# Value of I-training



## medicdan (Sep 12, 2007)

I have been lurking around here for a while and really value the opinion of the members of this community. 
Here is my story: I have just graduated from High School, and have been accepted to a University, but am deferring my admission for a year. I am in the process of mapping out the second half of my year now. In about a month, I am going to go to Israel and volunteer (intern) as a First Responder on the national Ambulance corps (MDA) (It seems to me that I am unable to transfer my basic certification right now). 
This summer I have been working with a fairly rural community EMS/Fire Department that has an Intermediate Ambulance but trouble getting 24/7 I coverage. They have been pushing their members to start I training, and although I am with them for a short period of time, they wouldn't mind it if I got the training and came back. 

I am a very new EMT (I got my cert over the summer), and hope to gain some experience in Israel. I plan on joining the on-campus EMS at my university, and they have a basic ambulance. 

Essentially I am going to have roughly 4-6 months free during this year and wonder if it is worth perusing Intermediate training. 
Is it worth the training if I have little experience (not even a years worth)?
Will I use the skills if only in a basic environment (no IVs or tubes, just advanced assessment)? 
Is it worth my time if I dont plan on perusing Paramedic training for at least five years? 
Is there really a use for Intermediates in the field? 
And is the time required for training and field internships worth it?

What do you think? What is the value of an Intermediate? 


Thanks a lot, I look forward to some interesting opinions.


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## ResTech (Sep 12, 2007)

Thats pretty neat u will experience EMS in Israel. Hopefully your not that desperate for experience!... lol. Least the violence has been somewhat simmered down. If u have a chance to get EMT-I, go for it. EMT-I is a great program and isnt much different then paramedic. EMT-I's are very valuable in the field as some systems use I's exclusively as their ALS providers. You will hear tons of negative comments (mainly from paramedics) that EMT-I is a waste of time and u should just get ur paramedic and this and that... but dont listen to it.... its all ego talking.


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## medicdan (Sep 12, 2007)

ResTech, no, I am not that desperate for expierence. I knew I wanted to spend time in Israel during my year off, and thought that would be a great use of skills and time. I am going five 8 hour shifts a week, so I am planning on spending most of my free time exploring.


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## medicdan (Sep 12, 2007)

Double post. Sorry


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## KEVD18 (Sep 12, 2007)

ResTech said:


> ... isnt much different then paramedic...



pardon me for asking, but have you been drinking? -i's being not much different than medics? interesting viewpoint, but your wrong. in ma, i's can intubate(without medication) and start iv's, but only run n/s through them. so basically, they can only tube unconcious unresponsive pts and cant administer any medications(above bls). at least this is all i have ever seen them used as but having never worked in rurual ma i aknowledge its a limited purview

medics can actually treat pt's at the als level. im not so egotistical to say -i's dont have a place in the system, but to say they arent much diff than -p's is stretching it.


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## EMTmetzger (Sep 12, 2007)

from what i'v heard I's arent widly used, but i would go for it, it will probobly help you when you start going for your paramedic.  i guess what im trying to say is, get your education now do your thing in isrial then come home and pick up the expiriance for a few years b4 u go 4 paramedic.


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## Rattletrap (Sep 12, 2007)

Ok, I am hopeing I am not misunderstood in what I say here. The EMT-I can be quite far from being a Paramedic and also be quite close. 

The national registry uses 2 different test which makes the difference along with the state and local protocols they are paired with. The test are the I-85 and the I-99 (being the more advanced and closer to paramedic).


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## Gbro (Sep 12, 2007)

I training is great;
I(Me) did it 15 or so years ago. Didn't mantain it, as we were a bare bones BLS then. 
Any training you get will make you a better Medic(?).


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## Grady_emt (Sep 13, 2007)

I know that here in Georgia, Intermediates are a big deal.  Just about all agencies prefer I's over Basic's.  In GA, we are on the I-85 Nat Reg Curriculum.  All the FDs are putting thier folks through I school when they first come through the academy now.


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## Ridryder911 (Sep 13, 2007)

EMT Intermediate is a cheap way of getting placebo paramedic. Intermediate literally means part or half way; unfortunately this means they are taught enough just to raise the rates for billing EMS services without any real substance to make changes in patient outcomes. 

My suggestion is to do what you believe is best. Remember, to be proficient in your skills, you will need to do such on a regular basis. If your state so happens to allow Intermediate to intubate (NREMT does not recognize such) will you be able to perform and keep up skills? As well, re-certifying will require additional time in CEU's and refresher length and medical control (physician) authorization. 

Good luck in your decision

R/r 911


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## ResTech (Sep 13, 2007)

KEVD.... I dont think ur talking about a true EMT-I (ie NREMT-I). Rid... how u can u say an EMT-I doesnt possess any real substance to effect patient outcome? Does an EMT-I not treat an arrest the same as a paramedic? Do they not treat diabetics the same as medics with D50, glucagon, IV, etc.?, do they not treat trauma pt's. pretty much the same with fluid resuscitation, advanced airway control, needle decompression, IO, EKG monitoring, etc? Do they not treat chest pain and CHF with NTG, ASA, O2, CPAP? Can they not treat hemodynamically unstable VTACH? Treat SVT with adenosine? Treat COPD with CPAP with albuterol, terbutaline, epi? Treat anaphylaxis with epi, benedryl? Seizures with valium or ativan? Narc OD with narcan?

This seems pretty substantial and clinically significant to me! here is the drugs approved for I/99.. note each state can add to this. 

I/99 PHARMACOLOGY (taken from the DOT curriculum)
Acetylsalicylic acid
Adenosine
Ativan
Atropine sulfate
Bronchodilators (Beta 2 agonists like Albuterol, etc. etc. etc. etc.)
Bronchodilator adjuncts (Dexamethasone, etc.)
Diphenhydramine
50% Dextrose
Diazepam
Epinephrine (1:1,000; 1:10,000)
Furosemide
Glucagon
Lidocaine (or Amiodarone)
Morphine sulfate
Naloxone
Nitroglycerin (not patient's own)
Thiamine


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## Rattletrap (Sep 13, 2007)

ResTech said:


> KEVD.... I dont think ur talking about a true EMT-I (ie NREMT-I). Rid... how u can u say an EMT-I doesnt possess any real substance to effect patient outcome? Does an EMT-I not treat an arrest the same as a paramedic? Do they not treat diabetics the same as medics with D50, glucagon, IV, etc.?, do they not treat trauma pt's. pretty much the same with fluid resuscitation, advanced airway control, needle decompression, IO, EKG monitoring, etc? Do they not treat chest pain and CHF with NTG, ASA, O2, CPAP? Can they not treat hemodynamically unstable VTACH? Treat SVT with adenosine? Treat COPD with CPAP with albuterol, terbutaline, epi? Treat anaphylaxis with epi, benedryl? Seizures with valium or ativan? Narc OD with narcan?
> 
> This seems pretty substantial and clinically significant to me! here is the drugs approved for I/99.. note each state can add to this.
> 
> ...




That is what DOT says. How ever, many medical directors will cut the squad protocols down to the point that the EMT-I is nothing more than a basic who can start IV's. Management in the company I work for just  brought our company out of the dark ages with the EMT-I protocols, and that is only for one division not the whole company.

Rid is correct. Many times haveing an EMT-I on the truck allows companies to bill ALS without paying a paramedic, and that is why they are desireable.


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## Ridryder911 (Sep 13, 2007)

ResTech said:


> KEVD.... I dont think ur talking about a true EMT-I (ie NREMT-I). Rid... how u can u say an EMT-I doesnt possess any real substance to effect patient outcome? Does an EMT-I not treat an arrest the same as a paramedic? Do they not treat diabetics the same as medics with D50, glucagon, IV, etc.?, do they not treat trauma pt's. pretty much the same with fluid resuscitation, advanced airway control, needle decompression, IO, EKG monitoring, etc? Do they not treat chest pain and CHF with NTG, ASA, O2, CPAP? Can they not treat hemodynamically unstable VTACH? Treat SVT with adenosine? Treat COPD with CPAP with albuterol, terbutaline, epi? Treat anaphylaxis with epi, benedryl? Seizures with valium or ativan? Narc OD with narcan?
> 
> This seems pretty substantial and clinically significant to me! here is the drugs approved for I/99.. note each state can add to this.
> 
> ...



Actually, there are very few states that accept the I-99 rather they accept the traditional Intermediate level which only includes 4 modules of the NHTSA curriculum. The same as the traditional NREMT Intermediate that does NOT test over intubation, administration of medications, ECG, etc... So I say NO they have no major outcome in major illnesses or injuries. 

If the service is utilizing EMT/I as the I-99 they are short changing the medic. Rather than pay them for the responsibility and basically doing a Paramedics job, they will not. Although, they are charging and getting reimbursed for such. Nice little scam they have.... 

Remember all * titles after the basic level is always in comparrision to the Paramedic,* almost, half way, near.. not quite, etc. 

R/r 911


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## medicdan (Sep 13, 2007)

Thanks to all for their responses. I truly do value them. 
What I am really trying to ask is:

1. Is it worth the time the course and internships take, if I am not immediately going to be able to use the skills, just the assessments, and if medic school if it ever happens for me, will only happen after 5+ years?

2. Is the Intermediate course (assume I am referring to the non '99 course) really a use in the field? When true ALS providers are not far off does the training serve any purpose other then billing?

3. I keep hearing how terrible it is for students to go directly from Basic to medic school and have heard some of the anecdotes of what they come out to be at the end. Will I be able to take advantage of the course, even with less then a year of field experience? 

Thanks again to all for your help and advice. 

DES


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## triemal04 (Sep 14, 2007)

emt-student said:


> Thanks to all for their responses. I truly do value them.
> What I am really trying to ask is:
> 
> 1. Is it worth the time the course and internships take, if I am not immediately going to be able to use the skills, just the assessments, and if medic school if it ever happens for me, will only happen after 5+ years?
> ...


1.  Yes.  Although you won't get anywhere near the amount of knowledge or ability to assess your pt's as you will in medic school, every little bit helps.  Even if you can't perform any of the skills, it will still help you (a bit anyway)to figure out what is wrong with the pt (maybe).  And regardless of whether or not it benefits the pt, it will help you down the road.

2.  Sometimes.  If a true ALS service is really close (less than 5 minutes)...probably not so much, although there will be times that it will.

3.   It depends on you, what you do during the course, and what you've done before the course.  If you go straight from the basic class to medic school, and don't have/get any field experience...it'll be a lot harder on you, and your first few months (or maybe longer) as a medic may be harder.  Not 
to say that it can't be done, depending on the person.  Experience counts for a lot, and being able to look at something and say, "oh yeah, nothing new, seen that before," even if you weren't able to treat before it will make things go a lot smoother for you.

As for Intermediates...I've got mixed feelings on them.  Here they came around when the state went from a 4 tiered system to a 3; they're closer to the I-99 than anything, and the point was to give the rural areas someone with skills close to a medic when they couldn't afford (or didn't need) an actuall paramedic.  Not to mention that people at the old level 3 weren't (admittedly by some of them) getting enough training to really know how to do the things they could do.  Originally I's could give asa, ntg, albuterol, activated charcoal, NS, LR, narcan, D50, epinephrine (1000 and 10000), atropine, lidocaine, give nebs, start peripheral IV's, ped IO's, defib, and use dual lumen devices (combitube).  From the people I've talked to, the classes aren't bad usually, but it really is classic cookbook medicine.  Do this when you see this...don't think about why or the consequences.  But...for the purpose they were created for, that's not to bad.  Unfortunately, they aren't always used like that, and now you have a lot of I's running around who have no clue how to do anything but start an IV.  Other than the outlying rural areas most services use medics, so the I's basically stagnant, and with no experience the skills and knowledge they have goes the same way.  Plus the state in all it's wonderful wisdom has now decided to add more skills and meds to the list with less than 30 hours added to the class length, and no additional clinicals.  (there never was and still isn't any type of internship)  So the cookbook has gotten thicker, but instead of using more words they just increased the size of the font.  Beautiful.  

Wow.  I fell better now.


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