# emt-b meds



## emt/ff71185 (Oct 29, 2007)

What meds does everyone carry and which ones, if any, do you have to call in to use?

We carry

O2, narcon, gluctagon, oral glucose, abutural, baby asprin, nitro (spray), and epi.

We have to call in prior to ped's epi and after the first dose of just about everything else.


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## Ridryder911 (Oct 29, 2007)

I believe if you do a search this topic has been discussed repeated times. As well as the complications associated in allowing Basics administering medications. 

R/r 911


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## akflightmedic (Oct 29, 2007)

8 Meds and 3 are mispelled....

I am sure 2 others would have been if spelled out entirely as well as full name of ASA.

Enough said regarding education.

Take Rid's advice and do a search. Have a great day!


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## emt/ff71185 (Oct 29, 2007)

if my spelling ever impedes my patient care, i'll let you know


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## BossyCow (Oct 29, 2007)

emt/ff71185 said:


> if my spelling ever impedes my patient care, i'll let you know



So, if you misspell a patients name and the wrong patient record comes up at the hospital?????


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## medic001918 (Oct 29, 2007)

It may not impede your care, but it does impede our reputation as providers.  This forum is not only read by your fellow healthcare providers, but it is a public forum.  Physicians, patients and the general public can and most likely do at least come here to browse.  As this is a public forum, your written word here is much like your spoken word in a face to face conversation.  Take your time and craft your posts with some forethought.  Remember that you're not only representing yourself here, but also OUR profession.  Until we can present ourselves as educated, capable provdiers we will not advance any further than we presently are.  Our protocols will generally only be as strong as what's viewed as the weakest providers by our medical control authorities.  If we bring the overall level up, they can raise the standards on our protocols.  This standard includes presentation.

On the spelling issue, it shows attention to detail which is rather important in our chosen profession.  This whole concept came about in another thread recently.  If someone can't even spell common medications correctly, could it be assumed that they didn't pay attention enough in class to justify administration?  Details count.  Not only here, but on your run forms and in speaking with other healthcare providers.

As far as basics carrying medications....they shouldn't.  A 120 advanced first aid course is not sufficient enough education to be handing out medications.  Many paramedics have spent more time sitting through anatomy and physiology then the time spent in the EMT-basic program to learn how the human body functions.  Without this understanding, you can't even begin to understand how all of those medications really work and what they're doing.  Not to mention that many of those medications have side effects that can't be effectively monitored or controlled by a BLS provider.

Feel free to search and I'm sure you'll come up with countless posts about EMT-Basic's administering medications, as well as education in our field and you'll probably even find some about spelling, punctuation and grammar (which believe it or not is really important).

Please try to give the impression that our profession is an educated group.  Not a group just getting by.

Shane
NREMT-P


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## emt/ff71185 (Oct 29, 2007)

I'm sorry, I was under the impression that personal attacks are not allowed here and that people do not assume that just because I focused on what the drug does instead of how it's spelled that I must be bringing down the profession.  Now I understand that it makes us look bad to have bad spelling and for that I am sorry and will try and do better in the future but to imply that I am a bad emt-b is just not right.  You do not even know me and you certainly do not know the level of detail I put into every patient I treat.  How I type on a day off sitting at my computer and how I train or act when it comes time to do so is not correlated.  

As far as emt-b's being able to administer med's I do not disagree completely with you.  I do feel that we get rushed through the course and we only learn a handful of counter-indications and side effects for each drug.  That is why many of us who actually care, not unlike you, go on to take further classes and become medics.  Remember though, that we all have to start as lowly, stupid, inexperienced B's.


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## medic001918 (Oct 29, 2007)

Wait a minute, where did I make a personal attack?  Please present the quote where I "attacked" you.  I made comments regarding lack of attention to detail in our profession, as well as a lack of education.  And spelling of medications is a rather important aspect to the overall scheme of things.  It's that same attention to detail that should carry through in everything we do.  It was in no way a personal attack, but a common trend in EMS to be content with complacency.  People continue to want to be able to do more, to be treated differently and to be viewed as equals yet as a whole profession, we don't tend to make much effort to advance ourselves.  We've become complacent to sit around and leave things as they are.  If we all put forth a little bit more effort (myself included), collectively the profession would stand a chance at growing.  Until that effort is pursued though, we will remain stagnant.

Shane
NREMT-P


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## BossyCow (Oct 29, 2007)

emt/ff71185 said:


> I'm sorry, I was under the impression that personal attacks are not allowed here and that people do not assume that just because I focused on what the drug does instead of how it's spelled that I must be bringing down the profession.



A good piece of advice for getting along here is to take a deep breath before you respond to perceived criticism.  The comments made were not about you personally, but were observations about very objective items.  Spelling is not subjective, it's either correct or incorrect.  It is not a personal reflection on your character, personality or integrity, but is an observation.  On the subject of meds, as Rid said, this topic has pretty much been done to death here and you can find all the information you need by doing a search of the forum.


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## Flight-LP (Oct 29, 2007)

emt/ff71185 said:


> I'm sorry, I was under the impression that personal attacks are not allowed here and that people do not assume that just because I focused on what the drug does instead of how it's spelled that I must be bringing down the profession.  Now I understand that it makes us look bad to have bad spelling and for that I am sorry and will try and do better in the future but to imply that I am a bad emt-b is just not right.  You do not even know me and you certainly do not know the level of detail I put into every patient I treat.  How I type on a day off sitting at my computer and how I train or act when it comes time to do so is not correlated.
> 
> As far as emt-b's being able to administer med's I do not disagree completely with you.  I do feel that we get rushed through the course and we only learn a handful of counter-indications and side effects for each drug.  That is why many of us who actually care, not unlike you, go on to take further classes and become medics.  Remember though, that we all have to start as lowly, stupid, inexperienced B's.



While on the crusade for better spelling, you may wish to consider grammatical content as well. I have a headache now..................

I do have a question for everyone else though, why is it EVERY time this subject comes up, this horribly false rationalization of "everyone started out as a lowly, stupid, inexperienced basic" comes up? Every single time!


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## rgnoon (Oct 29, 2007)

Flight-LP said:


> While on the crusade for better spelling, you may wish to consider grammatical content as well. I have a headache now..................
> 
> I do have a question for everyone else though, why is it EVERY time this subject comes up, this horribly false rationalization of "everyone started out as a lowly, stupid, inexperienced basic" comes up? Every single time!



Good question...i'm a "lowly, stupid, inexperienced basic" and spelling is one of my big pet peeves, while grammar is a close second. Go figure. Great point though LP.


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## Flight-LP (Oct 29, 2007)

rgnoon said:


> Good question...i'm a "lowly, stupid, inexperienced basic" and spelling is one of my big pet peeves, while grammar is a close second. Go figure. Great point though LP.



Stupid is as stupid does.............Sorry, I've always wanted to say that!

My friend you are not stupid, inexperienced maybe, I'm not sure as I do not know you. But what you do have is the ability to recognize the importance of character. This is usually the BIGGEST flaw in an EMT. Most want a fire truck or ambulance to ride on with pretty lights and away they go to save the world. They fail to recognize that this is a profession, one that is treading water with a cinder block because people do not see beyond the "coolness" of the job. Firefighters, especially volunteers, seem to have this syndrome the worst. I get so tired of EMT's "comparing" what cool things they could do. This isn't a game of "my brother could beat up your brother". EMT's who complete a 120 hour freakin' first aid course have ZERO business on the giving end of nitrates and beta agonists. To further complicate it, they self admit to not having the basic concepts of pharmacology when giving it. Sorry, but it makes every EMT out there look like a total fool when someone comes across with that topic.

@emt/ff71185-Sit back and do a little reasearch, read old threads. You may learn something along the way........


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## rgnoon (Oct 29, 2007)

Flight-LP said:


> Stupid is as stupid does.............Sorry, I've always wanted to say that!
> 
> My friend you are not stupid, inexperienced maybe, I'm not sure as I do not know you. But what you do have is the ability to recognize the importance of character. This is usually the BIGGEST flaw in an EMT. Most want a fire truck or ambulance to ride on with pretty lights and away they go to save the world. They fail to recognize that this is a profession, one that is treading water with a cinder block because people do not see beyond the "coolness" of the job. Firefighters, especially volunteers, seem to have this syndrome the worst. I get so tired of EMT's "comparing" what cool things they could do. This isn't a game of "my brother could beat up your brother". EMT's who complete a 120 hour freakin' first aid course have ZERO business on the giving end of nitrates and beta agonists. To further complicate it, they self admit to not having the basic concepts of pharmacology when giving it. Sorry, but it makes every EMT out there look like a total fool when someone comes across with that topic.
> 
> @emt/ff71185-Sit back and do a little reasearch, read old threads. You may learn something along the way........



"LP and me is like peas and carrots"...ok perhaps that is an overstatement. But I agree with you 100% and am glad that you simply "said it how it is."

As for the FF comment, I hold nothing against them PERSONALLY, but one of my more recent catch phrases has come to be "F@#@ing Firemen", for precisely the reasons you alluded to. Everywhere and everyone is different, but it seems at times like they are completely overwhelming our field.


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## emt/ff71185 (Oct 29, 2007)

I am very sorry that I started this thread.  I did not mean to offend everyone here.  I was not comparing all of the "cool" things I could do.  I was simply curious as to what differences there are around the country.

I am also sorry I did not do a search first to find this topic already discussed.  I am new to this forum and did not think to do that.


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## i5adam8 (Oct 29, 2007)

Where I work,all we can do is assist the patient in certain meds


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## Ridryder911 (Oct 29, 2007)

Because, it is an * excuse* to get by. Sorry, this is not directed at one particular person. I hear the same thing when asking about pathophysiology questions.. _"Hey, I am just a Paramedic"_... 

Whenever and if ever; we really want to be a profession with professionals, then we will demand such. Sorry, one does not "forget" how to read or write when they are off duty. As others have suggested one is judged by their communication skills, in their profession or common use. This is NOT an EMT/B versus EMT/P thing, all this was taught in elementary grade school! 

*Ironically, this forum has finally started endorsing common grammar and spelling. I took a lot of bruising, but it was worth it ! 

R/r 911


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## firetender (Oct 29, 2007)

> I do have a question for everyone else though, why is it EVERY time this subject comes up, this horribly false rationalization of &quot;everyone started out as a lowly, stupid, inexperienced basic&quot; comes up? Every single time!


 
Because it's true and often, we who have made every mistake in the book, become intolerant of those who make every other mistake in the book. It's something about preserving ego by making others appear less bright than ourselves. Very human.We have no choice but to make mistakes. We can either resist being told, or take in the info and use it to get better. Attacking has as little value as defending. Tolerance of the learning curve is important to everyone here, because if we're not all learning and making mistakes behind it, then we're not getting more proficient.


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## jrm818 (Oct 29, 2007)

Rid I'm going to disagree - there is a difference between writing in a professional publication and on a web forum.  On a forum like this the standard decorum is a little less strict - how many emoticoions do you see in JEMS?    Similarly, no one (myself included, exept that you brought the issue up) would say boo about the multiple sentence fragments, mis-used semicolon, etc. in your last post, because it is still readable despite that.  I'm pretty sure i misspelled something in this post, but overall I think it's not unprofessional looking, and thats sufficent for me.


Medication names are a whole different ball of whacks, becasue there are so many that sound alike or are spelled alike, and a lack of precision can, and does, kill patients. This issue is getting a lot of attention at the moment, and some govenrment body just released thier report about medical errors, and found that the impact from errors such as misspelled medications is _huge_.  I'm sure google could reveal the name of the report, for those interested.


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## bstone (Oct 29, 2007)

Flight-LP said:


> While on the crusade for better spelling, you may wish to consider grammatical content as well. I have a headache now..................
> 
> I do have a question for everyone else though, why is it EVERY time this subject comes up, this horribly false rationalization of "everyone started out as a lowly, stupid, inexperienced basic" comes up? Every single time!



Nod. It's EMT-Bs, not B's.


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## bstone (Oct 29, 2007)

emt/ff71185 said:


> I am very sorry that I started this thread.  I did not mean to offend everyone here.  I was not comparing all of the "cool" things I could do.  I was simply curious as to what differences there are around the country.
> 
> I am also sorry I did not do a search first to find this topic already discussed.  I am new to this forum and did not think to do that.



I am sorry you were getting pounded on. There are some elements on this forum which are a little rough around the edges. Good people, but a little rough.


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## Littlebit (Oct 29, 2007)

I normally just browse through EMS forums- Sometimes I learn -sometimes I am amused but I usually don't offer a response.   I just feel a need to respond to the chatter regarding EMT-B's and meds.  There are some EMT-B's that know more about meds than an I or a P- there are some that can out do an EMT-P in a heartbeat.   I think some of you came down pretty hard on the spelling issue- granted in a run report I would expect all of the spelling to be correct but this is a friendly forum- right?   When a person joins this community it says "we're a friendly bunch of EMS professionals"   
I have worked with FR-B's-I's and P's and some take the responsibility very seriously and some just like the sirens- I don't think spelling on a forum has anything to do with it. 
Littlebit


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## Ridryder911 (Oct 29, 2007)

To prevent from hijacking this thread. I started another posts in regards to the deviated subject. 

http://www.emtlife.com/showthread.php?p=59688#post59688

R/r 911


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## skyemt (Oct 29, 2007)

this thread spun off when akflightmedic pointed out that out of 8 meds, 3 were misspelled... 

the most amazing thing is that 4 out of 8 were misspelled, not 3...
narcon, gluctagon, albuteral, asprin.

so, akflightmedic, you can sit in the corner with emt/ff71185!


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## reaper (Oct 29, 2007)

emt/ff71185,
What state do you work on? I am just wondering because I have never seen any where that lets EMT-B's give injections.

If you give NARCAN to OD what will you do when that pt goes into seizures?
What if you put him into a lethal arrhythmia?


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## emt/ff71185 (Oct 29, 2007)

bstone said:


> Nod. It's EMT-Bs, not B's.




With this post I do believe that every single word in my original thread has been ridiculed.  I would like to move on and not be judged from now on as the unprofessional "EMT-B" who made a mistake in not thinking when spelling my meds in a forum.  If I had known it would have brought out the dark side of so many of you than I would have just kept my mouth shut or treated this forum like a patient report.

That being said...  

I do understand most of the points you all have made and will learn from them, I just do not appreciate some of the hypocritical statements and the extent of the judging on my whole outlook of my professional life based on one post.  

We all share a very stressful career; let's not take the not-so-important things quite so seriously.


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## emt/ff71185 (Oct 29, 2007)

reaper said:


> emt/ff71185,
> What state do you work on? I am just wondering because I have never seen any where that lets EMT-B's give injections.
> 
> If you give NARCAN to OD what will you do when that pt goes into seizures?
> What if you put him into a lethal arrhythmia?



I work in central IL.  We can give 2mg NARCAN IN.  Is this amount enough to cause seizures or lethal arrhythmia?  We were not informed of this in class, only that it works pretty quickly and that to be prepared to deal with the patient being mad at you ruining there high.


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## reaper (Oct 29, 2007)

Now this is not against you.

This is what the major discussions on this subject are about. You are trained to a skill and told to preform the skill. But, you are not taught about the drug or the understanding of how it works.

This is why no one below a paramedic level should be administering drugs. You must have the full knowledge of how it works, what it does to the body and how it interacts with other drugs or problems. You must have a full grasp of A&P and Pharmacology to learn this.

This is the biggest point most are trying to make here. Like the old saying, 
"once you push a med, you can't take it back". So you better be dam sure you know for sure that this is what the pt needs.


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## emt/ff71185 (Oct 29, 2007)

I agree completely.  As I’ve stated before in other threads.  I really hate how we just get rushed through this course and then are in charge of real lives.  We really learn only once a patient's life is on the line.  I have absolutely no arguments with you on that one.  I am currently enrolled to take the Paramedic course starting in January for this reason and am also currently pursuing my BCN because you can never know too much when it comes to the chance to save a life.

The problem is I haven't had a chance to get that far yet so I am at the stage where I have to follow protocols that I can only fully understand if I do my own research and pursue my own education outside of course work.


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## BBFDMedic28 (Oct 30, 2007)

medic001918 said:


> .
> 
> As far as basics carrying medications....they shouldn't.  A 120 advanced first aid course is not sufficient enough education to be handing out medications.  Many paramedics have spent more time sitting through anatomy and physiology then the time spent in the EMT-basic program to learn how the human body functions.  Without this understanding, you can't even begin to understand how all of those medications really work and what they're doing.  Not to mention that many of those medications have side effects that can't be effectively monitored or controlled by a BLS provider.
> 
> ...



My turn for a soap box. First of all I hope everything I am about to say is spelled correctly...god for bid I turn human and make a mistake.
Second- "Advanced First Aid"? WTF? Do EMT-Bs have as much education as EMT-Ps? No. But we are definately more qualified than advanced first aid.
Third- Sure lets try to give the impression that we are educated even though in the same post it was mentioned that EMT-Bs were only "Advanced First Aid". Sure that makes tons of sense...not
Fourth- Since When is an answer such as "That topic has already been discussed" not enough? Why go way off topic and ridicule? That is rediculous.
Thats all. 
BTW to the original poster.....Whoever you are send me a private message and I will be glad to tell you about the meds we carry on the box.


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## BBFDMedic28 (Oct 30, 2007)

My deepest apologies...one for the double post and two God was not capitaized in my above post. I just noticed this.


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## akflightmedic (Oct 30, 2007)

skyemt said:


> this thread spun off when akflightmedic pointed out that out of 8 meds, 3 were misspelled...
> 
> the most amazing thing is that 4 out of 8 were misspelled, not 3...
> narcon, gluctagon, albuteral, asprin.
> ...




Hey, I always take my spelling hits...as anyone that knows me from here or another forum where I frequent, I have never hid the fact that I am dyslexic.

I refuse to use spellcheck because of it. I force myself to review and review until I get it right. I am very tough and critical on myself. As you can see, I even edited once in my original post cause I caught an error. Yes, I did skim over aspirin and on recheck it appeared correct. 

Part of the reason for me skimming over it was I had lost interest. Once I see a post filled with spelling errors or poor grammar, I totaly lose any interest.

My point is when I see a post such as that, there is zero excuse for it. One word mispelled is ok as it might be a typo, fat fingers, or something; however, when you rattle off each drug that you carry and administer but can not spell any of them properly, therein lies my issue. I still say had any of the others been spelled out in their entirety, the count would be higher. 

If I can take the time with a legitimate condition and ensure my posts and my reports are accurate, I expect the same if not better from someone who does not have a condition. It all reflects on us as a profession and we must display some accuracy in our interactions if we are ever to get any type of credibility and semblance of professionalism.

Go to student doctor.net or a nurse forum and see if they are lazy and apathetic cause it is just a forum or their day off...


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## medic001918 (Oct 30, 2007)

Let's take your post section by section.



BBFDMedic28 said:


> My turn for a soap box. First of all I hope everything I am about to say is spelled correctly...god for bid I turn human and make a mistake.



This spelling issue is not about a simple spelling error, it's about misspelling medications that are commonly administered.  There's a significant difference between the two.  Medications errors have been committed in the healthcare profession due to misspellings.



BBFDMedic28 said:


> Second- "Advanced First Aid"? WTF? Do EMT-Bs have as much education as EMT-Ps? No. But we are definately more qualified than advanced first aid.[/QUOTE[
> 
> How is an EMT more qualified than advanced first aid?  Please share with us.  You can provide oxygen, and hold direct pressure.  The assessment and critical thinking skills provided in most EMT-Basic programs is poor at best in it's current form.  The anatomy & physiology is not there to perform proper assessments.  Without being able to perform a proper assessment and understanding of how the human body works, the information gained is of little value.  If you don't believe me, consider reading the current curriculum.  For the most part, every complaint gets "high flow oxygen, rapid transport and call a medic."  I've seen this trend continue.  Look at the dumbing down of CPR and the EMT program itself.  Compare the program now to someone who's had their card for fifteen or twenty years.  There's a huge difference in what was taught.  The EMT-Basic program really is little more than advanced first aid.  I'm sorry that offends you.
> 
> ...


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## Ridryder911 (Oct 30, 2007)

I smell a thread being locked..

R/r 911


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## indygirl14 (Oct 30, 2007)

This thread is making me re-think my decision to go into EMT school...who would want to after reading that after investing my time and money, I would be nothing more than a "lowly EMT-B" or "advanced first aid."....

You guys are doing zero to help your profession out.  Zero.

You have made your point -- how long are we going to keep hammering away at it?  I'm also re-thinking my decision to join this forum.  There is absolutely nothing helpful nor friendly going on in this post anymore-- just a whole lot of reaming.  Lock it and move on...please!


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## Ridryder911 (Oct 30, 2007)

indygirl14 said:


> This thread is making me re-think my decision to go into EMT school...who would want to after reading that after investing my time and money, I would be nothing more than a "lowly EMT-B" or "advanced first aid."....



So your not really in EMS? You have not even attended or even began any really part of the system yet. 

Although you have determined an opinion about the profession on what it involves or making a differential between license and certification levels. So you really would not know as of yet, if there is a difference between advanced first aid and EMT, really? 

This would be similar to me discussing differences in an plumbers forum between the levels of journeymen and a plumber. Not really a clue on the profession or the workings within it. 

The bad thing about forums is it allows everyone to view any speciality, profession, from inside. As well many representing themselves as being from within the speciality, when they really are not. 

The good thing about forums is that it opens debate within the profession, as well as exposure of EMS to others. With this also comes part of the real life of medicine and EMS. It is a job (paid or not). The job's main focus is to attempt to save lives and that is usually about all most will agree upon. With it comes different personalities and different ideas of how, what should be done. Like all professions, or even big families there is always internal discussions, turmoil, on a day to day operations. This is life.. I have yet seen any group work harmonious in any profession, especially in medicine. 

If this small "bickering" upsets you, I can assure you there is much more deeper and harsher arguments in EMS units, squad stations, O.R.'s, ICU's and definitely in ER's everyday. Be it right or wrong, it occurs. This is the way things get changed and evolves, otherwise it would be pretty stagnant. 

So yes, the advantage of about this forum, we are much nicer here than it is in real life. You do get to see what you will be getting yourself into. You do get observe debate about care, the profession, and even respect from others. You will not be entering the profession blindly.

R/r 911


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## VentMedic (Oct 30, 2007)

indygirl14 said:


> This thread is making me re-think my decision to go into EMT school...who would want to after reading that after investing my time and money, I would be nothing more than a "lowly EMT-B" or "advanced first aid."....
> 
> You guys are doing zero to help your profession out.  Zero.
> 
> You have made your point -- how long are we going to keep hammering away at it?  I'm also re-thinking my decision to join this forum.  There is absolutely nothing helpful nor friendly going on in this post anymore-- just a whole lot of reaming.  Lock it and move on...please!



Being an EMT can be just the beginning of a great career in medicine.  Sure there are many people out there who remain an EMT-Basic for a variety of reasons and are very good and comfortable in their profession. They also present a pride in what they can do and still realize their limitations. 

As an EMT you will gain experience with patients. If you use the opportunity well, you will meet many people in many different healthcare professions to show you a whole world of fascinating medicine.  

If you stay certified as an EMT-B, it doesn't mean your knowledge can not expand beyond that. Even if you are not able to perform all of the skills of an advanced level, you can still gain a better insight on any patient situation. 

There are several of us here  who have many years of education invested with a variety of degrees and credentials.  And yet, we are still taking more classes and trying to keep up with an ever changing and exciting field. 

You will only be a "lowly EMT-B" if you allow yourself to remain that in your own mind. In any profession, there will always be a pecking order of hierachy in the ranks. You have the choice to move on in credentials, education and knowledge.  Many of the people here, myself included, are pro education. We want people to think about what they are doing and why.  When you are working as an EMT, you will find that you will have to justify what you did to the patient and not just say "it's in the protocols so we can".  Physicians, nurses, other healthcare professionals, and law enforcement officiers may all want answers. These forums are a good place to ask questions and respond to questions that you may have to answer somewhere later in your career.  You may read what sounds like rude and demeaning responses to you now when you are just starting out, but in the world of medicine they may play a purpose. Being able to respond to those remarks or justify your actions professionally either here on these forums or in the field is just part of any medical career.   The more responsibility you are given, the more understanding of that responsibility should be expected.


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## skyemt (Oct 30, 2007)

well, in my county, emt-b's can carry oral glucose, epi-pens, albuterol (to be given via nebulizer) aspirin, O2 (obviously), and we can assist a pt with their own NTG...

i am an EMT-B, know the physiology and pharmacodynamics of each of these meds... the idea that emt-b's should not give meds is foolish...

Reaper, i am quite sure my knowledge of these meds is adequate...
and may save a pt one day if ALS is not available, which is often in many parts of the country...

i'm pretty sure it is the blanket generalizations, like the one reaper made, that rankles people... 

and really, if someone in my family needed meds from an emt, i'm not sure how comfortable i'd be if the emt couldn't spell half the meds he carried... is that personal? maybe, maybe not... but i'm sure deep down, everyone reading these threads would feel the same way... if that person is really the worlds best emt, then he is doing himself an injustice with the spelling... just the way it is...


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## DisasterMedTech (Oct 30, 2007)

reaper said:


> emt/ff71185,
> What state do you work on? I am just wondering because I have never seen any where that lets EMT-B's give injections.
> 
> If you give NARCAN to OD what will you do when that pt goes into seizures?
> What if you put him into a lethal arrhythmia?



EMT-Basics are allowed by protocol to give glucagon via IM injection in Illinois. Giving an IM injection isnt rocket science and the medic determines if it is to be given and the dose. The Basic draws up the medication, the Paramedic confirms the 5 Rights and the Basic puts the needle in the muscle. The Basic is not making the decision to give the drug, but rather simply administering the injection per medical control orders under the supervision of Paramedic.


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## DisasterMedTech (Oct 30, 2007)

Ridryder911 said:


> Because, it is an * excuse* to get by. Sorry, this is not directed at one particular person. I hear the same thing when asking about pathophysiology questions.. _"Hey, I am just a Paramedic"_...
> 
> Whenever and if ever; we really want to be a profession with professionals, then we will demand such. Sorry, one does not "forget" how to read or write when they are off duty. As others have suggested one is judged by their communication skills, in their profession or common use. This is NOT an EMT/B versus EMT/P thing, all this was taught in elementary grade school!
> 
> ...



It would seem to me that you shouldn't be bashing anyone for their grammar, use of punctuation, etc. I personally think it's not worth mentioning in general unless it impairs the readers' ability to understand the post. I count 5 grammatical and one spelling error in the above quoted posting authored by you and yet you are consistently among the most critical of the way in which others expressive themselves in written form. Perhaps it would be wise to work on your own writing and not worry quite so much about what others are doing. And I know THAT was taught in "grammar elementary" school because I used to teach it to my own students.


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## indygirl14 (Oct 30, 2007)

I have several family members involved in EMS, so no, I'm not going into this blindly, and yes, I do know the difference between advanced first aid and EMT-B, but thanks for checking!  I have spent many more hours riding along with services than is typically required of an EMT-B student to get their certification.

Oh, and trust me, I can handle the bickering -- I work in motor sports.  I deal with some pretty big egos on a daily basis.  

Where have I misrepresented myself?  I listed "student" because that is what I am.  When I signed up, I was in the middle of taking my online CPR for the Professional Rescuer course, am getting ready to start my First Responder course and am spending every possible minute on an ambulance.  So, where that doesn't make me a student, please let me know.

I simply think that you guys have let this get out of control...even you R/R, you said that you "smell a thread being locked."


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## Ridryder911 (Oct 30, 2007)

DisasterMedTech said:


> EMT-Basics are allowed by protocol to give glucagon via IM injection in Illinois. Giving an IM injection *isnt* rocket science and the medic determines if it is to be given and the dose. The Basic draws up the medication, the Paramedic confirms the 5 Rights and the Basic puts the needle in the muscle. The Basic is not making the decision to give the drug, but rather simply administering the injection per medical control orders under the supervision of Paramedic.



I ask why would a Paramedic want someone else to "draw up their med.'s" and then injecting it for them? Really, what advantage does this allow? 

R/r 911


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## Littlebit (Oct 30, 2007)

*Emt-ps*

This whole thread really bothers me.  There is a nice way to point out an error made by another and then there is "bashing"  I don't know if it was in this forum or a different one but I've seen comments such as "the dumb nurses in the nursing homes"  There are good nurses and there are poor nurses- the same with EMT's no matter what their credentials are.  If we want to build up our profession -then we should build each other up in a constructive manner.  I find it very distasteful when EMT's bash first rather than politely correct.  people learn faster that way.


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## Guardian (Oct 30, 2007)

darn, this thread was right up my alley and I missed out on it because I've been working too hard.


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## skyemt (Oct 30, 2007)

Littlebit, i suggest you go back and read the start of this post... when the original mistake was made, one person suggested he research the topic in past posts, and another person pointed out the spelling mistakes in a couple of sentences, that's it... kind of exactly what you are suggesting should have happened... BUT the person who make the mistakes didn't say, "ok, thanks, i'll get that straightened out", he fired back a snide remark about how spelling mistakes don't matter... that is why this thread took off...

i find there is a lot of insecurities out here, mostly from the lower level emt's... i have seen more experienced members posts where they admit mistakes, say "i stand corrected", etc...

but the emt-b's and students want to fight everything... now before you jump on me, i am an emt-b... you know what? CC's and Paramedics know more than we do... they have more knowledge and experience, and that is the way is should be... why people throw out the "stupid low level emt-b" stuff is beyond me... pure insecurities... if you are good at your level, be proud of it, but listen to those who know better...

i hope to be an ALS provider one day, and i am happy and competent at the basic level right now...


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## Jolt (Oct 30, 2007)

I have a couple of thoughts after reading this thread, but first, a little about myself.  I'm 16 years old, still in high school, and I'm a recently certified EMT-B in Connecticut (so I can guarantee I'll see medic001918 around).  I don't pretend to know anything about anything, but I'd still like to make a few points.

1) The curriculum for an EMT-B is the _minimum_ requirement to obtain a certification.  The minimum may not be very high, but it provides a starting point.  Just because someone is only an EMT-B doesn't preclude him or her from knowing anything else about emergency medicine (or just medicine in general).  I think the "stupid, lowly EMT-B" comments could stem from this line of thought.  I'm sure a lot of EMT-Bs have a strong interest in the field and will continue to pursue their education (even if it just involves reading a few articles) past the minimum curriculum.  One of the students in my class already had a bachelor's degree in biology before starting.  The AP classes I take in school also help me understand how the human body works (especially from biology), and chemistry has helped me understand a little about drug interactions.  So, while it may not be much and it doesn't affect our scope of practice, there's no level of knowledge that all EMT-Bs are automatically at.

It seems obvious, but I thought I'd post it as at least a reminder.

2) To all of the paramedics and nurses and whoever has any other funny acronyms following their names: what are you doing about the "stupid EMT-Bs?"  I take every opportunity that I get to teach people around me something that they may not know.  Do you do the same?  Even though what you say to us may not hit home the first time you say it, and even if it doesn't effect how much medical care we're allowed to give, don't you think that you could be sharing a lot with us from your thousands of hours of training?  What we learn as EMT-Bs could have some benefits for you, too.  Maybe next time we watch you push narcan a little too fast, we'll grab the emesis bins with enough time left so that no one has to wipe down the floor of the ambulance or walk in puke.

These were just a couple of thoughts.  I know I'm new, so you can disregard them if you'd like.

Best wishes,
Joe


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## DisasterMedTech (Oct 30, 2007)

Joe-

I think your post is the saving grace of this thread. People assume that because  in general, the number of hours for EMT-B certification is about 120 hours (thats an average that everyone has latched onto, including the NREMT when they say that the training shall not consist of less than 120 hours of didactic work. Before I ever came to EMT training, I had completed coursework in psychology, abnormal psychology, biology, chemistry, biochemistry, anatomy and physiology,  epidemiology, medical terminology, diagnostics and the "psychology of trauma" (which focused on how to help your patients and yourself get through traumatic experiences). I have military level training in landing zone operations and search and rescue. 

So what does all of that prove? It proves that when paramedics, nurses...whoever it is with the extra-long strings of initials after their names arent the only ones with training and expertise...start bashing Basics, saying we are worthless, wondering what we are doing drawing up meds, etc they are, without knowing it, making rash generalizations which are often not based in reality, but rather ego. If as health care providers we can lose the ego and remember that what we are there for, whether paramedic, basic, MFR, CCP, etc, is to help our patients and often to keep them from dying until they can be handed off to a higher level of care. It would seem that what is most important is the level of patient care. Basic and paramedics owe it to themselves and to the patients they will be asked to save to have as much training as possible and be as good (not  just competent) as we can. Im taking AHLS (advanced hazmat life support) in January of 2008. I cant get certified in it because the certification is only allowed to EMT-P and higher. The reason for this is that 98% of the interventions taught in this course cannot be carried out by a Basic operating properly within his/her protocols. But what happens when I am on a crew and we are called to a patient who has been exposed to hazardous materials or I am deployed with a disaster team to a chemical spill. I might be working next to a paramedic who hasnt had this particular course and I might be able to think of something he doesnt. Ive worked with paramedics that are 10 years younger than I am and often it has been shear life experience that has proven valuable.

When you label someone as "just a basic" or "crazy" or "stupid" you minimize and devalue that person. You put your label on them because you think you know what they are made of, that you know everything of which they are capable. How many paramedics out there are capable of tucking the ego away in favor of patient care and turning to your Basic partner and saying, as my EMT instructor says "I got nothin'. What are you thinking?" Most paramedics I have worked with wouldnt do this. But I have work with a few (maybe less than 5) that will do this. When you pigeon hole your partner, you cut off a valuable patient care resource and many times, the Basic senses or has been outright told that he isnt all that valuable as a member of the crew and might very well have that answer that the paramedic is looking for but wont say so because he has been told either in word or actions of the paramedic that Basics should be seen and not heard. Would you get into your ambulance every day when you start your shift and start tossing out extension tubing, pressure dressings, etc because there might be a more advanced way of doing something. Of course you wouldnt. So why toss away a person that happens to be a Basic simply because you assume you know what they can and cannot do. Ive known paramedics who wont ask a Basic to spike a bag because they assume that the Basic wasnt taught this and cant do it. Do yourself a favor if any of the above pertains to you. Talk to your Basic partner. Find our what their interests are. Ask what kind of education they have outside of EMT school. You might just be surprised at what they know and what they can do. Also it would be helpful to remember that they are not a lesser form of plant life, they are not something you clean off the bottom of your boot. They are a trained professional and deserve to be treated as such.

A PS to RidRyder- when you put quotes around something you say someone else has said, you are indicating that it is EXACTLY what they said. If you look back at where you quoted me, it is obvious that you didnt even bother to re-type accurately what I said.


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## JJR512 (Oct 30, 2007)

As an EMT-B in Maryland, my BLS ambulance is required to carry Epi-Pens (adult and junior), activated charcoal without sorbital, and glucose. Consultation with medical control is required for the charcoal. Additionally, we can assist patients to administer their own albuterol inhaler, and nitroglycerin tablet or spray. Some jurisdictions have a supplemental protocol that allows EMT-Bs to administer MARK I (I personally know nothing about that). Finally, let's not forget oxygen.

Do I know the pathophysiology of each of those medications? No. I know what they do, but not necessarily exactly _why_ they do what they do. I also know when I can and can't give each of them.

So here's my point: Some people are saying that EMT-Bs should not be allowed to give any meds because they are not taught, as part of the EMT-B curriculm, how the meds do what they do and why they work. My feeling is that *the doctors who wrote the protocols that specify when I can and cannot use the meds do know those details and they wrote the protocols so that an EMT-B can use those meds without having to know the details of how and why they work.*

Ultimately, if I follow protocol and administer a medication appropriately and something bad happens, is it my fault for not knowing how that medication works, or is it Dr. Alcorta's fault for writing (or signing off on) a poor protocol? (Dr. Alcorta is Maryland's chief medical director.) Well, I'll tell you that I don't personally think it's _my_ fault (again, assuming I properly followed the protocols).


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## Ridryder911 (Oct 31, 2007)

Jolt said:


> .
> 
> To all of the paramedics and nurses and whoever has any other funny acronyms following their names: what are you doing about the "stupid EMT-Bs?"  I take every opportunity that I get to teach people around me something that they may not know.  Do you do the same?  Even though what you say to us may not hit home the first time you say it, and even if it doesn't effect how much medical care we're allowed to give, don't you think that you could be sharing a lot with us from your thousands of hours of training?  What we learn as EMT-Bs could have some benefits for you, too.  Maybe next time we watch you push narcan a little too fast, we'll grab the emesis bins with enough time left so that no one has to wipe down the floor of the ambulance or walk in puke.
> 
> ...



Good points Joe, and I will answer them in regards to myself. 

What do I do to change things? Last Saturday, I was a clinical preceptor  for a Paramedic program (In OKC, they require Paramedic students to have an  EMS instructor/preceptor present in the hospital setting). This means I had 4 Paramedic students in ICU and 3 in CCU setting. I made sure that each performed detailed patient assessments, including heart tones, performed detail neuro assessments. I monitored them while administering medications, observed them while they placed a patient on a vent with the right settings and controls, and was even able pace one patient. Meanwhile, I continuously asked them detailed and tough questions during the tour, expecting an answer by the end of the shift (i.e why at a cellular level Glucagon works in Beta Blocker overdose).

Many were not used to real clinicals. All of these students have been a basic less than one year, with less work experience than that. Challenging, yes, but they did an excellent job. Again, I believe we can get what we ask for from people, the problem most programs never ask more than the "minimum". 

I teach continuously at work. That is my job. The same as it is your job to clean up the mess, prepare the unit for another response. If I push Narcan to fast, I will admit it and yes, clean up my own mess. (p.s. I never push Narcan < 3-5 minutes. I learned my lesson)

I have been riding with a basic/medic student for the past month. I expect them to listen and observe closely. I do not want to repeat myself or perform an action over and over again. By not paying attention, this only gives me the reflection that you do not care what I am teaching, nor care about the profession. 

Yes, there are stupid questions. Those that you should had already known the answer to and those that you failed to even attempt to research and look up for yourself before asking. I and many other professionals realize, one is much more to remember something if that person researches the answer for themselves. 

I find very few Paramedics that do not enjoy teaching. Rather I find many basics that develop an attitude that they do not need to learn anything that they cannot provide or perform immediately. Many really do not want to know more, rather just be able to perform the associated skill (the fun part). This causes a lot of frustration between the levels.

The "Stupid EMT/B"  came from watering down the curriculum. Review the EMT Basic 14 years ago, and one can definitely tell the difference. Although shorter in number of hours, it was much greater in detail than the current one. So yes, there is a reason why seasoned medics as well as seasoned Basics describe EMT the current courses as being nothing much more than advanced first aid. I highly encourage anyone to perform a comparison. One will see there is not much difference between the two. It is not the current Basics fault, rather we have allowed the system to lower it standards. Hopefully, with the new curriculum we can change this. 

Joe, you have a good perception of wanting to pursue to be better. That is what it takes to provide good patient care. Be sure to keep that attitude in your development, no matter what profession you choose. 

R/r 911


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## BBFDMedic28 (Oct 31, 2007)

Dear Shane
NREMT-P

Allow me to answer your questions and clear up some misconceptions you have.



Comment: This spelling issue is not about a simple spelling error, it's about misspelling medications that are commonly administered.  There's a significant difference between the two.  Medications errors have been committed in the healthcare profession due to misspellings.


My response: There is a nice way to point out the errors. And since when did we start administering meds in this forum? By saying the above you make it sound as though a med admin error was committed due to their misspelling.



Comment: How is an EMT more qualified than advanced first aid?  Please share with us.  You can provide oxygen, and hold direct pressure.  The assessment and critical thinking skills provided in most EMT-Basic programs is poor at best in it's current form.  The anatomy & physiology is not there to perform proper assessments.  Without being able to perform a proper assessment and understanding of how the human body works, the information gained is of little value.  If you don't believe me, consider reading the current curriculum.  For the most part, every complaint gets "high flow oxygen, rapid transport and call a medic."  I've seen this trend continue.  Look at the dumbing down of CPR and the EMT program itself.  Compare the program now to someone who's had their card for fifteen or twenty years.  There's a huge difference in what was taught.  The EMT-Basic program really is little more than advanced first aid.  I'm sorry that offends you.


My response: ONE Example of difference between First Aid and EMS..... First Aid training will give you no clue as to the indiations for certain drugs...EMT training will give you the indications, contraindications, and other info as well as the ability to admin them. 



Comment: In it's current form, the program is nothing to be proud of.  The industry as a whole could use to be restructured and requirements changed.  All the way from EMT-Basic to Paramedic.  I won't leave myself out of it.  I'm in favor of raising the standards across the board.


My response: If you arent happy or proud of what you are doing....get out.



Comment: If you're going to quote me, please do it correctly.


My response: I wasn't quoting you. I was giving an example of what should have been said. IE instead of ripping into someone, you should say "we have already disscussed that issue".



Comment: If you feel so strongly that the EMT-Basic program is more than advanced first aid, why not share your medications with us to be discussed?  We can all discuss our feelings on the issue?


My response: Because everyone was put out with this topic except me and the original poster. I was going to discuss it with that person in a manner that noone else had to hear it. 


Medic 28


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## medic001918 (Oct 31, 2007)

Jolt said:


> I have a couple of thoughts after reading this thread, but first, a little about myself.  I'm 16 years old, still in high school, and I'm a recently certified EMT-B in Connecticut (so I can guarantee I'll see medic001918 around).  I don't pretend to know anything about anything, but I'd still like to make a few points.
> 
> 1) The curriculum for an EMT-B is the _minimum_ requirement to obtain a certification.  The minimum may not be very high, but it provides a starting point.  Just because someone is only an EMT-B doesn't preclude him or her from knowing anything else about emergency medicine (or just medicine in general).  I think the "stupid, lowly EMT-B" comments could stem from this line of thought.  I'm sure a lot of EMT-Bs have a strong interest in the field and will continue to pursue their education (even if it just involves reading a few articles) past the minimum curriculum.  One of the students in my class already had a bachelor's degree in biology before starting.  The AP classes I take in school also help me understand how the human body works (especially from biology), and chemistry has helped me understand a little about drug interactions.  So, while it may not be much and it doesn't affect our scope of practice, there's no level of knowledge that all EMT-Bs are automatically at.
> 
> ...



If you're active somewhere in Central Connecticut, you more than likely will see me or have seen me around the hospitals at some point since I work for two services.

To answer your question about if I take the time to educate and teach those that work with me, the answer is yes.  My full time position puts me riding with volunteer EMT's and the opportunity to teach is rather plentiful.  Couple that with the having paramedic students riding with me and I can say that that I do my part.  It doesn't change that the larger problem with EMS as a whole is a lack of education in the first place.  This is something that I continually advocate for, but I don't see changing any time soon unfortunately.

Maybe I'll see you around the hospital sometime.

Shane
NREMT-P


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## Ridryder911 (Oct 31, 2007)

JJR512 said:


> Do I know the pathophysiology of each of those medications? No. I know what they do, but not necessarily exactly _why_ they do what they do. I also know when I can and can't give each of them.
> 
> So here's my point: Some people are saying that EMT-Bs should not be allowed to give any meds because they are not taught, as part of the EMT-B curriculm, how the meds do what they do and why they work. *My feeling is that the doctors who wrote the protocols that specify when I can and cannot use the meds do know those details and they wrote the protocols so that an EMT-B can use those meds without having to know the details of how and why they work.
> 
> Ultimately, if I follow protocol and administer a medication appropriately and something bad happens, is it my fault for not knowing how that medication works, or is it Dr. Alcorta's fault for writing (or signing off on) a poor protocol? (Dr. Alcorta is Maryland's chief medical director.) Well, I'll tell you that I don't personally think it's my fault (again, assuming I properly followed the protocols).*


*


This is called "cook-book"medicine. This is what majority of Paramedics are against. Patients never really fall into just one category or another, medicine is NEVER black and white. 

Do I realize it is not your fault? Yes. Does this change my attitude about the problem? No. 

In regards to :



			
				BBFDMedic28 said:
			
		


			Comment: In it's current form, the program is nothing to be proud of. The industry as a whole could use to be restructured and requirements changed. All the way from EMT-Basic to Paramedic. I won't leave myself out of it. I'm in favor of raising the standards across the board.


My response: If you arent happy or proud of what you are doing....get out.
		
Click to expand...


I much rather change it. Change the minimum level to be on an EMS unit as a Paramedic and the role of the Basic would strictly be for first response. Each patient deserves the examination and assessment of advanced level and treatment of ALS if needed. The role of the Basic would be strictly for stabilization prior to EMS transport and assisting Paramedics at different levels. 

The public expects to be treated by Paramedics and like other public health and public services should be given the right to. 

R/r 911*


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## JJR512 (Oct 31, 2007)

I understand that it seems I have basically stated that all I have to know is what the protocols tell me to do, so if I can memorize them and follow instructions, what else do I need to know, right? Well, to some extent, that's true, but...doesn't that apply to paramedics as well?

What I am saying is that although a paramedic has gone through a lot more schooling and completed a great deal more practical...ermm...practice than an EMT-B, and, yes, knows and understands a lot more than an EMT-B, isn't it also true, by the same token, that a medical doctor has been through a lot more school and practice and knows and understands a great deal more than a paramedic? Whether you're a basic or a paramedic, aren't you following protocols that were written by medical doctors, and aren't you following their instructions (or "recipes")? Aren't you learning the things that they have determined you should know, and aren't you making the decisions that they have decided you should be able to make?

In short, I'm saying that (using your analogy) basics may be making cupcakes from a boxed package and paramedics may be making crème brûlées from scratch, but we're all just following recipes handed down to us from the master chefs.

Paramedics may have more options, more things they can do, more choices to make, and more education to help them make those choices, but when it comes right down to it, you're still doing what a doctor has ordered you to do.


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## bstone (Oct 31, 2007)

DisasterMedTech said:


> EMT-Basics are allowed by protocol to give glucagon via IM injection in Illinois. Giving an IM injection isnt rocket science and the medic determines if it is to be given and the dose. The Basic draws up the medication, the Paramedic confirms the 5 Rights and the Basic puts the needle in the muscle. The Basic is not making the decision to give the drug, but rather simply administering the injection per medical control orders under the supervision of Paramedic.



Worked for 5 years as an EMT-B in Chicago North EMS system. I still have a valid IL EMT-B license. Never knew we had glucagn as part of our protocols. Our PMD doesn't allow it, seemingly. In the states where I trained and work as an Intermediate, it's just another tool in the box.


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## reaper (Oct 31, 2007)

JJR512,

 You have a point for some systems. Where I work our protocols are basically a list of what is available for us to use. we still get to make the decision of when and how we utilize our tools. 

That is why I hate algorithms in protocols. That is cook book medicine. A monkey can follow a algorithm. A human can use his brain to decide what to do.


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## Ridryder911 (Oct 31, 2007)

JJR512 said:


> I understand that it seems I have basically stated that all I have to know is what the protocols tell me to do, so if I can memorize them and follow instructions, what else do I need to know, right? Well, to some extent, that's true, but...doesn't that apply to paramedics as well?
> 
> What I am saying is that although a paramedic has gone through a lot more schooling and completed a great deal more practical...ermm...practice than an EMT-B, and, yes, knows and understands a lot more than an EMT-B, isn't it also true, by the same token, that a medical doctor has been through a lot more school and practice and knows and understands a great deal more than a paramedic? Whether you're a basic or a paramedic, aren't you following protocols that were written by medical doctors, and aren't you following their instructions (or "recipes")? Aren't you learning the things that they have determined you should know, and aren't you making the decisions that they have decided you should be able to make?
> 
> ...



Actually no. My protocols are only 15 pages thick for everything. Each starts with the statement:_ "This protocol is a guideline or suggestion only and maybe used in its entirety or may not, depending upon the discretion of the Paramedic. The Paramedic has the education of treating appropriately depending on the state and judgement of the Paramedic. Medical control should be contacted for advice, if needed or if possible."_ As well, not all physicians are created equal. Many have never intubated, or even rotated in an ER more than a 8 hr shift, as well have never read an ECG. I know, I teach or attempt to the residents and physicians in ACLS. 

We went from 600 pages to the 15 for a reason. Our medical director realizes and emphasizes we have the skill to assess and make a clinical impression (diagnosis) based upon our education and yes clinical experience. Since this reduction of protocols have we reduced our treatment? Actually no, we have increased the number of medications and treatments. 

Protocols for Paramedics should be used as guidelines only, not a prescription. There is no way one could write for every illness or injury, as well as every event. Many EMS Medical Directors feel the need to attempt to, rather they open themselves and the medic to more potential litigation by not having that medic perform treatment appropriately for the patient individual needs, again if one must follow every portion of a protocol may not be the best medicine. I know of services that promote one to treat the protocols instead of the patient. That is wrong. 

A patient may never meet a protocol, what do you do then? You treat appropriately. That is why education and knowledge is essential. Medicine is an art as much as it is a science. Each patient is unique, each disease and injury has its own idiosyncrasy. It may respond or may not respond to the standard treatment, or may not even need to be treated in some and while in others quite the opposite. 

That is why progressive EMS services do not promote such cookbook medicine. Realizing there will never be a step by step to treat most patients, nor should there be. They much rather focus on education and continuous reviewing of their care to make sure they are meeting the demands of the medical community and to the patients. 

R/r 911


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## skyemt (Oct 31, 2007)

JJR512-
i can't believe that you don't have a better knowledge of how those meds work... i completed my EMT-B course last spring, and we sure as heck knew how the meds worked... why would i give one witout knowing what it did...

do i know on a cellular level, perhaps not... do we learn that albuterol acts on beta-2 receptors to dilate smooth muscles of the lungs? yes... did we learn that it also acts on some degree on the beta-1 receptors of the heart? yes...
which would prevent us from administering albuterol to someone with a heart history, angina pectoris, etc...and certainly, armed with the knowledge that albuterol simply makes pt's breathe easier is just silly...

we were given this information and encouraged to learn in more detail, as of course, what we learn is a MINIMUM standard...

so, as a fellow EMT-B, do i think you would be partially to blame? yes i do... because if i didn't know, i would feel responsible as well..

if there are important things you don't feel you know, why don't you just go online and learn them? instead of passing the buck?

in other words, go out and be better than you have to be...
but if you don't want to do that, certainly don't complain if things go wrong.

-fellow EMT-B


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## DisasterMedTech (Oct 31, 2007)

I guess I really come down somewhere in the middle of this argument. Do I think I and my fellow Basics are ambulance drivers? No. Do I think we could and should know more and be trained in greater detail and for a longer period of time? Yes. I'd like to see the NREMT set the standard at 500 hours for EMT-Basic training. It would allow for a greatly expanded instructional level on the topics we now cover as well as things like basic ECG reading and also being able to not only measure vital signs, but know what they mean enough so as to be able to interpret them correctly at least at a rudimentary level. Until such changes can be made, it is incumbent upon us as Basics to continue to train past the level we currently do. Journal articles written at the scholarly and not the pop culture level, additional course work and certifications all add to our ability to add to the level of expertise that Basic-Paramedic crews can bring to pre-hospital emergency medicine. To be fair, I also dont think that 1000-1500 hours for Paramedic training is sufficient to allow them to reliably practice at the level of responsibility that so many do. I recently saw a newly graduated paramedic who started an IV which arriving at the hospital was determined to have accessed the vein, exited it and punctured it again in a second location. This kind of botched intervention is without excuse. IV access, at least in Illinois, is one of the very first skills taught to paramedic students and one that is drilled into them throughout their entire training. We need to smarten up and stop dumbing down the level of education for all EMS providers. Since the 500 hours I suggest for Basics is more than 3 times the current average, I dont think that 2000-2500 hours is too much to ask of our paramedic students. When I lived in New Mexico, I did an internship in a clinic where acupuncture was practiced. The state of NM requires in excess of 2000 hours for acupuncture licensure and acupuncturists are not providing invasive airways or decompressing a pneumo-thorax.


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## Ridryder911 (Oct 31, 2007)

I suggest we look at our neighbors up North. Minimal one year for entry level, with general education of 2-3 yrs and top level of a Baccalaureate degree. 

R/r 911


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## triemal04 (Oct 31, 2007)

I'm sorry, but everybody who has brought up how some basic's will get extra training on their own, you're making a point that is really worthless.  It's good to know that some people do, but it doesn't change the fact that the minimum requirements for certification as an EMT-B are just that; minimal.  It's also good to keep in mind that most people who certify as a basic, unless they are continuing on to a higher certification or different medical branch, will not take many, if any, advanced medical courses.  

I hate cookbook medicine.  Except where it concerns EMT-B's.  For what they are taught, and what they are expected to do, it's very appropriate.  They don't get the depth of knowledge to figure out more than simple, basic, easy to recognize problems, and their treatements are the same.  Which is as it should be, given what the educational standards are.  Teach them how use administer O2, no biggie.  Asprin too for chest pain.  Oral glucose for hypoglycemia, assisting with a patient's nitro for chest pain and inhalers for difficulty breathing.  None of those are an issue, the basic indications/contraindications are pretty easy to get, and the risk is pretty minimal for the most part.  Charcoal...with proper training that can also be a basic med.  Same for subq/IM epi, but then anaphylaxis needs to be covered in extreme detail.  I've got no problem with any of these meds being available to an EMT-B, even with the standards we have today.  At least in my state.   

If you are a basic and tired of being called a "lowly basic" or whatever crap you hear, do something about it.  Get a higher cert.  Show people that you actually know what you're doing.  But don't ever forget that your certification is called BASIC for a reason; you get minimal training and minimal skills and minimal knowledge.  Which is really as it should be, and if you've got a head on your shoulders instead of a big chip, you can still be a lot of help to whichever medic you work with.


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## Jolt (Oct 31, 2007)

Okay, I'm back with a few more thoughts/reactions.

Of course we should all be increasing our knowledge of medicine, but I'm not sure that I agree with doubling the amount of class hours that it takes to achieve certifications.  We have to look back and think about what kind of a need we have for this kind of training.  I think that a lot of this would discourage people from entering the field.  And what kind of a benefit would basics derive from this extra training?

The way I see it, EMS is just about getting people to the hospital alive.  This task obviously involves several different skills.  I think that EMT-Bs have an appropriate level of training for the task that they perform.  They do a quick assessment to determine the severity of the sickness/injury, and they take the proper actions to ensure that the patient arrives at the hospital in order for doctors to perform definitive care.  The way I see it, as long as the patient arrives at the hospital in a salvageable condition, we've done our jobs.

What would an extra thousand hours of paramedic training do for EMS?  Well, the first thing I think it would do is decrease the number of paramedics we see around.  Who wants to pay twice as much for a course that's twice as long?  You can keep adding hours, but eventually everyone who goes through the training is going to emerge with an MD, and I don't really think we need that.

Also, while I know I'm still incredibly new here, I think maybe we all have to take a reality check.  The notion that a doctor doesn't know what he/she is doing when it comes to medicine can be dangerous.  While it's true that many have not performed intubations since medical school, or that many have forgotten the finite details involved with reading an ECG, they're still doctors.  Paramedic training simply doesn't compare, and it would be asinine to disagree with that point.  I understand that many doctors will be out of practice when it comes to functions that don't directly relate to his/her job, but they do have a big picture that your average EMS provider (I mean _very_ few exceptions could compare to doctors) does not.  Four years of college and four years of medical school do not equal 1000 hours of paramedic school.

My other point may be more controversial, but I feel that it needs to be said.  I didn't appreciate the comment that EMT-Bs should clean the truck and prepare it for the next call.  Don't get me wrong.  That's part of our job, but the way it was said (without mentioning any of the other things EMTs are trained to do) implied that that's all we do.  EMT-Bs may not know much when it comes to medicine, but we do know something.  Most of us didn't do the coursework so that we could just drive ambulances really fast.  We also have a genuine inclination to want to help people, just like you (the paramedics).  The only thing that I ask is that you at least use us for what we _can_ do.

Thanks again,
Joe


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## jrm818 (Oct 31, 2007)

Jolt said:


> The way I see it, EMS is just about getting people to the hospital alive.  This task obviously involves several different skills.  I think that EMT-Bs have an appropriate level of training for the task that they perform.  They do a quick assessment to determine the severity of the sickness/injury, and they take the proper actions to ensure that the patient arrives at the hospital in order for doctors to perform definitive care.  The way I see it, as long as the patient arrives at the hospital in a salvageable condition, we've done our jobs.
> .



The way I see it, you're dead wrong (pun intended).  The purpose of EMS is goes waayyy beyond being a fast ride to the hospital.  Are you going to be patting yourself on the back when you start bringing vegtables into the hospital, since they're still technically alive?  EMS does include fast evaluation and transport to appropirate definitive care, but it also includes early treatment for any number of emergent conditions which can be alleviated pre-hospitally, preventing further damage.  Similarly, don't underestimate the need for a detailed examination by somebody who is medically trained.  Any number of minor conditions present very similarly to major conditions, and it takes a good deal of training to differentiate the two.  Sending someone with a AAA back to bed for a tummy-ache is not a good thing.

And what does "salvageble" mean?  Quadruple amputee?  Massive brain damage?  Etc. etc.  There is a lot that can be done pre-hospitally that has a range of implications (miniscule-major) for long-term patient outcome.  You need to do some major horizon-broadening.  Maybe a few extra hours of instruction would help with that.

Additionally, some definitive care (particulary in arrest cases) can be provided pre-hospitally.  And sorry to all the MD podiatrists, OB/GYNs, psychiatrists, GP's, etc. out there, but I'll take the paramedic in an emergency, thanks.  Ever wonder what happens if you GP finds out you're having an MI?  They call 911.


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## skyemt (Oct 31, 2007)

jolt,

it's ironic, but your post belittles emt-b's more than any other...
you just don't seem to get the big picture... we all do the "same tasks", as you put it... scene safety, assess the patient, perform appropriate interventions... emt-b's do this... don't paramedic's? of course they do...
the difference is in the level of interventions provided... a paramedic can do far more to treat a pt than an emt-b...  but can't an emt-b assess a pt as well as a higher level provider? of course he can, if he wants to learn how to do ti...

man, you make it sound like emt-b's are fedex drivers who "scoop and run"... make it to the hospital as fast as possible...what about the times you have to slow down and actually think about things? or do you not think...

it sounds like you don't... because why else would you say that more education doesn't matter...

also, you refer to emt-b's doing "quick assessment to determine severity of sickness/injury"... well, ok... maybe the initial assessment to determine life threats... but what about getting a history? what about interviewing family to get a baseline mental status...what about a thorough sample history?
what about trying to determine the nature of the illness... i'm sure you've heard of "load and go" for priority pt's, and "stay and play" for the others...
sounds like you never even heard of it! just load and go... get to the hospital as fast as possible! no time for histories! quick assessments only!

if a paramedic said half the things you did, the other emt-b's would be up in arms!


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## Flight-LP (Oct 31, 2007)

Wow, a lot to digest in only one day since I read this last..................

EMT's - Have you noticed a trend in this and every other B vs. P thread????

All of the name calling, usually self -descriptive, has come from the EMT's end of the keyboard. There has not been ONE degrading comment from a Paramedic, only the truth. And I'm sorry, EMT education is minimal and acceptable at best. Personally I think it is way substandard. 

A wise one spoke recently and said some very powerful words. "If your not happy, do something about it. Advance your certification". The truth has been spoken. Unless you show self improvement by affording your patients the best that they deserve, then you do not have a leg to stand on when a Paramedic points out your minimal education. Honestly, you need to just deal with it. 

With that in mind, I will point out that I do recognize the offerings and limitations of my EMT partners. And they operate within that limited scope when they work with me on a unit. I do agree with Rid on a hot topic though. Personally, if it was up to me, there wouldn't be an EMT-B on a 911 unit, it would be a dual medic truck. I believe in giving the community what they pay for. My service gets over $10 million annually, most from taxation. With that amount in mind, I am going to offer them the best service and care there is. I realize that many will not agree, that is fine, each is entitled to an opinion, and I also realize that many will dismiss this idea as "not feasible". Especially amongst volunteer and BLS agencies. But alas, this yet another topic for another day. Just one more issue for our never ending drama we call EMS!!


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## Littlebit (Oct 31, 2007)

The whole thing that set me off is how I percieved some of the messages toward EMT B's.  
There is a place for EMT B's same as anywhere in the health profession- CNA's are needed - LPN's are needed- but if we treat these individuals as though they provide the "dirt work" we'd be in a mess of trouble.
Some individuals are completely happy and content with the "level of care they provide" and all positions are important.  
I've worked in a variety of settings- I started out as a CNA - and have advanced to management positions and the biggest lesson I learned "is to treat all with respect- no matter what positon or certification they hold."  I would encourage anyone to advance thier education or skills  but not by belittling thier current position. 
Personally I feel most EMS providers have a  6th sense- they are able to recognize ominous signs and symptoms - we've all heard or seen the incidents where they bring in a patient on all fours because it was the only way to keep an airway patent (just an example) Or we've heard the stories of a Paramedic who was so bent on ACLS they forgot ABC's. 
Supporting our profession (EMS) and teamwork is I guess what I'm trying to get across.


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## skyemt (Oct 31, 2007)

flight-lp, you had me until the end...
dual medic truck for 911!!!
what a brilliant idea... broken ankle, lets send two paramedics!
separated shoulder! send two medics!

you do realize that in most of the country, 90% of 911 calls are NOT als calls, don't you?

please, do step down from that high horse... many emt's are quite capable...

if we need ALS, i'd be more than happy to have you show up.


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## skyemt (Oct 31, 2007)

as this post progressess, i wonder a couple of things...

what if the emt-b's out here spent as much time learning more as they do defending minimal education??

what if the paramedics out here spent as much time educating emt-b's out here as they do putting them down??

wouldn't we all be better off?


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## Flight-LP (Oct 31, 2007)

skyemt said:


> flight-lp, you had me until the end...
> dual medic truck for 911!!!
> what a brilliant idea... broken ankle, lets send two paramedics!
> separated shoulder! send two medics!
> ...



I too think it is brilliant! Although I actually believe it vs. your attempt at sarcasm. We do staff dual Paramedic trucks on occasion and yes a good portion of our calls are BLS. But the pt. benefits from having an ALS assessment performed and an underlying cause and diagnosis being identified through a critical thought process. Very few EMT's can offer that. Just because you don't stick an IV in them, shove a tube down their throat, or give them cool drugs, does not remotely mean that they deserve any level of care less. Plus it allows a reduced workload for medics and has increased morale throughout the organization.

If I were a patient and I was experiencing oh lets say abdominal pain, if the pain became unbearable, I would probably call 911. The last thing I want when an ambulance shows up, is the attendant to then call for a Paramedic. I want that Paramedic on the first ambulance that arrives. So do the majority of educated consumers, i.e. your clientele. Like it or not, EMS is a business, a customer service based one at that. When people pay for a premium service, then thats what they want and around here thats what they get. Not everyone believes in paying for EMS. All I have to say then is you get what you pay for and deserve what you get. 

Thank you for your contributions though, your responses are insightful and a welcome change from some of the ignorant and negative views and beliefs that have been floating around................................


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## DisasterMedTech (Oct 31, 2007)

I agree. There seems to be a trend in paramedic thinking that says "EMTs are minimally trained, so let's eliminate them."  Would these same paramedics say "that arm is bleeding, let's cut it off?"

As Ive said, I would like to see the amount of training for all levels of EMS providers increased, but...until they are, medical directors are physicians who are considerably more trained that paramedics. They set and enforce protocol. Yes I know there are paramedics on protocol boards. I just wonder how many of them set the final protocols. Not many Im guessing. The medical director in my region says that EMTs are qualified for combi-tubing, epi administration and reducing and field stabilizing a broken femur via traction, among other interventions. I dont really have a horse in this race: Im not intimidated or threatened by paramedics nor do I feel inferior because I am a basic. There should be changes, but until there are, it is what it is and Im going to do what Im trained to do safely, well and within my protocols.


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## triemal04 (Oct 31, 2007)

DisasterMedTech said:


> I agree. There seems to be a trend in paramedic thinking that says "EMTs are minimally trained, so let's eliminate them."  Would these same paramedics say "that arm is bleeding, let's cut it off?"



Don't recall a medic saying that we should eliminate basics; there is a place for them, and they can fill a role in EMS IF used properly.  What I recall is medic's saying that the training of basics (and of a lot of paramedics) is minimal and should be upgraded.  I also recall medic's saying that basics don't recieve enough training for some of the skills they are allowed in some areas.  (Due to that pesky minimal training and only being trained in BASIC areas)

And I say that quite often in fact; it's why there is a sawzall on my ambulance.


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## JJR512 (Nov 1, 2007)

reaper said:


> JJR512,
> 
> You have a point for some systems. Where I work our protocols are basically a list of what is available for us to use. we still get to make the decision of when and how we utilize our tools.
> 
> That is why I hate algorithms in protocols. That is cook book medicine. A monkey can follow a algorithm. A human can use his brain to decide what to do.


The Maryland protocols have some algorithms. I'm not sure if I could say it's algorithm _heavy_, but I have no basis of comparison. I understand your point, though. And it's worth remembering that whether the protocol is about a basic skill or an advanced skill, it only tells you what skill to use; it doesn't tell you how to actually perform it. That's where education comes in.



Ridryder911 said:


> Actually no. My protocols are only 15 pages thick for everything. Each starts with the statement:_ "This protocol is a guideline or suggestion only and maybe used in its entirety or may not, depending upon the discretion of the Paramedic. The Paramedic has the education of treating appropriately depending on the state and judgement of the Paramedic. Medical control should be contacted for advice, if needed or if possible."_


I suppose _all_ EMS protocols could be written like that. If I've been taught to apply pressure to an arterial bleed, do I really need a protocol that says "If the patient has an arterial bleed, first apply pressure"? No, one that says "You've been taught what to do in this situation so do it" would suffice.

Still, the point I was making in the post you were quoting from goes beyond the protocols. You'll notice I mentioned a paramedic's education as well. It's not just the protocols that are written and defined by the doctors, the doctors also have a lot to do with defining a paramedic's education curriculum. The overall point is that when a paramedic performs a skill in the field, he/she is doing it because a doctor wanted that skill performed in that situation; whether the paramedic decides to use that skill in that situation because it's written in a protocol or in a text book, it makes no difference. Paramedics, just like basics, are doing what the doctors want us to do; we're operating under their license, and when we screw up, we report to them.

Which brings me to...


Ridryder911 said:


> As well, not all physicians are created equal. Many have never intubated, or even rotated in an ER more than a 8 hr shift, as well have never read an ECG. I know, I teach or attempt to the residents and physicians in ACLS.


Come on, man, we all know that all physicians are not created equal, nor are all basics, all nurses, all plumbers, or all fry cooks. But I don't think those physicians who have never intubated or worked in an ER are the ones writing the protocols, so they're not really the ones I'm talking about, are they? So they can be left out of the conversation.




skyemt said:


> JJR512-
> i can't believe that you don't have a better knowledge of how those meds work... i completed my EMT-B course last spring, and we sure as heck knew how the meds worked... why would i give one witout knowing what it did...
> 
> do i know on a cellular level, perhaps not... do we learn that albuterol acts on beta-2 receptors to dilate smooth muscles of the lungs? yes... did we learn that it also acts on some degree on the beta-1 receptors of the heart? yes...


I think you misunderstood me, or perhaps I wasn't clear enough, and if so, I apologize. I know how the meds work as well as what I've been taught in EMT-B class, which sounds to be the same as you. What I meant is that I do not know _how they work how they work_, or, as you said, what exactly they're doing on a cellular level, or microphysiological level.

...
It seems that some times some people are saying, or trying very hard _not_ to say but meaning it anyway, that EMT-Bs, because they are not trained and educated as much as paramedics, are useless and should be done away with. For example, the notion that all 911 units should be staffed with ALS providers only.

Let's remember that we as EMT-whatevers are working in the field under the license of our respective medical directors; as such, we are working out there on their behalf. If it was possible to send a physician out on every call for medical assistance, there would be no need for paramedics. If it were possible to send out paramedics to every call for medical assistance when there are no physicians available to respond, then there would be no need for EMT-Bs. Would the world be a better place if all EMS providers were trained to EMT-P level? Yes. Would the world be an even better place than that if all EMS providers were trained to MD level? Yes. But the latter isn't possible, so the world has to make do with paramedics, and by the same token, neither is the former possible, so the world will just have to make do with EMT-Bs.


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## Ridryder911 (Nov 1, 2007)

Disaster, you have to remember that there is NO national mandating rule for medical directors to be emergency physicians. In fact, I know in my state that is a Dermatologist is the medical director of a service, as long as they are currently licensed and have a valid ACLS card. 

In fact, if you were to review NEMSP organization, you will see that they found very few EMS medical directors nationally were ER or critical care residency trained. This is why they are promoting their EMS medical directors course. 

Back to protocols, there are medical community and standards of care.( i.e NHTSA standard). In other words, one could only have to simply perform the standards as taught by the curriculum and be covered in some areas. Just like NP's, PA-C's etc have a scope of practice and standards without specific protocols. 

I agree basics definitely should NOT be eliminated, but their role should be changed. A formal assessment should be only be made by Paramedic level representing EMS. The same as an initial triage or MSE can only be provided by an RN or physician representative in the ED. 

Basics should be first responders to initially care for the patient and to assist in care. The 120 -200 hour length course, and the current curriculum is insufficient for EMS units. 

R/r 911


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## skyemt (Nov 1, 2007)

i'm not really sure why there is such an EMT-B/Paramedic debate on this thread...

i even find myself drawn into it, because my pride takes a ding when i read that i shouldn't be manning a 911 truck..  yikes, of course i should!

but then, sadly, if it is a real emergency, one involving an unstable pt, of course it is an ALS emergency, and i know i am not the best qualified level of provider... if it were me needing life saving care, yes the first unit i'd like to see is a Paramedic unit...

yes, my level of studies is not sufficient, i believe, for the tasks even emt-b's perform... i do my best to supplement my education on-line, extra classes, etc...  but, it does not make me a higher level provider, just makes me better at the level i'm at...

one day i will be a higher level provider, for all of the reasons said on this thread an elsewhere... i just want to get a couple of years of experience first... then next step for us is EMT-CC, which doesn't really get mentioned here much...

so, at the end of the day, after reading these posts, i have to agree with many of the paramedics sentiments... and if it bothers me, as it does, than i should just get a higher level certificate, which i will...

but, as emt-b's, we are not paramedics, will never be the best level care...
in many cases, even in districts near me, i wouldn't want many emt-b's showing up if my family had an emergency... we don't have the training, don't have the knowledge, can't provide the interventions necessary in a "true" emergent situation...

this is not a put down on emt-b's, i don't think any less of myself... and i want to be the best emt i can at whatever current level i'm at... to paraphrase another post, to "be an asset to a higher level provider"...
that's about the best i can do right now...

but instead of debating the value of emt-BASIC,  if you want to be better, be a higher level provider, than go out and study and get the certificate.

BASIC is basic, not inadequate... and there is nothing wrong with that... but the scope of a BASIC is small, and rightfully so... 

so, in ending, an emt-basic is not worthless, but worth less than a paramedic.


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## reaper (Nov 1, 2007)

Sky,

 I think that is one of the best posts ever written on the subject!

I applaud you.


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## medic001918 (Nov 1, 2007)

skyemt said:


> i'm not really sure why there is such an EMT-B/Paramedic debate on this thread...
> 
> i even find myself drawn into it, because my pride takes a ding when i read that i shouldn't be manning a 911 truck..  yikes, of course i should!
> 
> ...



Well spoken.  Strong work.

Shane
NREMT-P


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## Guardian (Nov 2, 2007)

I think Sky’s post is obvious in some ways and we need to redirect our focus.

I’ll reiterate my position on emt-basics as I think it is appropriate.  I have never had a problem with EMTs or their training.  They are necessary now more than ever.  I have no problem with an EMT riding on my truck.  You give me a good EMT and you will see a happy man.  My war has always been against public deception.  The public has a right to know they are receiving basic level care, and substandard ALS (emt-ABCD etc, anything but paramedic).  We are deceiving the public by letting them remain ignorant and even fooling them by giving emt-abcds the ambiguous title of “Medic” which the public thinks is a term meaning paramedic.


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## DisasterMedTech (Nov 2, 2007)

Guardian said:


> I think Sky’s post is obvious in some ways and we need to redirect our focus.
> 
> I’ll reiterate my position on emt-basics as I think it is appropriate.  I have never had a problem with EMTs or their training.  They are necessary now more than ever.  I have no problem with an EMT riding on my truck.  You give me a good EMT and you will see a happy man.  My war has always been against public deception.  The public has a right to know they are receiving basic level care, and substandard ALS (emt-ABCD etc, anything but paramedic).  We are deceiving the public by letting them remain ignorant and even fooling them by giving emt-abcds the ambiguous title of “Medic” which the public thinks is a term meaning paramedic.



Other than in the military, Ive never heard a basic being called a medic. I also agree that a "medic" and a "paramedic" are not the same thing. As for public deception, talk to the agencies and operations managers. We have several services in my hometown that have an agency patch on one sleeve and a flag  on the other and no indication anywhere on the uniform as to what level that EMT is. Also, if you believe that the public has a right to know you need to educate the public in the differences between a Basic and a Paramedic and then get LEOs to stop calling anyone on an ambulance a paramedic (eg: Dont worry. The paramedics are on their way).

Im glad to hear what you have to say about EMT-Bs on trucks. Other than in a code situation, Ive always sort of wondered what that second paramedic would be doing in most cases. One of them is going to be driving and one treating just like in an ALS/BLS rig. I also think that for many, MANY agencies especially in smaller communities, the cost of dual paramedic rigs is cost prohibitive. I guess its 6 of one and half dozen of the other. Which is more important that they have?  More EMT-Ps or more crews. Most communities recognize this situation and opt to have two rigs instead of one because that one would be staffed by two paramedics. The argument (which you arent making, of course) is that the standard of care is only acceptable when there are two paramedics on board is ludicrous. Yeah, lets pay a paramedics wages to the second crew member just so he can take vitals and load the cot just like his Basic counterpart would be doing. If there is a statistic out there that shows that dual paramedics have a higher success rate in terms of the outcome of treating their patients, Id like to see it and have the source cited. Ive never seen such a study, and I have looked high and low for it. I think of things like the field reduction/stabilization of a femur fracture. The EMT-Basic is taught this skill, practices it and is signed off on it. While traction/reduction usually involves two providers, are there folks out there who really think that the outcome will be better if one paramedic is holding the patient and the other is  setting the tension on the traction splint?

I have a friend who is in EMT school right now. She is doing her time in emergency departments. Last night a paramedic/basic rig brought in a patient with a skull fracture after a 10 foot fall onto concrete. The patient was brought in sitting up in Fowler's, not on a board and not collared.  If the paramedic is ultimately responsible for the decisions on that rig, that sort of shoots the theory that simply because there is a paramedic on a rig that the standard of care is higher. Knowledge without limitations gets people killed.

(dons flame suit)


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## Guardian (Nov 2, 2007)

DisasterMedTech said:


> Other than in the military, Ive never heard a basic being called a medic.



Are you new to ems? really, are you new?





DisasterMedTech said:


> I also agree that a "medic" and a "paramedic" are not the same thing. As for public deception, talk to the agencies and operations managers. We have several services in my hometown that have an agency patch on one sleeve and a flag  on the other and no indication anywhere on the uniform as to what level that EMT is. Also, if you believe that the public has a right to know you need to educate the public in the differences between a Basic and a Paramedic and then get LEOs to stop calling anyone on an ambulance a paramedic (eg: Dont worry. The paramedics are on their way).
> 
> Im glad to hear what you have to say about EMT-Bs on trucks. Other than in a code situation, Ive always sort of wondered what that second paramedic would be doing in most cases. One of them is going to be driving and one treating just like in an ALS/BLS rig. I also think that for many, MANY agencies especially in smaller communities, the cost of dual paramedic rigs is cost prohibitive. I guess its 6 of one and half dozen of the other. Which is more important that they have?  More EMT-Ps or more crews. Most communities recognize this situation and opt to have two rigs instead of one because that one would be staffed by two paramedics. The argument (which you arent making, of course) is that the standard of care is only acceptable when there are two paramedics on board is ludicrous. Yeah, lets pay a paramedics wages to the second crew member just so he can take vitals and load the cot just like his Basic counterpart would be doing. If there is a statistic out there that shows that dual paramedics have a higher success rate in terms of the outcome of treating their patients, Id like to see it and have the source cited. Ive never seen such a study, and I have looked high and low for it. I think of things like the field reduction/stabilization of a femur fracture. The EMT-Basic is taught this skill, practices it and is signed off on it. While traction/reduction usually involves two providers, are there folks out there who really think that the outcome will be better if one paramedic is holding the patient and the other is  setting the tension on the traction splint?
> 
> ...



The old cost prohibitive argument never stands up under scrutiny.  I'm not really going to go there however, because I already blew out a thread this year on that topic.  Also, do a search for medic=emt and you can read the huge thread on that topic as well.


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## Guardian (Nov 2, 2007)

here's the link http://emtlife.com/showthread.php?t=2753&highlight=bubba


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## JJR512 (Nov 2, 2007)

Guardian said:


> Are you new to ems? really, are you new?


People do speak differently in different parts of the country. The term "medic" referring to anyone who gets off an ambulance may be common in your area but never happen in another area. Similarly, volunteers are called "squirrels" in some parts of the country but not others. Remember there are regional differences before you think someone is a moron.


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## skyemt (Nov 2, 2007)

Guardian, 

you say my post, which actually offers a different point of view for emt-b, is obvious, yet you go back to the tired rant of "emt's are not medics" etc, "the public is being deceived...", blah blah...

PLEASE, as an emt, offer something useful out here...

your  comments are about as tired and obvious as they get...

time for a new thread anyone?


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## jrm818 (Nov 2, 2007)

DisasterMedTech said:


> . If there is a statistic out there that shows that dual paramedics have a higher success rate in terms of the outcome of treating their patients, Id like to see it and have the source cited. Ive never seen such a study, and I have looked high and low for it. I)



Well really there isn't much data (that I can find) to suggests that ALS in general has a huge impact on patient outcome at all. The majority, if not all, of the studies that have been done have methodological problems, and the data seems to be pretty conflicting and ambiguous.  A few studies have sorta suggested ALS can have some imporvement in cardiac arrest (maybe), and maybe some impact on trauma, but overall the impact of ALS is far from indesputable.  There are just as many (if not more) studies that have suggested no difference between ALS and BLS systems.  The only consistancy among the studies that I can find is that the data is impeachable in them all.

So what's the deal?  Am I missing some stellar major study that once and for all established that an ALS system is far far superior to a BLS sytem, and worth any cost?


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## DisasterMedTech (Nov 2, 2007)

No, I dont think your missing some unimpeachable study that shows that patients are more likely to arrive at hospital "alive and viable" more often or with greater consistency simply because there is an ALS provider on board. Ive dont literature searches in JEMS, the Journal of the American Medical Association and non-US sources like the Lancet. The statistics just arent there. As you say, perhaps in cardiac situations where cardio-verting is necessary we can say that there is a great advantage to having someone on the crew who can push drugs. As I say, though, I would also be interested to see statistics surrounding the number of patients whose condition is worsened due actions of ALS providers and the same statistics for worsened condition for BLS providers. Perhaps it would be found that because of the complexity and diversity of interventions performed by ALS responders that there are more likely to be mistakes. 

Also, just out of curiosity, I wonder what the ALS members of this forum think of EMT-I providers. In a move that I much disagree with, we are doing away with them slowly but surely here in Illinois. Just across the state line into Wisconsin they are still very much in use and they dont seem to have plans to eliminate them any time soon. When I worked and lived in the Southwest, I saw more of them than I do here in the Midwest.  Id be interested to know what the difference in training time, etc is between EMT-Is and EMT-Ps in the various states where both are licensed. It seems to me to be a good idea to have this in between step. If I could, I would very much like to go to Intermediate before going to Paramedic, but alas, they are a dying breed where I live.


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## Ridryder911 (Nov 2, 2007)

EMT/I is just another excusable level not to have the real deal. Remember, all multiple levels are compared to what? The Paramedic. 

Dependent on the level of Intermediate (I/99-84) It can range from a 4 week class to 9 months. Again skill levels can vary as well. 

Why can't we in EMS do the right way the first time, instead of doing it half arse? 

In regards to studies there are multiple studies verifying differential from ALS to BLS. The majority is in prevention and recognizing injuries and illnesses and treatment of acute care. Then in reality if one really considers the treatment of BLS, maybe just transportation would be enough? 

R/r 911


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## skyemt (Nov 2, 2007)

if you guys are trying to imply that there is little difference between bls and als crews, you are making the rest of us EMT-B's look very silly for no reason!

"here comes the ambulance... i really hope there are no Paramedics on board!"

you guys can't be serious...


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## emt/ff71185 (Nov 2, 2007)

Ridryder911 said:


> EMT/I is just another excusable level not to have the real deal. Remember, all multiple levels are compared to what? The Paramedic.
> 
> Dependent on the level of Intermediate (I/99-84) It can range from a 4 week class to 9 months. Again skill levels can vary as well.
> 
> ...



When you say doing it half arse, are you saying that going from EMT-B to EMT-I to EMT-P is doing it half arse or are you saying that we should all just go straight to EMT-P without a good base?  I have never heard of a course that takes someone with out an EMT-B license at least and makes them a paramedic.  If there out there then that is fine but from everything I know you have to start as an EMT-B so it is not necessarily doing it half arse.  It is just being in process to a higher license.

On your other topic... I do feel like ALS is vital to a good medical system but so is BLS because in the outlying regions, BLS is what is going to get to that patient first and keep them going until we can get ALS out to us.  Everyone is needed.  Obviously being a Paramedic gives you a lot more knowledge and in a perfect world it would be great if everyone that climbed into a rig was a paramedic but because that is not going to happen outside of cities why do away with the next best thing?


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## JJR512 (Nov 2, 2007)

Ridryder911 said:


> EMT/I is just another excusable level not to have the real deal. Remember, all multiple levels are compared to what? The Paramedic.
> 
> Dependent on the level of Intermediate (I/99-84) It can range from a 4 week class to 9 months. Again skill levels can vary as well.
> 
> Why can't we in EMS do the right way the first time, instead of doing it half arse?


_You_ may compare everyone else to _your_ level (EMT-Bs don't know as much, doctors know more); _I_ may compare everyone to _my_ level (paramedics are better, doctors are even more better); doctors might compare everyone else to _their_ level (paramedics are lower, basics are even more lower). We all have our knowledge and skill set, we all have our uses and our place, but to put yourself at the center of everyone else just blows my mind.

Why can't we do it right the first time? I assume from the egotistical attitude of the preceding section, I assume you mean why can't we all just be paramedics? Answers are as follows:

1. Time. Not everyone gets the idea of becoming a paramedic in time to go to paramedic school right out of high school (i.e., going to college and getting a 2- or 4-year degree as a paramedic). Later in life, it can be difficult to find the time for paramedic classes. Most of the paramedic programs in my area have a class/clinical/study load that is impossible to maintain while working a full-time job, so by the time some people decide to ditch whatever their old careers were to become a paramedic, they have responsibilities that require time put into working a full-time job.

2. Money. This ties in with the preceding answer. Not everyone can afford to switch to a part-time job so that they'll have the time to take paramedic classes. Additionally, not everyone can afford to take the classes in the first place. One community college estimates the cost of their paramedic certificate program to be $5,136, while their degree program (AAS) is estimated to cost $6,566. Five or six thousand dollars isn't a lot of money to people that have five or six thousand dollars of disposable money sitting around, but it's a heck of a lot of money to a heck of a lot of people. And not everyone can get financial aid or loans.

3. Interest. So one day, doing whatever non-health-care job he does, Joe Schmoe is suddenly going to have an idea to leave his current industry/career and become a paramedic, so he quits, goes to paramedic school for one and a half to two years, becomes a paramedic, and gets hired by his city's fire department. Actually...I don't think so. Taking classes two nights a week for half a year while keeping his regular job, so he can become an EMT-B, work one or two nights a week and maybe a weekend day or the whole weekend now and again, to get a taste for what EMS is like, sounds like a more sensible plan to me. Then Mr. Schmoe either decides that it's not really his thing and he stops doing it, or he decides that it is, he'd like to do it more and do it better, and eventually becomes a paramedic.

There are probably other reasons why we don't all "do it right the first time", but there's three I could think of quickly.


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## Ridryder911 (Nov 2, 2007)

Most studies that have been referred to, have been addressed multiple times and reviewed by many as tainted and bias studies. The major comparison was in regards to cost effectiveness of BLS versus ALS. Again, many that read such studies do not understand research and statistical results. Studies such as OPALS, and others have pointed out BLS in comparison appears to provide better results. Again, what many fail to read is that it is based upon BLS responding in < 8 min and have transport times within reasonable time to an appropriate center. 

In reality, what can BLS really do? Oxygen, bandaging, splinting, and some some supplemental medications... that is it. Initial treatment and assessment until medical intervention can occur. We have found out that IV fluid therapy in the field setting does more harm that actually good, providing "wash out" in shock syndromes, intubations without advance training (i.e. RSI) in trauma patients has drastic lower successes (Wang), and randomly administering NTG in non-monitored and no IV access patients can be detrimental in many AMI patients. 

The advantages of ALS is similar to any medical care. Prevention and treatment of illnesses. If we base our existence solely on outcome basis, we would never even attempt resuscitation efforts.  

Examples of differences is primarily seen in cases such as recognizing early cardiac infarctions, cerebral hemorrhages and stroke syndromes, pain management, and again in trauma the securement of airway and treatment of respiratory complications. Advance assessment skills with diagnostic tools, and in-depth interpretation; is the key in having major difference. Being able to notify ahead for early alert for cardiac catheterization, tPA for AMI and those that meet eligibility for CVA's versus those do not meet the criteria. Treatment or abolishment of life threatening arrhythmias, treatment of upper and lower airway complications, and treatment of general medical emergencies. Obstetric emergencies and neonate advance treatment definitely has a great differential. As well, low number of studies of transport of seriously ill patients that requires specialty care from small local hospitals to tertiary hospitals. 

The problem in most studies are that they usually are performed in high call volume, low protocol services, with receiving hospitals within a few minutes of EMS responses. Of course, most that work in EMS realizes that this is not where the emphasis of a progressive EMS should be. Rural areas, where treatments I described earlier are the ones that could benefit and actually have a potentially of change in outcomes. Again these are not where these studies are usually conducted. Low volume, poor statistical data, and multiple variables are the reasons they are not performed in rural setting. It would take years to obtain enough cases and data. 

Many are beginning to see EMS outside the box. For EMS to survive and be beneficially funded we will have to change our profession from pre-hospital to out-of-hospital expanded care. Again, compare to our neighbors in Canada, Australia, England, etc. (This is a another subject for another thread). 

BLS is part of patient care, not separation or a division, just like the so called ALS. Patient care should be in one continuum, with no separation. Only in EMS we attempt to separate the two in care.

R/r 911


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## jrm818 (Nov 2, 2007)

Rid i'm definatly with ya on the poor study quality.  I wasn't suggesting that studies which have shown that BLS is as effective as ALS (and yea...ive read at least one study that, as i recall, endorsed a "scoop and scoot" method) are of good quality or shoudl be taken as good evidence against ALS.  But I simply can't find any good quality studies which suggest that ALS is at all effective in improving either short or long term patient outcome.

I respect your years of knowledge and experience, but on a system-wide level, there has to be evidence of a benefit (and evidence of a lack of harm) before tons of money are spent on providing a specific treatment (in this case ALS).  This is no different than any other medical treatment - evidence based medicine is a model i'm more than willing to defend.

Unfortunatly what i suspect is that there's not the funding to do such a study, and even if there was, good quality studies i na field like this would be extraordinarily difficult.  I'm not sure what to do in that situation, as I also don't see simply assumign that more is better as a viable alternative.


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## BossyCow (Nov 2, 2007)

Ridryder911 said:


> In reality, what can BLS really do? Oxygen, bandaging, splinting, and some some supplemental medications... that is it. Initial treatment and assessment until medical intervention can occur.
> R/r 911



Rid, 
You left out a biggie, probably the most important role that the lowly EMT-B in the rural setting plays.  We transport to the hospital. My agency covers a 52 square mile district with mountains to the south and the salt water to the north.  We have a highway that runs east to west through the middle of it.  This highway is often blocked or impassable during the winter storm months.  Because of our proximity to the mountains and the rugged terrain, we are limited in the number of LZ's for Airlift and since Airlift comes from Seattle, we are looking at a minimum 1 hour response for airlift.  

I have ALS support from a private ambulance company that is generally 30 minutes away.  One of our most common scenarios is to be dispatched to an ALS call, Respiratory Distress, Cardiac Event, Multi-system Trauma, something that in a perfect world, would get an immediate ALS response.  But, instead of nothing, they get to be driven to the hospital, or towards ALS with someone skilled in CPR, able to use a BVM or OPA, Combi-tube.  We respond with an ambulance, which has an AED, O2, bandages and dressings, splints and backboards.  While none of this alone will heal what bothers them, it sure ups the odds that they arrive at ALS or the local hospital with a higher chance of survival than if they tried to drive themselves to the hospital in their car.

The comparison between BLS and ALS doesn't take into account those areas and situations where the choice is BLS or nothing.  But then, that's your free market system at work!


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## skyemt (Nov 2, 2007)

Bossycow, i don't think anyone would endorse nothing over emt-b...
but if you could, wouldn't you prefer higher level provider for a chest pain call? of course you would...

and with regards to all the talk about not being able to find studies... would anyone really spend much money to see if higher trained paramedics dealing with priority emergent patients would have better outcomes than lower trained providers dealing with priority emergent patients???

kind of obvious answers, no? who the heck would spend money on that study...

i still fail to see why the emt-b vs. paramedic debate still rolls on... can we not be so insecure?

i do get it, that some won't have the time or resources to become a paramedic... but that will leave you at the Basic level, and no study will change that... i would rather try to be the best emt-b provider, and search out studies on how to do that...


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## Aileana (Nov 2, 2007)

wow...9 pages of drama, from over such a short period of time...guess this is a fairly sensitive area *dodges flying keyboards in response to commentary*. 
The system we have here in Canada is a bit different, and it seems to be rather effective. We don't have EMT levels (as far as I know, atleast), but we have PCP (Primary Care Paramedics) and ACP's (Advanced Care Paramedics). To become a PCP, you need typically 2 years of college education, and to pass the A-EMCA (similar to the National Registry, I believe...a test that allows one to work as a paramedic in Ontario). For some regions, there is further testing, and you are ranked out of all of the applicants, and from these standardized scores and interviews, regions do their hiring. 
PCP's are allowed to do all the basic treatment, start IV lines (in some regions, depends though), defibrillate, interpret ECGs (I believe) and give 6 symptom relief meds. ACP's can do all of those, plus a lot more. We also have CCP's, but I have yet to encounter any of them, so I am not too sure about their role.   

In the region I am riding out with now, they seem to be aiming towards having an ACP and a PCP on each rig. Once, I was lucky enough to ride third with two ACP's (though one was consolidating). They're definately an asset in patient care, especially in pain management, I find. Also, with ACP skills being administered quickly (not having to worry about another line of communication in requesting backup), many potentially fatal incidents are deferred quickly. For example, the SVT call we did a while back, if there was not an ACP on board to give adenosine, the patient may have not made it to the hospital.

Sorry if I've gotten a bit off-topic/rambled (again) here, but I guess I was pointing out that here we have an example of what a bit more education does to help the public.  
*hides in corner, prepares to be flamed*


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## emt/ff71185 (Nov 2, 2007)

I cannot say that I am proud to have started this whole mess of a thread but it has taught me a lot about the topics that fire up EMS personnel.  I never knew of the feud that exists between EMT-B's and Paramedics.  I still cannot quite figure out if it is because EMT-B's try and be more than they are or that Paramedics forget that they started as EMT-B's and get a little too big of a head.  It is probably a combination of both.  Regardless of the reasons for it we all need to remember as Rid said that we all share the same goal of providing the best patient care we can.  Every one of us is part of the same system and some will change there level of education and some will not and it does not really matter in the end because we all are helping in our own way.


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## ffemt8978 (Nov 2, 2007)

emt/ff71185 said:


> I cannot say that I am proud to have started this whole mess of a thread but it has taught me a lot about the topics that fire up EMS personnel.  I never knew of the feud that exists between EMT-B's and Paramedics.  I still cannot quite figure out if it is because EMT-B's try and be more than they are or that Paramedics forget that they started as EMT-B's and get a little too big of a head.  It is probably a combination of both.  Regardless of the reasons for it we all need to remember as Rid said that we all share the same goal of providing the best patient care we can.  Every one of us is part of the same system and some will change there level of education and some will not and it does not really matter in the end because we all are helping in our own way.



And that's the reason why the CL's haven't closed this thread yet.  While it has been an emotional topic, everyone has done an excellent job of staying within the forum rules and keeping it civil.


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## BossyCow (Nov 5, 2007)

skyemt said:


> Bossycow, i don't think anyone would endorse nothing over emt-b...
> but if you could, wouldn't you prefer higher level provider for a chest pain call? of course you would...
> 
> ..



Of course, and I've stated so repeatedly.  The point I was making is that there are still many areas, most of them rural where ALS is not an option due to financial considerations.


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## skyemt (Nov 5, 2007)

of course, ALS is not available in many places... however, that doesn't mean we should have a comparison between BLS and ALS...

if there were enough ALS providers to staff all the crews, would there be BLS??

of course there would be BLS, but practiced by Paramedics when ALS is not required...

i think what gets lost here is the fact that BLS/ALS refer to "standards of care", not to reflections on the abilities of individual providers...

BLS is necessary and practised by all levels of providers, not just emt-b's...
but if more is needed, the advanced care provider can provide it... it is the continuum that Rid referred to earlier...

try not to take things personally... if there were enough Paramedics to staff ambulances, EMT-B's would just be driver/helpers... one of the only reasons EMT-B's exist is precisely because there are not enough ALS providers, due to time, expense, and all the other reasons stated out here a million times...


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## BBFDMedic28 (Nov 5, 2007)

Were still on this topic? thats awesome.


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## BossyCow (Nov 6, 2007)

I'm sorry, was I taking it personally?  I believe my posts were simply responding to the ALS will be everywhere comments.  Would I like to have it? Sure... Would I support it? Absolutely!  But its naive to imply that all systems are heading that way.  Population density is a huge factor that is often overlooked by those practicing in the more urban environs.


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## skyemt (Nov 6, 2007)

well, it's just that saying rural areas often don't have ALS, so BLS is helpful, is kind of obvious, no?

no one said ALS is everywhere...

i'm not really sure what you are trying to add to the mix here...


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## BossyCow (Nov 7, 2007)

It seems to me that there is a immediate jump that all EMT-Basics will or should eventually become medics.  This is not a reality in rural areas.  If there were criteria that agencies converted to ALS, many of them would simply choose not to provide service at all.  We even had a district drop their ALS and go to BLS.  

Very often on this topic, those practicing in densely populated areas assume their reality is ours.  I am merely 'adding to the mix' my reality.


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## DisasterMedTech (Nov 8, 2007)

firetender said:


> Because it's true and often, we who have made every mistake in the book, become intolerant of those who make every other mistake in the book. It's something about preserving ego by making others appear less bright than ourselves. Very human.We have no choice but to make mistakes. We can either resist being told, or take in the info and use it to get better. Attacking has as little value as defending. Tolerance of the learning curve is important to everyone here, because if we're not all learning and making mistakes behind it, then we're not getting more proficient.




I think this notion also comes from alot of the same folks that assume that all EMT-Bs want to be paramedics. Its like saying all nurses really want to be doctors or all dentists are really frustrated maxillo-facial surgeons. Do I want to eventually become a paramedic. Sure. But maybe 4 or 5 years down the road. Since I got involved in disaster/MCI response I am more interested in becoming the best BLS/BTLS provider I can. Since I have access to them at no charge, I do take some courses, like AHLS, that provide alot of information I cant use because it has to do with tx that are not in my protocol, but its not going to hurt anything to have some knowledge about VX gas exposure s and sx. Right now, Im more worried about getting my MS degree done in Disaster Medicine. Then maybe Paramedic school. The interesting thing is that it is an unwritten, but not often unspoken, rule, that we as Basics defer to our Paramedic partners on everything. What happens when I am working with a paramedic who doesnt have the level of MCI/Disaster response training than I have. I think I have been asked a question once by a paramedic who was 10 years younger than I am and I think the question was "do we have any more 4 x 4s?"  Just because you have the title, doesnt mean you have all the information, answers or solutions in the world, but I think there is a feeling among Paramedics that if they ask a question, their Basic partner will think less of them, whereas they should be asking whatever it takes to render the best patient care.


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## Ridryder911 (Nov 8, 2007)

Let's not confuse the issue. We again are trying to compare apples with oranges. Respectfully, Disaster I believe your analogy is not correct. Each of those professions, are a separate profession with separate requirements and expectations. Nurses and physicians are not the same as well as Dentist to become a maxillo-facial surgeon would have to re-attend medical school. There are no "advances within" since on its own is a separate profession. 

More of analogy would be an LPN to RN level. Not to long ago, LPN's were allowed to provide the majority of the patient care in all areas of the hospital setting, from critical care to the emergency department. With the expansion and development of needed more intense education, the LPN/LVN now has a choice of either returning to school obtain their RN to work in those specific areas or go into another area of nursing. Either move up or leave. 

Sorry, the Basic EMT is just a little more than advanced first aid. I did not write the curriculum, I just know it and teach it. The content has been diluted down over the past decade and if the program does have clinical time, it is more an observation than actually having set objectives in patient care that has to be met. Again, it is not the person or their intent that is wrong, rather it is the expectations and the ability to deliver better and more advanced care to patients. Which is in reality  is better for the patient. Even the Paramedic curriculum barely meets the minimum to provide care for critically injured patients. Two years, should be the minimum. 

Will there always be a need for Basic EMT's? You bet! It is their role needs to be redefined. There will always be remote areas, where the Basic is the highest trained individual available, until more advanced level can be obtained. Let's not promote maintaining or excusing the need of BLS levels because we have EMT's. Unfortunately, majority of U.S. still does not receive as much ALS care as was portrayed by the television show "Emergency" thirty years ago, this is horrible! 

As the population age increases, the illnesses and injuries will as well. The role will be changing soon, it has to. The demand for increased education will be there, just as it was for the LPN. It will be expected and demanded. Again, there will be EMT's, just not in the role EMS providers other than first responders and non-emergency transport techs. Again, similar to the LPN role changed. 

Respectfully, Disaster your role in an MCI for as medical will be based upon your medical license, no matter if you even had a PhD. I am enquiring, are you enrolled in the on-line Philadelphia Disaster Medicine and Management course? This type of program is more in risk management, developing policies and dealing with community response teams, and public issues, not specific treatment modalities. This should not be confused with a Disaster Medicine degree, that I have been familiar with. This one requires one to have a doctorate in medicine, and already be board certified in an emergency medicine or as surgeon. The Disaster Medicine program I have worked with is three years residency program after medical school and studies the medical treatment, scientific research of disaster programs and response teams, that is quite of bit of difference. 

I have experience in developing policies, and state systems to respond to disasters. I can agree one needs to have as much specific education in this field as possible. Especially with the multitude of different events, types that now can occur. I wish you the best of luck in your studies and professional growth. We definitely need professionals specifically in this area. 

R/r 911


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## skyemt (Nov 8, 2007)

unstable airway!
possible MI!
unconscious diabetic emergency!
severe pain management!
hypevolemic shock!
status asthmaticus!
bradycardic emergency!


i could go on and on, but in all of these common emergent situations, the EMT-B can provide little or no treatment, other than handholding, monitoring ABC's, and transport, and of course, calling for ALS...

this is a silly debate... EMT-B's can render very little in the way of interventions... 

they can do a great job within the small scope of what they do...

let's try not to be so defensive about (11 pages worth!)...
if you are not satisfied, get a higher certificate, or be the best you can be at the BASIC level...


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## Rangat (Nov 12, 2007)

You know what?

Industries evolve.:huh:

Henry Ford evolved the motor vehicle industry- Did he have a masters degree in Mechanical Engineering?

Wright brothers evolved the airplane industry- Did they have a masters in Aeronautical Engineering?

Florence Nightingale- R/N?

Leonardo da Vinci- Masters in Anatomy?


These individuals were interested in their fields. They were very experienced in their fields. 

Would you let Henry Ford develop the injection fractions of your W12 engine?

Wright bros, Airbus flap design?

Would you choose to Da Vinci teach 3rd year anatomy students?


They would be a lot better than no one.


Would you let an EMT-B manage your child with a GSW chest?

   I'm sure you would, or your child will likely die.

       Would you let your child be managed by an Emergency Care Practitioner with a Masters degree in Emergency Medical Care from an internationally recognized university, taking him at least 4 years full time, and 2 years part time study?


Industries evolve.:birthday:


I understand, that it is only a few fortunate enough to have a sufficient support system to educate themselves that far, but there aren't random people who only finish second year medical school and then go work somewhere in a hospital.


100 years ago, if you couldn't get a job, you could go connect some wires and help build a plane.

Now there are still people who couldn't get a job at the post office, so they go drive an ambulance.

I know this might be offensive, and I respect the care you rend, but around you has evolved a higher standard.

Pre hospital care is no longer just an extension of a REAL doctor. There are many countries where an MD contributes N O T H I N G to the emergency environment. Paramedics RSI, IC drain, everything. On-line permission is a thing of the past.h34r:


The MD's used to have us by the balls, because we couldn't assess and diagnose properly. That has changed. These courses include years of pathophysiology, diagnostics, and correct assessment techniques.


I am not suggesting that the experienced old school medics should go back to varsity, but it is a waste for fresh, motivated, and interested young adults to go do a couple of short courses and be satisfied. Never will they reach their full potential, or the potential of the industry.

Often will you find an EMT-B be burned out and become uninterested in the pre-hospital field.

Do you often see a fully educated person become bored with their field? No, maybe a certain job? But then they go to research, education etc.


Is it fair to the patient that because there are only short courses sent to his car crash, where he is in tetany gargling in his own blood, that the paramedic should first get permission from someone NOT ON THE SCENE before RSI?

"Sorry, we only had short course trained people to help you during your emergency- But no worries, here are educated graduates in Occupational Therapy to help you be rehabilitated-_-"


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## DisasterMedTech (Nov 12, 2007)

skyemt said:


> this is a silly debate... EMT-B's can render very little in the way of interventions...
> 
> l



Speak for yourself. Im on a disaster response team and basics are trained to give atropine for nerve gas exposure plus about 100 other things that ambulance basics dont do. And yes, we can provide airways. Im going to get flamed but its called a Combi-tube and when you have 600 patients on a single scene it may go from the airway of last resort to the first line intervention. Careful of rash, unresearched generalizations.


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## CutePolkaDot (Nov 12, 2007)

Rangat u have a thing for OT's don't you?


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## Rangat (Nov 13, 2007)

*Make 600 patients ALS?*



DisasterMedTech said:


> Speak for yourself. Im on a disaster response team and basics are trained to give atropine for nerve gas exposure plus about 100 other things that ambulance basics dont do. And yes, we can provide airways. Im going to get flamed but its called a Combi-tube and when you have 600 patients on a single scene it may go from the airway of last resort to the first line intervention. Careful of rash, unresearched generalizations.


 
You're going to run around on scene, sink 600 DLA's (and then what? put them on T-Pieces and vents?), atropinize them, and then find at least 300 paramedics able to care for these 600 patients with advanced airways and atropine on board?:huh:

I know it's the greatest good for the greatest amount, but that's patient abandonment. :sad:

Is this plan based on a study that proves that there will be less mortality/morbidity, when BLS treats with ALS procedures, spread over dozens of patients per provider? As opposed to detailed, continuous care, focused on those with the best prognosis?:unsure:

It takes a while to assess, and then atropinize someone correctly, and continuous monitoring thereafter is important.-_-

I'm sure in any case, that skyemt did not mean additionally trained BLS in his statement. One cannot defend the majority by referring to specialized units.:blush:


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## triemal04 (Nov 13, 2007)

DisasterMedTech said:


> Speak for yourself. Im on a disaster response team and basics are trained to give atropine for nerve gas exposure plus about 100 other things that ambulance basics dont do. And yes, we can provide airways. Im going to get flamed but its called a Combi-tube and when you have 600 patients on a single scene it may go from the airway of last resort to the first line intervention. Careful of rash, unresearched generalizations.


So you're going to run around giving IM injections of atropine to people who may have been exposed to nerve gas?  Good luck with that.  Seriously.  You're going to need it.  Because normally it takes a lot of atropine to really help, and usually it means that it needs to be given IV.  But, maybe they'll live long enough for someone else to take over.

And there are basic's in other areas that give atropine injections, so don't get to exited.

Same with the combitube.  What are you going to do after you drop those 600 combitubes?  Hook up 600 BVM's and run from one person to another ventilating them?  Find 600 people off the street to do it? 

Or follow your triage procedure and realize that some of those people are now black tags?

That is the biggest difference between a basic level provider and a paramedic; knowledge.  You could give the same patient to a basic and a paramedic who could only operate as a basic, and guess who would be able to render better care, figure out what was going on, and then pass that info to the hospital so that care there could be started faster?  The skills that we do don't always mean a lot, and it's not about who can do more.  It's about who really knows how to assess and treat patients.  Who knows when they should do something, and more importantly, when they should NOT do something.


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## skyemt (Nov 13, 2007)

ok, it is quite an honor to be chosen for your disaster response team...
but really, what does that have to do with the EMT-B curriculum in this country?
unless they are all on disaster response teams, what you are talking about, while noble, is completely irrelevant to EMT-B's...

once again...
why do EMT-B's continue to fight what they are? B-A-S-I-C...

you could roll out all the bells and whistles you have to make it sound like you are some kind of medic, but at the end of the day... YOU ARE NOT!

there is nothing wrong with being a basic and having limited scope...

why fight it?

triemal04, in regards to your comment, i was just speaking to one of our paramedics last night, who was very happy to work on and perfect his basic skills as well... armed with the knowledge a medic has, you will have superior care even on a basic level...


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## DisasterMedTech (Nov 13, 2007)

triemal04 said:


> So you're going to run around giving IM injections of atropine to people who may have been exposed to nerve gas?  Good luck with that.  Seriously.  You're going to need it.  Because normally it takes a lot of atropine to really help, and usually it means that it needs to be given IV.  But, maybe they'll live long enough for someone else to take over.
> 
> And there are basic's in other areas that give atropine injections, so don't get to exited.
> 
> ...



Read the previous post I wrote in response to Rangat. It answers your questions. And when your talking about a mass exposure to a chemical agent, the term to remember is austere care. Its fast, its ugly but it works. It has been proven to work. And the atropine to which you refer is often the answer. And in the cases such as I discuss it is not given IV, it is given IM via Mark 1 Auto Injector until the Sx I discuss in my other post stop. Thats your dosage. Until the symptoms stop. As a medic with what I assume is some knowledge of treating protocols for WMD attacks, I would assume you know that. It is the field of emergency medicine in which I practice and it is the subject of my graduate coursework. I'll recommend that you go with Rangat to Hadassah and let them give you some useful information. As is said so often in terror/disaster medicine "Thus ends theory. Let us begin the fact." Your nice, neat, in the box NREMT-P protocols are theory. The events I describe are the fact. Its a good idea to know the difference.

 Because you are a paramedic doesnt mean you have experience in the types of emergency medicine i am talking about. It is entirely different from EMS. It is the type of mass casualty medicine that occurs when local EMS is immediately overwhelmed and rendered useless in scenarios such as the one I offer in my previous post. Put away the paragod complex. Its useless when dealing with a few thousand patients. 

And for your further edification, triage tags for dead or death imminent patients are no longer called black tags after the racial unrest in the wake of the V2 Night Club fire in Chicago in 2002.


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## triemal04 (Nov 13, 2007)

skyemt said:


> triemal04, in regards to your comment, i was just speaking to one of our paramedics last night, who was very happy to work on and perfect his basic skills as well... armed with the knowledge a medic has, you will have superior care even on a basic level...



Yeah, that was my point.  All the neat blinky thingies and pokey thingies we have don't mean as much as what you've got between your ears.


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## BossyCow (Nov 13, 2007)

skyemt said:


> once again...
> why do EMT-B's continue to fight what they are? B-A-S-I-C...
> 
> you could roll out all the bells and whistles you have to make it sound like you are some kind of medic, but at the end of the day... YOU ARE NOT!
> ...



I don't think the issue is are basics and paramedics the same.  I think its simply a matter of respect.  Personally, in the field, I have always felt respected for the part I play in EMS.  Occasionally on this forum, I have felt there is a bias on the part of *some *that those of us who remain basics do so because we lack the intellect, or just don't want to work hard enough to become 'real medics'.  

My husband is a career ff/medic.  I admire and respect the job he does and the amount of study and effort that still goes on to maintain his skills and certifications.  I do not think of myself as certified at anywhere near the same level.  I am painfully aware of the limitations a BLS provider is under.  However, I do what I do as a volunteer for an area where it is us or nothing.  To listen to constant diatribes about how everything we do is worthless or futile is insulting.  

I am also embarrassed by those basics who respond to these posts with belittling comments about medics, nurses and doctors.  We are all part of a system.  We all work together.  I may be just another set of hands on an ALS call, but since most of my ALS calls are answered by only one medic, I've never heard any of the medics complain about my saying "Sure" when asked to prepare the IV stuff for them, or put the leads on, lay out the airway kit, hand them the stylet, put cricoid pressure on a pt they are trying to tube, or whatever is needed.  Could another medic do that?  Sure.. where is he/she???  Not in the back of my ambulance!

If we are going to look at what is optimum, that would be for all of our patients to actually have their symptom onset in the waiting room of an ER.  Life is messy.  Humans are imperfect.  In the meantime, we do what we can.  That isn't an excuse, its not refusing to look at where we can improve, its simply doing what we can, with who we are and what we know at the time.


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## triemal04 (Nov 13, 2007)

So...guess let's start in an orderly fashion.  And mods...I swear, there will be no personall attacks this time.  Honest.  I'll be a good boy.  :angry:

Guess I was right and you do only give atropine IM.  (you'll see where I mentioned that)  We'll ignore the fact that at some point they're getting it IV since that is way way beyond your scope.  Tell me, how much atropine will it take to reverse the effects?  I've got a good idea, since this is part of the paramedic curriculum.  Do you?

Guess what again...you don't have any experience in disaster mediciene either.  You've got the book smarts.  Pleasepleasepleasepleaseplease stop acting like you are some superdooper wonderful all-knowing specialist.  It doesn't fit the facts as YOU'VE relayed them.  It's very nice that you want to do some good, and for awhile there you were really doing good at asking questions and listening/learning.  But now you're right back into the mode you where in before your chest pain.  Stop being so confrontational.  You aren't at the level where you can do that and get away with it.

Please, answer the question about combitubes and triage if you don't mind.  Oh, and so so sorry about not being PC.  Oops.  :wacko:

And leave Rangat alone.  For someone who has no experience to fall back on, you throw a lot of stones.  Here and other places.  Stop that.  That guy at least is trying to learn, and from some of what I've seen him post ain't half bad either.  So stop.

I don't know what else I can say that hasn't been said before.  Maybe grow up.  Cheers.


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## DisasterMedTech (Nov 13, 2007)

skyemt said:


> ok, it is quite an honor to be chosen for your disaster response team...
> but really, what does that have to do with the EMT-B curriculum in this country?
> unless they are all on disaster response teams, what you are talking about, while noble, is completely irrelevant to EMT-B's...
> 
> ...



And once again, why do paramedics continue to fight what they are? E-M-T.

I also reiterate that the terms "medic" and "paramedic" are not interchangeable nor are the various individuals to who these terms apply all at the same skill, education or training level. A Medic is a military medical care provider. I believe this has been talked about on this very forum on more than one occasion. Specifically, the term medic refers to military personnel with the MOS of Combat Medic aka 68Whiskey or 68Whiskey1 (68W1) which is a Combat Special Operations Medic. The Army's MOS list can clarify this further for you


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## skyemt (Nov 13, 2007)

BossyCow, i would never try to say that Basics and Medics were the same... that would be silly...

this thread has been just about the facts... compared to medics, basics can do much less, are less educated, less experienced, etc...
while time and money have often been cited as reasons, i have never felt  like a medic has belittled the intellect of a basic.

but you can not argue the differences... the problems arise because many basics do argue them... and in fact, many have brought up studies, etc saying that there is no difference in care between basics and medics... you can review the threads if you like.

i appreciate your comments, you sound like an excellent EMT-B...
Respect the job you do, and don't worry about what others think...

you know as well as i do, that there are many emt-b's who frankly shouldn't be out there... and they are the root of many sentiments from medics, and in reality, i don't blame them...

however, if you know you do a good job, then the comments don't apply to you.


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## skyemt (Nov 13, 2007)

"And once again, why do paramedics continue to fight what they are? E-M-T."

umm, DisasterMedTech, i am not a paramedic, i'm an EMT-B...
i am just not as insecure as you are about it...


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## BossyCow (Nov 13, 2007)

skyemt said:


> i appreciate your comments, you sound like an excellent EMT-B...
> Respect the job you do, and don't worry about what others think...
> 
> you know as well as i do, that there are many emt-b's who frankly shouldn't be out there... and they are the root of many sentiments from medics, and in reality, i don't blame them...
> ...




I know, its just frustrating when the discussion gets so _emotional_!


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## DisasterMedTech (Nov 13, 2007)

skyemt said:


> "And once again, why do paramedics continue to fight what they are? E-M-T."
> 
> umm, DisasterMedTech, i am not a paramedic, i'm an EMT-B...
> i am just not as insecure as you are about it...



Oh...Im sorry. Where did I refer to you as a paramedic? If I misquoted your licensure or certification I apologize. The reference was intended, as I believe is perfectly clear, that paramedics are still emergency medical TECHNICIANS.


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## ffemt8978 (Nov 13, 2007)

And that's enough of this thread.


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## ffemt8978 (Nov 15, 2007)

This thread is now reopened provided everyone can remain civil.


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## skyemt (Nov 15, 2007)

in an effort to get this thread back on track, i have a question about nebulized albuterol...

we are allowed to give it if the pt has an exacerbation of previously diagnosed asthma...

we can also assist with their inhaler, but usually they have done that and it has not been effective, or they have lost it and they now need more treatment...

my question is this... the contraindications are a pt older than 65, a pt unable to take adequate respirations, or a pt with heart history...

what is not mentioned is whether or how many times a pt may have taken albuterol with his own inhaler... no difference is noted between a pt who has lost his inhaler or has taken 5 puffs before we arrive...

is there no problem with overloading a pt with albuterol??

i would think, as it acts on the beta-1 receptors in some form, this may be an issue?


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## Flight-LP (Nov 15, 2007)

DisasterMedTech said:


> Oh...Im sorry. Where did I refer to you as a paramedic? If I misquoted your licensure or certification I apologize. The reference was intended, as I believe is perfectly clear, that paramedics are still emergency medical TECHNICIANS.



Not all of 'em...............There are Licensed Paramedics out there (myself being one).


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## medic001918 (Nov 15, 2007)

Flight-LP said:


> Not all of 'em...............There are Licensed Paramedics out there (myself being one).



Add me to the licensed paramedic list.  My state license says nothing other than "Paramedic."

Shane
NREMT-P


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## Ridryder911 (Nov 15, 2007)

Yes, yes, and yes. This is part of the problem with anyone that lacks or does not have a full understanding of pharmacology administering medications. I don't care what level they are. 

Usually COPD patients (asthmatics/bronchitis, emphysema) will hold off notifying EMS until exacerberated. Now, most EMS only carries albuterol, alupent (combination) and is working up hill, due to they are resistant to the common treatment. Will one more inhaler treatment make a beneficial difference after 5-7 treatments to EMS arrival? 

With these types of illness, fluids may need to be given as well as carefully monitoring of cardiac activities. 

I believe most of the concern is many EMT's are not aware or even care of the possibilities and dangers something that appears simple and benign, can be really a bad situation. 


p.s. My  license as well says Paramedic, not EMT. I am fighting with several EMT's from other states for removal of the EMT wording before Paramedic. Some even considering not even having to have EMT at all before entering Paramedic school. 

R/r 911


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## Flight-LP (Nov 15, 2007)

skyemt said:


> in an effort to get this thread back on track, i have a question about nebulized albuterol...
> 
> we are allowed to give it if the pt has an exacerbation of previously diagnosed asthma...
> 
> ...



None of those are actual contraindications, they seem to be limitations more than anything. I've given plenty of geriatric neb treatments, almost all have some form of cardiac past. In-line treatments can be given with a BVM or even the vent, so the inability to take adequate resps isn't an issue.

Asking if overloading a pt. with Albuterol is a problem just reinstates a sound justification as to why EMT-B's have no business administering meds...........

(and yes, it is a problem as it can cause uncontrolled tachycardia and possible V-fib / V-tach)


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## triemal04 (Nov 15, 2007)

Flight-LP said:


> None of those are actual contraindications, they seem to be limitations more than anything. I've given plenty of geriatric neb treatments, almost all have some form of cardiac past. In-line treatments can be given with a BVM or even the vent, so the inability to take adequate resps isn't an issue.
> 
> Asking if overloading a pt. with Albuterol is a problem just reinstates a sound justification as to why EMT-B's have no business administering meds...........
> 
> (and yes, it is a problem as it can cause uncontrolled tachycardia and possible V-fib / V-tach)


And knowing why it can somtimes cause vfib/vtach/PVC's is mandatory before you should be giving it.  And knowing how to treat those.  

Know when to give a drug/perform a procedure, know why to do it, know how to do it, know what the complications/side effects are, know why those occur, know how to treat those side effects/complications if they arise, (and side effects/complications from THOSE treatements and how to treat them and so on), know what to do if it doesn't work, know what to do if it makes the pt worse, and most importantly, know when NOT do give a med or perform a procedure.

If you don't know all of the above...don't even think about doing it.


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## skyemt (Nov 15, 2007)

Flight-LP said:


> None of those are actual contraindications, they seem to be limitations more than anything. I've given plenty of geriatric neb treatments, almost all have some form of cardiac past. In-line treatments can be given with a BVM or even the vent, so the inability to take adequate resps isn't an issue.
> 
> Asking if overloading a pt. with Albuterol is a problem just reinstates a sound justification as to why EMT-B's have no business administering meds...........
> 
> (and yes, it is a problem as it can cause uncontrolled tachycardia and possible V-fib / V-tach)



actually, i coped them verbatim from "contraindications" portion of our protocol... yes, you are quite wrong about that...

as far as a "sound justification" as to why EMT-B'S have no business administering meds..."

thanks for the vote of confidence... please forgive me, but i have tried to contibute here with valid questions and comments, and i and others are often met with hypocritical remarks...

you say you want emt-b's to be better educated... well, i give you a chance to do that... what i get back are put downs, and "reaffirmations" about why i have no business doing this and that... 

it must be fun to get a question like that...probably couldn't wait to type in that response and prove something to yourself...

the fact is, boys, that we are authorized to give certain meds, and i will do it under our protocols... none of your snitty remarks will change that...

given that, why don't you try to make me a better emt, rather than try to prove that you are superior?

i would welcome ALL CONSTRUCTIVE replies to help me learn and grow as an emt... that is what you pretend this site is about anyway...


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## triemal04 (Nov 15, 2007)

skyemt-

Not to speak for anyone else, but flight is right.  None of those things are really true contraindications for albuterol.  I understand that YOUR protocols say that they are, but that may be due in part because of the side effects of to much albuterol; they can be treated, but not by a basic.  Or it may just be how your doc feels about it.  I don't know.  I do know that what YOUR protocols say about something does not make it the last word on the matter.  Just like MY protocols don't.  Or flights, rids...anyone here.  Because YOU can't do it does not mean that everyone can't, or that you can't do it because it is truly medically contraindicated.  

Don't take to much offence; there are to many lower level EMT's out there who act like more than what they are, and don't bother learning anything more.  That's what bothers me, and maybe a lot of people here.  Really, that doesn't seem to apply to you, so don't let it get to you.  

For your questions:  if an asthmatic pt is allready tachy and hypoxic, then albuterol can still be given.  It may effect their heartrate some, but, the rate may also fall as the hypoxia decreases.  People with a predisportion to cardiac problems/dysrythmias may sometimes show an increase in the heartrate, but this is still not a true contraindication.  Far as having taken multiple hit's from an MDI...remember, and MDI gives maybe 100mcg of Albuterol per dose, while a neb gives 2.5mg.  Big difference between then two.  Now, with that being said, too much albuterol, especially in people with hypothyroidism, or any condition that has the potential to create electrolyte imbalances may cause problems with hypokalemia.  That's where the vfib/vtach/PVC's come in, and very likely why you aren't allowed to give it to people over 65.  If that's not clear, then ask more questions.  (this does not in anyway negate my previos post...I stand by that completely.  Sorry.)

If you want to know something, keep asking.  At some point someone will answer.  If not, emedicine.com is a great place to find info.  Look in the emergency medicine sections or wherever you need to.  Great place.


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## Flight-LP (Nov 15, 2007)

skyemt said:


> actually, i coped them verbatim from "contraindications" portion of our protocol... yes, you are quite wrong about that...
> 
> as far as a "sound justification" as to why EMT-B'S have no business administering meds..."
> 
> ...



There is no hypocrisy from me, I could care less about the EMT-B's education. An EMT is not expected to be educated, nor skillful. A Paramedic on the other hand is a different story. I support the furthering of this industry by raising the standards of care and having a Paramedic on every primary 911 response unit. My personal preference is dual medic trucks. I believe that an EMT-B has a place in EMS, but it does not involve being the leader of a 911 crew. That is substandard care, period. You can rationalize it and provide the usual logistical or financial restraint excuses if you wish. It is still below the available par, plain and simple. You say you are tired of hearing this from me, well I am tired of hearing excuses as to why unqualified people are making half arsed attempts at being something they are not. 

As long as you pitch the ball my way, you need to be ready to have it hit back to you. If not, go back to the dugout!


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## skyemt (Nov 15, 2007)

Flight,
i gave no excuses...
emt-b's are expected to be qualified and educated, and good at what they do... the scope is not great of course, but your dismissal is old...

as far as "going back to the dugout",
some paramedics here want to make the emt's better, and some don't..
i don't think i have to spell it out for you...

perhaps you should stay in the ALS forum? not helping much here...


Triemal04, thanks for the info... it is appreciated, and i'll keep asking.


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## ffemt8978 (Nov 15, 2007)

Okay, this one is closed permanently.


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