with the staff and created some great relationships.  After a while the nurses will no longer be able to answer your questions and likely will just tell you like they did to me to just go straight to the MD with questions.  As they couldn't answer the majority of them.

Granted if you work as a EMT and have a good partner who treats you as more then a driver and isn't himself/herself already burnt out and likes to mentor, you have a chance to learn quite a bit also.


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## Shishkabob (Mar 21, 2012)

Corky said:


> Not only will you gain great skills in a ED, you will learn when to truely be concerned about a patients condition.  Instead of getting an adreniline rush during every call, which trust me is not a good thing.  After a while in an ED you will be able to spot a truely sick patient from half a block away.  If you can remain calm as the paramedic on scene, everyone else around you will be able to hopefully remain calm also.



Corky... your pros of working in the ED aren't just pros for the ED.  You're saying a field provider can't see a sick patient from accross the room?  You're saying a field provider can't learn / become / be calm under the pressure?


In fact, I'd argue, that a lone Paramedic (or EMT?) needs to be calmer, and better at recognizing sick patients, in the field than in the ED, as they don't have a higher provider to back them up or take control and make the decisions.




Corky said:


> You will read (and look up medication names and uses hopefully) so often you will have a understanding of home meds most paramedics dont even have, unless they had the initiative to learn them on their own.



Uhh.. what? So, a pro of working in the ED as opposed to the truck is that you will look up medications "so often" that you'll get an understanding of them... that field medics won't... without looking them up themselves?  Huh?

"Hey guys, guess what, you'll do something so much more than other people unless they do it alot too!" is essentially what you just said...



Sure, in general, you will see a 'wider variety' of patients in any given shift at a busy ED compared to a busy EMS system because that's where the patients are taken, HOWEVER, working in the field is invaluable, much more beneficial, as you are actually in the decision making and critical thinking aspect of patient care as opposed to "I'm going to splint your leg then take you to the bathroom'.  Most EDs don't used Paramedics to their fullest potential as it is, so as an EMT, you'll do almost nil in that aspect aside from the nursing tasks the nurses don't want to do themselves. 


Do one FT and the other per diem.  Benefit from both.


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## DrankTheKoolaid (Mar 21, 2012)

*re*

Linus I think you missed my point.  Ive been doing this for 20 years, 10+ in the field and 10 in an ED.  What I am trying to do is dispel any notion that ED experience is wasted time.  It is far, far from it. 

And as to the medication, unless a EMT or Medic is motivated enough to spend their free time reading home medications then yeah I stick to what I said.  In an ER you are constantly bombarded with different and new medication names as you are getting patient information.  Which I found invaluable in learning medications and how they react with other medications.  

I am not knocking field experience as this is what we do.  But for a new EMT I think tech'ing for a while makes MUCH more sense then working a BLS IFT rig where you need to make no critical decisions.  At least in a ED you watch others make those decisions and have the ability to discuss with them why they chose to go one route versus another, with how the patient presented and lab studies etc etc.  

Linus you also have to remember that not all EMT/Medics are the same.  Trust me I know of many that I would not want working on my family members and I am positive you have the same, so you know exactly what I am talking about. Sure any monkey with a license is fine with urban 10 minute ETA to super centers, but come play in my neck of the woods and the not so bright stand out like sore thumbs, quickly when they are stuck on a snow covered summit with 2+ hours to the nearest Level 2/STEMI/Stroke center with a truly critical patient.


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## Shishkabob (Mar 21, 2012)

Corky said:


> And as to the medication, unless a EMT or Medic is motivated enough to spend their free time reading home medications then yeah I stick to what I said.In an ER you are constantly bombarded with different and new medication names as you are getting patient information.



How is that NOT happening in the field if you're doing your job?  Do patient medications just not exist until a patient crosses the threshold of the ER?  Do ED providers learn medications just by reverse osmotic pressure, or do they themselves ALSO have to be motivated enough to learn about the medications?

I'm not dispelling the benefits of working in one place over another, but "learn medications" in the ED over in the field is not one.   Seeing the meds used in more variety, more often, in off box uses?  Sure.  But not just learning patient meds, where in both avenues, you have to care enough to learn what they are and what they do.


Yay Epocrates.


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## Ackmaui (Mar 21, 2012)

I've been an ER Tech for 10 1/2 years and an EMT-B for 12 and I am currently in paramedic school. I also have been an on call EMT with the local fire department as well. I think that the experiences that I have had in the ED have made me a better EMT. I think that it has made me more comfortable with people and I have learned so much form the staff here. I do EKGs and the docs ask me for my interpretation to help me learn to read them and this was before I was in medic school. I agree that there isn't the critical decision making that happens in the back of the rig. I have also had the charge nurse tell me she trusts me to tell her when a patient isn't doing well if for some reason there isn't a nurse with the patient. 
I think you should try both of them and see which you like best. Both are great for experience and both have their pros and cons.


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## DrankTheKoolaid (Mar 21, 2012)

*re*

The OP posted he is just starting his training as an EMT.  In what world is a new EMT going to be doing much more then driving and maybe assisting the medic with IV setup on a 911 rig.  They do not have time to look up medications or even know what the patient even says they are on for that matter if history is obtained in the back of the rig.  

Understandably every medic is different with his/her approach, but I know plenty of medics who spend absolutely as little as time as possible on scene, that means they walk in the door get a complaint and that patient is in the back of the truck and they are en route to the ED.  Any further history is established while en route including medications, which were just bagged up blind and bagged for transport.  What could a new EMT possibly learn from that?  Especially if it is in a busy system with very little down time to be able to talk to the medic about calls.  

But I concede, either way they have to be self-motivated as I knew other tech's at the time that did not belong in a ED and probably should have been kept in the litter box known as skilled nursing


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## Tigger (Mar 21, 2012)

Corky said:


> The OP posted he is just starting his training as an EMT.  In what world is a new EMT going to be doing much more then driving and maybe assisting the medic with IV setup on a 911 rig.  They do not have time to look up medications or even know what the patient even says they are on for that matter if history is obtained in the back of the rig.
> 
> Understandably every medic is different with his/her approach, but I know plenty of medics who spend absolutely as little as time as possible on scene, that means they walk in the door get a complaint and that patient is in the back of the truck and they are en route to the ED.  Any further history is established while en route including medications, which were just bagged up blind and bagged for transport.  What could a new EMT possibly learn from that?  Especially if it is in a busy system with very little down time to be able to talk to the medic about calls.
> 
> But I concede, either way they have to be self-motivated as I knew other tech's at the time that did not belong in a ED and probably should have been kept in the litter box known as skilled nursing


There are many, many places where basics are not the medics driver. I've worked in places that have P/B and the basic attends as many calls as possible. I work on a straight BLS truck that does get dispatched alone to calls. Is our system providing the best possible care by not having medics going to every call? No, absolutely not but that's how it works in the system I work in.

Also in regards to ER techs being "bombarded" by meds, how is this any different than a basic working IFT? Neither the ER tech nor the IFT EMT must know an extensive list of medications since they are not actually administering any of them. As a result, both positions will require self study to learn them. Merely being continuously exposed to them is not learning them.


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## Miscusi (Mar 21, 2012)

" someone with only a 120 hour course "  

I see that alot here, but I think that we, as human beings, dont have that much to go wrong when it comes to emergencies.  120 hours should cover more than enough for what the EMT-basic job requires.  Sure you can add hours, double the hours why dont they?  but if they do, it would just be 120 hours of instruction and 120 hours of sitting doing nothing...  

Just IMHO !


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## Tigger (Mar 21, 2012)

Miscusi said:


> " someone with only a 120 hour course "
> 
> I see that alot here, but I think that we, as human beings, dont have that much to go wrong when it comes to emergencies.  120 hours should cover more than enough for what the EMT-basic job requires.  Sure you can add hours, double the hours why dont they?  but if they do, it would just be 120 hours of instruction and 120 hours of sitting doing nothing...
> 
> Just IMHO !



That is one of the more illogical things I have seen posted on this board. It is just not possible to address.


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## DrankTheKoolaid (Mar 21, 2012)

I give up.  You guys completely missed me saying they have to be self motivated.

And who is a new EMT going to bounce questions off of on a BLS or IFT rig? Another EMT doing IFT?  Sure if he wants to know how to push a wheel chair more effectively, not, higher learning type questions.  At least in a ED you can be 99% sure the Doc knows what he/she is talking about, usually.  Can you honestly tell me that about all the Paramedics and EMT's he can be partnered with.  

Anyways my favorite Un-PC show of all time is on, Family Guy.


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## Handsome Robb (Mar 22, 2012)

Linuss said:


> How is that NOT happening in the field if you're doing your job?  Do patient medications just not exist until a patient crosses the threshold of the ER?  Do ED providers learn medications just by reverse osmotic pressure, or do they themselves ALSO have to be motivated enough to learn about the medications?
> 
> I'm not dispelling the benefits of working in one place over another, but "learn medications" in the ED over in the field is not one.   Seeing the meds used in more variety, more often, in off box uses?  Sure.  But not just learning patient meds, where in both avenues, you have to care enough to learn what they are and what they do.
> 
> ...



I'd be willing to bet that unless you work in a really slow ER you have more time on the truck to look up and research meds.

Like corky said though, it's up to the provider to take the initiative to extend their education and take the time to look meds up.


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## Tigger (Mar 22, 2012)

Corky said:


> I give up.  You guys completely missed me saying they have to be self motivated.
> 
> And who is a new EMT going to bounce questions off of on a BLS or IFT rig? Another EMT doing IFT?  Sure if he wants to know how to push a wheel chair more effectively, not, higher learning type questions.  At least in a ED you can be 99% sure the Doc knows what he/she is talking about, usually.  Can you honestly tell me that about all the Paramedics and EMT's he can be partnered with.
> 
> Anyways my favorite Un-PC show of all time is on, Family Guy.



I guess I missed the part about the techs also having to be self motivated.

Also I don't push wheelchairs, not every call I do is an emergency but I am not a wheelchair van. And yes if I do have a higher level question, I will ask my partner. They may be like me and have already asked it, and if that fails I'll find someone else to ask like a doctor or a medic or a nurse or gasp, the internet.


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## Handsome Robb (Mar 22, 2012)

Tigger said:


> or gasp, the internet.



Where did you get your medical degree?

WebMD...duh!!!


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## hibiti87 (Mar 22, 2012)

if working out in the field is your end goal i think working on a BLS rig would be more beneficial if given the choice between an ER tech position or rig work. While ER tech positions can provide you with a wealth of knowledge, you are pretty much spoon fed the patients history instead of obtaining it yourself through questioning and assessment.


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## Cindigo (Mar 22, 2012)

Corky said:


> Once you master that, IV's on a veinless cabbage in a well lit room with the bed at whatever level you want it to be will be cake......



I just spit milk out of my nose.....and, I'm not even drinking milk.


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## Tigger (Mar 22, 2012)

NVRob said:


> Where did you get your medical degree?
> 
> WebMD...duh!!!



Is it bad that when my patients ask "how did you learn that" I answer "wikipedia?"h34r:


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## Miscusi (Mar 22, 2012)

Tigger said:


> That is one of the more illogical things I have seen posted on this board. It is just not possible to address.



with all due respect, I think that makes perfect sense.  IF 120 hours is not really enough for the emt B job, then it wouldnt be currently 120 hours....


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## Miscusi (Mar 22, 2012)

Corky said:


> And who is a new EMT going to bounce questions off of on a BLS or IFT rig? Another EMT doing IFT?  Sure if he wants to know how to push a wheel chair more effectively, not, higher learning type questions.  At least in a ED you can be 99% sure the Doc knows what he/she is talking about, usually.  Can you honestly tell me that about all the Paramedics and EMT's he can be partnered with.



I know some MDs who should be plucking veggies in a farm.  but in all fairness,  If an EMTB is in medical school, trying to be something higer up the medical care field, then of course the ER Tech job would be more beneficial...

but for those not in school, with no intention of taking more classes,  knowing more than what the EMTB should know holds no real job value as the emt b is prohibited from doing more than what the standard of care is anyway. these emtbs are better off in the truck, perfecting the art of the perfect stair chair grip, and etc..

we are all given a place in life, a role to play,  if it is to be an EMTB, then I rather learn to do the best and fastest AED application rather than to take the time to learn the EKG which I will never use anyway.

IMHO


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## Tigger (Mar 22, 2012)

Miscusi said:


> with all due respect, I think that makes perfect sense.  IF 120 hours is not really enough for the emt B job, then it wouldnt be currently 120 hours....



One day, when you're working on that FDNY BLS ambulance you'll have a really sick patient and no medics will be available and you'll have to treat them by yourself. And all you will be able to do is give them a pillow and a hand to hold. Then you'll understand.


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## Miscusi (Mar 22, 2012)

Tigger said:


> One day, when you're working on that FDNY BLS ambulance you'll have a really sick patient and no medics will be available and you'll have to treat them by yourself. And all you will be able to do is give them a pillow and a hand to hold. Then you'll understand.



OK.. i know im new, but I understand that we are to never go beyond our scope of practice.  

I know that if I work BLS, and the patient is really sick and no medics are avail, then yes indeed I will do everything I can for him, which is everything an EmtB is allowed to do, and I will do that to the best of my ability.  

I will put him in the most comfortable of all positions of comforts, turn the 02 up to as high as can be, ( 15 LPM here in NY ), and do every intervention that is known to the emtB. 

I know that I cannot give him our baby asprin for his pain, even if I really wanted to I cannot, it is only for AMIs...   If I did give, and a review happens, there goes my cert...

Even if I happen to have a IV and morphine in my back pocket for whatever reason, and I have learned how to administer it at the er tech job, I can not give it.  We just cant..  unless, you know something I dont about what our scope of practice is....


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## dmc2007 (Mar 22, 2012)

Miscusi said:


> OK.. i know im new, but I understand that we are to never go beyond our scope of practice.
> 
> I know that if I work BLS, and the patient is really sick and no medics are avail, then yes indeed I will do everything I can for him, which is everything an EmtB is allowed to do, and I will do that to the best of my ability.
> 
> ...



You've just proved his point, as well as the point that the EMT curriculum needs to be longer.  It may seem like there is a lot we can do while we're in school, but once you get out into the field, you'll quickly realize that the list of "every intervention that is known to the emtB" is extremely short, and covers only a small portion of the patients you'll actually encounter.  Further, you'll find that the limited A&P knowledge you get in EMT school doesn't leave you feeling nearly prepared enough to deal with many of the highly sick patients you'll encounter-hence the need for more than the 120 hours.


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## Ackmaui (Mar 22, 2012)

Miscusi said:


> I know some MDs who should be plucking veggies in a farm.  but in all fairness,  If an EMTB is in medical school, trying to be something higer up the medical care field, then of course the ER Tech job would be more beneficial...
> 
> but for those not in school, with no intention of taking more classes,  knowing more than what the EMTB should know holds no real job value as the emt b is prohibited from doing more than what the standard of care is anyway. these emtbs are better off in the truck, perfecting the art of the perfect stair chair grip, and etc..
> 
> ...



If you are comfortable being an EMTB and decide you don't want to learn more than that is up to you. But In the ER I can attach pads faster than any nurses, doctors or,other techs, and whip out an EKG in less than 30 seconds and that's counting putting on the leads in the correct place. I took the time to learn EKGs because I wanted to learn more. Why do just your job when you can do your job and learn more. Being the best at any job you do should always be your goal, and learning everything you can will only help you be a better EMTB.


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## Level1pedstech (Mar 22, 2012)

hibiti87 said:


> if working out in the field is your end goal i think working on a BLS rig would be more beneficial if given the choice between an ER tech position or rig work. While ER tech positions can provide you with a wealth of knowledge, you are pretty much spoon fed the patients history instead of obtaining it yourself through questioning and assessment.



Is that a first hand observation or just an assumption on your part. Depending on the ER and of course all are a little different in what your scope of practice allows,you can indeed use your assessment and patient history skills. Its a pretty safe bet you could if motivated and on the ball use them much more than you would in the field. Let me offer up an example.

The triage nurse brings back a patient and gives you the reason your patient is here today. Your going to get about the same amount of information you would receive with a field dispatch,basically the patients chief complaint. Knowing as a good tech does that you want to be one step ahead of your RN's you would do a brief history focusing on todays visit,obtain vitals and do an assessmet. All this is done so you can form a basic treatment plan to help you and your RN in the rapid treatment and diposition of this patient. Of course your RN will repeat the assessment process for the PA or MD.

Just like in the field your next step would be thinking about what interventions you could get started monitor,O2,EKG and basic comfort measures come to mind. You should be thinking about what additional resources and supplies may be needed to help speed up the delivery of care to your patient this would include lines,labs,RT and radiological studies. Within minutes your RN walks in the room and you give them the same information you would if you rolled in from the ambulance bay. Just like in the field you want to work quickly so you keep the system moving.

Looks to me like you have used and applied the same patient history and assesment skill set you would use in the field especially as a basic on a BLS rig. You also had the chance to practice some hand on skills some you would never do as a basic in the field. Of course this would not be possible in an ER where techs are used more as CNA 's or in an ER where your practice level is extremely limited.


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## Miscusi (Mar 22, 2012)

re: #34 and #35. 

I can see your point,  you think 120 hours is not enough for the best prehospital care, and it isnt.  Here in NY we have two kinds only. BLS and ALS. one is the EMT-B and the other is EMT-P. nothing in between.

the EMTB is allowed to only do what is allowed for EMTB, and the P is allowed to do what the P is allowed.

I can honestly say, I wish every bus out there was a moving ED complete with diagnosis machines and surgery compartments, Portable X-Ray and MRI, Full Lab and pharmacy, yada yada and with 2 MDs and a surgeon per bus. But we cant have everything we want...

So we have the EMTB, and the EMTP.. anything else goes to the hospital.

The current EMT-B Class, if done correctly, and the student learns all of it, then that 120 hours worth of training is plenty enough to do the job of the EMT-B.

If you add more hours to the class, then these people would end up being a higher level and not a Basic anymore. which is not my agrument.

I know you might think that they should get rid of the EMTB rank, and start letting people on the street starting at AEMT or maybe even a all paramedic force,  but that is not reality, the goverment decided that emtB is good for the street. I think the current class is more than adequate for the skills an EMT B must peform, and only perform, and if he performs more than that he gets fired.


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## Ackmaui (Mar 22, 2012)

Miscusi said:


> re: #34 and #35.
> 
> I can see your point,  you think 120 hours is not enough for the best prehospital care, and it isnt.  Here in NY we have two kinds only. BLS and ALS. one is the EMT-B and the other is EMT-P. nothing in between.
> 
> ...



I never said 120 hours isn't enough. I think it's good for what EMTBs can do. I get to do more because I also work in the ER. We are the only ER on this island and I get to see just about everything. The nurses know me and trust in my skills and I even got our nurses excited about using an IO when they can't get a line on priority patients.
My point is that I learn more because I want to..if you are happy being a EMTB and don't want to learn more..that's your choice.


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## Miscusi (Mar 22, 2012)

you as an EMT in the ER is allowed to go IO ?  There must be something I am missing about scopes of practice, or maybe its a NY thing...


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## Miscusi (Mar 22, 2012)

it must be a NY thing, here, the Basic dont include any phlebotomy training / certs at all.


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## Tigger (Mar 22, 2012)

Miscusi said:


> re: #34 and #35.
> 
> I can see your point,  you think 120 hours is not enough for the best prehospital care, and it isnt.  Here in NY we have two kinds only. BLS and ALS. one is the EMT-B and the other is EMT-P. nothing in between.
> 
> ...



When you have a job as an EMT, the deficiencies in your training will come to light, as they have for everyone else. Every job is going to have a certain degree of "on the job" learning, but there is to much of it going on in EMS, especially with basics.

You could certainly add hours to the EMT-B class without adding any skills or interventions. Much more time should be spent learning anatomy and physiology beyond "this is the femur, it hurts when you break it." More time could be spent on proper lifting techniques (bed to bed, chair to stretcher, etc). Documentation is very important in EMS yet how long do we spend learning to write narratives? I could go on but I hope you get the point, even with the current basic scope 120 hours is still not enough. 

And despite working on a BLS ambulance, I am wholly in favor of their elimination from American EMS.


Miscusi said:


> it must be a NY thing, here, the Basic dont include any phlebotomy training / certs at all.



Many times in the hospital you will find that techs have an expanded scope of practice authorized by the ER's medical director.


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## Vetitas86 (Mar 22, 2012)

I've heard stirrings of a push to redo the education requirements from EMT-B on up. Anyone heard anything about this?


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## Miscusi (Mar 23, 2012)

Re: 41,  Oh yes, I know that alot of people can improve on what they learned that 120 hours. I know a few females in our class werent able lift her end of the stretcher. they could really use a year of bodybuilding and protein eating training.

I can see how if the Director at the hospital directs the EMT-B to do an IO, then I guess the B is then authorized to do it. Perhaps there would have been some kind of expansive training period in-house for the newly hired ER TECHS...  I just could just imagine that then the EMTB is no longer working as one, but working as an ER TECH which then might fall into a different legal catagory.... somehow....


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## Handsome Robb (Mar 23, 2012)

Level1pedstech said:


> The triage nurse brings back a patient and gives you the reason your patient is here today. Your going to get about the same amount of information you would receive with a field dispatch,basically the patients chief complaint.



I'd be willing to be that information is more accurate than dispatch info especially in a 911 system but I do agree with the rest of your post. 



Miscusi said:


> but for those not in school, with no intention of taking more classes,  knowing more than what the EMTB should know holds no real job value as the emt b is prohibited from doing more than what the standard of care is anyway. these emtbs are better off in the truck, perfecting the art of the perfect stair chair grip, and etc..
> 
> we are all given a place in life, a role to play,  if it is to be an EMTB, then I rather learn to do the best and fastest AED application rather than to take the time to learn the EKG which I will never use anyway.



Just because you can't perform advanced skills doesn't mean you can't use the knowledge you gain to perform a more thorough assessment to help the ED in their treatment path...Sure everyone will argue that the ED doesn't listen to EMS and does their own assessment which is true to a point but at least in my system the nurses definitely listen to the EMS report and take advantage of the information we have for them. It's not uncommon for nurses to ask field crews for help with a critical patient once we get to the ED, especially if they are busy or shorthanded.

Example, we had a heroine OD that desatted while we were waiting for a nurse and an MD in the room with a "Trauma Tech 1" <- intermediates who were grandfathered in after they switched to all Paramedic techs. He couldn't do anything about it besides bag the patient and wait for orders and while we were waiting i gave him another .4 of narcan and improved the patient's respiratory drive to only require a nasal cannula at 4 lpm rather than sitting there bagging him and inflating his stomach which could cause further problems for the hospital down the line.


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## Vetitas86 (Mar 23, 2012)

Something that would be interesting is specialized training for ER techs, leaving prehospital to the extant EMTs. 

Pharm already does it with compounding and such certs for techs. Why not EMT-Emergency Dept? You'd get less exposure to nonsituational patients. Yes, there'd be loss of flexibility, but each would be able to function independently. 

Then again, that kind of scope really has been the domain of nursing, so why not let EMTs focus solely on prehospital?

Thinking out loud, but imagine an ED staffed with EMTs under a charge nurse or similar. They'd have the duties of CNAs and RNs, but within the limited scope of the ED. This would make cross training and ease of information easier from EMT to midlevel to doc. 

Again. Just thinking out loud.


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## Miscusi (Mar 23, 2012)

_Example, we had a heroine OD that desatted while we were waiting for a nurse and an MD in the room with a "Trauma Tech 1" <- intermediates who were grandfathered in after they switched to all Paramedic techs. He couldn't do anything about it besides bag the patient and wait for orders and while we were waiting i gave him another .4 of narcan and improved the patient's respiratory drive to only require a nasal cannula at 4 lpm rather than sitting there bagging him and inflating his stomach which could cause further problems for the hospital down the line. _

well ok.  I am all for people to learn everything their job entails.

If they switched to all Paramedic Techs, and dude was grandfathered in as an EMT-I, shouldnt he be required to do more training to achieve the new job's requirements ?  

Then this is the fault of the system.  they should have taken the man off the floor if he did not meet the new requirements. grandfather or not.

things change everyday, as the demands of medicine gets greater, the ER Techs must meet the challenge.  

this is a case of the person not knowing all that he should know...

but I am saying that there is not much of a need to know MORE than what you should know... 

I think every position has a purpose. I think the EMTB are more transport, and less medicine,   so they should work greatly on the specific skills of driving, map reading, staying strong and working out for the lifting and moving, and knowing all they should know for the job of the EMT B...  I think IMHO that knowing your OWN JOB is the most important thing,  Knowing the job of a paramedic when you arent one just do not help because you cannot know everything the medic knows, and he went to a thousand hour class to know,  whats worse, is that if you think you know, but then you are mistaken because you werent formally trained and taught, leads to distaster and dead patients.. just imho..


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## Level1pedstech (Mar 23, 2012)

NVRob said:


> I'd be willing to be that information is more accurate than dispatch info especially in a 911 system but I do agree with the rest of your post.
> 
> 
> 
> ...



You have the right attitude and I imagine you dont suffer from the problems that those with "issues" do when it comes to dealing with the ER staff. Honestly it took me a few years to figure out that we are all working towards the same goal and it never hurts to show your appreciation and say thank you. 

Your probably right about being given more information from the triage nurse than you would usually get from the 911 folks. Of course a good call taker on the 911 end might mean having a good idea what to look forward to,or not. When we had 15 or so kids in the waiting room you would be suprised how little informtion I would get out of the triage booth. When it got crazy the "urgent care" kids would get thier triage in back leaving the triage nurse free for the more complex patients. This was the same on the adult side which made for great practice especially for those that needed to brush up on thier triage skills this included techs and nurses.


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## Handsome Robb (Mar 23, 2012)

Miscusi said:


> _Example, we had a heroine OD that desatted while we were waiting for a nurse and an MD in the room with a "Trauma Tech 1" <- intermediates who were grandfathered in after they switched to all Paramedic techs. He couldn't do anything about it besides bag the patient and wait for orders and while we were waiting i gave him another .4 of narcan and improved the patient's respiratory drive to only require a nasal cannula at 4 lpm rather than sitting there bagging him and inflating his stomach which could cause further problems for the hospital down the line. _
> 
> well ok.  I am all for people to learn everything their job entails.
> 
> ...



No he knew what needed to happen he just couldn't do it. The "Trauma Tech 2s" which requires paramedic + street experience couldn't do anything about it either. They can't push meds thanks to the nursing union. 

That was more an example of how prehospital and ED staff work together, that tech asked us if we could give the narcan so he didn't have to bag the patient. Sorry I should have done a better job of specifying that in the original post.


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## Miscusi (Mar 23, 2012)

wait a minute, how were you able to give the .4 if you werent the nurse ?, your avatar says you are a medic student ?


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## DrankTheKoolaid (Mar 23, 2012)

He hadnt turned care over i would assume.


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## Miscusi (Mar 23, 2012)

well, IIRC,  here in NY, EMTb and Aemts dont have any narcan.... I think the medics do, but I guess thats vegas..


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## Ackmaui (Mar 23, 2012)

Miscusi said:


> you as an EMT in the ER is allowed to go IO ?  There must be something I am missing about scopes of practice, or maybe its a NY thing...



I'm not allowed to do IOs, what I said was that I got the nurses thinking about IOs. There are things that's techs cannot do, due to liability reasons. It's also up to the medical director and what they are comfortable with having the ER techs do. By the way there were 6 males in my EMTB class that couldn't lift their end of the stretchers.. The 9 females in my class?... Well, none of us had a problem lifting the stretcher. Just sayin


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## dmc2007 (Mar 23, 2012)

Miscusi said:


> _Example, we had a heroine OD that desatted while we were waiting for a nurse and an MD in the room with a "Trauma Tech 1" <- intermediates who were grandfathered in after they switched to all Paramedic techs. He couldn't do anything about it besides bag the patient and wait for orders and while we were waiting i gave him another .4 of narcan and improved the patient's respiratory drive to only require a nasal cannula at 4 lpm rather than sitting there bagging him and inflating his stomach which could cause further problems for the hospital down the line. _
> 
> well ok.  I am all for people to learn everything their job entails.
> 
> ...



So you're basically saying we should go back to being Ambulance drivers...

(not saying that we aren't, but EMS in this country will never gain respect if we keep this attitude up).


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## usalsfyre (Mar 23, 2012)

dmc2007 said:


> So you're basically saying we should go back to being Ambulance drivers...
> 
> (not saying that we aren't, but EMS in this country will never gain respect if we keep this attitude up).



As long as we insist the level of care of EMTs provide is acceptable we won't gain any respect...


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## Miscusi (Mar 23, 2012)

Re : 9 hulking super chicks: i gotta meet them lol...

Re : respect...  To gain respect is to do your job well.  EmtB is necessary in the world. Who else is gonna care and transport the sick and injured? I will respect any emtb who do their job well. Knows their job limits and takes the job seriously. Every role in ems is vital and commands respect already. It is the individual behavior of some that makes people lose respect for those peeps, and as far as self respect, if you cant understand that emtb is a good thing, then stop the chip on shoulder thing and go school urself till u r the surgeon general.


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## Vetitas86 (Mar 23, 2012)

dmc2007 said:


> So you're basically saying we should go back to being Ambulance drivers...
> 
> (not saying that we aren't, but EMS in this country will never gain respect if we keep this attitude up).



I agree 100%. EMS needs to push for more respect. It's part of the Public Safety establishment along with Fire and LE. Why not be respectable and able to operate in multiple environments?

I think EMS needs an overhaul to its education system and a definite across the board scope of practice to ever be taken seriously. That's why everyone from EMT-B on up needs to push for it. Change will never happen if no one acts on it.

As far as EMT-Bs having their place, I doubt anyone will dispute that. But as far as career advancement, etc there are relatively few options compared to Fire and LE except for going back to school. 

And just because there is a demand and a job done well, it doesn't mean that the profession will be more respectable. I think that's the issue rather than the individual EMT being respected or not.


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## Ackmaui (Mar 23, 2012)

Miscusi said:


> Re : 9 hulking super chicks: i gotta meet them lol...
> 
> Re : respect...  To gain respect is to do your job well.  EmtB is necessary in the world. Who else is gonna care and transport the sick and injured? I will respect any emtb who do their job well. Knows their job limits and takes the job seriously. Every role in ems is vital and commands respect already. It is the individual behavior of some that makes people lose respect for those peeps, and as far as self respect, if you cant understand that emtb is a good thing, then stop the chip on shoulder thing and go school urself till u r the surgeon general.



Lol..we aren't hulking chicks..just strong!! I agree with your comment about respect...I think anyone, regardless of their title, who does a great job will earn respect.


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## Shishkabob (Mar 23, 2012)

Vetitas86 said:


> I agree 100%. EMS needs to push for more respect. ...Why not be respectable and able to operate in multiple environments?



Because we're fighting an uphill battle with the IAFF and the nursing unions, both who have very lengthy and powerful unions that benefit greatly by keeping Paramedics down at the current level.


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## Vetitas86 (Mar 23, 2012)

I do agree its an uphill battle. That's why I think the best thing to do is redo education and procedure across the board. Set concrete standards that are transferrable from state to state, moreso than they are now. 

I don't see it happening soon. EMS is the youngun in healthcare, but its shown it has a place. I'm not advocating expanding into nursing or related fields, just making the standards of care on par with the existing organizations, but still functionally different.


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## dmc2007 (Mar 23, 2012)

usalsfyre said:


> As long as we insist the level of care of EMTs provide is acceptable we won't gain any respect...



^This is what I was trying to get at, if I wasn't clear.


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## aaron911 (Mar 24, 2012)

I would STRONGLY suggest working in the ER. I work in the ER as a tech as well as the local 911 ambulance agency. So I see the best of both worlds! ha ha. If you are going to PA school the ER is a great place to work especially if you build a relationship with the MD's...(I have had MD's go out of there way multiple times to either show me an Xray or a lab result and explain a disease process which is really cool) Also your scope is expanded a lot, I get to do orthoclase splints, long term wound care, get to help the MD with really cool skills like chest tubes, pic lines, I&D's sutures... I can go on for days. And if your MD trusts you, he will let you interpret the EKG instead of tracking him down to show him. Plus it really sharpens your assessment skills because A patient will be put in a room and you are expected to hook them up to the monitor and do an assessment. Plus you get paid A LOT more


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## Miscusi (Mar 26, 2012)

Respect?

I had to look up the word after reading about so much of it here...  I thought respect means to hold in high esteem, have proper recognition, acknowledgment, etc....

but when you people here say respect, means something else, like better working conditions, career advancement, and stuff like that... 

I thought EMS was being DISrespected somehow and I didnt know ! LOL


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## Vetitas86 (Mar 26, 2012)

Considering EMS by and large are considered little more than ambulance drivers...

I think that entails not getting the proper recognition.


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## Pavehawk (Mar 26, 2012)

Vetitas86 said:


> Considering EMS by and large are considered little more than ambulance drivers...
> 
> I think that entails not getting the proper recognition.



How can we as a profession expect OTHER people to respect us when we constantly fight among ourselves, smack talk, disparage other people in the business, whine about nurses and doctors being "unprofessional compared to us" and devote a thread as to who's Med-Peen is bigger, ED techs or field medics. 

Perhaps when EMS people start to respect others and ourselves AND act accordingly we will start to get some in return.


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## SliceOfLife (Mar 26, 2012)

Pavehawk said:


> How can we as a profession expect OTHER people to respect us when we constantly fight among ourselves, smack talk, disparage other people in the business, whine about nurses and doctors being "unprofessional compared to us" and devote a thread as to who's Med-Peen is bigger, ED techs or field medics.
> 
> Perhaps when EMS people start to respect others and ourselves AND act accordingly we will start to get some in return.



Indeed.  But it's not just limited to our industry.  You should hear cops talk about other agencies, town, city, state, corrections, jail, gov cops, environmental police they all bicker about who is the real deal.


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## Vetitas86 (Mar 26, 2012)

Amen to the above. I know plenty of cops who play the whose Richard is bigger game, so to speak. Jursidiction and whatnot (which is punny, when you think about it).

Point being though, the bickering is in every industry. It's not a matter of "why can't we all just get along," its a matter of having pride in our profession, which I believe EMS already has. That's the first step, but what's next?


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## Miscusi (Mar 27, 2012)

_*Considering EMS by and large are considered little more than ambulance drivers... I think that entails not getting the proper recognition. *_

but but but...  ambulance driving is what the job is !   the goal is to get the patient to the hospital isnt it ?


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## Tigger (Mar 27, 2012)

Vetitas86 said:


> Amen to the above. I know plenty of cops who play the whose Richard is bigger game, so to speak. Jursidiction and whatnot (which is punny, when you think about it).
> 
> Point being though, the bickering is in every industry. It's not a matter of "why can't we all just get along," its a matter of having pride in our profession, which I believe EMS already has. That's the first step, but what's next?



When you enter it, you may reconsider your position. 

Many people take pride in what they do but allow others to not do so, therefore bringing down the entire ship.



Miscusi said:


> but but but...  ambulance driving is what the job is !   the goal is to get the patient to the hospital isnt it ?



The most important goal yes. But if it that's the only goal, why bother taking an EMT class? It's not like the class really teaches you very much about driving an ambulance or really even moving patients. If getting the patient to the hospital is our only goal we might as well go back to the days of using a hearse and having no one in back with the patient.


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## the_negro_puppy (Mar 27, 2012)

Interesting that you guys can work as EMTs/Medics at hospitals.

We don't even do any hospital clinical time in our training. I am about to finish my training after nearly 2.5 years working on the road and i've never even seen a baby delivered in real life. <_<  

I really wish we could work at hospitals here, we can;t evening et clinical placements in them anymore.


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## Vetitas86 (Mar 27, 2012)

Where are you training? I know for sure ER and OBGYN are part of our curriculum, even at the B level.


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## Miscusi (Mar 28, 2012)

I know the class dont teach u driving, thats because you already can drive. Emt class teach you how to prep and handle the shipment that u go pick up, and bring to the hospital... In the ambulance.  The guy in the back makes sure the package dont go bad in transit. Thats all,


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## Miscusi (Mar 28, 2012)

I meant the guy in back is neccessary to keep the package in good condition until delivered.  The ultimate goal of emtb is to get the pt to the hospital we all agree.  Ambulance is the machine to do that, and we really dont do much above that.  In point, for accessments, the more sick the pt, the faster we load and go... Almost everything importantly dangerous is a load and go, and with ALS intercept.. If we the emtb want to be "more than ambulance drivers", then the indvidual needs to go to medic school and be ALS.   no one can really say an ALS unit staffed with 2 paramedics are ambulance drivers because we all  know that medics are advanced and i totally see them more as 30-40% healthcare and 60-70%driver, whereas emtb is a 3/97 - 13/87 ratio. Imho.


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## Tigger (Mar 28, 2012)

Miscusi said:


> I know the class dont teach u driving, thats because you already can drive. Emt class teach you how to prep and handle the shipment that u go pick up, and bring to the hospital... In the ambulance.  The guy in the back makes sure the package dont go bad in transit. Thats all,



So you learned how to drive an ambulance when you first got your license? Drivers Ed car had lights and sirens on it? Your little old instructor taught you how to back up with just mirrors into an alley?



Miscusi said:


> I meant the guy in back is neccessary to keep the package in good condition until delivered.  The ultimate goal of emtb is to get the pt to the hospital we all agree.  Ambulance is the machine to do that, and we really dont do much above that.  In point, for accessments, the more sick the pt, the faster we load and go... Almost everything importantly dangerous is a load and go, and with ALS intercept.. If we the emtb want to be "more than ambulance drivers", then the indvidual needs to go to medic school and be ALS.   no one can really say an ALS unit staffed with 2 paramedics are ambulance drivers because we all  know that medics are advanced and i totally see them more as 30-40% healthcare and 60-70%driver, whereas emtb is a 3/97 - 13/87 ratio. Imho.



If that's really your attitude, you need to get out of EMS before you start. If your patient is just a package, well there's not really anymore that I can say.


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## EMTSTUDENT25 (Mar 30, 2012)

Back to the OP, If you can get on the box FT and ED Tech PRN then do it...Its not going to hurt your education one bit.  BLS or 911, ask questions to those with more experience and learn.  In my experience it is very difficult to get a tech position as an emt.  ED's usually want a year of experience. 

I would finish school, pass your tests, and then go from there.  Your mind might change 10 times from now to then.  Good to have a plan though.


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## MusicMedic (Mar 30, 2012)

Im planning on volunteering at the Local ER here and try to make a name for myself.. ER Tech jobs are impossible to land here (Orange County) unless your best friends with the hospital director or you work on the inside. 

I plan on starting Nursing school either fall of this year or spring of next.. almost done with my science classes (Chem,Anatomy,Physio,Micro). Currently taking physio this semester and it is my fav class!

One thing though i can tell you.. im learning HOW MUCH i DONT/DIDNT know from all these science classes.. 

IMHO Er Tech and EMT on the Rig are different animals.. the whole comparison of Pre-Hospital to Hospital is kind of hard to do.


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## Miscusi (Apr 3, 2012)

patients are just packages...  getting emotional over your packages wont get them to the destination any better or faster..

The buses here are Ford trucks, drives just like any other, you dont need any special licencese to drive these. backing them up?  the partner would direct I guess.

lights and sirens,  so ?  that dont make driving any harder... no one should be driving recklessly anyway.  ambulances are not race cars.

attitude is fine, the most imporant thing in EMS is to do the job well. and to get your package to the destination the way you are supposed to.


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## firecoins (Apr 4, 2012)

Miscusi said:


> patients are just packages...  getting emotional over your packages wont get them to the destination any better or faster..
> 
> The buses here are Ford trucks, drives just like any other, you dont need any special licencese to drive these. backing them up?  the partner would direct I guess.
> 
> ...



NYS hasn't even sent you your card yet and your attitude is fine?  Whatever


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## Tigger (Apr 4, 2012)

firecoins said:


> NYS hasn't even sent you your card yet and your attitude is fine?  Whatever



Agreed, I'm done here. Well maybe. I can't stand letting stupidity just sit there unchallenged. 

"Just packages." What more is there to say?


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## Handsome Robb (Apr 4, 2012)

Miscusi said:


> patients are just packages...  getting emotional over your packages wont get them to the destination any better or faster..
> 
> The buses here are Ford trucks, drives just like any other, you dont need any special licencese to drive these. backing them up?  the partner would direct I guess.
> 
> ...



You can't really talk about the driving aspect unless you've done it. They don't teach you how to decide when to oppose traffic or when to play it safe and shut down and wait for the light in driver's ed. They don't teach you how people react to your lights and sirens. They don't teach you how to properly clear intersections. You're right, ambulances aren't race cars, but that doesn't stop people from treating them like one once the lights come on because "someone might be dying". Ambulances are long, wide, accelerate slowly and accelerate slowly. Now add in driving while your partner is working in the back. Turn that to driving code while your partner is working and it gets even more difficult. 

Patients are not packages, they are people. If you say the things we see in EMS don't affect you you have a rude awakening coming my friend. Just because something touches your emotions doesn't mean it compromises the care you provide. You have to know how to separate it and deal with it in the proper manner. 

I'm with firecoins, you're attitude is not ok.


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## Miscusi (Apr 4, 2012)

Yes package.. The package is a person yes. Do u know what package means? It seems you are making it more than it really is!  So what if pt codes? So what if ppl are dying. You still drive it in a safe and responsible manner. One accident and your package will be delayed. Or die in transit.  Driving is not hard, not even with the variables you mention. Its not huge either its a pickup truck. U haul has bigger vehicles.  I dont think attitude matters at all, we all have opinions but fact remains the same. Do the job right, do it well. Speeding kills.


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## Miscusi (Apr 4, 2012)

_"NYS hasn't even sent you your card yet and your attitude is fine? Whatever "_

Yes, though two very independent things you have pointed out, but yes, the state havent mailed the cards yet, and also yes, my attitude is fine.  Perfectly fine.


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## Miscusi (Apr 4, 2012)

NVRob said:


> You can't really talk about the driving aspect unless you've done it. They don't teach you how to decide when to oppose traffic or when to play it safe and shut down and wait for the light in driver's ed. They don't teach you how people react to your lights and sirens. They don't teach you how to properly clear intersections. You're right, ambulances aren't race cars, but that doesn't stop people from treating them like one once the lights come on because "someone might be dying". Ambulances are long, wide, accelerate slowly and accelerate slowly. Now add in driving while your partner is working in the back. Turn that to driving code while your partner is working and it gets even more difficult.
> 
> Patients are not packages, they are people. If you say the things we see in EMS don't affect you you have a rude awakening coming my friend. Just because something touches your emotions doesn't mean it compromises the care you provide. You have to know how to separate it and deal with it in the proper manner.
> 
> I'm with firecoins, you're attitude is not ok.





_You can't really talk about the driving aspect unless you've done it._

Done it.

_They don't teach you how to decide when to oppose traffic or when to play it safe and shut down and wait for the light in driver's ed. _

No, Im sure driver's ED dont teach you that sir. but Im sure its not rocket science.

_They don't teach you how people react to your lights and sirens. They don't teach you how to properly clear intersections. _

No, im sure drivers ed dont teach that either, but im sure its not rocket science.

_You're right, ambulances aren't race cars, but that doesn't stop people from treating them like one once the lights come on because "someone might be dying". _

THESE are the people that needs to get out of EMS... emotionally driven EMTs  who would speed the ambulance ? thats a no-no. 

_Ambulances are long, wide, accelerate slowly and accelerate slowly. _

Here we have ford truck based buses...  im sure they arent any longer wider or behave differently than other ford pickup based cube-trucks because they are painted red.

_Now add in driving while your partner is working in the back. Turn that to driving code while your partner is working and it gets even more difficult. _

What are you talking about? how on earth would driving get more difficult ?  You are only supposed to drive as fast as safety allows anyway.  What you do? blast through red lights ?  turn corners so fast that your tires skid ?  what is this ? stunt driving ?  no !     


_Patients are not packages, they are people._ 

I will package the patients for transport as per the conditions found. therefore they are packages.  otherwise, I would be a livery driver, not an ambulance driver.

_If you say the things we see in EMS don't affect you you have a rude awakening coming my friend._ 

I have seen alot.  nothing really bothers me.

_Just because something touches your emotions doesn't mean it compromises the care you provide. You have to know how to separate it and deal with it in the proper manner. _

Yes it does.  emotions require your brain to work.  your emt services requires your brain to work...   you cant do two things at once.  

If you have to seperate and deal with it, then you are doing three things at once,.. have the emotion come,  deal with the emotion, and then try to do your job.

I rather just focus on doing the job.  Time is of the essence.


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## Shishkabob (Apr 4, 2012)

Miscusi said:


> THESE are the people that needs to get out of EMS... emotionally driven EMTs  who would speed the ambulance ? thats a no-no.


  Nope, nothing wrong with having emotions, and nothing wrong with speeding, so long as the two are done in appropriate ways at appropriate times.




> What are you talking about? how on earth would driving get more difficult ?  You are only supposed to drive as fast as safety allows anyway.  What you do? blast through red lights ?  turn corners so fast that your tires skid ?  what is this ? stunt driving ?  no !


  The fact that you don't understand that driving with everyone belted in safely is different from having someone standing in the back, handling sharps, and someone on a bed that probably doesn't trust the restraints prove that you missed his point.





> I have seen alot.  nothing really bothers me.


  This is a funny statement coming from someone who, let's be honest here, has probably not seen as much as they think.  You JUST got certified and this is your FIRST time doing anything in this type of field, correct?

Most people I see who say that type of thing, don't last long in this career.



> Yes it does.  emotions require your brain to work.  your emt services requires your brain to work...   you cant do two things at once.



I've been doing this for coming on 4 years.  There are many things I can do without thinking about them, "muscle memory" have you.  My hands can be doing one thing while my mind is elsewhere, such as thinking about the next 3-4 things I want done.

But, emotions don't just mean DURING the call.  You can get emotional after a call.




> Time is of the essence.



Rarely.


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## Miscusi (Apr 4, 2012)

_Nope, nothing wrong with having emotions, and nothing wrong with speeding, so long as the two are done in appropriate ways at appropriate times._

appropriate being the key word here.  if it is appropriate then yes, thats fine... but it just isnt appropriate for my locality.


_The fact that you don't understand that driving with everyone belted in safely is different from having someone standing in the back, handling sharps, and someone on a bed that probably doesn't trust the restraints prove that you missed his point._

i know the difference sir, and the driving still does not get more difficult. I avoid potholes and sudden moves in my everyday driving style regardless. 

_This is a silly statment, and always one I see from people who don't last long in this career._

I dont know about others, but my statement still stands un-silly. I have seen alot, and nothing really bothers me.  my worse:  man machine gunned with an AK47 dying where he fell in the SNOW !     2nd worse,  man pooed his wheelchair,  then his toilet,  then himself, then flooded his house in 1 inch of water so poo was everywhere, the whole place stunk to high heaven... no,  dont really bother me.

_I've been doing this for coming on 4 years.  There are many things I can do without thinking about them, "muscle memory" have you.  My hands can be doing one thing while my mind is elsewhere, such as thinking about the next 3-4 things I want done._

Good for you. that is good.

_But, emotions don't just mean DURING the call.  You can get emotional after a call._

Emotional after a call is worthless, you got the next call to think about, and if its the last call for the tour, then you gotta concentrate on dinner plans.

Time is of the essense.

"Rarely"

Really ?  I guess is not a very busy area where you are.  everyone here is concerned about response times, and the ability to go to the next call as soon as it comes in.


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## Miscusi (Apr 4, 2012)

I see you edited:

"This is a funny statement coming from someone who, let's be honest here, has probably not seen as much as they think. You JUST got certified and this is your FIRST time doing anything in this type of field, correct?"

i guess I didnt say eariler.  Im not some kid.  Im 38 years old, former military.


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## MassEMT-B (Apr 4, 2012)

Miscusi said:


> I see you edited:
> 
> "This is a funny statement coming from someone who, let's be honest here, has probably not seen as much as they think. You JUST got certified and this is your FIRST time doing anything in this type of field, correct?"
> 
> i guess I didnt say eariler.  Im not some kid.  Im 38 years old, former military.



So since you were in the military you've seen everything, nothing will ever bother you? Most likely, it won't the gory stuff that will bother you. It will be seeing the sick dying person that reminds you of someone you know. Also all this about how you won't be emotional and how people are just "packages" makes you sound like a robot, you have to be compassionate towards people. You're not providing the best care possible if you can't at least help some of the emotional needs of people.


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## firecoins (Apr 4, 2012)

Miscusi said:


> I see you edited:
> 
> "This is a funny statement coming from someone who, let's be honest here, has probably not seen as much as they think. You JUST got certified and this is your FIRST time doing anything in this type of field, correct?"
> 
> i guess I didnt say eariler.  Im not some kid.  Im 38 years old, former military.



Your 38 and have this type of attitude? I expect it from an 18 year old. Maybe I am missing something. Maybe something isnt translating over the internet.  

You still need experience.

EMS is not the military.  Its not combat. Blood and guts are the easy part of the job. Were not under fire here. I have had ex militart partners.  My experience has mixed. Some people with military medics excel.  Some don't.  Its not a given. 

Your dealing with people not packages.


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## Medic Tim (Apr 4, 2012)

Is this guy for real or is this a gag account. If not I really feel for the guys and or girls who have to be his partner.


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## dmc2007 (Apr 4, 2012)

Miscusi said:


> U haul has bigger vehicles.



U-Haul's trucks are on the average lighter and have a lower center of gravity then the average ambulance.  Inertia makes a huge difference.

I'll let others chime in on the rest...


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## Shishkabob (Apr 4, 2012)

Miscusi said:


> I dont know about others, but my statement still stands un-silly. I have seen alot, and nothing really bothers me.  my worse:  man machine gunned with an AK47 dying where he fell in the SNOW !     2nd worse,  man pooed his wheelchair,  then his toilet,  then himself, then flooded his house in 1 inch of water so poo was everywhere, the whole place stunk to high heaven... no,  dont really bother me.



Not one to compare war stories (pun not intended) but if those two are the 'worst you've seen', boy are you in for a wakening.  Everyone has different things that get to them.  Everyone.

How many times have you had to tell a family that there is nothing you can do for their loved one?  How many times have you seen an absolutely abysmal lifestyle, but still have to try and save a life?  How many times have you seen families torn apart, physically and mentally, by a mere wrong move?  How many times have you seen someone commit suicide to prove a point to their family and put it on display?


Don't be ashamed if a call effects you.  Just don't let it ruin you.



> Really ?  I guess is not a very busy area where you are.  everyone here is concerned about response times, and the ability to go to the next call as soon as it comes in.



One of the biggest service areas in the country, one of the busiest call volumes in the country in one of the biggest cities, and one of the most progressive agencies medically in the country. 

 Nope, I clearly am wrong when I say time rarely matters in EMS.


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## Medic Tim (Apr 4, 2012)

Miscusi said:


> Time is of the essense.
> 
> "Rarely"
> 
> Really ?  I guess is not a very busy area where you are.  everyone here is concerned about response times, and the ability to go to the next call as soon as it comes in.



this made me literally LOL


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## firecoins (Apr 4, 2012)

Miscusi said:


> Yes package.. *The package is a person yes. Do u know what package means? It seems you are making it more than it really is!  **So what if pt codes?* *So what if ppl are dying. *You still drive it in a safe and responsible manner. One accident and your package will be delayed. Or die in transit.  Driving is not hard, not even with the variables you mention. Its not huge either its a pickup truck. U haul has bigger vehicles.  I dont think attitude matters at all, we all have opinions but fact remains the same. Do the job right, do it well. Speeding kills.



We are making people more important than they really are? Why are you doing EMS?


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## Shishkabob (Apr 4, 2012)

firecoins said:


> We are making people more important than they really are? Why are you doing EMS?



The money, babes, and free food.



Oh, you meant him. :unsure:


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## Handsome Robb (Apr 5, 2012)

firecoins said:


> We are making people more important than they really are? Why are you doing EMS?



What he said.


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## Miscusi (Apr 5, 2012)

Why? What?  Why all the sissy stuff? Telling the family ? Who cares? Thats not my job! Im supposed to cpr the package all the way to the er!  Im aint telling nobody nuttin! And who cares if the pt looks like your mom?  Man.. You ppl are really something!


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## firecoins (Apr 5, 2012)

Miscusi said:


> Why? What?  Why all the sissy stuff? Telling the family ? Who cares? Thats not my job! Im supposed to cpr the package all the way to the er!  Im aint telling nobody nuttin! And who cares if the pt looks like your mom?  Man.. You ppl are really something!



:rofl:


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## Miscusi (Apr 5, 2012)

And why do emtb? Because its fun and exciting? Bejeeze it is an ambulance, not a hippie love wagon...


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## Medic Tim (Apr 5, 2012)

Miscusi

most ppl i know got into ems because they like to help people. The ones that did it because it was cool didnt last long at all. 

I really hope you are just trolling and don't seriously believe most of what you say. If you do, EMS will be a very rocky road and not as enjoyable as you think it will be. You will also be hard pressed to find a partner willing to work with you or trust you.


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