# If there were no EMT-B certification .....



## Outbac1 (Jun 22, 2008)

If there were no EMT-B certification as a starting point. Would you still try to get into EMS. 

  Here in Canada we have Primary Care Paramedic, (PCP), as our BLS level on ambulances. It is about a 1500 hour course with about 800 hours didactic/lab, 200 hours of hospital clinical and 500 hours as a student on an ambulance. The course costs about $12,000.00 (plus your living expenses) and takes about 10 months to complete. 

 If you knew you could get a job paying double the minimum wage plus benefits, would you quit your current job and make the time and monetary investment to be in EMS? Or does that kind of commitment scare you away?


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## Hastings (Jun 22, 2008)

I just went straight from nothing to Paramedic without any experience in between anyway. I skipped Basic all together. And while some may believe that's a poor way of doing it, I have no complaints. I admit that it took a bit longer than the experienced basics to get comfortable with patient assessments, but other than that, I was quickly at the level of any other paramedic.

So the answer is yes. I skipped Basic, and from my own experiences, I can confidently say that I didn't miss out on anything. Basic isn't required training for paramedic.

Edit: All together, 2 years non-stop full-time schooling. Not paid.


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## mikeylikesit (Jun 22, 2008)

I would have liked to skip basics. but around here in Colorado that wasn't an option for me. i think basics was like...college prep. you get everything that you need to learn at a semi comfortable level before attempting bigger things.


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## seanm028 (Jun 22, 2008)

The problem out here is that there really aren't any schools that accept non-firefighters.  Anyone can go get their EMT training, but if you aren't currently employed by a fire dept or private ambo company, you can't even go near the paramedic classes.


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## Alexakat (Jun 22, 2008)

Outbac1 said:


> If there were no EMT-B certification as a starting point. Would you still try to get into EMS.
> 
> If you knew you could get a job paying double the minimum wage plus benefits, would you quit your current job and make the time and monetary investment to be in EMS? Or does that kind of commitment scare you away?



I am a volunteer, so unlike many on this forum, I do not make my living in EMS (not sure if you were looking for an answer from someone in my situation).

Yes, if there were no EMT-B cert. as a starting point, I believe I would still get into EMS.  I am not willing to give up my current job, though, for a job in EMS.  I'm just not ready to give up the kind of money I currently make.  I looooove EMS, but I guess not enough to change the way I live now--too comfortable.  Commitment doesn't scare me away---I chose to put my time & monetary investment into a college degree.


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## MMiz (Jun 22, 2008)

If I wasn't able to take an EMT course over the summer, then unfortunately I wouldn't be an EMT.  My EMT-B course was 300 hours, including 72 hours of clinicals.

Hastings, where did you go for your cert?  Lansing Community College?


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## Jeremy89 (Jun 23, 2008)

seanm028 said:


> The problem out here is that there really aren't any schools that accept non-firefighters.  Anyone can go get their EMT training, but if you aren't currently employed by a fire dept or private ambo company, you can't even go near the paramedic classes.



There's one in Mesa where I went for my Basic.  they were ready to accept me out of basic school.  In fact, a classmate of mine went on to that class, tryin to do the medic-RN thing.  I thought about it, but I'm going to get my BSN, just to have the degree.


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## CFRBryan347768 (Jun 23, 2008)

Outbac1 said:


> If there were no EMT-B certification as a starting point. Would you still try to get into EMS.
> 
> Here in Canada we have Primary Care Paramedic, (PCP), as our BLS level on ambulances. It is about a 1500 hour course with about 800 hours didactic/lab, 200 hours of hospital clinical and 500 hours as a student on an ambulance. The course costs about $12,000.00 (plus your living expenses) and takes about 10 months to complete.
> 
> If you knew you could get a job paying double the minimum wage plus benefits, would you quit your current job and make the time and monetary investment to be in EMS? Or does that kind of commitment scare you away?



Absolutely, the more I think about it I really can't do much for my pt's as an EMT-B


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## Hastings (Jun 23, 2008)

seanm028 said:


> The problem out here is that there really aren't any schools that accept non-firefighters.  Anyone can go get their EMT training, but if you aren't currently employed by a fire dept or private ambo company, you can't even go near the paramedic classes.



Actually, I got my spot in paramedic school and at the agency I work because I am NOT a firefighter. Those who are dedicated to the medical side only are extremely attractive these days, believe it or not.



> Hastings, where did you go for your cert? Lansing Community College?



That's the one. Great program.


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## Flight-LP (Jun 23, 2008)

Outbac1 said:


> If there were no EMT-B certification as a starting point. Would you still try to get into EMS.
> 
> Here in Canada we have Primary Care Paramedic, (PCP), as our BLS level on ambulances. It is about a 1500 hour course with about 800 hours didactic/lab, 200 hours of hospital clinical and 500 hours as a student on an ambulance. The course costs about $12,000.00 (plus your living expenses) and takes about 10 months to complete.
> 
> If you knew you could get a job paying double the minimum wage plus benefits, would you quit your current job and make the time and monetary investment to be in EMS? Or does that kind of commitment scare you away?



I would absolutely love to see a similar program here in the states. U.S. folks, take notes! Our friends to the north know how to educate EMS providers.........................

And they compensate them appropriately!

So much for the that myth being spewed as false by some..............................


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## mikeylikesit (Jun 23, 2008)

Hastings said:


> Actually, I got my spot in paramedic school and at the agency I work because I am NOT a firefighter. Those who are dedicated to the medical side only are extremely attractive these days, believe it or not.
> 
> 
> 
> That's the one. Great program.


I agree with you on this Hastings, the oral boards and interview process here makes it very difficult unless they believe that your going to stayt in the profession for a few years and not just use it as a stepping stone.


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## Outbac1 (Jun 23, 2008)

Alexakat:  Yes I'm looking for answers from everyone. 

  Please don't get me wrong, our systems here are not perfect, and I know there are some very well run services in the US. 

  There has been so much "discussion" here on EMT-B I'm curious as too how many would make the commitment to a higher level,(but not EMT-P), if they only had a higher level of course to take. Much harder to "try it to see if I like it". 

 Please keep your comments coming.


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## mikeylikesit (Jun 23, 2008)

Outbac1 said:


> Alexakat: Yes I'm looking for answers from everyone.
> 
> Please don't get me wrong, our systems here are not perfect, and I know there are some very well run services in the US.
> 
> ...


I would like the idea of not having a basic but rather it start out in a level that takes 1-2 years of school to complete. reason being is that i think it would almost weed out all of the ones who are doing this jobs because 
1. they thinks its cool.
2. only takes a few weeks to be a "trained professional"
3. they use it as a stepping stone just to get on a FD and then forget what they learned in class but still attempt it in error.
I think that if EMS was a lot harder to get into for schooling like nursing programs then we would weed out the individuals who would say "oh two years plus a wait time just to get through school, I'm doing something else." however if everyone had to go through with 2 years of school just to start out in the job then they would inherently expect better pay...which i don't foresee in the near future.


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## Ridryder911 (Jun 24, 2008)

If there were not EMT/B's then just think we would have ALS on all calls. Seriously, we would had progressed into the next stage or step up. As I have mentioned, in the early years of EMS, it was assumed that communities as well as the EMS community the next step would be to improve patient care..... not to become stagnant. 

Also why would communities want to deliver routine general care to their citizens? If they can afford water, sanitation and law enforcement then they can afford EMS. It is the public has a choice, which is unfortunate and of course we (EMS) directed the citizens which route and to direct them into what was supposed to be best for their health. They trusted us.. and we failed. 

As well, I believe if there were not EMT/B there would be another term or categorization. This would be probably be more appropriate as again the MFR role. Stabilize and perform initial care until more advanced medical care arrives. This could be per multiple type agencies and not really even associated with EMS. Call it what you may, but without the EMT/B level, I personally believe EMS would had advanced further and definitely into a more profession. 

R/r 911


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## daedalus (Jun 24, 2008)

Outbac1 said:


> If there were no EMT-B certification as a starting point. Would you still try to get into EMS.
> 
> Here in Canada we have Primary Care Paramedic, (PCP), as our BLS level on ambulances. It is about a 1500 hour course with about 800 hours didactic/lab, 200 hours of hospital clinical and 500 hours as a student on an ambulance. The course costs about $12,000.00 (plus your living expenses) and takes about 10 months to complete.
> 
> If you knew you could get a job paying double the minimum wage plus benefits, would you quit your current job and make the time and monetary investment to be in EMS? Or does that kind of commitment scare you away?



With respect, PCP is no comparison to EMT, and it is not fair to compare them. It is the only option for us in california. We MUST become an EMT for six months before advancing to paramedic (if one wants to go to a respectable school, such as Ventura College or UCLA daniel freeman)


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## MedicAngel (Jun 24, 2008)

Ridryder911 said:


> If there were not EMT/B's then just think we would have ALS on all calls. Seriously, we would had progressed into the next stage or step up. As I have mentioned, in the early years of EMS, it was assumed that communities as well as the EMS community the next step would be to improve patient care..... not to become stagnant.
> 
> Also why would communities want to deliver routine general care to their citizens? If they can afford water, sanitation and law enforcement then they can afford EMS. It is the public has a choice, which is unfortunate and of course we (EMS) directed the citizens which route and to direct them into what was supposed to be best for their health. They trusted us.. and we failed.
> 
> ...



I disagree with you that we are basically giving the community a bad set of skills to give them EMT-B's. While I can only speak for myself, I am glad I am starting from the bottom so to speak and working my way up. We have not failed our communities nor or citizen's by giving them basics, what we have done is failed them if we have not trained them to have strong skills and to know when to call for ALS. 

I have heard of more ALS providers failing their hands on skills when being tested because they forgot their basic set of skills. I think each level is well needed, none should be forgotten and all should work as a team. We can advance further if we wish, but we have to do it with the citizen's in mind and with our community and believe me, I have also seem more crappy ALS providers who get the big eye and don't see the whole picture or get attitudes and egos because they are the ALS provider. Doesn't make you any more valuable than I, as I worked just as hard and put in just as much time and effort as you did, mayhaps not as much class hours but learning and sharpening my skills and volunteering to be on that rig at any time of the day or night or asking questions and going to extra classes when offered. 

So please, don't discount the EMT-B. We are needed, some just don't want to see it or care to acknowledge us.


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## Hastings (Jun 24, 2008)

I'm fine with having Basics to send out on the 90% of calls that are BS and don't require ALS.

However, to make the suggestion that Basics can run advanced calls effectively is simply wrong.


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## mdkemt (Jun 24, 2008)

Outbac1 said:


> If there were no EMT-B certification as a starting point. Would you still try to get into EMS.
> 
> Here in Canada we have Primary Care Paramedic, (PCP), as our BLS level on ambulances. It is about a 1500 hour course with about 800 hours didactic/lab, 200 hours of hospital clinical and 500 hours as a student on an ambulance. The course costs about $12,000.00 (plus your living expenses) and takes about 10 months to complete.
> 
> If you knew you could get a job paying double the minimum wage plus benefits, would you quit your current job and make the time and monetary investment to be in EMS? Or does that kind of commitment scare you away?




This is a generalization here!  In Canada it is different from province to province not only on levels but with the skill sets you get from each level.  Alberta uses EMR EMT EMT-Paramedic, SK uses EMR PCP ICP ACP.

The PCP, ICP, ACP programs have not been passed through federal legislature yet and made equal.  This is a goal they want to go for but as it stands right now it still isnt equal throughout.  Yes our level of Education is higher as a PCP compared to US EMT-Basic but I am not entirely positive on the skill sets they all have.  I know a lot of it is similar.  Also provincial legislation has just recently passed the bill to use PCP ICP and ACP in SK.

If you just go to the Paramedic Association of Canada you go to each provinces site to see there levels and skill sets.

MDKEMT


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## Clibby (Jun 24, 2008)

No basic will say that 

Honestly, I wish the basic program was at least 500 class hours and at least 100-150 clinical. That way we would be prepared to be permitted to do more skilles. Most states allow combitubes for basics, because without a viable airway, the pt is dead: my state doesn't. Now they are planning on allowing us to do it in a couple of years, but w/e all 911 around me have a medic. More than that though, basics cannot run an ambulance without being able to give life saving treatment. We are good for bs calls, assisting a medic, and trauma without a medic (I mean the bad ones where no one but the doctors can do anything except IVs and they just need fast transport.) l think basics should be phased out and EMT-Is should become the new basics. We need to be able to administer more epi and start IVs for anaphalaxis, give more nitro for cardiac pts even if its mith med control. Possibly even atropine and epi for cardiac like NH EMT-Is, but that would have to include ekg interpretation which would essentially be a medic. To be honest though V-fib and A-fib are the easiest rythms to see. We need to be able to give fluids in a trauma and should be able to administer more drugs, even if its only with med control. Narcan though should be a basic skill, even if its nasal narcan. It will save a pt's life and it only has risks with some head traumas and possible strokes. Boston EMS and the surrounding areas are given permission for basics to give it, but noone else in the state. Why do we even have an EMT-I? Those skills are fairly basic and should be considered so.


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## VentMedic (Jun 24, 2008)

MedicAngel said:


> I have heard of more ALS providers failing their hands on skills when being tested because they forgot their basic set of skills.



Basic set of skills?   

BVM? BP?  Backboarding?  C-Spine immobilization?  Bandaging? 

To forget these skills is not the fault of an ALS system but the fault if the individual providers.   These skills can and should be refreshed often.  However, skills and knowledge that have not be learned are another thing all together.   Basing one's "worth" purely on skills is a deadend street. Education is important also. 

If you are involved in all the training, education and classes as you claim, you should be able to take the next step to Paramedic.   It is too easy to be the backseat quarterback making judgements on a profession that you yourself have not yet accomplished. 

If a patient is having chest pain in a hospital room and is sent a couple of CNAs to assess instead of an RN, I don't think that would go over very well.  There is an expectation, or should be, from the public even in EMS.  

Yes, there is a place for the EMT-B education/training in situations where a basic knowledge and skills are required like FFs, industrial workers and coal miners.   BLS transport and transfer trucks are also not going away. 

quote by *Hastings*


> I'm fine with having Basics to send out on the 90% of calls that are BS and don't require ALS.



The profession also needs to drop the term "BS" from its vocabulary.  Many of those "BS" calls spend weeks in the hospital or die because the EMS (BLS or ALS) provider did not fully assess or have enough education to recognize something very seriously wrong.   The term itself can cause one to skew their assessment before even seeing the patient.  Does anyone realize how much respect is lost each time you give report in the ED with the term "BS" used?  Sometimes that patient is intubated right after the ambulance leaves. There were recognizable signs had they actually went through the motions of assessment.   There may even come a day when Paramedics can do more treatment in the communities but not with the "BS" mentality.  Repeated use of the term "BS" shows you have no respect for the people of your community and especially not when it is used to describe the elderly in nursing homes.   Its time to grow up and be medical professionals.  

Yes, there are calls that probably should not require an ambulance. But, if the layperson was to stumble upon any EMS forum just doing their own research about what an EMT or Paramedic is, would they not be shocked to hear some of the views of the providers?   Just the derogatory terms used when describing the elderly and nursing home patients are enough to make them see EMS providers in a different light.   There have even been "Bash Patients" threads on a couple of forums.

It is rare that you would ever see these comments on the forums of other professionals even though they take care of those BS patients alot longer than the 15 - 30 minute ambulance ride. Nor, by being health care professionals do they cast off patients' complaints until proven otherwise.  They may use the term "clinic patients" but would not call a pt "bulls*&#".   Has EMS reduced human care to the same mentality as leaving our nearly dead patients lying alone along the roadside like road kill and then making excuses for it?

Bottomline, the people of the U.S. (and elsewhere) deserves to be provided with the best possible healthcare systems.  We have become a country of distinct classes of the "haves" and the "have nots".


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## JPINFV (Jun 24, 2008)

MedicAngel said:


> I disagree with you that we are basically giving the community a bad set of skills to give them EMT-B's. While I can only speak for myself, I am glad I am starting from the bottom so to speak and working my way up. We have not failed our communities nor or citizen's by giving them basics, what we have done is failed them if we have not trained them to have strong skills and to know when to call for ALS.


The problem is not necessarily poor training (how much training is really needed to take a blood pressure), but that there isn't enough education (education and traing are two vastly different concepts) to understand what their assessment is telling them and what their treatments are doing. Assuming no change in scope, a strong background education is still needed to be able to handle patients that don't necessarily fall into the premade boxes that training gives us. 



> I have heard of more ALS providers failing their hands on skills when being tested because they forgot their basic set of skills. I think each level is well needed, none should be forgotten and all should work as a team. We can advance further if we wish, but we have to do it with the citizen's in mind and with our community and believe me, I have also seem more crappy ALS providers who get the big eye and don't see the whole picture or get attitudes and egos because they are the ALS provider. Doesn't make you any more valuable than I, as I worked just as hard and put in just as much time and effort as you did, mayhaps not as much class hours but learning and sharpening my skills and volunteering to be on that rig at any time of the day or night or asking questions and going to extra classes when offered.




As I've said before, show me a medic who is failing at basic patient care and I'll show you a medic who needs remedial education and training (to be fair to the medics, insert nurse, physician, or basic in place of "medic" as you see fit). Furthermore, yes, a medic is much more valuable than a basic. A boy scout could do most of the "skills" that a basic does (I was a boy scout and am basic). Yes, the extra class hours does matter and does make a difference that no "sharpening of skills" or "volunteering" or "taking CMEs" will ever change. That would be like an associate degree register nurse complaining that they are just as important as a physician because they do extra things that don't even come close to the differene between 2-3 years of education to 8+ years. 




> So please, don't discount the EMT-B. We are needed, some just don't want to see it or care to acknowledge us.


By writing a sentence in first person you are indicating that you are taking this personally and you shouldn't. Any system that fails communities by thinking that 110 hours (per NHTSA) of first aid training is sufficient enough for a primary 911 response is failing their providers as well.


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## JPINFV (Jun 24, 2008)

Hastings said:


> I'm fine with having Basics to send out on the 90% of calls that are BS and don't require ALS.
> 
> However, to make the suggestion that Basics can run advanced calls effectively is simply wrong.



Ahh, but here's the rub. Who gets to decide which calls are "BS" and which require a medic? Can a level that lacks the background education and assessment knowledge to provide (or justify providing) the needed care adequately determine which level is needed for the patient?


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## BossyCow (Jun 24, 2008)

There is no point to the "I've seen medics fail" comments. Who hasn't? Medics fail, stumble, make mistakes.. hey.. even neurosurgeons have bad days! Just happens when you put human beings into jobs. A bad or inadequate Medic isn't proof that BLS is or isn't needed on as an adjunct to Pre Hospital care. Using that in your post merely shows a lack of professionalism, maturity and critical thinking skills.

I've seen medics blow IV starts, gut-tube, and misread vitals..... still, if I have an unstable pt I want whoever's on duty that shift! The point of the post as I understand it is to determine if .. given the option of EMT-P or nothing.. would you enter EMS? 

If the educational requirements for doing what you do, regardless of your status of career or volly, were the same as for paramedic.. would you jump in, or pass on it.  Personally, I'd probably go for EMT-P. If it were the only route, and my district would pay for it, as they did my EMT-B, I would do it. 

I think the point is to prove or disprove whether or not, those happy with being 'just EMT-Bs' make that decision based on a lack of desire to further themselves academically or for other reasons. I am reading this thread carefully, I would love to see it discussed without the acrimony and emotional outbursts that other threads on the topic have taken. So, EMT-Bs... and I am one of you... speak up on this.... If you had to take more education than the crash course you were initially given.. would you have signed up or sat out?


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## MedicAngel (Jun 24, 2008)

My apologize for speaking in first person. To the original question, if I had the chance, I would work toward a paramedic license. 

I don't see why there has to be, do we need basics. Okay, some don't think were needed, but others do. And your right, when do we know when it is a "bs" call or one that you truly need an ALS provider? You can't until you get on the scene and assess the situation. I know when I need an ALS provider and I will call for one while doing what I can in my scope of practice to ensure the patient is comfortable and hopefully, calm enough till help arrives. 

Some instructors I have talked to say that it is better for someone to start from being a basic and work your way up from there to intermediate to paramedic. Give yourself some time in each step to assess and see if you truly like what you do and can handle the stress that comes with emergency medicine. There is some validity in that. Some people aren't prepared to take on all that is required to be a paramedic. 

My husband hates sometimes that I am a basic, that I run calls and that I am gone a few nights a month. Unfortunately my first fire/rescue squad had a lot of internal problems and were pretty hard on the EMS side of the house.


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## Hastings (Jun 24, 2008)

JPINFV said:


> Ahh, but here's the rub. Who gets to decide which calls are "BS" and which require a medic? Can a level that lacks the background education and assessment knowledge to provide (or justify providing) the needed care adequately determine which level is needed for the patient?



Actually, it'd be dispatch. God knows that the information given over the radio is rarely accurate, but it would at least ensure Basics never got sent to Priority 1 or 2 calls. They should be restricted to 3 and 4, and be trained to recognize and call ALS the SECOND the patient starts deteriorating.

Dispatch Information / Call Priority Basics should never be sent for except as *first responders* in locations where ALS is an *EXTENDED* amount of time away:

1 - DIB
1 - CP
1 - Altered LOC
1 - MVA
1 - Cardiac Arrest
1 - Respiratory Arrest
1 - CVA
1 - Diabetic
1 - Uncontrolled Bleeding
1 - GSW / Stabbing
1 - Seizure
1 - Drowning
1 - Burn
1 - Cold Injury
2 - Overdose
2 - ETOH
2 - Abdominal Pain
2 - Syncopal Episode
3 - Unknown Medical

And most Assault, especially of a sexual nature, with a special victim, or with the involvement of weapons.



But that being said, and the list being made (I know I'm still missing plenty), and the unreliability of dispatch information, is it worth sending EMTs out at all? What isn't in that list?

4 - Transfer



The solution is to train more medics and phase out Basics. THAT is the highest level of care.


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## Hastings (Jun 24, 2008)

Add:

1 - Electrocution
1 - Poisoning
1 - Machine Trama
1 - Pinned Victim / Extrication Required
2 - Significant Fall
2 - Bloody N/V
2 - Bloody Stools
2 - Uncontrolled Vomiting


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## MedicAngel (Jun 24, 2008)

Hastings said:


> Actually, it'd be dispatch. God knows that the information given over the radio is rarely accurate, but it would at least ensure Basics never got sent to Priority 1 or 2 calls. They should be restricted to 3 and 4, and be trained to recognize and call ALS the SECOND the patient starts deteriorating.
> 
> Dispatch Information / Call Priority Basics should never be sent for except as *first responders* in locations where ALS is an *EXTENDED* amount of time away:
> 
> ...



WOW Hastings...lets just give all the basics the crap calls...and I mean literally. I live in a rural area, sometimes all the caller or patient has IS a basic and their driver, so were trained to call for an ALS, load and go and meet en route. I have been on an MVA, cardiac, entrapment, stroke, heart attack, suicide, ETOH, and diabetic to name a few and some of them I have transported with just myself in back and my driver, got that patient to the hospital and none worse for wear. 

I am amazed that all the ALS providers are so dead set on phasing us out and if not that, giving us the crap calls. Why ARE we trained in basic life support if  all you think we should do is wipe noses and hold hands?


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## Hastings (Jun 24, 2008)

MedicAngel said:


> WOW Hastings...lets just give all the basics the crap calls...and I mean literally. I live in a rural area, sometimes all the caller or patient has IS a basic and their driver, so were trained to call for an ALS, load and go and meet en route. I have been on an MVA, cardiac, entrapment, stroke, heart attack, suicide, ETOH, and diabetic to name a few and some of them I have transported with just myself in back and my driver, got that patient to the hospital and none worse for wear.
> 
> I am amazed that all the ALS providers are so dead set on phasing us out and if not that, giving us the crap calls. Why ARE we trained in basic life support if  all you think we should do is wipe noses and hold hands?



That's the point. If all Basics were replaced with medics, everything is solved. Higher level of care, better for the community. And it's not an unrealistic goal either. Why are some Basics so set on not advancing?

As for your question, because wiping noses and holding hands is basic. Cadiac problems, diabetic emergencies, CVAs, and anything else in that list is far from basic. As in, not for an EMT-*Basic*.


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## JPINFV (Jun 24, 2008)

MedicAngel said:


> WOW Hastings...lets just give all the basics the crap calls...and I mean literally. I live in a rural area, sometimes all the caller or patient has IS a basic and their driver, so were trained to call for an ALS, load and go and meet en route. I have been on an MVA, cardiac, entrapment, stroke, heart attack, suicide, ETOH, and diabetic to name a few and some of them I have transported with just myself in back and my driver, got that patient to the hospital and none worse for wear.
> 
> I am amazed that all the ALS providers are so dead set on phasing us out and if not that, giving us the crap calls. Why ARE we trained in basic life support if  all you think we should do is wipe noses and hold hands?




No worse for the wear? So being nothing better than a taxi should be good enough? So what about the "crap calls?" Do you think that emergency PAs and NPs complain because the physicians get all the "good patients?" The PATIENT CENTERED ideal is to get the highest level of care to all patients. Yes, a paramedic might not be able to treat all conditions, but there are several conditions that can mimic each other that does require a paramedic to differentiate between (stroke/hypoglycemia). Any one suggesting otherwise ("giving crap calls to basics") does not have their priorities straight. Yes, lower acuity calls might not be as fun as playing with the pretty lights, but I thought that the primary thing from a treatment and patient care standpoint was the patient, not the providers enjoyment or ego. 

Furthermore, no one is impressed with a laundry list of calls. I've been on all of those calls as well as other types of calls, both serious, specialty, minor, event, routine, and regular first aid (water park). Just because all of my patients make it to the hospital in one piece doesn't mean that I've just justified a basic attending to a diabetic patient. In fact, no one should be justifying having a basic handle a call that would be better suited for a paramedic. That's like arriving at a hospital to find a CNA with a phone number to call a doctor. 

Finally, yes, most of what basics can do is wipe butts and noses. Sorry, but BLS is, for the most part, first aid. A very large portion of the EMT-Basic course is covered in the Boy Scout first aid merit badge and even the life guards at the water park I worked at were trained in administering oxygen (as well as AHA CPR and first aid). It's good as a support and/or first responder role. 

Now to be clear, am I calling all basics stupid or ignorant? No. There are a lot of smart and intelligent ones out there. Unfortunately, this is more often due to the individual than anything relating to their EMT-B class. You simply can't provide enough of a background or education in 110 hours (NHTSA standard, no one cares that your (generic "your") course was an exception).


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## BossyCow (Jun 24, 2008)

Hastings said:


> Why are some Basics so set on not advancing?



I'm sorry, I missed this part. Who said that Basics are 'so set on not advancing'. There are a number of reasons why someone chooses to certify or license to a particular level. Please show me what evidence you have that supports your assumption.

Saying that Basic Life Support has a place in EMS is not saying.. "I don't want to advance and wouldn't even if I could"


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## Hastings (Jun 24, 2008)

BossyCow said:


> I'm sorry, I missed this part. Who said that Basics are 'so set on not advancing'. There are a number of reasons why someone chooses to certify or license to a particular level. Please show me what evidence you have that supports your assumption.
> 
> Saying that Basic Life Support has a place in EMS is not saying.. "I don't want to advance and wouldn't even if I could"



They have a place. First aid. Wiping noses and holding hands, as was suggested.

But medical emergencies in the list above are not basic. And while Basics are great for simple hospital transfers, they have no place in that list. It's that simple.


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## VentMedic (Jun 24, 2008)

Hastings said:


> Why are some Basics so set on not advancing?



Let me toss out some numbers:
source: http://www.emsresponder.com/survey/

*Florida*:

 EMT-Basic 25,063
 Paramedic 14,910


*New York*:

CFRs  13,136 (all are trained in defibrillation)
 EMTs (below Intermediate level) *37,945 *(all EMTs in New York state are trained in defibrillation)
Intermediate EMTs  2,033; 
EMT-Critical Care technicians 2,773
Paramedics *4,297*


*California*:

Basic EMT 70,000
 EMT-I   119
 EMT-P 14,500


*Washington*:

First Responder  1,336
Basic EMT  *14,232*
Intermediate EMT  862 
Paramedic  *1,723 *

What interesting about Washington is its levels:
*EMT-Basic*
IV Technician
Airway Technician
IV/Airway Technician
*IV Intermediate Life Support Technician (ILS)
EMT-Paramedic*

Correct me if I am wrong but the EMT-B numbers still reflect the other 3 different inbetween certs until ILS is reached?


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## JPINFV (Jun 24, 2008)

As a note about California, EMT-I (technically EMT-II (2)) is only used in a handful of counties.


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## VentMedic (Jun 24, 2008)

JPINFV said:


> As a note about California, EMT-I (technically EMT-II (2)) is only used in a handful of counties.



One could literally go bonkers keeping track of EMS "certs" for each state.


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## JPINFV (Jun 24, 2008)

http://en.wikipedia.org/wiki/Emergency_medical_responder_levels_by_U.S._state

and a new layout once we finally get it set up:
http://en.wikipedia.org/wiki/Talk:Emergency_medical_responder_levels_by_U.S._state/draft


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## Guardian (Jun 24, 2008)

Hastings said:


> They have a place. First aid. Wiping noses and holding hands, as was suggested.
> 
> But medical emergencies in the list above are not basic. And while Basics are great for simple hospital transfers, they have no place in that list. It's that simple.




I don't agree.  I've seen successful systems that use emt-basics extensively.  My system for example runs 1 paramedic and 1 basic on an ambulance.  They then dispatch supervisor paramedics for complicated calls or MCIs.  Therefore, on the "real emergencies" calls, there might be 4 emt/firefighters, 1 emt partner, maybe 1 emt bystander, and 1 or 2 paramedics.  I use this, as an example to illustrate there is a huge need for emts on bona fide emergency calls.  They can do a lot of stuff on scene.  Even on the "real emergencies," 85% of it is BLS.  That's 85% that I don't have to worry about doing.  2 paramedics/truck would be better, but not realistic for some places at the current time and I have seen no studies that indicate 2 paramedics is better than 1.  My main point is that this issue is not cut and dry.  To come on a site that is made up primarily of emt-basics and say that all they’re good for is wiping noses and holding hands is being a little extreme.  Oh, I'm sorry, you're only implying it by pointing out that others have suggested it.  Where I’m from, we consider people who talk like this to be smarmy.  I say we should continue to work and try and get ems back in a progressive state that doesn't rest on its laurels, while at the same time recognizing the gigantic and obvious need for emt-basics.  That means that part of our progression should include carving out new places for emts if necessary.  To that end, why do we even bother continuing with the emt verses paramedic threads.  If I were an emt-basic and were given a chance to run as primary provider on 911 calls, I'd probably do it.  The real culprits here are the ems leaders (who are usually ALS) who allow this to continue to cover up their own shortcomings.  Let's turn our aggression to these SOBs.  I feel like there are enough of us starting to trickle into leadership positions now that we might have a chance at really making a change for the better.  So lets focus on overthrowing the current leadership who is keeping our profession stagnate, while backing the progressive ems leaders.


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## Hastings (Jun 24, 2008)

The progressive leaders are those who are trying to replace Basics with Paramedics. Seriously. How can you not see that doing so is the only way to provide the highest level of care to members of the community most efficiently? There is nothing a Basic can do that a Paramedic can not, and as such, having Basics on scene is not in fact necessary. No, there should be no starting point at EMT-B, and no one should be allowed to stop at that level. It should be all or nothing. Instead of one year for Basic, one year for Paramedic (or however individual systems work), it should be two years for Paramedic.


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## VentMedic (Jun 24, 2008)

Guardian said:


> I The real culprits here are the ems leaders (who are usually ALS) who allow this to continue to cover up their own shortcomings.  Let's turn our aggression to these SOBs.  I feel like there are enough of us starting to trickle into leadership positions now that we might have a chance at really making a change for the better.  So lets focus on overthrowing the current leadership who is keeping our profession stagnate, while backing the progressive ems leaders.



The problem is, as I have mentioned in other threads, lack of support from the providers.  When the politicians and EMS leaders who do lobby for us come to a State or National seminar, out of 10,000 conference attendees, only 10 -20 may show up to listen to these people speak or to express an opinion.  What interest in change does that show?   The other 9,990 will be at the pool or lounge griping about how bad things are.  

When Nurses or RRTs show up to a conference where there will be legislators and professional representatives to discuss change, the entire group of conference goers show up which can easily be over 10,000 people per conference also.   RT had some of its best conference attendence prior to the 2002 mandate of the 2 year degree as entry.  The majority were there to support it.   

I also put the numbers of EMTs and Paramedics on my previous post to show how opinion to the legislators could be skewed.  The ratios of EMT-B to Paramedic are something like FL 1:2, NY 1:9 , CA 1:5 and WA 1:7.  Now based on some of the opinions expressed on this and other forums, if the legislators and EMS leaders took a poll on if higher education should be instituted, what would the numbers look like?  Quite possibly the same ratios would show up as for these states.  There might even be a bigger gap for those at the Paramedic level to contribute a NO vote that don't want to advance to a two year degree.


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## MedicAngel (Jun 24, 2008)

This is from my state that I live in: 

Numbers of  EMS  personnel. (state certified). First Responders, 1,503; *Basic EMT, 23,677*; Shock Trauma, 470; EMT-Enhanced, 1,251; Cardiac Technicians, 1,232; EMT-Intermediates, 1,791; EMT-Paramedic, 3,348; EMS instructors, 548; ALS coordinators, 418.

Numbers of EMS services. *Volunteer, 491*; commercial, 76; governmental, 89; industrial, 32; nonprofit, 13; other, 18.


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## Ridryder911 (Jun 24, 2008)

Personally, I have never stated that there was not a place for EMT Basics. In my "perfect EMS world" there would be three places. 

1) MFR level. What they are trained and designed to do. Be the first on the scene, prepare for treatment and quickly initiate first line tx. 
2) Very remote areas, where medical care will never be feasible, but will not be considered the "end all". Continuous action with documentation of that those areas are attempting to improve care & services. 
3) While in Paramedic school, to assist Paramedic in care. Obtain experience on those so called .."B.S." calls. After a Paramedic has made the determination that the patient does not or will not need more interventional therapy. The EMT will be held accountable to detect such treatment or changes occur. This will allow those EMT's to come in contact with patients and clinical exposure. Certifications and license would be only good for two years. 

As one becomes more educated in medicine, one finally is able to determine that there is not B.S. call! Stating such is demonstrating ignorance of the medical system. Is it frustrating and will cause one to be jaded.. yes. Abuse, and misuse .. Yes! Again, granny calling at 0200 for inability to get up, or "panic attacks"; one learns that it maybe a form of loneliness, chemical imbalances, stress, or even psychological problems... It could be said even the abuser, has a psychological problem to attract attention. Yes, probably not treatable or treated by us except our presence but still a real problem. 

Is the role of the EMT way out of proportion .. A definite yes. We are placing to much emphasis on substitute provider and placing way too much responsibility on those that lack the education and training. Too many place emphasis on "basic skills". Not that they are not important, but the reason many do is that is *all* that they know. Again, nothing to compare to. 

I am sure that many probably critique my BLS skills when I am a preceptor. That I do not always obtain a auscultated blood pressure before I move a patient, or that I do not always take a full minute respiration count or place oxygen on every chest pain and supposedly trauma patient, or raise the feet in trendelenburg for that "shocky patient". 

Although, they are able to critique such actions, they do not understand my level of assessment and history as well. They do not understand that I was able to detect perfusion level by grades of pulse, location of perfusion will give me an estimate of a blood pressure, that not all chest pains are an AMI and in the need of oxygen therapy, or know that Trendelenburg position is a myth. Yet, they maybe the first to write on here, what a lousy provider I am for "missing my basics".. 

On the other hand, they do not realize the in-depth's of assessment I have obtained by extensive education and decades of clinical practice, as well as literally thousands of patients. 

We have made erroneous teaching errors by teaching step by step process. Unfortunately, we continue to do so because the normal aptitude of EMT students do not have the broad background or education level to understand differently. Yes, that has been proven..over & over. The same reason we still teach out of a 6'th grade reading level single textbook. 

Yes, one has to have a methodological way but medicine is an art.. it is unique and to the individual. Something that comes with higher education and formal education. 

Is there too many EMT's .. Yes! For the wrong reason. If they were to be in a role as I described, then there would not be, but I doubt that many would stay in EMS or participate if the roles changed. 

We still keep repeating ourselves.. 
R/r 911


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## Guardian (Jun 24, 2008)

Hastings said:


> The progressive leaders are those who are trying to replace Basics with Paramedics. Seriously. How can you not see that doing so is the only way to provide the highest level of care to members of the community most efficiently? There is nothing a Basic can do that a Paramedic can not, and as such, having Basics on scene is not in fact necessary. No, there should be no starting point at EMT-B, and no one should be allowed to stop at that level. It should be all or nothing. Instead of one year for Basic, one year for Paramedic (or however individual systems work), it should be two years for Paramedic.



We're probably not going to agree on this one, but just to make myself clear; I'll put my opinion on the record.  Then the readers can decide for themselves.  Making everyone that is even remotely involved with ems a paramedic is overkill.  All or nothing doesn't work in the real world.  It never has and never will.  If it did, everyone involved in medicine would be a doctor and graduate of Harvard medical school.  My medical director once told me that a good rule of thumb in life was to always be suspicious of those who held extreme positions.  And he said to be suspicious of their ideas, not the person.  People can be sincere and wrong at the same time.  The smartest people on the planet have no idea what makes up 99% of the universe.  For this reason, they call it dark matter.  My point is you really don't know very much, just like the rest of us on here.  Lets just try and get the wheel moving again before we reinvent it.  I do admire your optimism though.


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## Guardian (Jun 24, 2008)

VentMedic said:


> The problem is, as I have mentioned in other threads, lack of support from the providers.  When the politicians and EMS leaders who do lobby for us come to a State or National seminar, out of 10,000 conference attendees, only 10 -20 may show up to listen to these people speak or to express an opinion.  What interest in change does that show?   The other 9,990 will be at the pool or lounge griping about how bad things are.




I agree and my intention was to inspire more people to take an active role.  History has certainly shown the human tendency to be sheepish.  People basically do what they're told.  That's the way of the world.  But there is plenty of blame to go around.  I know from personal experience that they aren't always receptive to differing opinions.


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## Outbac1 (Jun 24, 2008)

Touchy Touchy Touchy!!! I didn't start this to be another place for "B"s and "P"s to bash and pick on one another. In the US you have a level EMT-B with 120 hours (+/_) of training. You don't have to like it but that's what you have. At least until you change it, which may never happen.

  The point of the question, which was directed at the "B"s, was if there were NO "EMT-B" to take as an entry level to EMS and you had a course similar to our PCP, would you make the commitment?


daedalus
  I am not trying to compare our PCP with EMT-B. They are not comparable.


bossycow
   You wrote "The point of the post as I understand it is to determine if .. given the option of EMT-P or nothing.. would you enter EMS?" 
 Not quite right. I'm thinking of a level below EMT-P similar to our PCP. Although that is a good question as well.

mdkemt
  Yes I am aware that not all provinces are totally on board with the National Occupational Competency Profile (NOCP) as put out by the Paramedic Association. I know that the skill set and meds available for use by a PCP in BC are not the same as for a PCP in NS as an example.   The NOCP serves as a baseline for education and comparison. If I want to work in another province for example someone looking at my PCP will know to what standard I have been educated/trained. If that medical director wishes to add or subtract from that they may. As I said our systems here are not perfect. We certainly have room for improvement. However I believe we are more with it as a nation in EMS than the US.

  Please keep the comments comming. But it's not a bash fest.


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## Ridryder911 (Jun 24, 2008)

Outbac1 said:


> I believe we are more with it as a nation in EMS than the US.
> .



I believe this was the most important issue. Not only can we not unite as a profession, but we are fragmented state by state, and even in some states county/provinces, community by community. 

Now, I agree there needs to be a standardization, but as well each area should be unique its own local medical community. Is there systems that need more advanced Paramedics than others .. yes, and is there areas that only need the bare essentials due to close proximity of multiple health centers.. yes. It does NOT mean though there should not be a standard of educational level. Remember, just because one can only perform at a level or function does NOT mean that one has to be ignorant or have lack of education. 

It is much more advisable to be over educated (if there is such a thing) than the other. ...

R/r 911


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## Outbac1 (Jun 24, 2008)

Ridryder911 said:


> but we are fragmented state by state, and even in some states county/provinces, community by community.
> 
> 
> R/r 911



Yes there certainly is fragmentation. However if one were to look at Canadian EMS 10 - 12 years ago vs now. One would see a steady state of progress. We are getting much closer together in standards of care and even reciprocity. I believe I can see the day when my provincial tag (to NOCP std), will be accepted across Canada with little fuss. With steady work, by the dedicated few, the fragmentation is getting less and less.


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## Ridryder911 (Jun 24, 2008)

I did a talk show (podcast) with a Canadian Paramedic that is very active on another EMS forum(s). It was very informative on how your system changed in such a rapid response. At least you identified your problems and came with an approved solution, instead of attempting to make excuses or inventing multiple levels as an alternative, something we can learn from.....

R/r 911


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## mikeylikesit (Jun 25, 2008)

the whole training process wouldn't be too smooth without some form of education before entering a medic program if the Basic didn't exist...is it essential to make a "shake and bake medic", no. It is however much easier to teach someone who has a little understanding than none at all. i don't mind if the Basic is a prerequisite into medic school with a break to work the field for a while in order to let their new knowledge sink in before attempting a more rigorous curriculum. i do however believe that there should be a mandate on how long a person should be able to hold a Basic cert. before being required to get out or move up. i think that Basics *may* have an easier time with patient care and the transition into a higher education than one without any what so ever...maybe thats why some places require A&P before even attempting Paramedic school.


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## VentMedic (Jun 25, 2008)

If the Paramedic program was a two year degree like many other professions, one would get about 5  semesters of clinicals.  That is way more than the 20 hours of clinicals an EMT gets now and possibly more patient contact than at many of their jobs.  The clinicals should also be done under closer supervision  to learn the "basic skills" such as BPs and assessments of many different patients rather than the usual coffee pot "ride time".  The skills would be built upon with each semester as the "book learning"  progresses. Even an introduction to IVs, EKGs and phlebotomy could be done within that first year to prep the student for the 2nd year of Advanced or Paramedic.   There could be some type of provisional certification issued at the end of the first year that would allow the person to work for a limited amount of time while continuing through the 2nd year.


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## daedalus (Jun 25, 2008)

VentMedic said:


> Let me toss out some numbers:
> source: http://www.emsresponder.com/survey/
> 
> *Florida*:
> ...


With these ratios, you prove the need for EMTs. Our 1,700 paramedics need partners! I have never ran a call with a paramedic where I could not greatly assist them. I dont wipe noses, and I rarely hold hands. I assist my paramedic and drive my ambulance, and I do not argue that I hsould be able to do more, but dont reduce a EMT to a nose wiper.


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## daedalus (Jun 25, 2008)

Ridryder911 said:


> Personally, I have never stated that there was not a place for EMT Basics. In my "perfect EMS world" there would be three places.
> 
> 1) MFR level. What they are trained and designed to do. Be the first on the scene, prepare for treatment and quickly initiate first line tx.
> 2) Very remote areas, where medical care will never be feasible, but will not be considered the "end all". Continuous action with documentation of that those areas are attempting to improve care & services.
> ...


Agreed. I think this is what most of us would want.


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## wolfwyndd (Jun 25, 2008)

Outbac1 said:


> If there were no EMT-B certification as a starting point. Would you still try to get into EMS?
> 
> Here in Canada we have Primary Care Paramedic, (PCP), as our BLS level on ambulances. It is about a 1500 hour course with about 800 hours didactic/lab, 200 hours of hospital clinical and 500 hours as a student on an ambulance. The course costs about $12,000.00 (plus your living expenses) and takes about 10 months to complete.
> 
> If you knew you could get a job paying double the minimum wage plus benefits, would you quit your current job and make the time and monetary investment to be in EMS? Or does that kind of commitment scare you away?


Hard to say.  You see, I only do it as a volunteer / part time thing.  Even making double the minimum wage isn't much as an incentive for me since I make  . . . . . probably close to three times the minimum wage now with my full time job.  IF I could still do the training as an evening / weekend training class for about a year (or however long it took) I'd probably still do it.


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## VentMedic (Jun 25, 2008)

daedalus said:


> With these ratios, you prove the need for EMTs. Our 1,700 paramedics need partners!



It also means a lot of people stopped their education at EMT and did not advance to Paramedic.    In some areas there may be little choice but to run EMTs on all calls with or without a Paramedic. 

If you really analyze the numbers and the methodolgy behind the "training" of EMS providers in the U.S., it is amazing that it is even a profession at all. 

I guess it just amazes me that some in the profession continue to support the minimum amount of care to the patients.    Do you expect that when you go into a hospital for yourself or a loved one?   Why should EMS be any different?   And, it is really sad that as the educational standards stand, it doesn't take that many "hours" to complete a Paramedic program.  Its not like you have to even go to college, although recommended, like all the other health care professions.   You also can't say because of the pay because those that are saying it continue to make a lower wage as an EMT.  The wage for the Paramedic is higher than EMT.   One can also talk about benefits and poor working conditions, yet, they continue with their EMT job.     

Hospital professionals fought the idea of lower level providers in many areas and won.  They helped professions push their entry level educational standards higher.  They did this by providing solid arguments based on patient care.


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## BossyCow (Jun 25, 2008)

Hastings said:


> They have a place. First aid. Wiping noses and holding hands, as was suggested.
> 
> But medical emergencies in the list above are not basic. And while Basics are great for simple hospital transfers, they have no place in that list. It's that simple.



Hastings, my question was regarding the comment that BLS providers are against furthering their education. I still have not seen an adequate response to that. 

As to wiping noses, holding hands and first aid... I'm sure the drowning victim that made it to ALS breathing and with a pulse would disagree that my basic care was not better than wiping their nose. I'm sure the countless diabetics I've treated with glucose, insuring their arrival at the ER in more stable condtion than I found them, would also disagree. 

Can all of that be done by a medic? Certainly it can, but since ALS is going away in my area, not increasing, I'm going to say that BLS has a place. By the time an ALS rig can get to my critical pt, which is often 15 - 30 minutes, the patient is getting O2, major bleeds have been stopped, injuries splinted, CPR in progress if needed, C-Spine precautions in place if needed, extricated from the vehicle. As a first aid instructor, I can tell you, our level of service far exceeds what is taught in first aid. 

So, back to the topic of the thread.... if there were no EMT-B.... would you sign on for the more advanced certification like EMT-P or would you not enter EMS at all. I would really like to hear from EMT-B's on this.


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## Buzz (Jun 25, 2008)

BossyCow said:


> if there were no EMT-B.... would you sign on for the more advanced certification like EMT-P or would you not enter EMS at all. I would really like to hear from EMT-B's on this.



I probably would have not gotten into EMS. I was making far more at my old job (though I hated it). Taking a 1 semester class in something that I found highly interesting is far less of a commitment than actually entering a paramedic program where continuing on at the aforementioned job would have been impossible. After Basic, I decided that this is what I want to do and started preparing for my next step. It gets said around here quite a bit that EMS is not for everyone, and the Basic level seems to be a good way to be exposed to a small part of the profession to find out if it is right for you.


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## T1medic (Jul 1, 2008)

I myself would probably have not gotten involved in EMS if it was not for EMT. I originally became an EMT just so I can get into fire school and try and become a firefighter. I had no ambition for the medical aspect of it. Since completing school and now acquiring a job with a private ambulance service I am diving head first into the "medical" aspect of being a firefighter. I am now contemplating going to medic school before fire academy.


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## Foxbat (Jul 31, 2008)

VentMedic said:


> Many of those "BS" calls spend weeks in the hospital or die because the EMS (BLS or ALS) provider did not fully assess or have enough education to recognize something very seriously wrong.


One of my first calls was for an elderly pt. requesting lift assist only. It turned out that the pt. was kind of week and lethargic for a last few days and that's what caused him to fall. My partner (medic) persuaded him to call his physician... The physician recommended him to go to the hospital by ambulance.
When we were transporting the pt. to the hospital, he went into V-Tach (not pulseless) and we ended up going lights and sirens...


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## firecoins (Jul 31, 2008)

I support keeping the EMT-B but with alot more education.  A&P 1 & 2 should be required for everyone.  Add general psych, abnormal psych and medical terminology on as optional.  And a hell of alot more clincal than 2 shifts split between the ER and ambulance.


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## mikeylikesit (Jul 31, 2008)

firecoins said:


> I support keeping the EMT-B but with alot more education. A&P 1 & 2 should be required for everyone. Add general psych, abnormal psych and medical terminology on as optional. And a hell of alot more clincal than 2 shifts split between the ER and ambulance.


 Agreed, but, where is the A&P knowledge going to applied by the Basic? They may be able to more clearly recognize a problem, but quite often the problem recognized is something that is treated by means outside of their scope. Would be good to know for splinting though.


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## JPINFV (Jul 31, 2008)

You can't justify increasing the scope of practice of basics, though, untill they have an actual background to work off of.


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## paccookie (Aug 1, 2008)

I started as a Intermediate.  I don't think basic is a necessary step for EMS, but it's a nice idea for those who only want to volunteer.


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## paccookie (Aug 1, 2008)

firecoins said:


> I support keeping the EMT-B but with alot more education.  A&P 1 & 2 should be required for everyone.  Add general psych, abnormal psych and medical terminology on as optional.  And a hell of alot more clincal than 2 shifts split between the ER and ambulance.



I totally agree with this idea.


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## fortsmithman (Aug 1, 2008)

Outbac1 said:


> If there were no EMT-B certification as a starting point. Would you still try to get into EMS.
> 
> Here in Canada we have Primary Care Paramedic, (PCP), as our BLS level on ambulances. It is about a 1500 hour course with about 800 hours didactic/lab, 200 hours of hospital clinical and 500 hours as a student on an ambulance. The course costs about $12,000.00 (plus your living expenses) and takes about 10 months to complete.
> 
> If you knew you could get a job paying double the minimum wage plus benefits, would you quit your current job and make the time and monetary investment to be in EMS? Or does that kind of commitment scare you away?


In Alberta the entry level into EMS is EMR.  If you were to try to get registered with the Alberta College of Paramedics you would only be eligible for registration as a EMT.  In Alberta the Paramedic course is 2 yrs long.
These are the EMS designations in Alberta
Emergency Medical Responder
Emergency Medical Technician
Emergency Medical Technologist Paramedic

Although I am in the Northwest Territories My agency uses the designations of the Alberta College of Paramedics.  EMR is the equivalent of the EMT Basic.  Our EMR's are certified by NAIT Northern Alberta Institute of Technology.


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## 2serveothers (Aug 1, 2008)

New to the forum I am hesitant to share my thoughts, but contributing is what makes a forum a forum. In answering the threads initiating question, I personally wouldn't have been a part of EMS without the EMT-B Certification. 

   Now having said that my experience was while I was living in rural Wyoming where a Paramedic was unheard of. Frankly if you were fortunate to have an Intermediate on board, you also were blessed. Right, Wrong or indifferent, that was largely how rural Wyoming was.

   Oft times you were lucky if you could get a ambulance staffed mid-day or heaven forbid need an additional ambulance. Our Fire dept had a roster of 54 volunteers and there primary responsibility was for Fire suppression, Extrications, and HazMat, obviously simply put. I was only one of 5 EMT's that had been cross trained enough to provide relatively proficiently play two roles volunteering for both services. We werent compensated for helping our cities citizens, we did it because if we did not, Hell there wouldn't be anyone there to help in times of need. A town of 10,000 can only support so many Nurses and the reason they were Nurses is because they got paid, and they chose to work in a semi-controlled environment.



   The part I admired the most was that when Police, Fire and EMS were all on scene together, we worked together. There was no indifference, we were all there to serve, protect and do all we could to sustain life. Having been out of the Emergency Service for nearly 15 years, I have been revisiting the idea entering the field again. I have been trolling and reading the posts and wonder to myself what the worth in returning is. It would seem that becoming a BLS provider the luster of support has diminished so to speak. It also bespeaks itself that Paramedicine, Nursing, and Doctors are the only ones proficient enough to give any care worthy of its salt.


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## firecoins (Aug 1, 2008)

mikeylikesit said:


> Agreed, but, where is the A&P knowledge going to applied by the Basic? They may be able to more clearly recognize a problem, but quite often the problem recognized is something that is treated by means outside of their scope. Would be good to know for splinting though.





JPINFV said:


> You can't justify increasing the scope of practice of basics, though, untill they have an actual background to work off of.




Right. Knowledge of the human body and how it works is the basis for all medical professions.  EMT-Bs need to have it.   What is in the EMT-B class doesn't cut it.  I guess you can argue a pathophysiology class would be in order.  It probably too should be required.


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## rchristi (Aug 1, 2008)

I just got my EMT Basic. Previously I was a First responder although that was 20 years ago. I want to get more education and training. At the same time, the reality is that I have a full time job and it pays well. If I could not start as an EMT-B I would not have been able to start my progression of learning. Furthermore, I intend to take my skills with me when I retire to a rural area that is always short of people in their volunteer EMS. In the meantime I intend to keep getting educated and to continue learning.


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## ILemt (Aug 1, 2008)

Speaking for myself:
While i mentioned in another post that some IL services are trying out the idea of only employing Medics, that is a far off dream for many vollie and POC services, as the majority of vollie rig in IL run only at the BLS or ILS level. The best you can expect of a POC service (and many pro services) is a EMT/Medic rig. 

If Paramedic was the minimum, I see dark days for IL.


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## ILemt (Aug 1, 2008)

Second...

I started out to volunteer in EMS... I was a full time college student (in a non-healthcare study) when I was asked to become an EMT. The basic class was held in the summer after my junior year of college. I would not have been able to complete the course of study for paramedic, nor would I have switched majors. 
At present time however, i am working EMS professionally and am scheduled to attend paramedic training (its the only way to make a living in EMS) As to whether or not i personally feel an EMT is a bad thing in terms of patient care: NO! Basics are a great resource in many ways. Nor do i feel that EMTs are against furthering their education.

What would you rather have? -- A local vollie  BLS or ILS ambulance with a 4 minute ETA to a trauma case/ heart attack or a 30 minute ETA by a paid ALS unit coming from a larger town? 

At a minimum, a BLS or ILS crew can get a pt. immobilized, on O2 and stop bleeds and get an IV started.
 (Some systems in IL allow an EMT to do ET tubes, neb treatments, cardiac monitoring and even start Saline IVs, also, an Intermediate is only two or three drugs short of a paramedic. ILS can give the full range of cardiac drugs, pain meds etc. )

If nothing else, the BLS or ILS crew can get on its way and intercept with ALS if need be.


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## Foxbat (Aug 1, 2008)

If there was no EMT-B certification, I would be a first responder or just first aid certified (which I was before EMT-B class). As of being a medic... I am thinking about that, but now I am busy with working on my bachelor's degree; I will probably take A&P classes through university because I'm interested, but the whole medic program - probably no; I doubt I will have enough patient contacts to maintain ALS skills.


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## MikeRi24 (Aug 1, 2008)

i wouldnt trade the experience I get as a basic for anything. Working with a medic for a while, you start to learn a lot of what they do, so going into medic school you already have a basic idea of whats going on. Also, if you think about it, you can't do your medic skills without the basics, so why not start off at the basic level and build a sold foundation for yourself so you have all the core skills to fall back on.


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## JPINFV (Aug 1, 2008)

MikeRi24 said:


> Also, if you think about it, you can't do your medic skills without the basics, so why not start off at the basic level and build a sold foundation for yourself so you have all the core skills to fall back on.



Why don't physicians start off as PAs then? RNs as LVNs or CNAs?


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## mikeylikesit (Aug 3, 2008)

MikeRi24 said:


> i wouldnt trade the experience I get as a basic for anything. Working with a medic for a while, you start to learn a lot of what they do, so going into medic school you already have a basic idea of whats going on. Also, if you think about it, you can't do your medic skills without the basics, so why not start off at the basic level and build a sold foundation for yourself so you have all the core skills to fall back on.


 the ideas there but a tad off, some people learn by seeing, but if they don't understand why the intervention is done on a cellular level then they could only employ the skill when the exact same circumstances show again. Unfortunately that how i learned on cars was by watching but i never would have been able to diagnose and repair as well as i can if i didn't know what was going on inside the engine.


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## Ridryder911 (Aug 3, 2008)

MikeRi24 said:


> i wouldnt trade the experience I get as a basic for anything. Working with a medic for a while, you start to learn a lot of what they do, so going into medic school you already have a basic idea of whats going on. Also, if you think about it, you can't do your medic skills without the basics, so why not start off at the basic level and build a sold foundation for yourself so you have all the core skills to fall back on.



Although experience is never replaceable it can be good or bad. I much rather have a clean slate to train and work with. Really how hard is it to take vital signs, bandage, place a splint or LSB someone? Sorry, so many come into Paramedic school or exit assuming it is the same as being a Basic and then use their "short cuts" and bad habits that they have picked up over the years. Many of those become the "Paragods" and those we hear of ...'' did not perform the basics first"...

When in fact, Basic EMT and Paramedic care have NOTHING in common. Truthfully, one can become a great Paramedic without ever being an EMT, and there is NO such thing as "basic" or even "advanced" skills. Medical care is medical care.. either you can provide it or you can not. There is a reason we (EMS) are the only ones to label care as such. We do so to prevent from hurting feelings and to differentiate the care being able to be provided. 

R/r 911


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