# medics with attitudes



## gposs71

How do you and your squad deal with medics who think they are flawless and nothing BLS does is good enough?


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## medic417

I promote them.:unsure:

Really not sure what you are asking with your question.  You can not force someone to think the "basics save Paramedics" is factual.  You will find some of us respect the efforts the lower certified people make but you will find others that will not.  You can not force respect it must be earned.


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## abckidsmom

Flawless?  I discipline that kind of behavior, usually by applying strong negative peer pressure.

Nothing BLS is good enough?  There are better ways to put it.  

Sounds like you're a volly squad?  Good luck.  You need to call on the most experienced ALS providers to lead the way in developing good attitudes.  It's hard to discipline in a volunteer squad because instead of having a crappy provider, you have no provider, and it looks even worse.


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## adamjh3

Sometimes it comes down to a breakdown in communication. A does something one way, B thinks it should be done another way and tells A how it should be done. B comes off looking like an a-hole. 

I know I've come off like that before without meaning to, it's prone to happen at 0400 in the final stretch of a 72 hour shift.


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## CANMAN

Alot of good points on this thread. It would definately help to clarify what kind of system you are in. I will be honest in saying that everytime I have had a negative call involving a EMT-B it has been a volunteer. There are also MANY MANY times I have had exceptional calls with volunteer EMT-B's and I 100% of the time to make it a point and commend them on a job well done. 

I look at it like this. Me=EMT-P with a license, EMT-B is a certification. The amount of training involved does not give me the "I am god complex" but I did work very hard and endure almost 1700hrs more of education. This is also my CAREER, full-time, what I do to make a living. Someone who does this day in and day out is going to be much stronger then someone who volunteers and does it one night a week or less. 

I have met and worked with great medics and emt's as well as really crappy emt's and medics. I think alot depends on what kind of arena you are working in. 

With all of that being said I had a call this past shift that is a prime example of how my system works. Dispatched for breathing problems severe distress, volunteer EMT-B provider jumps on the career (me and my partner) paramedic unit as we are going out the door. We are a paid crew in a volunteer house so they can ride with us whenever they feel and aren't even required to tell us if they are riding. So we are going down the rode. I didn't even know this girls name so i asked her, and also asked if she was a EMT or a student. Get to the call, dude is sick, CPAP him etc etc and in the process drained out portable O2 tank. So we are transporting to the hospital and I am getting IV access and consulting and I asked if she knew how to change the O2 bottle. She said yes, long story short she had no clue and I had to do it after the rest of the things I was doing. Prime example of how I was counting on someone to deliver a basic skill and they couldn't accomplish that for me. If I would have known I most likely would have spent an extra minute or two on the scene and changed it myself. Once we came back I made it a point to go over the proper way to change the tank and told her if she doesn't know how to do something to tell someone before just saying yes and screwing the pooch.


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## 18G

I've experienced a few of those types of Medics when I was an EMT. And I always vowed never to allow myself to act like them when I became a Paramedic. Why some Medics get that complex I'm not really sure but yeah it does suck. 

Unless the Medic with the attitude goes overboard there isn't much you can do except to tactfully try to put them in their place. If it's causing issues with working as a team you can always report it to your line officers and let them address it with the ALS service. I'm assuming these are Medics not within your own organization?


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## JPINFV

CANMAN13 said:


> Me=EMT-P with a license, EMT-B is a certification.



...and what's the functional difference between the two based solely on the certification/licensure distinction? Aren't both providing a restricted service (i.e. you can't provide care on an ambulance without some sort of government permission)? Don't both face a government committee regarding their actions if they screw up? Are the standards lower for EMT-Bs because they are certified, or because they are EMT-Bs?


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## CANMAN

To answer your question JPINFV yes there is a huge differential when it comes to a CERTIFICATION as a EMT-Basic and a LICENSE to practice as a Paramedic. The easiest way to explain it is when operating on the scene of a call the EMT-P is in charge and RESPONSIBLE for all patient care. Legally they will not care or come after a EMT-Basic provider if there was a EMT-P on scene ALSO PROVIDING medical care. End of story. I am not sure if your reply was a question or the start of a responsibility and liability discussion......


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## JPINFV

...and if an EMT is working on the scene with a bunch of first responders, isn't the EMT responsible for the care provided by the first responders?


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## Phlipper

I guess I'm very lucky.  The medics I work with are generally very good at their jobs, patient with the rest of the crew, and they love to teach.  One only has to show a motivation to learn, to want to pitch in and handle pts, and give them the appropriate respect - and they do deserve respect, because their butts are on the line in ways ours aren't.  Our medics bend over backwards for a good Basic or MR who wants to step up and who isn't lazy.  

So when they have bad days/calls they get a lot of slack for grumpiness.  It happens.  It's a tough and often unrewarding job with a tremendous amount of risk.  But if you have one who is a typical Paragod every day and just bossy and grumpy and disrespectful you either have to talk to them one-on-one and clear the air or try to get on a different team.  That or a different job.  Good luck.


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## EMS49393

CANMAN13 said:


> Alot of good points on this thread. It would definately help to clarify what kind of system you are in. I will be honest in saying that everytime I have had a negative call involving a EMT-B it has been a volunteer. There are also MANY MANY times I have had exceptional calls with volunteer EMT-B's and I 100% of the time to make it a point and commend them on a job well done.
> 
> I look at it like this. Me=EMT-P with a license, EMT-B is a certification. The amount of training involved does not give me the "I am god complex" but I did work very hard and endure almost 1700hrs more of education. This is also my CAREER, full-time, what I do to make a living. Someone who does this day in and day out is going to be much stronger then someone who volunteers and does it one night a week or less.
> 
> I have met and worked with great medics and emt's as well as really crappy emt's and medics. I think alot depends on what kind of arena you are working in.
> 
> With all of that being said I had a call this past shift that is a prime example of how my system works. Dispatched for breathing problems severe distress, volunteer EMT-B provider jumps on the career (me and my partner) paramedic unit as we are going out the door. We are a paid crew in a volunteer house so they can ride with us whenever they feel and aren't even required to tell us if they are riding. So we are going down the rode. I didn't even know this girls name so i asked her, and also asked if she was a EMT or a student. Get to the call, dude is sick, CPAP him etc etc and in the process drained out portable O2 tank. So we are transporting to the hospital and I am getting IV access and consulting and I asked if she knew how to change the O2 bottle. She said yes, long story short she had no clue and I had to do it after the rest of the things I was doing. Prime example of how I was counting on someone to deliver a basic skill and they couldn't accomplish that for me. If I would have known I most likely would have spent an extra minute or two on the scene and changed it myself. Once we came back I made it a point to go over the proper way to change the tank and told her if she doesn't know how to do something to tell someone before just saying yes and screwing the pooch.



This. ^^  Exceptionally well put, I can not improve upon this, so I will just agree.


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## Aidey

It is really hard to give any advice without knowing more specifics. There are definitely paramedics with attitude problems out there, but I've also noticed how experience and education differences can end up causing problems. 

The last agency I was at was a volly FD, when I got my paramedic I was really the only practicing medic. We had a couple others, but they were assistant chiefs or never around. Our Chief routinely called paramedics "paragods" before I ever went to school. When I came back from my internship there were a good number of problems, most of them stupid, and always blamed on me being a paramedic now. There was the time I didn't know my co-worker had passed his intermediate test while I was out of town, so I started the IV, offending him and getting myself reported to the Captain. There was a discussion about not giving everyone 15lpm, and a discussion about giving a COPDer more than 2lpm. In both of those cases the people I was working acted like I was committing some grievous violation of appropriate medical care, when in reality a broken leg doesn't need 15lpm, and someone who is cyanotic does. It really didn't matter to anyone that I was clinically right, what I was doing was going against what their EMT B/EMT I classes had taught so I was out of line. 

Another more current example was we (my EMT B partner and I) made the decision to take a patient off of a back board. The patient was in a minor MVA and complaining of ankle pain, they had been up walking around, no neck/back pain and no LOC. It was a 20+ mile drive. A volunteer, EMT B only agency had been the first responders. 

I'm pretty sure we offended them. I've noticed that no matter how polite one is, or how much one tries to explain their actions in those cases, the other people are always offended. They may have perfectly packaged the patient, but it wasn't indicated and was going to cause a very uncomfortable ride for the patient. 

I'm not trying to turn this around and shift blame, like I said, there are a lot of medics out there with attitude problems. I just also want to make the point that what is perceived as a problem by someone may not be, it may just be a difference in education.


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## usafmedic45

gposs71 said:


> How do you and your squad deal with medics who think they are flawless and nothing BLS does is good enough?


Hang their asses out to dry when they do screw up.  Document the hell out of it and hand it over to the medical director when the time comes.


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## usafmedic45

> Me=EMT-P with a license, EMT-B is a certification.



So you can practice independent of your medical director?  If not, what you're looking at is nothing more than feel good semantics.  Not to detract from the rest of your post, but I thought I would toss it out there.



> This is also my CAREER, full-time, what I do to make a living. Someone who does this day in and day out is going to be much stronger then someone who volunteers and does it one night a week or less.



You know...except for the volunteers who are nurses (in a useful specialty), RTs, docs, PA-Cs, etc.


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## traumahawk

I am a volly as well as paid EMT. When I first got my cert medics did give me hard time. But when they saw I knew what I was doing as an EMT they where great with me. When I didn't know I told them I do not know. And instead of making my self look like a fool they respect it more when u tell them u don't know. BLS is not a hard skill to learn. I picked I up very fast and was on my own two feet in the skill very quickly. Now here is the thing. I believe volunteering is great that's y I do it. But even some of my guys I get a frustrated with becuz they only do this one day a week and they don't have the greatest experience on the job and even I get mad at them EMT To EMT. Learn ur skill and instead of worrying about the attitude of a medic learn ur skill and be at ur best.


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## mgr22

gposs71 said:


> How do you and your squad deal with medics who think they are flawless and nothing BLS does is good enough?



I'm just wondering -- how do you know those medics feel that way? Would it be worth considering the possibility that there's a misunderstanding? What would you want someone to do if they were making those kinds of assumptions about you?


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## Shishkabob

Are there medics with attitudes?  Hell yes.  Hate them.


But at the same time you need to view it from our perspective.  We (generally) have way more education (atleast 10x the amount of an EMT if you want to be specific).   We (generally) have a bigger clinical and knowledge base, with a longer looking perspective at what we're doing now and how it will effect the patient in the long run, not just 10 minutes from now.  We have to deal with the thought process of a lot more drugs than you, a lot more treatment modalities, and a lot more complications in our differential diagnosis.  We DO have a bigger legal responsibility--  We're held to a higher standard than EMTs.  Something goes wrong, we have a helluva lot more to lose than you. 

And we are expected to take control of the scene and patient care from the moment of contact until we drop the patient off at the ED.  Part of that means being assertive... and some people view being assertive as being an ***.  They aren't the same. 



Most medics I know aren't purposefully trying to be jerks to EMTs, but when you're trying to get a lot of things done quickly, someones feelings might be hurt.  I know I'll be seen as crass with some EMTs at times while trying to get stuff done on a call, but I always try to apologize afterwards, among other things to show that you're not "just the driver" and I'm not "just the medic", but that we're partners.



But even still, it IS my patient, and it IS my call.  If I piss a "lower" provider off because they don't agree with me while I provide competent medical care, oh well, tough noogies, deal with it.


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## cmetalbend

Linuss said:


> Are there medics with attitudes?  Hell yes.  Hate them.
> 
> But even still, it IS my patient, and it IS my call.  If I piss a "lower" provider off because they don't agree with me while I provide competent medical care, oh well, tough noogies, deal with it.



 Ya see, it's comments like this that fuel the EMT vs Paramedic fire. A call is not determined to be yours or mine, its OUR. Sure your in charge, but without EMT's or help in general you aren't gona save chit. Period.  But seriously the ER doc gets all the glory. So why are we waisting time trying to put each other down or "In there place". And I really like that post till the last paragraph.<_<


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## traumahawk

One things that medics do need to understand is that you where once a basic. Yes you did go to school and yes u do have a higher understanding of medicine and the human body. Now I know I am a good EMT. But that's what I am and that what I know. Don't put me down because I don't know every thing. That's y u r on scene in the first place. Now I will not stand here and say that their is excuse for stupid moves made by some EMTs like I said in my last post. But once again u where in the same shoes I was once. Don't forget where you came from.


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## Aidey

I don't think Linuss' post was about glory or credit. No matter how much teamwork happens, there is always one person that is ultimately held responsible. In most places that is the paramedic. I don't give a rats tail about who gets credit for what, but I do care what I'm going to be held responsible for. I work in a system with EMTB/FFs and Paramedic/FFs, and my partner is usually a basic. It doesn't matter if it is an EMT or a Paramedic, I'm not keen on being held responsible for what anyone else did, no matter their certification level.


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## rhan101277

A good EMT means everything though.  It effects scene time, if they fumble around and don't know where stuff is and we gotta do it, it sucks.


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## abckidsmom

Linuss said:


> Are there medics with attitudes?  Hell yes.  Hate them.
> 
> 
> But at the same time you need to view it from our perspective.  We (generally) have way more education (atleast 10x the amount of an EMT if you want to be specific).   We (generally) have a bigger clinical and knowledge base, with a longer looking perspective at what we're doing now and how it will effect the patient in the long run, not just 10 minutes from now.  We have to deal with the thought process of a lot more drugs than you, a lot more treatment modalities, and a lot more complications in our differential diagnosis.  We DO have a bigger legal responsibility--  We're held to a higher standard than EMTs.  Something goes wrong, we have a helluva lot more to lose than you.
> 
> And we are expected to take control of the scene and patient care from the moment of contact until we drop the patient off at the ED.  Part of that means being assertive... and some people view being assertive as being an ***.  They aren't the same.
> 
> 
> 
> Most medics I know aren't purposefully trying to be jerks to EMTs, but when you're trying to get a lot of things done quickly, someones feelings might be hurt.  I know I'll be seen as crass with some EMTs at times while trying to get stuff done on a call, but I always try to apologize afterwards, among other things to show that you're not "just the driver" and I'm not "just the medic", but that we're partners.
> 
> 
> 
> But even still, it IS my patient, and it IS my call.  If I piss a "lower" provider off because they don't agree with me while I provide competent medical care, oh well, tough noogies, deal with it.



Not to be all maternal or anything, but this comes down to manners.  I think I've experienced maybe a dozen times over the course of my career where time and a critical incident took away the luxury of communicating with please and thank you, respectful requests and not barking orders.

Adults in a work environment don't get the luxury of saying tough noogies, deal with it.  I bet that your words got ahead of you and maybe you didn't mean to say that out loud, but the fact remains that the thought is there.

I've got a new partner these days, a brand new, 50 year old female EMT.  She can't lift, she has no EMS experience, and she can't read a map.  Every day we spend together is frustrating beyond words, when we're on a call.  Off the call, she's awesome- an Air Force wife who lived all over the world and has had such a varied life experience that there's always something to talk about.

I can't let my frustration with her performance on the calls take away the rest of her that deserves and inspires respect.  EMS can be learned, but polite society requires that ALL people treat ALL people respectfully and kindly ALL the time.

There's no "get over it" in kind, respectful behavior.  It's lazy to fall back to that instead of educating people to see it your way or communicating with them until you can see it their way.


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## cmetalbend

Aidey said:


> I don't think Linuss' post was about glory or credit. No matter how much teamwork happens, there is always one person that is ultimately held responsible. In most places that is the paramedic. I don't give a rats tail about who gets credit for what, but I do care what I'm going to be held responsible for. I work in a system with EMTB/FFs and Paramedic/FFs, and my partner is usually a basic. It doesn't matter if it is an EMT or a Paramedic, I'm not keen on being held responsible for what anyone else did, no matter their certification level.



I agree, it's not really about the glory or credit. But again responability is upon everybody. Not just the medics. I would hate to see a good medic loose his lic. or job for a another responder of any type. In my opnion, "What happens on the truck, stays on the truck". Nobodys perfect, we all make mistakes, the only difference is how and if we learn from them.B)


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## Aidey

It isn't about how you view responsibility, it is about how managment and state law view it. The fact is that one person is ultimately deemed to be most responsible, and it is usually a paramedic.


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## CAOX3

I have a simple rule, I respect you, you respect me, if you want to act like a five year expect to be treated like one.  This rule applies to everyone on the ladder from the top to the bottom.


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## EMS49393

I have a personal rule in addition to the treat me with respect and I'll return the same and be professional rules.  If you do not know, ask.  I love to teach and do not mind answering questions or showing you how to do something.  That said, please know when to ask your questions.  There are times when your question may be perceived by the patient as personally questioning my treatments thereby killing my credibility.  The best worded questions usually start with "can you explain why...?"  

I've never been one of those medics that throws a fit with a new EMT or medic.  I can handle about any level of partner, I just like to know what I'm dealing with before hand.  If you're green, it's cool, we'll get through it.  If you're green and act like you've been in EMS for 40 years because your Daddy's a paramedic at such and such service but you don't know an oxygen wrench from a spider strap, be prepared to get schooled real quickly.  I rarely ever have to pull rank, but I will if I have to because I have several thousand hours and several thousand dollars invested in my license that I'm only giving up when I decide it's my time, and not before.


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## rhan101277

EMS49393 said:


> I have a personal rule in addition to the treat me with respect and I'll return the same and be professional rules.  If you do not know, ask.  I love to teach and do not mind answering questions or showing you how to do something.  That said, please know when to ask your questions.  There are times when your question may be perceived by the patient as personally questioning my treatments thereby killing my credibility.  The best worded questions usually start with "can you explain why...?"
> 
> I've never been one of those medics that throws a fit with a new EMT or medic.  I can handle about any level of partner, I just like to know what I'm dealing with before hand.  If you're green, it's cool, we'll get through it.  If you're green and act like you've been in EMS for 40 years because your Daddy's a paramedic at such and such service but you don't know an oxygen wrench from a spider strap, be prepared to get schooled real quickly.  I rarely ever have to pull rank, but I will if I have to because I have several thousand hours and several thousand dollars invested in my license that I'm only giving up when I decide it's my time, and not before.



LOL "my daddy is a paramedic"


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## Shishkabob

abckidsmom said:


> Not to be all maternal or anything, but this comes down to manners.  I think I've experienced maybe a dozen times over the course of my career where time and a critical incident took away the luxury of communicating with please and thank you, respectful requests and not barking orders.


  Oh, agreed.  I tend to say please/thanks/would you mind, etc etc, 99.9% of the time.  However, don't fault me every time if I don't, as I have other things on my mind.

I don't see anyone ****** when a doctor says "Let's go ahead and put them on the monitor" etc etc without always saying please.



> Adults in a work environment don't get the luxury of saying tough noogies, deal with it.  I bet that your words got ahead of you and maybe you didn't mean to say that out loud, but the fact remains that the thought is there.


  Nope, I meant what I said and I said what I meant.  





> There's no "get over it" in kind, respectful behavior.  It's lazy to fall back to that instead of educating people to see it your way or communicating with them until you can see it their way.



The "get over it" was aimed more at "If you don't like how I run a call, oh well", and I stand by that.


I will be one of the FIRST to educate my partners on why I did or did not do something on a call as I LOVED it when I was an EMT and my medic took the time and did the same, but if my treatment decision offends you, it's a competent decision, and it's not yours to make, then that's your problem to deal with.  



Let's be clear here:  I don't treat my partner, be it an EMT, Intermediate or another Paramedic, as an idiot.  They are their own certified or licensed professional, and they get treated as an equal, and as a partner, not as a lowly servant.     However, my patient is my patient, and my call is my call.  That cannot be argued.


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## CAOX3

EMS49393 said:


> I have a personal rule in addition to the treat me with respect and I'll return the same and be professional rules.  If you do not know, ask.  I love to teach and do not mind answering questions or showing you how to do something.  That said, please know when to ask your questions.  There are times when your question may be perceived by the patient as personally questioning my treatments thereby killing my credibility.  The best worded questions usually start with "can you explain why...?"
> 
> I've never been one of those medics that throws a fit with a new EMT or medic.  I can handle about any level of partner, I just like to know what I'm dealing with before hand.  If you're green, it's cool, we'll get through it.  If you're green and act like you've been in EMS for 40 years because your Daddy's a paramedic at such and such service but you don't know an oxygen wrench from a spider strap, be prepared to get schooled real quickly.  I rarely ever have to pull rank, but I will if I have to because I have several thousand hours and several thousand dollars invested in my license that I'm only giving up when I decide it's my time, and not before.



First your investment is no more important them mine, this is my career also.  So the entire premise of that comment is condescending.

And since I keep hearing over and over how a incompetent lower level provider can somehow cost a medic their certification can anyone provde some evidence maybe a link where this has occured?


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## ffemt8978

cmetalbend said:


> I agree, it's not really about the glory or credit. But again responability is upon everybody. Not just the medics. I would hate to see a good medic loose his lic. or job for a another responder of any type. In my opnion, "*What happens on the truck, stays on the truck*". Nobodys perfect, we all make mistakes, the only difference is how and if we learn from them.B)



No it doesn't, nor should it.  What happens on the truck can affect the patient's final outcome.  If somebody screws up on scene or "in the truck" it needs to be appropriately documented so that it can be dealt with correctly.

The "blue wall" mentality is detrimental to the patient, and ultimately EMS is all about the patient.  If your patient's final outcome is less of a concern to you than keeping your license or job, then maybe you should be looking at a different career option.

But I am curious as to how the statement "What happens on the truck, stays on the truck" enables the last statement in your post "Nobodys perfect, we all make mistakes, the only difference is how and if we learn from them".  If you're keeping a mistake on the truck, how can you learn anything from it and how can anybody else?

Maybe I misunderstood your post, and if I did I apologize.


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## Aidey

I can't provide a link because it wasn't the sort of thing that would make the news, but I know of one case. A Medic was fired after an IV line an EMT I started infiltrated and the Medic pushed meds through it, causing permenent damage. Even though the emt had started the line the medic was held responsible because they should have known the line was bad.


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## EMS49393

CAOX3 said:


> First your investment is no more important them mine, this is my career also.  So the entire premise of that comment is condescending.
> 
> And since I keep hearing over and over how a incompetent lower level provider can somehow cost a medic their certification can anyone provde some evidence maybe a link where this has occured?



I never said my investment was more important than yours, however it is much more time consuming and expensive.  120 hours compared to 3000 hours of paramedic didactic and clinical hours?  $400 plus books (unless you got yours for free at the local FD) versus over $8000?  I'm only counting my science related courses and paramedic program.  I didn't even count any of my humanities or English courses because I can apply them toward my current degree track as well.  I have substantially more time and money invested in my career then I care to lose.  

We have IV techs and EMT-I's in Maryland.  I am ultimately responsible for their actions.  If they do something that causes harm to a patient, MIEMSS is going to knock on my door and ask why I didn't stop them seeing as how I was the highest level provider.  If they start an IV, I HAVE to check it before I use it.  Several medications cause tissue necrosis.  As was stated before, I could be liable for their mistake because I did not recognize and correct the mistake.  

I can not use the phrase "um, well, you see, I didn't know" if I get questioned about patient care.  It's my job to know any and everything that is being done to a patient because I am ultimately responsible for the outcome.  Because I am responsible, I have to be able to intervene if someone is doing something incorrectly or something that would potentially harm a patient.  If I idly stand by and let an EMT-I give a patient complaining of toe pain 10 mg of valium just because it's his first day and he wanted to see how the drug affected a person, I will be held accountable because I knowingly and willingly stood by and watched a lower level provider (or even another paramedic provider) deviate from the standard of care and potentially harm the patient.

This is the same reason I always check my ambulance personally.  I will never "blame" an EMT for something not being on the truck when it was my responsibility to insure all the equipment was in place and operable.


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## traumahawk

Aidey said:


> I can't provide a link because it wasn't the sort of thing that would make the news, but I know of one case. A Medic was fired after an IV line an EMT I started infiltrated and the Medic pushed meds through it, causing permenent damage. Even though the emt had started the line the medic was held responsible because they should have known the line was bad.



Yes because they. Key word they should have known. So it is the medic fault to. But could a fellow medic made the same mistake? Yes. Nobody is perfect. Your post is arrogant.


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## usafmedic45

ffemt8978 said:


> No it doesn't, nor should it.  What happens on the truck can affect the patient's final outcome.  If somebody screws up on scene or "in the truck" it needs to be appropriately documented so that it can be dealt with correctly.
> 
> The "blue wall" mentality is detrimental to the patient, and ultimately EMS is all about the patient.  If your patient's final outcome is less of a concern to you than keeping your license or job, then maybe you should be looking at a different career option.
> 
> But I am curious as to how the statement "What happens on the truck, stays on the truck" enables the last statement in your post "Nobodys perfect, we all make mistakes, the only difference is how and if we learn from them".  If you're keeping a mistake on the truck, how can you learn anything from it and how can anybody else?
> 
> Maybe I misunderstood your post, and if I did I apologize.


You're officially my favorite moderator now.


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## CAOX3

EMS49393 said:


> I never said my investment was more important than yours, however it is much more time consuming and expensive.  120 hours compared to 3000 hours of paramedic didactic and clinical hours?  $400 plus books (unless you got yours for free at the local FD) versus over $8000?  I'm only counting my science related courses and paramedic program.  I didn't even count any of my humanities or English courses because I can apply them toward my current degree track as well.  I have substantially more time and money invested in my career then I care to lose.
> 
> We have IV techs and EMT-I's in Maryland.  I am ultimately responsible for their actions.  If they do something that causes harm to a patient, MIEMSS is going to knock on my door and ask why I didn't stop them seeing as how I was the highest level provider.  If they start an IV, I HAVE to check it before I use it.  Several medications cause tissue necrosis.  As was stated before, I could be liable for their mistake because I did not recognize and correct the mistake.
> 
> I can not use the phrase "um, well, you see, I didn't know" if I get questioned about patient care.  It's my job to know any and everything that is being done to a patient because I am ultimately responsible for the outcome.  Because I am responsible, I have to be able to intervene if someone is doing something incorrectly or something that would potentially harm a patient.  If I idly stand by and let an EMT-I give a patient complaining of toe pain 10 mg of valium just because it's his first day and he wanted to see how the drug affected a person, I will be held accountable *because I knowingly and willingly stood by and watched a lower level provider (or even another paramedic provider) deviate from the standard of care and potentially harm the patient.*This is the same reason I always check my ambulance personally.  I will never "blame" an EMT for something not being on the truck when it was my responsibility to insure all the equipment was in place and operable.



This is the key, if you didnt know how could you be held responsible and that was my whole point.  We are all providers allowed to work autonomously, you being present shouldnt relieve me of my responsibility to act as a competent provider within my scope.


----------



## usafmedic45

> This is the key, if you didnt know how could you be held responsible and that was my whole point. We are all providers allowed to work autonomously, you being present shouldnt relieve me of my responsibility to act as a competent provider within my scope.



No, but a reasonable person would still hold the person guilty for the act of omission as much as the other person guilty of comission.  You have a professional and moral expectation to intervene and protect your patient if you know what is about to happen is going to likely be harmful to the patient.


----------



## ffemt8978

usafmedic45 said:


> You're officially my favorite moderator now.



It only took 6 years for that to happen.  

/threadjack


----------



## usalsfyre

I'm gonna go with an unpopular opinion here...

What I say goes, period. You as any other level of provider are certainly more than welcome to offer ideas and suggestions, which I will take under advisement. If it's good/appropriate we'll go with it. If not, don't get your feelings hurt. I'll be more than happy to explain my reasoning, but unless I'm about to kill someone, don't argue in front of the patient. If I AM about to kill someone, then by all means object loud, pround and often (I ran into that as the objector recently, thankfully my advice was listened to and it turned out ok). The only people who can ultimately trump me though are my med control physicians and sending physicians (and even the latter is pretty flexible).

Don't like how I do things, go to school and be a medic. I try not to be an ***, but some providers have a VASTLY overestimated view of where they fit in the system. Paramedics included, so it's not just a bag on basics, but there seem to be more "I save lives" basics than medics. These are the people I have found get upset when I don't recognize their brilliance.


----------



## CAOX3

usalsfyre said:


> Don't like how I do things, go to school and be a medic. I try not to be an ***, but some providers have a *VASTLY overestimated view of where they fit in the system*. Paramedics included, so it's not just a bag on basics, but there seem to be more "I save lives" basics than medics. These are the people I have found get upset when I don't recognize their brilliance.



You dont say..  I also think anyone who has spent any time isn this field recognises if a life is saved it will take a team of players not just the lead off hitters.


----------



## traumahawk

usalsfyre said:


> I'm gonna go with an unpopular opinion here...
> 
> What I say goes, period. You as any other level of provider are certainly more than welcome to offer ideas and suggestions, which I will take under advisement. If it's good/appropriate we'll go with it. If not, don't get your feelings hurt. I'll be more than happy to explain my reasoning, but unless I'm about to kill someone, don't argue in front of the patient. If I AM about to kill someone, then by all means object loud, pround and often (I ran into that as the objector recently, thankfully my advice was listened to and it turned out ok). The only people who can ultimately trump me though are my med control physicians and sending physicians (and even the latter is pretty flexible).
> 
> Don't like how I do things, go to school and be a medic. I try not to be an ***, but some providers have a VASTLY overestimated view of where they fit in the system. Paramedics included, so it's not just a bag on basics, but there seem to be more "I save lives" basics than medics. These are the people I have found get upset when I don't recognize their brilliance.



What u say does go. U r the higher medical authority. But that is the attitude that make this rivalry. And yes I am in medic school and I have a minor in nursing. But I don't like medics who walk in push me aside. Its not about PT care, its about the medic god complex.


----------



## JPINFV

CAOX3 said:


> You dont say..  I also think anyone who has spent any time isn this field recognises if a life is saved it will take a team of players not just the lead off hitters.



True, but there's a reason the CNAs aren't speaking at the news conference regarding Representative Giffords.

There's also a reason why malpractice insurance premiums are different for CNAs than physicians. 

There's also no "I" in "team" until the lawyers come out.


----------



## ffemt8978

CAOX3 said:


> You dont say..  I also think anyone who has spent any time isn this field recognises if a life is saved it will take a team of players not just the lead off hitters.


Anyone who has spent anytime in this field realizes that the past 40 years of EMS in this country have been more orientated to not killing anybody than actually treating them.

Thankfully, this is starting to change but it is going to be a long, hard trip to get to the point that EMS actually saves lives on a regular basis.


----------



## Shishkabob

JPINFV said:


> There's also no "I" in "team" until the lawyers come out.



There's a "me" hidden in there!




usalsfyre said:


> What I say goes, period.



Well, they did say you sure did take charge at the code the other day


----------



## MrBrown

Brown gives them an award for being a Parathinktheyare


----------



## usafmedic45

> True, but there's a reason the CNAs aren't speaking at the news conference regarding Representative Giffords.



Besides the fact most neuro ICUs don't have them?  



> Brown gives them an award for being a Parathinktheyare



Is that anything like a parakeet?  Like the New Zealand version of a budgerigar or something?


----------



## MrBrown

*Parathinktheyare:*  A provider of prehospital emergent medical treatment and transport whos education and modalities of clinical praxis are disproportinatly rudimentary when compared with comparable systems in other jurisdictions.  May be the product of a patch factory (which may or may not predominantly serve the needs of the barely homeostasasasing who inturn may or may not be Fire Service employees or candidates) without comprehensive understanding of basic sciences (biological and/or clinical) and rationale-driven modalities of praxis avaliable elsewhere evidenced by best practice applicable to his or her level of clinical certification.  Most likely has a high reliance upon delegated protocols and potential for extremely high levels of recourse to online medical direction and justifies clinical praxis based upon orders recieved by online direction.  Fails to understand limitations of practice modalities and education as witnessed by others.  Most often found in the USA.


----------



## Aidey

34responding said:


> Yes because they. Key word they should have known. So it is the medic fault to. But could a fellow medic made the same mistake? Yes. Nobody is perfect. Your post is arrogant.



I'm sorry you think my post is arrogant, but I really don't see how it is. I used "they" because I was avoiding using he or she. My post was simply an example of a case where a Paramedic was held more responsible for the EMT I's mistake than the EMT I was. The line could have also be written "Even though the emt had started the line the medic was held responsible because the paramedic should have known the line was bad".

The real kicker in that case is that the paramedic figured out the line was bad when the pushed the med, and d/c it immediately, it wasn't like the medic dumped 500cc of saline in before figuring it out. But since the damage was done, it didn't really matter.


----------



## CANMAN

USAFmedic.... My post about the license vs. certification isn't strictly talking about the fact that in a legal case THEY WILL come after the person with the license over the provider with a certification. 

As far the volunteers who are a RN, MD, RRT, horse doctor, whatever I guess to each their own. I have yet to meet someone who works in healthcare as something other then a EMT/EMT-P who is exceptional at field EMS in a volunteer capacity. Like I said previously I will put a GOOD MEDIC who does it day in and day out as a career up against a ER RN who volunteers and rides a unit any day....And I work with RN's who have ER and ICU background on a critical care transport team as well.


----------



## Veneficus

CANMAN13 said:


> USAFmedic.... My post about the license vs. certification isn't strictly talking about the fact that in a legal case THEY WILL come after the person with the license over the provider with a certification.





CANMAN13 said:


> As far the volunteers who are a RN, MD, RRT, horse doctor, whatever I guess to each their own. I have yet to meet someone who works in healthcare as something other then a EMT/EMT-P who is exceptional at field EMS in a volunteer capacity.* Like I said previously I will put a GOOD MEDIC who does it day in and day out as a career up against a ER RN who volunteers and rides a unit any day*....And I work with RN's who have ER and ICU background on a critical care transport team as well.



I have met several RNs who volunteer as EMS providers. Another handful who are paid EMS providers, I do not know of any intrisic shortcomings they have other medics don't.

As for the bolded part.

Why?


----------



## CANMAN

Well I am not trying to start another topic but I feel like we function totally different. From thought process to skill set etc... In over 5 years of working with a RN every shift I have realized there are so many differences in what we do and think. While you can crosstrain both providers I am just saying I would personally take a strong medic over another provider. Not everyone will agree and I accept that. I am also speaking about my particular system, state, experiences...


----------



## jjesusfreak01

Well, by that definition MrBrown, I am not a Parathinktheyare. I have a bachelors degree in Biology, had a 180 hour EMT-B class, and am currently in the process of completing a few months of third rider field training. I work with experienced paramedics so calling for online medical direction is never necessary, and do not plan on staying at this level of practice for more than a year (EMT-I or med school is in my immediate future). 

I was understanding parathinktheyare to refer to people who fancy themselves as paramedics when they aren't, which I may be somewhat guilty of (says Brad, as he picks up his copy of Dubin's Rapid Interpretation of EKGs).


----------



## JPINFV

jjesusfreak01 said:


> Well, by that definition MrBrown, I am not a Parathinktheyare. I have a *bachelors degree in Biology, had a 180 hour EMT-B* class, and am currently in the process of completing a few months of third rider field training. I work with experienced paramedics so calling for online medical direction is never necessary, and do not plan on staying at this level of practice for more than a year (EMT-I or med school is in my immediate future).
> 
> I was understanding parathinktheyare to refer to people who fancy themselves as paramedics when they aren't, which I may be somewhat guilty of (says Brad, as he picks up his copy of Dubin's Rapid Interpretation of EKGs).



1. Based on Brown's definition, "parathinktheyares" include the level of paramedic in most US states. 

2. Congrats on being different from the average EMS provider. If your education far exceeds what most people have, then you lose the right to complain about people talking poorly about the average provider. There's a reason I don't take offense to comments like those, and that's because I recognize that they aren't directed towards the EMT (I'm still active for another few months...) with a BS, MS, and 3/8ths of the way through medical school. Even with just the BS, it's simply not comparable to the education of most EMTs and paramedics.


----------



## MrBrown

Lets not forget another key trait of the Parathinktheyare:  They justify themselves, often too highly, based upon principles not supported by the medical literature such as "the medical director told me", "I know I am right", "it always helps", "the textbook says" and "its always been this way".


----------



## Bosco578

gposs71 said:


> How do you and your squad deal with medics who think they are flawless and nothing BLS does is good enough?


 
Point,laugh, walk away.........:deadhorse:


----------



## supergirl534

personally i deal with way to much.  i work and volenteer with both my agencies being als.  the als providers that think they are higher then GOD and think that i as a BLS provider am on scene to carry there stuff and be their goffer...... there is an easy way to deal with that.  after the call i simply take them aside and talk to them.  i usually take one of the things that they said that were condisending and through it beack in their face and in my exsperience they have realized how much of a jerk that they sounded like.  for those who are still standing on their milk crete thinking they are better than anyone who has walked the earth i go out of my way to prove them wrong.  some people call me a :censored::censored::censored::censored::censored: for it but im okay with that because im not losing any sleep over their ignorence....... but if they really think that they are that good they will lose sleep over the fact that you came to them and talked to them about it .

good luck some people refuse change!


----------



## NREMTroe

Going back to the license and certification thing, didn't they change the EMT "certification" to a license now? I mean I don't want to start anything because believe me I won't be staying an EMT for long, paramedic school starts in August and I will be in that class. It just seems like there is a lot of bickering lately, and it shouldn't be like that.


----------



## JPINFV

NREMTroe said:


> Going back to the license and certification thing, didn't they change the EMT "certification" to a license now? I mean I don't want to start anything because believe me I won't be staying an EMT for long, paramedic school starts in August and I will be in that class. It just seems like there is a lot of bickering lately, and it shouldn't be like that.



The only entity that can issue a license is the government, so it all depends on what the state wants to call it's EMT/paramedic authorizations. Regardless, for all intents and purposes, what the state authorities hand out are paramedic and EMT licenses. 

NREMT's official take on licensing and certification can be found here:
https://www.nremt.org/nremt/about/Legal_Opinion.asp


My favorite example of the stupidity of debating the difference between a "license" and "certificate":

California Professions Code regarding the practice of medicine.


> 2040.  The terms "license" and "certificate" as used in this chapter
> are deemed to be synonomous.



http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=02001-03000&file=2030-2041

Once I realized that the people who write the laws couldn't figure out the difference, I stopped caring.


----------



## NREMTroe

JPINFV said:


> The only entity that can issue a license is the government, so it all depends on what the state wants to call it's EMT/paramedic authorizations. Regardless, for all intents and purposes, what the state authorities hand out are paramedic and EMT licenses.
> 
> NREMT's official take on licensing and certification can be found here:
> https://www.nremt.org/nremt/about/Legal_Opinion.asp
> 
> 
> My favorite example of the stupidity of debating the difference between a "license" and "certificate":
> 
> California Professions Code regarding the practice of medicine.
> 
> 
> http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=02001-03000&file=2030-2041
> 
> Once I realized that the people who write the laws couldn't figure out the difference, I stopped caring.



Thanks JPINFV, I enjoyed reading that article. I think that should "settle" a lot of the discussion about it, even though it really doesn't matter B)


----------



## usafmedic45

> USAFmedic.... My post about the license vs. certification isn't strictly talking about the fact that in a legal case THEY WILL come after the person with the license over the provider with a certification.


Does it really matter what they call your state credential?  Either way, MIEMSS barely grant you folks the ability to wipe your own butts without asking Dr. Bass' explicit permission.  Truth be told, I have so little faith in that state, that I would not be surprised if "dingleberries" would not be a qualifying criterion for a MSP mission.  But back to the actual topic at hand....

As someone who works as a "PRN" expert witness for a malpractice attorney, we aren't going to go after the medic or the EMT anymore (assuming they both screwed up equally) unless the medic allowed the EMT to do something that violated a standard of care.  This is not to mention that BLS screwups are very difficult to prove in court unless you have it on videotape or one of the providers on scene turns evidence for the plaintiff.  The licensed person we are going to go after is the doc overseeing the service since they are the one with the nice fat wallet.  

To be frank, if we want to punish an EMS provider for something they did, it's much easier just to have their credentials yanked.  Not to mention, it's often much more productive, satisfying and less guilt-inducing. 



> As far the volunteers who are a RN, MD, RRT, horse doctor, whatever I guess to each their own. I have yet to meet someone who works in healthcare as something other then a EMT/EMT-P who is exceptional at field EMS in a volunteer capacity. Like I said previously I will put a GOOD MEDIC who does it day in and day out as a career up against a ER RN who volunteers and rides a unit any day....And I work with RN's who have ER and ICU background on a critical care transport team as well.


No offense, but that seems to just smack of hubris.  In other words, you have have a confirmation bias that doesn't allow anyone to meet your standard.  You're telling me that someone with several more years of education, probably more experience (since most EDs, even the slow ones, see more patients in a given time period than even busy ambulance services) and the ability to juggle multiple patients is less qualified than a full-time medic with a minimal education, limited scope of practice, etc?  Maybe you guys just have some really crappy ED nurses out there in Maryland nowadays....

Let's use an example I know quite well: the medical director I worked under the longest and his assistants.  All of them were EMS providers (the medical director had a state certification in EMS that put him among some of the first classes of ALS EMS providers; most of his assistants were EMT-Bs but a couple were EMT-Is or EMT-Ps) and all were required by policy to ride shifts with us if they wanted to remain able to give medical control orders.  That usually amounted to one or two shifts per month for most of them.  Are you really going to tell me that, as a general rule, a NREMT-P who works a busy service is a better provider in the field than a MD/DO with a board certification in emergency medicine (or in the case of our medical director: boarded in EM, CCM and IM, not to mention SF combat medic experience in Nam) just because they are volunteers who aren't spending all their working time on the ambulance?  I know the field is a different environment than the ED but then again it's not _that_ different and to be honest, clinical judgment is what matters and in that case the guy or gal with more knowledge and more patients under his belt is probably going to be a better provider.  

It's kind of like how I'm willing to bet that I could probably outperform you clinically given that I'm used to working in situations (in and out of hospital; civilian and military) where the scope of practice would make Maryland style ALS look like ARC style first aid.  However, that said, I still meet EMS providers of all ilks (BLS, ALS, RN, EMT-P, EMT-B, first responder, etc) who are sharper than I am.  Included in this list are several members of this forum (Ridryder to name one). 

Hands down the sharpest person I have ever seen clinically was a dairy farmer who never "advanced above" the level of first responder on a volunteer department which ran a whopping 100 or so calls a year.  Even when I was his lieutenant, I looked to him for advice because he had been doing it far longer than I had been alive  and likely longer than you have been alive. Literally, his state certification number had two digits in it that were not precedent place holding zeros; when he finally "retired" he was the longest active EMS provider _in the state_ with something like 40 years of service, just counting the years _after_ EMS was formally organized at the state level.  I'd take his word clinically over most EMS providers I know  and would even seriously reconsider my take on a case if he said "Hey...something's not right here, LT". 

Even our medical director (the one I mentioned before) spoke to him with a respect that was freakishly abnormal for this doc.  I found out when Dave (the first responder) retired, he had been one of the doc's EMS mentors _after he came back from Viet Nam_.   It's an extreme example, but if you want to talk about how frequency of exposure to the back of ambulance being some form of penultimate determinent of prehospital clinical ability,  I think a high school dropout who milked cows for a living and saw one hundred or fewer patients a year is a counterpoint to your argument.


----------



## MrBrown

Brown thinks of it this way .... on the behaviourist level the application of treatment modalities betweeen a barely homeostasasing Parathinktheyare Medicfighter who turned up on the big red "first responder non transporting ALS engine" vs one of our Intensive Care Paramedics or HEMS Doctors will look the same.

But can you really compare the two equally?

Brown would rather work with an ICU RN who has had one day of psychomotor skills training than some of these so called "Paramedics" with ten or twenty years on the job.

Lets face it, if all you have is the two bit Parathinktheyare training special then that is as good as you are ever going to be because that will be your most limiting factor it does not matter how much experience you have.


----------



## CodyHolt83

I just got my basic in December, so I havn't really experienced it with my new certification.  I know where I sit on the food chain of EMS.  If I do something wrong, I expect to be told.  If I do something right, I don't expect anything.  I'm a dispatcher--trained to do things without praise.


----------



## CANMAN

USAFmedic, while I understand your points, I am going to agree to disagree on some things and pretty much leave it at that. We could go back and forth all day long and the bottom line is neither of us truely know each other's backgrounds, training, work history, etc.


----------



## BigPoppa

supergirl534 said:


> personally i deal with way to much.  i work and volenteer with both my agencies being als.  the als providers that think they are higher then GOD and think that i as a BLS provider am on scene to carry there stuff and be their goffer...... there is an easy way to deal with that.  after the call i simply take them aside and talk to them.  i usually take one of the things that they said that were condisending and through it beack in their face and in my exsperience they have realized how much of a jerk that they sounded like.  for those who are still standing on their milk crete thinking they are better than anyone who has walked the earth i go out of my way to prove them wrong.  some people call me a :censored::censored::censored::censored::censored: for it but im okay with that because im not losing any sleep over their ignorence....... but if they really think that they are that good they will lose sleep over the fact that you came to them and talked to them about it .
> 
> good luck some people refuse change!



have any of them told you about a dictionary or a spell checker?


----------



## njff/emt

The majority of the medics I work with are great. There are however afew that I believe don't have the GOD complex but are either having a very bad day or is never in a pleasant mood. For them I ask if they need help with anything and if they say no, I just let them do their job and assist them if they need it. If I feel like they were way out of line of how they treated me and my crew while we were being professional and respectful, I let my director know of the situation to see if we can work things out before it gets out of hand. All in all everybody has a bad day, sometimes more than others. So if they are nasty, after you're done with the job and they're still the hospital try to talk to them and see how they are doing, maybe they just have to vent and got alot of pressure on them. If they still brush you off, oh well at least you tried. Sometimes I think that they bring personal issues into work and things get worse from there. I just try to never take things personal and let it roll off, just some food for thought.


----------



## MediMike

Interesting view points all around  I gotta agree with the unpopular opinion that was mentioned earlier though.  This IS my call. Yes we work together on it, but it is MINE and what I say is whats going to happen. Arrogance? No. Scene management and control.  I will be more than happy to explain my reasoning at a later point, but while we are there I will be making the determination of whether this is an ALS or BLS patient, what the differential diagnosis is, and what the treatment modalities will be.  Now, that being said, I involve my partner to the limit of their skills base and do my best to educate them above and beyond wherever they're at. Me likey teachey.

I also expect my partner, Basic or Medic, to be competent at their level of training.  If I need you to backboard a patient and you don't know how, or are unable to perform competently, we are going to have words.  Want to call that a "god complex"? No, its professionalism and expecting the same in return.  What would you think if I wasn't unable to run that code, start that I.V., or figure out why the pt. was having trouble breathing?

And to whoever was complaining about being a "goffer"...I'm guessing you were aiming at "gopher" "go 'fer" or "go for", that is part of your responsibility on scene, much like a 1st Asst to a Surgeon has a job, I consider my Basics MY 1st Asst.


----------



## KillTank

gposs71 said:


> How do you and your squad deal with medics who think they are flawless and nothing BLS does is good enough?



Good ole Paragod syndrome. 

This cannot be cured. Once and Ego develops it cannot be shut down. 

This is how I handle...

Show respect, If they don't show it back then proceed to be a ****. 

I grew up with the mentality of showing respecting to gain it. I refuse to kiss anyone's butt though. Respect, but show no fear. Know your skills and always be ready to learn. You will never gain any respect jumping in a box and pretending you know everything. Tell your partner you want to learn and I am sure they will be more than happy to teach you. One day you will earn that trust with them and the paragod syndrome will calm. I never had a problem with a paramedic. You gotta let em know respect runs 2 ways but If you are a rookie then you just gotta take the crap as it comes, we all have. ^_^


----------



## VirginiaEMT

gposs71 said:


> How do you and your squad deal with medics who think they are flawless and nothing BLS does is good enough?




You do that by running with them and gaining their trust that you can perform the tasks that they ask of you, like an expert BLS provider.

It feels really good when the medics say that they like running with you because they trust you and your skills.


----------



## Trip

gposs71 said:


> How do you and your squad deal with medics who think they are flawless and nothing BLS does is good enough?



Ok, I have a story I have to share. I work for a company that is staffed with every NYS level (except EMT-I, don't know why...) and hires quite a bit due to demand for IFTs. We hired a Paragod (not my usual term for paramedics, so don't get your panties in a bunch, lol) who decided to get into it with an EMT-D that is usually too bull-headed to back off. In this case, he was in the right (and I *hate* it when I agree with him...) as the Paragod pretty much stated that EMT-D's (Basics) serve no other purpose than to drive the ambulance. He completely forgot that we handle the ABCs so they can handle the more knowledge-intense stuff (i.e. meds, cardiac care, IVs, etc... and it's not that I think Paramedics can't do ABCs, I just believe they have so much more going on for pt care that some of the other things may be inadvertantly overlooked.)

What this Paragod overlooked was that he was the only ALS in the area with 7 EMT-Ds at the table. There was an uprising and he darn near pooped himself.

Anecdote (sp?) aside, I remind them there is no ALS without BLS. ABCs come first. If that doesn't work, we escalate to the higher ups or just put him in his place. Most AEMT-CCs back us on this as well as most of the AEMT-Ps and ORMs. Diplomacy first, try to walk away, if all else fails, let them have it.


----------



## JPINFV

Trip said:


> ABCs come first. If that doesn't work, we escalate to the higher ups or just put him in his place.



...which, of course, when deranged often requires paramedic level interventions. After all, your AED doesn't work on someone who's unstable in SVT or in a 3rd degree AV block.

Being a paragod is just as stupid as the "ABCs, hence BLS, comes first" spiel used by EMTs.


----------



## clibb

My medics let me deal with all of the BLS calls and let me assist with their ALS calls. I have never run into trouble where they have argued with me on scene or afterwards. I like their feedback though, since I don't have too, much experience. I usually tell them to give me a lot of feedback, otherwise I wouldn't learn.


----------



## Trip

JPINFV said:


> ...which, of course, when deranged often requires paramedic level interventions. After all, your AED doesn't work on someone who's unstable in SVT or in a 3rd degree AV block.
> 
> Being a paragod is just as stupid as the "ABCs, hence BLS, comes first" spiel used by EMTs.



I think there was a miscommunication. First, there is no ALS without BLS. The ABCs come first was part of that statement.

The escalate was referring to if the Paragod keeps the attitude, take it to the boss, not regarding when to call for ALS.

Sorry for the confusion.


----------



## rhan101277

KillTank said:


> Good ole Paragod syndrome.
> 
> This cannot be cured. Once and Ego develops it cannot be shut down.
> 
> This is how I handle...
> 
> *Show respect, If they don't show it back then proceed to be a ****.*
> 
> I grew up with the mentality of showing respecting to gain it. I refuse to kiss anyone's butt though. Respect, but show no fear. Know your skills and always be ready to learn. You will never gain any respect jumping in a box and pretending you know everything. Tell your partner you want to learn and I am sure they will be more than happy to teach you. One day you will earn that trust with them and the paragod syndrome will calm. I never had a problem with a paramedic. You gotta let em know respect runs 2 ways but If you are a rookie then you just gotta take the crap as it comes, we all have. ^_^



I personally would just kill them with kindness and try to work it out.  If they continue to be a bad partner, then just let your supervisor know.  No since then you getting grumpy back with them.


----------



## Veneficus

Trip said:


> First, there is no ALS without BLS.



Why do people say this at all?

It has very little relation to reality.


----------



## JPINFV

Trip said:


> I think there was a miscommunication. First, there is no ALS without BLS. The ABCs come first was part of that statement.
> 
> The escalate was referring to if the Paragod keeps the attitude, take it to the boss, not regarding when to call for ALS.
> 
> Sorry for the confusion.




Ok, ABCs comes first. I get that. What, exactly, do you plan on doing with a patient in 3rd degree AV block? This, of course, would fall under the "C" of "ABCs."


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## usalsfyre

There is no medical care without, well, medical care is closer to reality.


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## alphatrauma

trip said:
			
		

> there is no ALS without BLS





Veneficus said:


> Why do people say this at all?
> 
> It has very little relation to reality.



Was having this discussion the other day... perhaps it is for the sake of morale :glare:


----------



## Trip

JPINFV said:


> Ok, ABCs comes first. I get that. What, exactly, do you plan on doing with a patient in 3rd degree AV block? This, of course, would fall under the "C" of "ABCs."



Ok, this is getting ridiculous. Again, I am not questioning when to call for ALS as an AED can not be used to pace, as well as setting an SCT or LifePak to pace a pt is outside of the scope of a basic, at least here it is. Chest compressions until ALS arrives, is within my scope. No airway? No pt. No breathing? No pt. No *C*irculation? No pt. I can't do anything within my scope of practice to pace a pt other than chest compressions. _THIS_ was never in question. If I had a pt in 3rd degree AV block, I wouldn't have the gear on my rig to determine that. I would however be able to determine the blood is not Circulating properly and do what I was trained to do until ALS arrives. No question, CC or Paramedic necessary.

And the ALS without BLS goes to that every medic at any level has to verify/monitor/maintain airway, breathing and circulation, not just ALS providers, but Basics as well. The difference comes as to what steps each level can perform. It's not just a morale thing.

The issue, to say it again, was not when to escalate a pt from BLS to ALS, but when to tell the boss that the Paragod was too big for his britches when it comes to snubbing EMT-Ds. We are their support, not just there to drive the ambulance and take their abuse.


----------



## JPINFV

Trip said:


> The issue, to say it again, was not when to escalate a pt from BLS to ALS, but when to tell the boss that the Paragod was too big for his britches when it comes to snubbing EMT-Ds. We are their support, not just there to drive the ambulance and take their abuse.



See, I have a few problems. 

What's wrong with driving? It seems to be an integral part of EMS. It's like CNAs complaining about wiping butt. You know what, if I have a family member in the hospital or (starting in June) when my patients are in the hospital, someone wiping their butt tends to be extremely important. In fact, life saving important. It might not be savory, but, be it butt wiping or ambulance driving, it's exceedingly important. A better tactic would be owning it. "Yea, one of the things I do is drive, but it's better than crashing into your family on a transport." The only reason why it has power in the first place is because you give it power as a negative. 

However, the paragod tends to be constantly pared up with EMT-Hero, and both are exceedingly stupid. You're an EMT. Outside of patient packaging and driving, there really isn't much you can do in a patient that doesn't "need" a paramedic. CPR? Needs a paramedic on the off chance of ROSC. Outside of that, it just needs someone who can push fast on the chest and run an idiot box (on a side note, I'd love it if someone made an AED for EMS that didn't include voice instructions). Neither of those are restricted acts, as can be seen by public access defibrillators. The vast majority of what EMTs do are rather simplistic, over used, or not really effective. Normally a combination of at least 2 of those. Saying "Yea, we're better than driving" is like a McDonalds employee complaining that Gordon Ramsay isn't giving him respect because their both "chefs." 

The unfortunate fact is that, given the limited scope of practice,the most important job an EMT does is drive, regardless of EMT/EMT or EMT/Paramedic crewing as that's the one thing that EMTs do that can kill the patient if done incorrectly. The problem with paragods is that they tend to shove the EMT's face in it, which is completely unnecessary the vast vast majority of the time.


----------



## Trip

JPINFV said:


> See, I have a few problems.
> The unfortunate fact is that, given the limited scope of practice,the most important job an EMT does is drive, regardless of EMT/EMT or EMT/Paramedic crewing as that's the one thing that EMTs do that can kill the patient if done incorrectly. The problem with paragods is that they tend to shove the EMT's face in it, which is completely unnecessary the vast vast majority of the time.



There's nothing wrong with driving. But not all rigs are EMT/EMT or EMT/Paramedic. My fire department, as with many, are BLS level. The drivers tend not to be EMTs and are often not even CPR/AED trained. No epi, no aspirin, not even O2 without an EMT-D or higher telling them to. Using your reasoning, anyone can drive an ambulance.

I'm out. Think what you will. The issue was Paragod syndrome, not ALS vs BLS.


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## usafmedic45

> The drivers tend not to be EMTs and are often not even CPR/AED trained.



In a lot of states, that's illegal although I see no inherent problem with it so long as you run a three person crew.



> The issue was Paragod syndrome, not ALS vs BLS.



Unfortunately those two are inexorably tied.



> There's nothing wrong with driving.



I think you completely misunderstood what he was trying to say.


----------



## Trip

Trip said:


> I'm out. Think what you will. The issue was Paragod syndrome, not ALS vs BLS.



 Sorry, didn't mean ALS vs BLS, meant "The issue was Paragod syndrome, not when should BLS call for a CC or Paramedic."

And NY volunteers don't need CPR/AED cert to drive as long as one person that is with the pt is certified, ie an EMT-D or higher.


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## Madmedic780

Luckily with my dept, theres only one paramedic that I routinely work with that has the P-Patch Pathology. He's fairly new to EMS, (Went from basic to Paramedic school in under a year) so I deal with it. The hilarious part is the other medics who won't hesitate to rip him a new one if they see him ragging on our Basics and FRs. 

But as it was pointed out, in a P/B team the paramedic is ultimately responsible for the care rendered by us, it will be their clinical judgement that is examined in court. The best thing to do IMHO is to talk to the medic and try to establish a mutual agreement about what they expect and how you want to treat each other. Some of the best crews and teams I've seen act like a old married couple.


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## kbrodie694

seems like those people are the ones who always make mistakes and don't learn from them so you try and teach them to step back and listen to others around them, sometimes it is a matter of letting them get chewed on by the chief after a screw up!


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## 46Young

I didn't read much of this thread, but I felt the need to point out that such saying as "BLS before ALS" and "EMT's save medics" make no sense. The medic's title is EMT-P. We know how to do BLS; it was required to learn BLS before we moved up to medic. My medic partner can do all the BLS that an EMT can, in addition to the ALS assessment and skills. In the NYC 911 system, it's often just the two medics on the scene by themselves. No one's saving them, and the BLS gets done before we drop a lock and push meds. What's the issue? EMT's are useful, they have their place, but their scope is limited. It doesn't give the medic the right to s*** on them, but the EMT needs to know their boundaries. In many medic/EMT txp systems, the EMT is basically performing tasks for the medic. It's not to belittle the EMT, but they lack the education and skills to have much of a say in pt care, unless the medic is weak and is neglect in performing a basic diagnostic or intervention before moving on. 

It's like when you test for your medical or trauma scenario - you have a few partners, be they imaginary or real for the evaluation. You're ordering vitals, C-spine, bleeding control, assisted vents, a NRB, etc. That's kind of how the medic runs the scene. They need various tasks and assessments completed, not someone of a lower cert level offering opinions as to the pt's treatment course. When managing the scene, that doesn't give the medic the right to belittle the EMT's, however. If you run your scenes like that, you'll lose confidence from your crew (or other responders), you'll lose respect, and they'll look to help you as little as possible, and maybe even try to jam you up.

Edit: At the EMT-P level, I don't really see pt care as "BLS" or "ALS." There's no division. It's all pt care. Some assessments and interventions are always going to come before others. I only use "ALS" to define the point where the EMT-B's scope and abilities end.


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## Jon

As has been said - the issue is Paragods and EMT-Heros.

I'm a paramedic. I went to school for it. I passed my tests. I maintain my merit badge certs, pursue con-Ed, maintain medical command status with multiple services, and try to keep learning.

Just because I don't do things exactly the same as another medic doesn't mean I'm not a good medic. And *****ing and belittling me behind my back because you don't understand the whole picture - that's not teamwork. If I say I want a 12/15 lead - I've got reason for it. Yup. I know the patient isn't having chest pain.

It goes the other way too. I still volunteer on a BLS truck. When I get a Paragod as my ALS provider, it's frustrating.


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## Veneficus

I would just like to share an anecdote that happened the otherday that I think ties into this.

We started our day with grand rounds as usual. One of my classmates noticed a crucifix in the ward.

Next we went to the out pt clinic where again we saw a crucifix on the wall.

Another in the hall and 2 in the ICU.

But it was then noticed there was not one in the operating theatre. To which it was remarked in jest that in C/T surg, God stands at the table, not on the wall.

Now on to the OP.

In medicine, the earlier and more simple one's education, the more absolute things are presented. Providers are trained there is only one right thing to do and only one proper way to do it. 

It is presented that way to dissuade people from taking shortcuts that may be harmful or defeat the original purpose.

I am not interested in the quality of education except to say they is a very disproportionate difference between EMT and medic material. Not respecting that difference is where the problems come from the EMT end. They only see skills, they cannot see thought process, so they are usually oblivious to it. Eventually they see the skills so often they believe they could do it themselves. Their criticism is from their perspective of absolute right and wrong, what and how things "should be done."

From the medic perspective, it is important to continue the education of the EMTs and always remember to take an active role in that by explaining the thought process as soon and as often as practically possible. Empty criticism does get very old no matter what your title or role. 

If you notice, a vast majority of providers of all titles are eager to learn why as well as teach their perspective. It is only with this collaboration that the art of patient care is advanced.  

It took me a few years to figure out that all healthcare providers are teachers by default. No matter what your position, talk before you criticize.


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## RiverpirateEMT

Luckly Ive never had to run with a paramedic with an attitude. Although I do know a few. Best way for a EMT-B to deal with them? Ignore them. If they have the attitude that a EMT-B is just a ambulance driver then be just a ambulance driver to them. I have no problem going to work and just driving. Im not paid much to begin with , lol. A medic that wants my help will show respect to get my help, otherwise he can bring it up to the supervisor and let the supervisor deal with it. A paramedic that complains about multiple EMT-B's not wanting to help him/her obviously shows who is the problem.
I know my limit when it comes to knowledge ( I am in nursing school right now ) but as with any job, it takes respect to get respect. The medics I run with are all great. They are willing to teach and willing to answer questions, they also are willing to step back and let me do my job sometimes because they know without EMT-B's their job is much harder.


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## reaper

RiverpirateEMT said:


> Luckly Ive never had to run with a paramedic with an attitude. Although I do know a few. Best way for a EMT-B to deal with them? Ignore them. If they have the attitude that a EMT-B is just a ambulance driver then be just a ambulance driver to them. I have no problem going to work and just driving. Im not paid much to begin with , lol. A medic that wants my help will show respect to get my help, otherwise he can bring it up to the supervisor and let the supervisor deal with it. A paramedic that complains about multiple EMT-B's not wanting to help him/her obviously shows who is the problem.
> I know my limit when it comes to knowledge ( I am in nursing school right now ) but as with any job, it takes respect to get respect. The medics I run with are all great. They are willing to teach and willing to answer questions, they also are willing to step back and let me do my job sometimes because they know without EMT-B's their job is much harder.



Well you had a great post, right up until the last sentence!


----------



## RiverpirateEMT

reaper said:


> Well you had a great post, right up until the last sentence!



In all truthfullness Medics need EMT-B's. Who does their grunt work? Who drives them ? Who gets them the things they need? Who does the lifting for them? Who carries all their bags? A medic can not do it on their own period. They either need an EMT or a Fire fighter. My job is to make their job easier. Sometimes a medic just needs to step back and let us EMT-B's do our job. Get the patient in the rig , get them set up for the medic and let us get them to the hospital. Face it a medic can not do it alone no matter how much some ( and I mean some not all ) think they can. 
I dont claim to know a 10th of what a medic does , but I know what I need to do serve my patient and that is to get them to the hospital  no matter what.


----------



## 46Young

RiverpirateEMT said:


> Luckly Ive never had to run with a paramedic with an attitude. Although I do know a few. Best way for a EMT-B to deal with them? Ignore them. If they have the attitude that a EMT-B is just a ambulance driver then be just a ambulance driver to them. I have no problem going to work and just driving. Im not paid much to begin with , lol. A medic that wants my help will show respect to get my help, otherwise he can bring it up to the supervisor and let the supervisor deal with it. A paramedic that complains about multiple EMT-B's not wanting to help him/her obviously shows who is the problem.
> I know my limit when it comes to knowledge ( I am in nursing school right now ) but as with any job, it takes respect to get respect. The medics I run with are all great. They are willing to teach and willing to answer questions, they also are willing to step back and let me do my job sometimes because they know without EMT-B's their job is much harder.



Well said! "It takes respect to get respect." Like I said, as a crew leader, you have to gain the confidence of your crew. Respect comes with that. If you're a d-bag, your crew will just underperform, or even look to sabotage you. If you forget to order the BLS to resume compressions after a pulse check or shock, they'll just sit there. They may apply a mask, and "forget" to turn on the O2. They may hand you the wrong med. They may stand around and do nothing unless you explain in detail what they should do. A good crew will start getting your vitals, hook up the monitor, opening then O2 and asking how you want to give it, they may already be getting the stair chair, without you having to say anything. If you treat them badly, they'll just stand around with their hands in their pockets. The station's a very lonely place if everyone ignores you.

Edit: Yes, medics ahould teach EMT's whenever possible. If I'm asked a question on the scene, I tell them that we're busy now, but I'd be happy to explain everything after we drop the pt off. We hold regular drills at the station and try and up the EMT's knowledge with every session.


----------



## reaper

RiverpirateEMT said:


> In all truthfullness Medics need EMT-B's. Who does their grunt work? Who drives them ? Who gets them the things they need? Who does the lifting for them? Who carries all their bags? A medic can not do it on their own period. They either need an EMT or a Fire fighter. My job is to make their job easier. Sometimes a medic just needs to step back and let us EMT-B's do our job. Get the patient in the rig , get them set up for the medic and let us get them to the hospital. Face it a medic can not do it alone no matter how much some ( and I mean some not all ) think they can.
> I dont claim to know a 10th of what a medic does , but I know what I need to do serve my patient and that is to get them to the hospital  no matter what.



Well, this is the thinking that gets you in trouble. I carry my own equipment. Double medic trucks work just fine. I work a QRV. I am by myself on scene for long periods of time, all alone. I do just fine by myself.

A good EMT is nice to have as a partner and we should always respect them as a partner. But, when you think that EMS cannot work without you, then you get in trouble. Do the job, hold mutual respect for each other and learn all you can. That is what will make you stand out above the rest!


----------



## 46Young

RiverpirateEMT said:


> In all truthfullness Medics need EMT-B's. Who does their grunt work? Who drives them ? Who gets them the things they need? Who does the lifting for them? Who carries all their bags? A medic can not do it on their own period. They either need an EMT or a Fire fighter. My job is to make their job easier. Sometimes a medic just needs to step back and let us EMT-B's do our job. Get the patient in the rig , get them set up for the medic and let us get them to the hospital. Face it a medic can not do it alone no matter how much some ( and I mean some not all ) think they can.
> I dont claim to know a 10th of what a medic does , but I know what I need to do serve my patient and that is to get them to the hospital  no matter what.



Every medic needs a partner. In NYC it was another medic. In Charleston SC it was an EMT. Where I am now, it's usually another medic and 3-4 BLS. Unless the pt is crashing, the one medic will talk with the family, the other medic will get L/S and ask questions, and the BLS pretty much know what to do otherwise. For most pts, they'll ask if I want O2 and how, when and how to move them, and that's about it. I don't have to manage them otherwise. They introduce themselves appropriately, explain what we're doing and what to expect, get vitals, BGL if appropriate, monitor, proper positioning, and generally make them as comfortable as possible and try to put them at ease. In the bus, they're hooking the pt back up to the monior, pulse ox, ETCO2, BP cuff, O2, asking if I want a bag spiked, or maybe preparing my IV materials and a chuck pad for under the arm in case I blow the tamponade. My job is eay thanks to the BLS crew that I have.


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## RiverpirateEMT

reaper said:


> Well, this is the thinking that gets you in trouble. I carry my own equipment. Double medic trucks work just fine. I work a QRV. I am by myself on scene for long periods of time, all alone. I do just fine by myself.
> 
> A good EMT is nice to have as a partner and we should always respect them as a partner. But, when you think that EMS cannot work without you, then you get in trouble. Do the job, hold mutual respect for each other and learn all you can. That is what will make you stand out above the rest!



Doesnt happen like that in my state. Your either a MICU or in a chase truck by yourself. Our medics carry two heavy bags plus a monitor. They "can" carry it by themselves but not likely to.  Again Id like to see a medic load a 300lb person in the back of a ambulance by themself. 
Just remember no one person is any better than another. One may be better learned , but that does not make them a better person.


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## johnmedic

It seems to me that the Medics are saying two medics on a team are better than a medic and an emt. Meanwhile the Basics's are saying a medic and an emt is better than just a medic.

Both are correct.

Are we done now?


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## JPINFV

RiverpirateEMT said:


> In all truthfullness Medics need EMT-B's. Who does their grunt work? Who drives them ? Who gets them the things they need? Who does the lifting for them? Who carries all their bags? A medic can not do it on their own period. They either need an EMT or a Fire fighter.



...or, they could be partnered with another medic...


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## usalsfyre

johnmedic said:


> It seems to me that the Medics are saying two medics on a team are better than a medic and an emt. Meanwhile the Basics's are saying a medic and an emt is better than just a medic.
> 
> Both are correct.
> 
> Are we done now?



Two well rounded medics where one is the clear lead probably makes the most effective crew configuration. 

Barring that, a well rounded medic and an EMT is probably a  better combination than two "parathinktheyares" (thanks Brown) where no one is in charge.


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## EMS49393

RiverpirateEMT said:


> In all truthfullness Medics need EMT-B's. Who does their grunt work? Who drives them ? Who gets them the things they need? Who does the lifting for them? Who carries all their bags? A medic can not do it on their own period. They either need an EMT or a Fire fighter. My job is to make their job easier. Sometimes a medic just needs to step back and let us EMT-B's do our job. Get the patient in the rig , get them set up for the medic and let us get them to the hospital. Face it a medic can not do it alone no matter how much some ( and I mean some not all ) think they can.
> I dont claim to know a 10th of what a medic does , but I know what I need to do serve my patient and that is to get them to the hospital  no matter what.



Wow!  Apparently paramedics are not the only ones with bad attitudes.  You might want to check yours at the door.


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## Shishkabob

RiverpirateEMT said:


> Again Id like to see a medic load a 300lb person in the back of a ambulance by themself.



I can, have, and do.




RiverpirateEMT said:


> In all truthfullness Medics need EMT-B's. Who does their grunt work? Who drives them ? Who gets them the things they need? Who does the lifting for them? Who carries all their bags? A medic can not do it on their own period.



I carry my own bag.  I carry my own monitor.  I clean up my own mess in the ambulance.


When I first work with an EMT, I tell them they have their own certification and that they can do any and everything that their protocols allow without worrying about asking me... though I make the exception about giving drugs for the fact that it might change what I do.



> Sometimes a medic just needs to step back and let us EMT-B's do our job. Get the patient in the rig , get them set up for the medic and let us get them to the hospital.


  What if the patient doesn't need to go to the rig, get set up, or go to the hospital?  What's the EMTs job then, in your eyes?


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## CAOX3

How about putting attitudes and ego aside and working together towards the ultimate goal?

I have an eighteen-month old, if you choose to act like her you will be treated accordingly, I dont care what level you are.

Attitude and egos have nothing to do with certificatin level, its a personality flaw, respect is earned and goes both ways.


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## usalsfyre

It's entirely possible for me to take care of a patient that requires advanced care (with in the realms of EMS, none of the care we provide is really advanced in the grander scheme) by myself with the exception of lifting help. I've done it with some of the more booger-eating partners I've had. That said, it's massively easier to do my job with a strong partner I don't have to worry about. This is the reason I try like hell to take care of my current partner. 

Taking care of a patient that requires advanced care is not something a Basic can do by themselves. THAT said, I know of basics that have to hold their medics hand to ensure the proper care gets done. Neither one is anything close to ideal. 

Both sides usually have something to offer. However, as I mentioned earlier, at the end of the day I answer for what goes on. So if I correct a basic, it's not because I think they're stupid, it's because I have to answer for it (not to mention I've probably got a reason for doing it the way I do, based on problems in the past). Both sides should approach the issue with mutual respect in mind as it will make the day go much smoother. However, the medic is the _defacto_ supervisor.

Another example would be although a physician may not appear in a nurses organizational chart, at the end of the day the physician is responsible. Doesn't mean the nurse is dumb, can't operate independently based on orders, or has no insights to patient care. Just means there's someone in charge. Just like medics, some physicians are bigger jack@sses than others. It's worked well for the rest of medicine for a long time, why not here?


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## 46Young

johnmedic said:


> It seems to me that the Medics are saying two medics on a team are better than a medic and an emt. Meanwhile the Basics's are saying a medic and an emt is better than just a medic.
> 
> Both are correct.
> 
> Are we done now?



An extra set of hands can only help a lone medic. That's obvious. If that person is also a medic, then they are more useful. If you have two medics and a couple of basics, it works even better still. Everyone is a valued resource.


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## CAOX3

I think it may have something to do with the design of your system, in a PB system I would imagine some EMTs are looking for acceptance and approval from their medic partner, the medic takes on more of a preceptor role and at times the medic is going to have to put his foot down, the EMT never has to make treatment or transport decision they have a safety net. In a tiered system the EMT is soley responsible for all decisions, he works autonomously 85 percent of the time, on most occasions they will never see a medic.  Its easier for me to turn over all responsibility to the medics when they arrive because I understand the complaint is beyond my reach.

 I'm not looking for approval, acceptance, friend or anything I'm looking for whats in the best interest of the patient, the medic provides that when he arrives

I have no problem carrying bags or cleaning up a mess, while the medics tend to the patient its called professionalism, I don't have an ego problem nor do most of the ALS providers I work with, if the call dictates I carry the bags, clean the mess or stand on one foot and recite a nursery rhyme (LONG STORY) that's fine.

We are all part of a team, the duties we perform change from call to call my goal which is whats in the best interest of the patient never does and if ego or attitude ever gets in the way of that its time for a career change.


----------



## usalsfyre

CAOX3 said:


> I think it may have something to do with the design of your system, in a PB system I would imagine some EMTs are looking for acceptance and approval from their medic partner, the medic takes on more of a preceptor role and at times the medic is going to have to put his foot down, the EMT never has to make treatment or transport decision they have a safety net. In a tiered system the EMT is soley responsible for all decisions, he works autonomously 85 percent of the time, on most occasions they will never see a medic.  Its easier for me to turn over all responsibility to the medics when they arrive because I understand the complaint is beyond my reach.
> 
> I'm not looking for approval, acceptance, friend or anything I'm looking for whats in the best interest of the patient, the medic provides that when he arrives
> 
> I have no problem carrying bags or cleaning up a mess, while the medics tend to the patient its called professionalism, I don't have an ego problem nor do most of the ALS providers I work with, if the call dictates I carry the bags, clean the mess or stand on one foot and recite a nursery rhyme (LONG STORY) that's fine.
> 
> We are all part of a team, the duties we perform change from call to call my goal which is whats in the best interest of the patient never does and if ego or attitude ever gets in the way of that its time for a career change.



Important distinction, I work in a P/B crew configuration. MOST of the time when I have an issue with an EMT it's over second guessing treatment in an inappropriate manner, such as "do we really need one" in response to a 12 lead, or "why can't we just no ride/take them to doc in the box local ED/call HEMS" when I want to transport to a tertiary center. Another favorite is "my regular partner doesn't do that" when their regular partner is often a lazy mouth-breathing, window-licking excuse of a paramedic. It's VERY easy to second guess and armchair quarterback when you have very little responsibility and often times are clueless as to the intricacies of what's going on. 

In a tiered system where Basics actually do have a fair bit of responsibility I would imagine there's fewer issues.


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## Veneficus

usalsfyre said:


> In a tiered system where Basics actually do have a fair bit of responsibility I would imagine there's fewer issues.



It has been my experience that this is the case. However, because the basics have far more direct patient care and some time being in charge of patient care, they have considerably more employer provided training as well as command skills that basics who always have and work with a medic lack.

From my perspective, a great basic is like a great NCO, they are not the Captain, they know they are not and don't pretend to be. But they are great at performing the tasks that make the whole operation run smoothly.


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## usalsfyre

Veneficus said:


> From my perspective, a great basic is like a great NCO, they are not the Captain, they know they are not and don't pretend to be. But they are great at performing the tasks that make the whole operation run smoothly.



Great way of putting it into words.


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## DrParasite

you know what's amazing?  all you paramedics are stupid.  Just ask MrBrown or Veneficus or anyone in medical school, you really don't know anything, your education is laughable, and you can't do anything without a doctor holding your hand (at least that is what they always say).  Hell, there are other US paramedics (on this board!!!) who say the same thing.  

and the secret truth of EMS is that prehospital ALS has minimal impact on patient mortality rates (and no, I don't have the study in front of me, but I am sure someone has read it and will stomp their feet that the research doesn't apply to them).  Helicopter EMS is in the same boat.

The other secret truth is outside of a cardiac or respiratory most medics can't do much.  In a major trauma, they have no beneficial effect http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522139/  and the bulk of EMS calls aren't cardiac or respiratory in nature.

Now EMTs?  120 hours is pretty pitiful.  of course you can combine all the con ed training (pepp, phtls, ics, START, GEMS, and every other course you can name) and you can get it to between 250 and 500 hours.  college level courses can help (A&P I & 2 can be useful if you have a decent prof, and I enjoyed Bio 1 & 2, but Organic Chem did make my brain hurt), but the biggest advantage Paramedics have is their clinical time, where they can screw up as a student under the supervision of a senior paramedic instructor, while an EMT is given her or her card and cut free (sans the clinical experience under an experienced provider).

Do some medic's have attitudes?  you betcha.  are some EMTs retarded?  you betcha.  are some medic's retarded?  you betcha.  do some EMTs have attitudes?  you betcha.  And just like some medic's don't respect EMTs, some EMTs don't respect medics.  an ignorant *** is still an *** whether it be an EMT or paramedic.

There are some medics that don't respect me.  There are some that don't respect any BLS provider. There are some paramedics I don't respect. there are some paid BLS providers that don't respect volunteer providers.    I do my job and go home, I have enough confidence in myself and my abilities to not give a F*ck if someone respects me or likes me.  and I refuse to kiss *** to be more liked by certain providers.

I know what I can manage on my own, based on my training, and when I need to call for help.  and I have no problems calling for ALS if they can benefit the patient, or cancelling ALS if the patient needs definitive care in an ER, not a paramedic who can only do so much.  I have activated BAT teams on my own, trauma teams, and just once I even notified the ER I had a patient who was having an MI, despite not having a paramedic on my truck, and he was treated by the ER staff based on my dumb EMT's report.  Would a paramedic have helped?  well, considering I was arguing with a paramedic with 10 years experience who didn't want to call a brain attack on a patient as we were transporting to the hospital, I don't know.  BTW I finally convinced her partner to call it, and the follow up on the patient showed she was having a massive bleed in her head, and the ER had orders to intubate and send her to the Neuro ICU.

and while I'm sure I pissed off the paramedics here, a) I don't care and b) paramedics are a valuable resource that should be used correctly.  Sick patients who need them should get them; but if for some reason they can't get them, than BLS should know what do do.  EMTs should NOT need a paramedic in order to operate they should have enough knowledge of the situation to know what is going on, and what they need to do.  and even paramedics miss things and do make mistakes (I know this might shock some people)

geez, we all have EMT in front of our cert/license (although EMT-Paramedics seem to forget that, and that they were once dumb (sometimes even volunteer) EMTs ones).  working together is often a lot more effective than fighting each other.  and lets also try to remember, it's supposed to be all about patient care, not the egos of individual providers.


----------



## Shishkabob

DrParasite said:


> geez, we all have EMT in front of our cert/license (although EMT-Paramedics seem to forget that,).



In, what, a year, we won't have EMT infront of Paramedic anymore.  And heck, some places already don't have EMT infront of Paramedic.




DrParasite said:


> The other secret truth is outside of a cardiac or respiratory most medics can't do much.  In a major trauma, they have no beneficial effect http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522139/  and the bulk of EMS calls aren't cardiac or respiratory in nature.



According to that study, doctors are even worse than Paramedics... with a much bigger difference between Physician and medic (11%) than medic and EMT(6%).



> The overall mortality rates by type of on-site personnel were physicians 35%, paramedics 24%, and EMTs 18%


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## JPINFV

DrParasite said:


> you know what's amazing?  all you paramedics are stupid.  Just ask MrBrown or Veneficus or anyone in medical school, you really don't know anything, your education is laughable, and you can't do anything without a doctor holding your hand (at least that is what they always say).  Hell, there are other US paramedics (on this board!!!) who say the same thing.



Are you arguing that the education currently required for EMTs and paramedics in the US is appropriate? If not, why complain about people arguing that the current requirements are not enough?

Additionally, where has anyone said that hand holding must occur?



> and the secret truth of EMS is that prehospital ALS has minimal impact on patient mortality rates (and no, I don't have the study in front of me, but I am sure someone has read it and will stomp their feet that the research doesn't apply to them).  Helicopter EMS is in the same boat.
> 
> The other secret truth is outside of a cardiac or respiratory most medics can't do much.  In a major trauma, they have no beneficial effect http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522139/  and the bulk of EMS calls aren't cardiac or respiratory in nature.


Minus transport, which doesn't even need EMTs, is there any evidence that "BLS" has benefits in the sense of life saved?

Additionally, the vast majority of studies are relatively flawed in the sense that they only look at survived/died. How about instances where hospital stay is decreased? How much is the relief of suffering worth? Sure, the patient with reactive airway disease will most likely survive just fine in urban and suburban areas for that 10 minute ride to the hospital sans beta agonists. How much is relieving the shortness of breath sooner worth? Same with pain management. Prehospital pain management doesn't save lives, but it's a service worth having if providers are already properly educated to provide it. 



> Now EMTs?  120 hours is pretty pitiful.  of course you can combine all the con ed training (pepp, phtls, ics, START, GEMS, and every other course you can name) and you can get it to between 250 and 500 hours.  college level courses can help (A&P I & 2 can be useful if you have a decent prof, and I enjoyed Bio 1 & 2, but Organic Chem did make my brain hurt), but the biggest advantage Paramedics have is their clinical time, where they can screw up as a student under the supervision of a senior paramedic instructor, while an EMT is given her or her card and cut free (sans the clinical experience under an experienced provider).


What about people who don't have those merit badge CMEs?

Should patients suffer because their EMTs are fresh out of class and the course work relies, in part, on providers taking a few years to get appropriate CMEs to cover pertinent education not covered in class?





> geez, we all have EMT in front of our cert/license (although EMT-Paramedics seem to forget that, and that they were once dumb (sometimes even volunteer) EMTs ones).  working together is often a lot more effective than fighting each other.  and lets also try to remember, it's supposed to be all about patient care, not the egos of individual providers.



Actually, the national standards have changed and it's no longer EMT-paramedic. NREMT just hasn't implemented it yet.


----------



## DrParasite

Linuss said:


> In, what, a year, we won't have EMT infront of Paramedic anymore.  And heck, some places already don't have EMT infront of Paramedic.


I'll believe it when I see it.  There is always talk.  I am also curious if the EMT certification will be removed as a prereq to becoming a paramedic.


Linuss said:


> According to that study, doctors are even worse than Paramedics... with a much bigger difference between Physician and medic (11%) than medic and EMT(6%).


you are absolutely right.  a trauma patient needs bright lights and cold steel, not prehospital ALS interventions; the exception being if there is an ABC problem,and even then if an OPA and BVM are doing the job, don't mess around intubating.


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## JPINFV

DrParasite said:


> I'll believe it when I see it.  There is always talk.



Ask and ye shall receive. 

http://ems.gov/pdf/811077a.pdf

and

http://www.nhtsa.gov/people/injury/ems/EMSScope.pdf

and

http://www.nremt.org/nremt/downloads/Newsletter_2009.pdf


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## samiam

NREMTroe said:


> Going back to the license and certification thing, didn't they change the EMT "certification" to a license now? I mean I don't want to start anything because believe me I won't be staying an EMT for long, paramedic school starts in August and I will be in that class. It just seems like there is a lot of bickering lately, and it shouldn't be like that.



In michigan MFR, EMT-P and EMT-B are all "licenses" for legal purposes.


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## DrParasite

JPINFV said:


> Ask and ye shall receive.
> 
> http://ems.gov/pdf/811077a.pdf
> 
> and
> 
> http://www.nhtsa.gov/people/injury/ems/EMSScope.pdf
> 
> and
> 
> http://www.nremt.org/nremt/downloads/Newsletter_2009.pdf


ummmm, yeah, those are the proposals..... they have been kicked around for a while, and discussed, but never actually implemented by a national EMS governing body, or each 50 state's EMS regulatory agencies.

even the national scope of practice, while is good, isn't adopted by all 50 states..


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## JPINFV

Yea... and the old National Standard Curriculum wasn't adopted by all 50 states, but it is now the standard for the NHTSA (which is as close as you're going to get to a national EMS governing body). These are the closest you'll find to national standards. Many states are adjusting their standards to meet them, including the more often than not behind the times State of California. 

Oh, and the last one from the NREMT isn't being proposed, it's currently being implemented. 


So, what's your source that there's a national governing body still using EMT-P" or that all 50 states use the designation "EMT-P" now that the old National Standard Curriculum is no longer the guiding document from the federal level?


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## MrBrown

DrParasite said:


> you are absolutely right.  a trauma patient needs bright lights and cold steel, not prehospital ALS interventions



Ask any surgical registrar, they will tell you trauma is increasingly a non surgical disease.

Does that mean stay on scene and wongle your dongle? No but it doesn't mean every trauma patient is going to get surgery.


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## CAOX3

DrParasite said:


> you know what's amazing?  all you paramedics are stupid.  Just ask MrBrown or Veneficus or anyone in medical school, you really don't know anything, your education is laughable, and you can't do anything without a doctor holding your hand (at least that is what they always say).  Hell, there are other US paramedics (on this board!!!) who say the same thing.
> 
> and the secret truth of EMS is that prehospital ALS has minimal impact on patient mortality rates (and no, I don't have the study in front of me, but I am sure someone has read it and will stomp their feet that the research doesn't apply to them).  Helicopter EMS is in the same boat.
> 
> The other secret truth is outside of a cardiac or respiratory most medics can't do much.  In a major trauma, they have no beneficial effect http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522139/  and the bulk of EMS calls aren't cardiac or respiratory in nature.



Most of this post is laughablle at best.

Maybe you should have prefaced this with "your medics."

I havent ssen a paramedic call for orders in fifteen years.

If your system still bases treatment on who survives then you should run, it hasnt been about survival rates in decades. 

If you havent witnessed the benefits an educated and experienced medic brings the table your either not looking or dont care to know.

I love the trauma refrences also, ever witness a decompression, surgical cric,  the list goes on.  There is plenty that can be done by an ALS provider to change the mortality rates of traumatic injuries, but the medics have to be on their game and from your tone Im guessing yours are not.


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## DrParasite

CAOX3 said:


> Most of this post is laughablle at best.


the first paragraph was intended to be laughable





CAOX3 said:


> Maybe you should have prefaced this with "your medics."


actually, I am basing that based solely on what I read on this forum.  Many of the medics I know are pretty good, many are extremely knowledgeable, and the experienced ones are good at what they do.  I guess it helps that every NJ medic has a degree behind them.


CAOX3 said:


> I havent ssen a paramedic call for orders in fifteen years.


cool.  Neither here nor there, but cool. Sidenote: I know some EMTs who haven't called for paramedics in 10 years. Doesn't mean they were right just that they chose not to do it.





CAOX3 said:


> If your system still bases treatment on who survives then you should run, it hasnt been about survival rates in decades.


really?  so all these studies by doctors and research specialists are wrong?  and here I was thinking medicine was about not killing people.  imagine my shock to learn that all the evidence is, well, not evidence at all, and there is no proof.  Anecdotal (which is "I think is the best thing to do because I say it is") is the way to go!!!!!  I can't wait for the research community to pick that up.


CAOX3 said:


> If you havent witnessed the benefits an educated and experienced medic brings the table your either not looking or dont care to know.


I didn't say that.  In fact, the entire first paragraph was sarcasm based on what others say.


CAOX3 said:


> I love the trauma refrences also, ever witness a decompression, surgical cric,  the list goes on.  There is plenty that can be done by an ALS provider to change the mortality rates of traumatic injuries, but the medics have to be on their game and from your tone Im guessing yours are not.


Actually a surgical cric and chest decompression are two amazing procedures that paramedics can do.  you truly are saving someone's life with your intervention, and yes, I have seen it done.  my medics are on their game, and typically only treat sick patients, so their skills aren't diluted by BS.  and what other items are on your "list that goes on" that a paramedic can do for a trauma patient that will save his or her life?

But lets be honest, how many chest decompressions and crics does your typical medic do a year?  maybe 12?  once a month?  maybe 6 a year?  1  year, if that?  So if do you something maybe once a year, is it really good support for your argument?

Some in EMS are trying to move toward evidence based medicine.  Using research to show was works and what doesn't.  And yet, you want to ignore the evidence using skills that are used on maybe 1% of patients to support your position?

well done good sir, you have convinced me.


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## usalsfyre

Focusing solely on mortality is only half the picture, although it greatly suits basics who argue to keep the status quo. Tell me DrParasite, how much can a basic due to reduce morbidity and ease pain and suffering?


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## CAOX3

usalsfyre said:


> *Focusing solely on mortality is only half the picture,* although it greatly suits basics who argue to keep the status quo. Tell me DrParasite, how much can a basic due to reduce morbidity and ease pain and suffering?



Apparently in New Jersy its the whole picture.


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## Handsome Robb

If you are so anti-EMS Dr. Parasite, why do you stick around this site? If EMS was not useful, you'd think that they would have done away with it years ago. We must make a difference, otherwise why pay us to do this job?


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## 46Young

usalsfyre said:


> Focusing solely on mortality is only half the picture, although it greatly suits basics who argue to keep the status quo. Tell me DrParasite, how much can a basic due to reduce morbidity and ease pain and suffering?



Wasn't he the one that was arguing againt the necessity of an ALS evaluation of an injured pt, to decide whether or not pain management needs to be implemented? The bottom line for a basic, is that you don't know what you don't know. Like others said earlier in the thread, if the EMT sees the medics react a certain way to certain pt presentations, they begin to think they know as much as the medic. 

BTW DrParasite, if every medic in NJ is degreed, then explain why I had four NJ guys in my class at NY Methodist, from 8/2004-9/2005? What about the NJ guys at the classes after that, both in Brooklyn and the Bronx? I have a hard time believing that your state has only degreed medics. We have a few NJ guys on my dept. OR is the only state I know that can make that claim.


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## Shishkabob

DrParasite said:


> But lets be honest, how many chest decompressions and crics does your typical medic do a year?  maybe 12?  once a month?  maybe 6 a year?  1  year, if that?  So if do you something maybe once a year, is it really good support for your argument?



Actually, yes.  If just 1 life is saved in a year by a surgical cric or needle thoracostomy, then it is worth it.


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## CAOX3

Linuss said:


> Actually, yes.  If just 1 life is saved in a year by a surgical cric or needle thoracostomy, then it is worth it.



Hey wait didnt I just say that?


Hmmmm.... apparently you have to hit submit after you type your response. :wacko:


----------



## DrParasite

usalsfyre said:


> Tell me DrParasite, how much can a basic due to reduce morbidity and ease pain and suffering?


well, I'd say lets basics give pain meds, but we all know that isn't allowed.  





CAOX3 said:


> Apparently in New Jersy its the whole picture.


hmmm, and where did I say that?  where did anyone say that?  in fact, can you show any scientific data supporting your claim?


NVRob said:


> If you are so anti-EMS Dr. Parasite, why do you stick around this site? If EMS was not useful, you'd think that they would have done away with it years ago. We must make a difference, otherwise why pay us to do this job?


haha.  "If EMS was not useful, you'd think that they would have done away with it years ago." sorta like how we done away with back boards?  and prepackaged oxygen tubing?  and books that advocate putting an NRB on everyone?  after all, if they weren't useful, we would have done away with them years ago... right 

and I am not anti-EMS.  what I am anti is non-evidence based medicine.  Concepts like "an all ALS system is the best way to go", "every patient needs to be assessed by a paramedic and a heart monitor, because their stubbed toe might be referred pain from a heart attack", and "lets use the FD as first responders to bandaid the understaffed EMS system."  EMS could be better, but some levels need more training, but I am also smart enough to realize that the system isn't perfect, and educated enough (you know, bachelor's degree, upper level science courses, probably could qualify as premed if I wanted), to know that often the best thing to do for the patient is give them a comfy ride to the hospital and let the doctors examine them.  not for everyone, just often.  it also needs to be funded properly, not just as an afterthought, or as the :censored::censored::censored::censored::censored::censored::censored: stepchild of health care and emergency services.  give EMS enough funding to do the job right, on it's own, without need the help of others.

I have worked in both NJ and NY, as an EMT.  It is my career, and I only work in 911 systems.  I must make a difference, otherwise why would my bosses pay me to do my job?





46Young said:


> Wasn't he the one that was arguing againt the necessity of an ALS evaluation of an injured pt, to decide whether or not pain management needs to be implemented?


yep, that was me.  The bottom line for a basic, is that you don't know what you don't know. Like others said earlier in the thread, if the EMT sees the medics react a certain way to certain pt presentations, they begin to think they know as much as the medic. [/quote]and if a medic sees how a doctor reacts to a certain pt presentations, they begin to think they know as much as the doctor.  amazing isn't it?





46Young said:


> BTW DrParasite, if every medic in NJ is degreed, then explain why I had four NJ guys in my class at NY Methodist, from 8/2004-9/2005? What about the NJ guys at the classes after that, both in Brooklyn and the Bronx? I have a hard time believing that your state has only degreed medics. We have a few NJ guys on my dept. OR is the only state I know that can make that claim.


Damn, you got me. that's what happens when I make generalizations.  let me rephrase: every person who is EDUCATED as a paramedic in NJ, has a degree.  If you are a medic elsewhere and want to work in NJ, you can provided you meet certain criteria set force by the Department of Health after you file for reciprocity.  My fault for generalizing.





Linuss said:


> Actually, yes.  If just 1 life is saved in a year by a surgical cric or needle thoracostomy, then it is worth it.


I see you support a paramedic on every fire truck, ambulance, garbage truck, because as you said, if 1 life is saved in a year by the providers, than it's worth it.


----------



## JPINFV

DrParasite said:


> well, I'd say lets basics give pain meds, but we all know that isn't allowed.




Ok, which pain medications do you wish to allow EMTs to utilize to treat acute pain and how much education are you going to require in addition to the current level?


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## Shishkabob

DrParasite said:


> well, I'd say lets basics give pain meds, but we all know that isn't allowed.


  You HAVE a pain med already.


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## usalsfyre

DrParasite, you contradict yourself. If the best thing we can do for a patient is to give them a comfy ride then we're probably massively OVERfunded. I could easily pick out two beefy unemployed guys, give them a CPR class, put them in a Spartan N.E.A.T. with lots of pillows and blankets while paying them minimum wage. Hell with enough folks I could keep them part-time and not worry about benefits. This could be done MUCH cheaper than what we currently have.

I'm really, really unsure of the point your trying to make. What comes across is  "I'm just as good as a medic, see I've got a degree". The holder of a degree that does not educate one in the clinical component is not useless per say, but certainly not as useful in clinical medicine as those who have education in the practice of medicine.

 If you truly believe in EBM then you need to explain away narcotic pain meds, CPAP, ACE inhibitors and nitrates for CHF, early cath lab and stroke team activation (real activation systems, not a basic bullying someone into it), antihistamines in anaphylaxis, the entire Surviving Sepsis campaign, the list goes on and on. Each of these are care most paramedic can provide (or at least begin to) that most basics can not. Where studies of prehospital medicine tend to fail is they are in urban areas with poorly trained medics, because that's where academic medicine is. 

I'm not sure what you want out of EMS, or what you want it to be.


----------



## JPINFV

usalsfyre said:


> I'm really, really unsure of the point your trying to make. What comes across is  "I'm just as good as a medic, see I've got a degree". The holder of a degree that does not educate one in the clinical component is not useless per say, but certainly not as useful in clinical medicine as those who have education in the practice of medicine.



Hell, I've got an undergraduate degree, graduate degree, and am almost halfway through medical school, and if I had to choose between a clone of myself and a paramedic that isn't an idiot taking care of my emergency, I'd take the paramedic that isn't an idiot at this point.


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## RiverpirateEMT

EMS49393 said:


> Wow!  Apparently paramedics are not the only ones with bad attitudes.  You might want to check yours at the door.



No attitude here at all. I get along very well with every medic I work with. It seems that no one has bothered to read the previous post I have made. In my state there is no such thing as 2 medics on a rig period. Doesnt happen end of story. If it is a MICU there is a EMT_B and a medic, otherwise it is 2 EMT-B's on a rig with a medic is a chase truck. That is how it works. Yes 2 medics on a truck would be wonderful , but it doesnt happen so again the medic has a EMT-B partner. That partner is there to do the medics grunt work. There is no calling for another medic except in extreme situations they can be called from another area. 
When it is a MICU the EMT-B sets up everything for the medic ( 12 lead , iv bag and iv kit, sets up meds if needed , sets up glucometer and the likes). The EMT-B also drives the rig , helps load the patient , puts them on O2 if needed and so on. The medics pretty much depend on the EMT-B to know what they are doing to work together.
Again this is not an attitude. If a medic wants to go it alone more power to them, they will have to just do a lot more themselves. I am well aware this is not how it is in all states, it is just how it works here.
Oh also on the MICU if it is not a class 1 call the medic drives and the EMT-b is in back with the patient. This system works well here and it causes the EMT-B to be on top of their skills or get left behind.  We are required to take ALS assist classes before we can run on the MICU's so we know what the medic needs before they ask for it most times ( not all times ).

Im quiet older than most EMT-b's I run with and learned long ago that no one is better than anyone else even if they think they are. I go with the flow and go home at the end of my shift to my family.


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## Shishkabob

So, uh... which state is this that there are absolutely NEVER 2 medics in a single ambulance?


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## RiverpirateEMT

Linuss said:


> So, uh... which state is this that there are absolutely NEVER 2 medics in a single ambulance?



there is no such thing as a absolute. In fact your right , my 72 y/o boss is a medic ( she keeps her cert up but doesnt touch patients she only drives ) so when a medic steps onto our rig there is technically 2 medics of board although all she does is take patient info and drive the rig. I work for a private company, we have 127 EMT's and medics. Our company will not pay for 2 medics on one truck. I also work for the local hospital that employs medics. They are in chase trucks not on rigs. There is no "rule" saying you cant have 2 medics just it doesnt happen because no company will pay for 2 medics on the same truck. We work under a federation that covers 9 counties, in that area there are no 2 medic trucks. It is the largest federation in the state.


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## MrBrown

Linuss said:


> So, uh... which state is this that there are absolutely NEVER 2 medics in a single ambulance?



Brown knows of no ambulance in the nation where two Intensive Care Paramedics are crewed together


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## medicRob

I would not want to ride with anything less than EMT-IV (i/85 trained). The ideal situation for me would be RN/RN, RN/Paramedic, or Paramedic/Paramedic depending on the type of transport unit and whether or not they utilize critical care transport nurses. Paramedic / EMT-B would just increase my work load.


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## firecoins

I deally it would be Medic/Medic and EMT-B driver.


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## JPINFV

firecoins said:


> I deally it would be Medic/Medic and EMT-B driver.




I went on a ski trip to one of the local ski areas (Big Bear for the So Cal people) and one thing I noticed was that the fire department does staff 3 people to their ambulances. I'm not sure what the  levels are except that at least one of them is a paramedic.


----------



## lightsandsirens5

firecoins said:


> I deally it would be Medic/Medic and EMT-B driver.



You deally? Are you sure? 


Sorry, couldn't resist.


----------



## firecoins

JPINFV said:


> I went on a ski trip to one of the local ski areas (Big Bear for the So Cal people) and one thing I noticed was that the fire department does staff 3 people to their ambulances. I'm not sure what the  levels are except that at least one of them is a paramedic.



its always good to have 2 people in the back.  Just my opinion.  2 medics or RN/medic.  Let the EMT-B drive and help with lifting.


----------



## Aidey

I'm not sure I would say "always". There are plenty of calls where one person is more than enough, namely the "I have this non-emergent issue and no ride to the ER" calls. Once the patients reach a certain level of acuity, I agree that having two or more people would be better.


----------



## EMS49393

Linuss said:


> So, uh... which state is this that there are absolutely NEVER 2 medics in a single ambulance?



Since he won't answer it, I will.  It's clearly Pennsylvania.

Parasite,

I've worked on a MICU and a squad out here and honestly, I don't NEED an EMT.  I need a driver and a patient transport person, hell, an orderly would do.  I'm not a wilting flower, I can carry my own equipment.

As for doing all the ALS assist stuff, you can keep it.  I am just as capable of putting a patient on oxygen as you are and more likely to make the correct clinical judgment as to how much oxygen they actually require.  I run my own EKGs because not one EMT I have met here knows how to place a 12 lead, so I'm sure no one could place a 15 or 18 lead for me.  Worse then not knowing, they refuse to ask and learn!  Bottom line, I can do the patient care on my own, and I have been doing it on my own since I left my double medic system.

Now, if an EMT cares to check their God-like saving paramedic butt attitude with the lovely blonde at the coat counter, I'll be more then happy to let them engage in patient care.  If not, well, they can get up front and drive.  I do most of my magic while I'm rolling anyway.

And that degree crap you're spewing... my Mom is a very well educated RN, you know with a degree and stuff.  In fact she's brilliant, with geriatrics and psychiatric patients.  She'll be the first to tell you that she is unable to handle emergency medicine.  She's educated enough to know what she does not know.  Now that is a brilliant health care provider.


----------



## 46Young

There are plenty of instances where having a medic as a partner was better than having a basic. 18 minutes from pt contact to delivery at the ED for an asthmatic w/ silent chest and multiple intubation hx. We had nebs, solumedrol, and mag onboard, with orders for epi if needed. She turned out well, and we saved her from being on a vent. Any working arrest; one medic is interpreting the monitor and dropping a line, and the other is handling airway and directing CPR. Any situation where we need meds onboard right away; if I'm dropping a lock, who's drawing up the meds? It bears mentioning that in NYC and where I work in VA, you're either a B, or you're a medic. We don't use the enhanced EMT. Sometimes you get a real tricky presentation and need another medic to consult. With a critical pt, it's good to have another medic monitoring the pt closely while I'm preparing an intervention off to the side somewhere. If you're drawing meds, you should llook to minimize distractions. What about IFT's? One medic for a balloon pump job? Three or more drips? The vented, sedated pt?

Sure, 90-95% of our pts in an all ALS system are not time sensitive (maybe 80% in the NYC tiered system), but having two medics onscene is necessary from time to time.


----------



## mgr22

DrParasite said:


> you know what's amazing?  all you paramedics are stupid.



Yeah, but we're high-functioning


----------



## RiverpirateEMT

I just realized something about this site. After reading multiple threads and their responses i see this isnt a site "for" all EMT's. Its more of a site that allows some people feel superior to others. I see no respect for others on this site, I just see a place for people to puff up their chests and "prove" who they are. I see no brotherhood here, only attitudes and Im much to old to play those games. That being said enjoy your life and work, I'll stick to those who I know and respect.


----------



## Chimpie

RiverpirateEMT said:


> I just realized something about this site. After reading multiple threads and their responses i see this isnt a site "for" all EMT's. Its more of a site that allows some people feel superior to others. I see no respect for others on this site, I just see a place for people to puff up their chests and "prove" who they are. I see no brotherhood here, only attitudes and Im much to old to play those games. That being said enjoy your life and work, I'll stick to those who I know and respect.



No, this site is for all levels of EMS, and for those interested in EMS.

Our site is also full of type A personalities.  This has pros and cons.

But after being a member of this site for over six years now I will say that there are perceptions of attitudes here because people are passionate.  They believe in what they believe in and, being a discussion forum, have no other way to express their beliefs than through written word.

This thread is filled with passion and as long as it remains within the boundaries of our rules will stay open.

RiverpirateEMT, feel free to PM me if you have any concerns.  That goes for everyone else as well.

Now, back on topic....


----------



## medic417

RiverpirateEMT said:


> I just realized something about this site. After reading multiple threads and their responses i see this isnt a site "for" all EMT's. Its more of a site that allows some people feel superior to others. I see no respect for others on this site, I just see a place for people to puff up their chests and "prove" who they are. I see no brotherhood here, only attitudes and Im much to old to play those games. That being said enjoy your life and work, I'll stick to those who I know and respect.



You obviously have not visited many EMS sites.  This is the friendliest one I have ever found, in fact way to often I get sick at how much I have to sugar coat my true feelings in order to comply with the rules.  

The majority of people that survive in EMS have dominate personalities, and often it comes across as or seems to be rude or "Paragod".  If you choose to limit yourself to those just like you, you will fail to grow as a person and as a patient care provider.


----------



## CAOX3

EMS49393 said:


> Since he won't answer it, I will.  It's clearly Pennsylvania.
> 
> Parasite,
> 
> I've worked on a MICU and a squad out here and honestly, I don't NEED an EMT.  I need a driver and a patient transport person, hell, an orderly would do.  I'm not a wilting flower, I can carry my own equipment.
> 
> As for doing all the ALS assist stuff, you can keep it.  I am just as capable of putting a patient on oxygen as you are and more likely to make the correct clinical judgment as to how much oxygen they actually require.  I run my own EKGs because not one EMT I have met here knows how to place a 12 lead, so I'm sure no one could place a 15 or 18 lead for me.  Worse then not knowing, they refuse to ask and learn!  Bottom line, I can do the patient care on my own, and I have been doing it on my own since I left my double medic system.
> 
> Now, if an EMT cares to check their God-like saving paramedic butt attitude with the lovely blonde at the coat counter, I'll be more then happy to let them engage in patient care.  If not, well, they can get up front and drive.  I do most of my magic while I'm rolling anyway.
> 
> And that degree crap you're spewing... my Mom is a very well educated RN, you know with a degree and stuff.  In fact she's brilliant, with geriatrics and psychiatric patients.  She'll be the first to tell you that she is unable to handle emergency medicine.  She's educated enough to know what she does not know.  Now that is a brilliant health care provider.



Wow do your uniforms come with the big "S" on the chest or do you guys have a phone booth in your station?

And give me five minutes before you reply I want to get my chair and a notebook and hear all about this magic you speak of.


Anyways as has been said its guaranteed at some point you are going to run into someone who is a little too big for their britches, be professional and handle the aspects of your job and you will be fine.


----------



## 46Young

I don't care how much of a machine you are, you can't be as effective alone as you'll be with at least an EMT partner. Things just aren't going to get done as quickly. If that partner is a medic, they become more useful after the initial BLS interventions, since you can get multiple ALS interventions done at the same time. Things work even better if you have two medics and an EMT. The EMT can do the BLS stuff, and the medics can do multiple ALS interventions. Each configuration works faster than the other. It's not so much about whether you're capable of doing everything youreslf; it's about how to get things done as efficiently (quickly) as possible. If it's not a time sensitive pt, it's a moot point. You can work by yourself and take as long as you want.


----------



## medic417

RiverpirateEMT said:


> I just realized something about this site. After reading multiple threads and their responses i see this isnt a site "for" all EMT's. Its more of a site that allows some people feel superior to others. I see no respect for others on this site, I just see a place for people to puff up their chests and "prove" who they are. I see no brotherhood here, only attitudes and Im much to old to play those games. That being said enjoy your life and work, I'll stick to those who I know and respect.





46Young said:


> I don't care how much of a machine you are, you can't be as effective alone as you'll be with at least an EMT partner. Things just aren't going to get done as quickly. If that partner is a medic, they become more useful after the initial BLS interventions, since you can get multiple ALS interventions done at the same time. Things work even better if you have two medics and an EMT. The EMT can do the BLS stuff, and the medics can do multiple ALS interventions. Each configuration works faster than the other. It's not so much about whether you're capable of doing everything youreslf; it's about how to get things done as efficiently (quickly) as possible. If it's not a time sensitive pt, it's a moot point. You can work by yourself and take as long as you want.



I like three.  Sadly economics will keep it from becoming the standard.


----------



## 46Young

medic417 said:


> I like three.  Sadly economics will keep it from becoming the standard.



I like three as well. I thought that we were badass back in the day as a NYC double medic unit, that just the two of us could handle most anything. We did strong work, but having that third person makes things so much better. I didn't realize this until I starting working at my FD. I think an extra three or four person crew is overkill, but having a medic intern ride with us is plenty enough help. Having the third gives you a driver and there will always be two providers riding with the pt, which I feel is ideal. The crew leader can enter info and call the hospital, and the pt get undivided attention from the other provider. For lifting, you'll always have a spotter to help the two that are lifting down the stairs.


----------



## medic417

46Young said:


> I like three as well. I thought that we were badass back in the day as a NYC double medic unit, that just the two of us could handle most anything. We did strong work, but having that third person makes things so much better. I didn't realize this until I starting working at my FD. I think an extra three or four person crew is overkill, but having a medic intern ride with us is plenty enough help. Having the third gives you a driver and there will always be two providers riding with the pt, which I feel is ideal. The crew leader can enter info and call the hospital, and the pt get undivided attention from the other provider. For lifting, you'll always have a spotter to help the two that are lifting down the stairs.



I've always felt that the intent of the law/rule makers when they wrote that 2 certified people be on the ambulance was that 2 certified people be with patient.  But since they did not clarify and say that now we have what we have.


----------



## frankiemuniz01

usually by applying strong negative peer pressure.


----------



## fireemsmike

Hello all, as you can see I am brand new to the forum however not so much to the world of medics, emt's, ccm's and so on. First of all, respect is earned not given. In my opinion and it is that of many that I work with is that EMT's are the back bone to the entire system of EMS. Without them the system falls apart. The other day I was talking to a good friend of mine about this same topic. He, a CCM-P, told me how he lacked respect of an EMT for years, and that it wasnt until he got his paramedic that he really realized how vital Basics are to the system.
Now I know lazy EMT-I's and EMT-P's that should be shot. I have had medic's choose to ride with me over another medic. This is because you have to show them what you know. A good seasoned EMS provider is able to asses the call, make a plan and put that plan to work with little hesitation. My partner and I need to talk very little to each other on a call, I know what he wants done and he knows what I expect from him. We joke constantly about him being a medic and me being a basic. For example, "hey kevin, its a good thing I'm with you today cause if it were two of you ALS guys you guys wouldn't be lifting anything" and his come back " good thing we're ALS so we might get out the door once today". This is a great relationship. We are always joking with each other and always laughing about everything EMS until a call, then its PT care first.
How to address your issue...
I would personally ignore him till I get paired with him. Then talk to him, not about his view's but what he expects on calls. Then tell him what your capable of doing. No _good_ medics going to be mad if you ask first. Then prove your self. Do what is asked of you on calls and preform to your best. Believe it or not I have turned a Paramedic who at 0600 one day was cursing my existence to the next day at 0600 thanking me for being so helpful. And if none of this works try the old EMS trick... KILL THEM WITH KINDNESS!


----------



## bradford

I can't stand medics who "big league" EMT-Bs. I have worked as a basic with medics that were total jerks to me because I was educationally inferior to them. I have also worked with medics who went out of their way to be nice and help me learn. 
I never understood the superiority complex that some medics have towards their basic counterparts. Paramedic school for most parts of the U.S. is about 1 calendar year. Sure, we learn quite a bit about patient care, drugs, etc., but it is really only one more year of training. To think that paramedics are so high and above EMTs is laughable. 
I am a paramedic now, but as soon as I find myself berating an EMT-B because I am so highly superior to them, I think it is time to find a new profession.
EMTs serve an invaluable and integral part of pre-hospital EMS. Remember, all paramedics started as EMTs.


----------



## medic417

bradford said:


> Remember, all paramedics started as EMTs.



Actually that is not correct.  There are exceptions to that.


----------



## cruiseforever

medic417 said:


> Actually that is not correct.  There are exceptions to that.



I agree.  Some of the schools in our area have gone to if you got the money we have the time.  I have had riders from one school that have no idea how to work a stretcher.  I have asked our managers to let the school know their traing program sucks.

On the other hand the schools that require you to be an EMT or take an operations traing have a higher level of students.


----------



## usalsfyre

cruiseforever said:


> I agree.  Some of the schools in our area have gone to if you got the money we have the time.  I have had riders from one school that have no idea how to work a stretcher.  I have asked our managers to let the school know their traing program sucks.
> 
> On the other hand the schools that require you to be an EMT or take an operations traing have a higher level of students.



Not excusing mills but....

Why is working a stretcher ANY measure of knowledge. Neither service in this area allows students to handle stretchers, so it's understandable they wouldn't know how. This is something that should be covered in new employee training/orientation.

I would take a student who has a firm grasp on pharmacology, A&P, pathophysiology and MEDICAL psychomotor skills that can't work a stretcher over an "experienced" Basic who can't articulate the above concepts and is chock full of bad habits. I can train you easily on operational concepts.


----------



## Anjel

usalsfyre said:


> Not excusing mills but....
> 
> Why is working a stretcher ANY measure of knowledge. Neither service in this area allows students to handle stretchers, so it's understandable they wouldn't know how. This is something that should be covered in new employee training/orientation.
> 
> I would take a student who has a firm grasp on pharmacology, A&P, pathophysiology and MEDICAL psychomotor skills that can't work a stretcher over an "experienced" Basic who can't articulate the above concepts and is chock full of bad habits. I can train you easily on operational concepts.



At hour school we were required to do 50 stretcher lifts in and out of there little fake ambulance before going on a clinical. BUT still we weren't allowed to touch them while actually on the clinical.


----------



## emt seeking first job

*I embrace snobby Medics.*

Because when they do acknowledge me, thank me, compliment me, invite me to ride in their rig...I know I did something right. They are not doing any of those things to be nice.


----------



## HeadNurseRN

*Medics are ****s (Some Are)*

*A*lways *L*aying *S*upine


----------



## EMTGunney

CANMAN13 said:


> I asked if she knew how to change the O2 bottle. She said yes, long story short she had no clue and I had to do it after the rest of the things I was doing. Prime example of how I was counting on someone to deliver a basic skill and they couldn't accomplish that for me.



ok that all comes down to the training they have taken. my EMT School had us test out of every skill before we could go out to the field obviously it was her schools fault for not training her for the Field. Just Saying


----------



## the_negro_puppy

We dont have this problem as we only have paramedics, trainee paramedics and a small number of intensive care paramedics.


----------



## EMS49393

the_negro_puppy said:


> We dont have this problem as we only have paramedics, trainee paramedics and a small number of intensive care paramedics.



:beerchug: ^ is awesome.


----------



## Jon

the_negro_puppy said:


> We dont have this problem as we only have paramedics, trainee paramedics and a small number of intensive care paramedics.


You still have some toolbag co-workers, though?


----------



## Sasha

emt seeking first job said:


> Because when they do acknowledge me, thank me, compliment me, invite me to ride in their rig...I know I did something right. They are not doing any of those things to be nice.



Nope, they're doing it so they don't have to clean up afterwards!


----------



## mct601

I helped a medic work a trauma code the other day in an ER ambulance bay. His EMT vanished trying to find help inside the ER because he had two PTs (the primary pt crashed en route). Don't ask me why they lolligagged, I just knew he needed help and quick so I provided it and did what he asked of me. He was from a different service. When it was all said and done, not only did he not thank me but he grunted and turned away at the sight of me in the ER. I have never been so appalled in my life.


----------



## AtlantaEMT

The worst people I struggle working with are other EMTs who feel that being an EMT is beneath them and that they really should be a paramedic with the scope of practice of an intensivist.  Those people drive me nuts, and are often the ones who freak out when their BLS patient suddenly goes ALS.

MICU Nurses on the other hand, I've had very few good experiences with them.  I had a Nurse one time that I started referring to as "doctor" becuase that is what he thought of himself.  It is always interesting when their patient goes south and they don't have a doctor and 30 other specialists there to back them up.


----------



## EMTinNEPA

EMS49393 said:


> Since he won't answer it, I will.  It's clearly Pennsylvania.



My former service routinely had two paramedics on a truck.  Now that we've merged with another service and are significantly larger, it's much less common, but it still happens.  The side benefit is we now always have a supervisor or two for back-up.


----------



## puppet87112

Well I work for a paid company and work with a paramedic, and while I get upset sometimes that I don't get to take a certain call cause of things I think I can do i know he has his reasoning behind it. 

Like I know I get upset when he says something like if it wasn't an airway problem it would be yours and my first thought is, "isn't that why I have a combi tube" 

He does come off like it he a know it all, and flawless but he will tell you himself, that he is not, and that I the basic have saved him many times.

So I have to agree with some of the other posts that they may come off like that sometimes without meaning to, or not realizing that its coming off that way. 

But there are probably some that think there S*** don't smell as well.


----------



## freeresumetemplates

*Reply*

Just ignore them. If you can report them to their superiors report them. Abusive EMT are common nowadays.


----------



## Enigma

CANMAN13 said:


> Alot of good points on this thread. It would definately help to clarify what kind of system you are in. I will be honest in saying that everytime I have had a negative call involving a EMT-B it has been a volunteer. There are also MANY MANY times I have had exceptional calls with volunteer EMT-B's and I 100% of the time to make it a point and commend them on a job well done.
> 
> I look at it like this. Me=EMT-P with a license, EMT-B is a certification. The amount of training involved does not give me the "I am god complex" but I did work very hard and endure almost 1700hrs more of education. This is also my CAREER, full-time, what I do to make a living. Someone who does this day in and day out is going to be much stronger then someone who volunteers and does it one night a week or less.
> 
> I have met and worked with great medics and emt's as well as really crappy emt's and medics. I think alot depends on what kind of arena you are working in.



Good post


----------



## ParrotMedics

*This is my first EMTLife post.  Read on.*

I've been lurking on these forums for a few months now as part of my research on what "EMT life" - with other EMS personnel - is like, as I am considering civilian involvement in the field now that I'm semi-retired.

Following this particular thread has been quite an eye opener, and I think it behooves all of you to take note:

You've lost your way. 

You cannot actually comprehend, I fear, how immature, insecure, and adolescent the vast majority of you "licensed professionals" sound to someone outside your EMS environment. 

After serving twelve years at Yokota Air Base as a C4 Commander I've watched plenty of LDOs jumping on top of line officers the first chance they can because of their additional "training" - and you know what happens? They get their as*es handed to them and find they don't progress much farther.  

Pubescent p*ssing matches show how low they don't grow, boys.

The most humble and sincere of your bunch seem to be the NJ men. To you I say keep up the respect for your colleagues and the reverence for your work and don't mind a lick of what the Calibrats and others are chafing about on these forums.

The rest of you should look in the mirror and ask yourselves what makes you feel like a man when you see your face in the morning.  If it's that EMT-P "license" - as opposed to how you treat your fellow man regardless of his education, training, or experience level - you have a reckoning headed your way.


----------



## medic417

ParrotMedics said:


> I've been lurking on these forums for a few months now as part of my research on what "EMT life" - with other EMS personnel - is like, as I am considering civilian involvement in the field now that I'm semi-retired.
> 
> Following this particular thread has been quite an eye opener, and I think it behooves all of you to take note:
> 
> You've lost your way.
> 
> You cannot actually comprehend, I fear, how immature, insecure, and adolescent the vast majority of you "licensed professionals" sound to someone outside your EMS environment.
> 
> After serving twelve years at Yokota Air Base as a C4 Commander I've watched plenty of LDOs jumping on top of line officers the first chance they can because of their additional "training" - and you know what happens? They get their as*es handed to them and find they don't progress much farther.
> 
> Pubescent p*ssing matches show how low they don't grow, boys.
> 
> The most humble and sincere of your bunch seem to be the NJ men. To you I say keep up the respect for your colleagues and the reverence for your work and don't mind a lick of what the Calibrats and others are chafing about on these forums.
> 
> The rest of you should look in the mirror and ask yourselves what makes you feel like a man when you see your face in the morning.  If it's that EMT-P "license" - as opposed to how you treat your fellow man regardless of his education, training, or experience level - you have a reckoning headed your way.



HAHAHAHAHAHAH  That is the funniest post of all time.  Who are you really?  Did you not know it is against policy to have multiple accounts?  And multiple personality disorder does not qualify one for multiple accounts, trust me my personalities attempted it.


----------



## mgr22

ParrotMedics said:


> I've been lurking on these forums for a few months now as part of my research on what "EMT life" - with other EMS personnel - is like, as I am considering civilian involvement in the field now that I'm semi-retired.
> 
> Following this particular thread has been quite an eye opener, and I think it behooves all of you to take note:
> 
> You've lost your way.
> 
> You cannot actually comprehend, I fear, how immature, insecure, and adolescent the vast majority of you "licensed professionals" sound to someone outside your EMS environment.
> 
> After serving twelve years at Yokota Air Base as a C4 Commander I've watched plenty of LDOs jumping on top of line officers the first chance they can because of their additional "training" - and you know what happens? They get their as*es handed to them and find they don't progress much farther.
> 
> Pubescent p*ssing matches show how low they don't grow, boys.
> 
> The most humble and sincere of your bunch seem to be the NJ men. To you I say keep up the respect for your colleagues and the reverence for your work and don't mind a lick of what the Calibrats and others are chafing about on these forums.
> 
> The rest of you should look in the mirror and ask yourselves what makes you feel like a man when you see your face in the morning.  If it's that EMT-P "license" - as opposed to how you treat your fellow man regardless of his education, training, or experience level - you have a reckoning headed your way.



I agree with you about the contentious tone of many of our discussions, and the unfavorable impressions outsiders might develop about our industry. One of the problems, I think, is respondents who generalize about the tendencies of large groups, then offer unsolicited advice tainted by sarcasm, self-indulgence, and hypocrisy.


----------



## medichopeful

cmetalbend said:


> Sure your in charge, but without EMT's or help in general you aren't gona save chit. Period.



Say WHAAAT? :huh:

Working as a team is definitely important, but this sounds like a rather arrogant statement...


----------



## medichopeful

JPINFV said:


> ...or, they could be partnered with another medic...



But JP you're forgetting the fact that once a paramedic has all that "book learning" they forget how to do all that simple stuff they learned as a basic.  That's why a medic HAS to have a basic with them.  All the learning in the world won't help if they can't get the patient into the ambulance! 

Can't you picture an all paramedic crew sitting there next to an unconscious patient on the sidewalk saying to each other "Now just how the _hell_ are we supposed to get this patient into our ambulance?!" :unsure:


----------



## medicRob

cmetalbend said:


> Sure your in charge, but without EMT's or help in general you aren't gona save chit. Period.



Give me one situation where a Paramedic / Paramedic configuration or a Paramedic / RN configuration cannot do the exact same thing (and in most cases more, where medically necessary) than a Paramedic with an EMT-B.. 

Your logic is severely flawed.


----------



## JCFE-Medic2112

All Paramedic services in the State of Wisconsin that were providing ALS prior to 2001 MUST be a 2 Paramedic rig, period. 

Also, in Wisconsin, all levels of EMS are Licensed though the State, then Credentialed through their service and service Medical Director.

To be a good Paramedic, you need to first be a great Basic.

You don't need squat to be a *edited* Paramedic though, except a bad attitude and a lack of compassion- which coincidentally is the same recipe for a sh!tty Basic.

My Basic and/or Intermediate partners thankfully are all awesome, and always eager to learn, and have great skills. You give what you get and you get what you give. This is a Team sport, and every single call can be a teachable moment if you open your mind instead of your mouth, and let it happen. 

The Paragod attitude is something that old Paramedics fall back on when they can't remember why they do what they do, and it is a facade for those new medics that can't accept the fact that they are truly clueless. Paragods need to have their licenses revoked, because it is no longer about the patient for them, it is about themselves and their egos. Then there are the Critical Care Basics... those who think that they know it all, and when the Paramedic does something different, they come onto a website and *EDITED* and moan about Paramedics with attitudes instead of taking the time to learn what the Paramedic was doing and why.

Oh, and Hi there! I am new here!


----------



## Shishkabob

JCFE-Medic2112 said:


> To be a good Paramedic, you need to first be a great Basic.



So I'm not a good Paramedic?


----------



## medicRob

JCFE-Medic2112 said:


> To be a good Paramedic, you need to first be a great Basic.



Also, to add to Linuss' question, what about the many RNs who bridge to medic? I completed a full EMT-IV and EMT-P program, and then completed a full BSN program, but I will be the first to brag on some of the fantastic providers that I have seen out there that did not take the traditional path to paramedic.


----------



## JCFE-Medic2112

Linuss said:


> So I'm not a good Paramedic?



Are you a great Basic?


----------



## JCFE-Medic2112

medicRob said:


> Also, to add to Linuss' question, what about the many RNs who bridge to medic? I completed a full EMT-IV and EMT-P program, and then completed a full BSN program, but I will be the first to brag on some of the fantastic providers that I have seen out there that did not take the traditional path to paramedic.



Wisconsin actually got rid of test out RN to Paramedic because it was apparent that it was not working here. They found that the Basic skills were lacking. Now in Wisconsin, an RN can run as a Basic after going to an EMT Basic class. After that they can operate at the Intermediate level too, and then they can take a separate course for the ALS Prehospital aspects not taught in Nursing school to be able to operate as Paramedics.

With that said, RNs are not worth a **** without Basic skills either. Basic skills are not defined by an EMT Basic class, they are defined by your Patient Care.

And yes, some of the best providers I have ever met also did not take the traditional route, but they do have great Basic Skills, and they are absolutely needed to be able to provide good ALS.


----------



## ffemt8978

JCFE-Medic2112 said:


> Wisconsin actually got rid of test out RN to Paramedic because it was apparent that it was not working here. They found that the Basic skills were lacking. Now in Wisconsin, an RN can run as a Basic after going to an EMT Basic class. After that they can operate at the Intermediate level too, and then they can take a separate course for the ALS Prehospital aspects not taught in Nursing school to be able to operate as Paramedics.
> 
> With that said, RNs are not worth a **** without Basic skills either. Basic skills are not defined by an EMT Basic class, they are defined by your Patient Care.
> 
> And yes, some of the best providers I have ever met also did not take the traditional route, but they do have great Basic Skills, and they are absolutely needed to be able to provide good ALS.


Yeah, and what happens in Wisconsin applies everywhere else in the country or the world.  :wacko:

If I was you, I'd avoid making blanket statements like yours that you aren't going to be able to prove outside of a limited area.


----------



## TransportJockey

JCFE-Medic2112 said:


> Wisconsin actually got rid of test out RN to Paramedic because it was apparent that it was not working here. They found that the Basic skills were lacking. Now in Wisconsin, an RN can run as a Basic after going to an EMT Basic class. After that they can operate at the Intermediate level too, and then they can take a separate course for the ALS Prehospital aspects not taught in Nursing school to be able to operate as Paramedics.
> 
> With that said, RNs are not worth a **** without Basic skills either. Basic skills are not defined by an EMT Basic class, they are defined by your Patient Care.
> 
> And yes, some of the best providers I have ever met also did not take the traditional route, but they do have great Basic Skills, and they are absolutely needed to be able to provide good ALS.


Heh, I have decided to forgo medic school to pursue my RN, but plan on challenging the medic testing when I'm done. Remember, some RNs spent plenty of time as Intermediates or Basics before they decided on another path. Goes with the blanket statement bit from FFEMT


----------



## medicRob

JCFE-Medic2112 said:


> With that said, RNs are not worth a **** without Basic skills either. Basic skills are not defined by an EMT Basic class, they are defined by your Patient Care.



Is that why we spend more time in clinicals alone that you spend in the entirety of your medic program? Not to mention, as far as basic skills go, we certify our competency all the way through. If we do not possess the skills that the program requires for the particular place we are in clinical, we are given one chance to remediate, after that, we are gone. 

Is that why some of the best flight teams are composed of an RN/RN configuration? You are delusional or severely misinformed.


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## JCFE-Medic2112

ffemt8978 said:


> Yeah, and what happens in Wisconsin applies everywhere else in the country or the world.  :wacko:
> 
> If I was you, I'd avoid making blanket statements like yours that you aren't going to be able to prove outside of a limited area.



Thank You Doctor.


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## JCFE-Medic2112

jtpaintball70 said:


> Heh, I have decided to forgo medic school to pursue my RN, but plan on challenging the medic testing when I'm done. Remember, some RNs spent plenty of time as Intermediates or Basics before they decided on another path. Goes with the blanket statement bit from FFEMT



Could you please try reading the entire post? There were no blanket statements made at all.


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## ffemt8978

JCFE-Medic2112 said:


> Could you please try reading the entire post? There were no blanket statements made at all.


Sure, I'll even highlight them in bold for you.



JCFE-Medic2112 said:


> All Paramedic services in the State of Wisconsin that were providing ALS prior to 2001 MUST be a 2 Paramedic rig, period.
> 
> Also, in Wisconsin, all levels of EMS are Licensed though the State, then Credentialed through their service and service Medical Director.
> 
> *To be a good Paramedic, you need to first be a great Basic.*
> 
> You don't need squat to be a *edited* Paramedic though, except a bad attitude and a lack of compassion- which coincidentally is the same recipe for a sh!tty Basic.
> 
> My Basic and/or Intermediate partners thankfully are all awesome, and always eager to learn, and have great skills. You give what you get and you get what you give. This is a Team sport, and every single call can be a teachable moment if you open your mind instead of your mouth, and let it happen.
> 
> *The Paragod attitude is something that old Paramedics fall back on when they can't remember why they do what they do, and it is a facade for those new medics that can't accept the fact that they are truly clueless.* Paragods need to have their licenses revoked, because it is no longer about the patient for them, it is about themselves and their egos. Then there are the Critical Care Basics... those who think that they know it all, and when the Paramedic does something different, they come onto a website and *EDITED* and moan about Paramedics with attitudes instead of taking the time to learn what the Paramedic was doing and why.
> 
> Oh, and Hi there! I am new here!





JCFE-Medic2112 said:


> Wisconsin actually got rid of test out RN to Paramedic because it was apparent that it was not working here. They found that the Basic skills were lacking. Now in Wisconsin, an RN can run as a Basic after going to an EMT Basic class. After that they can operate at the Intermediate level too, and then they can take a separate course for the ALS Prehospital aspects not taught in Nursing school to be able to operate as Paramedics.
> 
> *With that said, RNs are not worth a **** without Basic skills either.* Basic skills are not defined by an EMT Basic class, they are defined by your Patient Care.
> 
> And yes, some of the best providers I have ever met also did not take the traditional route, but they do have great Basic Skills, and they are absolutely needed to be able to provide good ALS.


And I am not a Doctor, nor do I play one on TV.


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## beandip4all

ParrotMedics said:


> ....Pubescent p*ssing matches show how low they don't grow, boys.





ParrotMedics said:


> ..... seem to be the NJ men......





ParrotMedics said:


> ....ask yourselves what makes you feel like a man when you see your face in the morning.




i think you forgot to leave out all the female care providers in this diatribe!


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## JCFE-Medic2112

medicRob said:


> Is that why we spend more time in clinicals alone that you spend in the entirety of your medic program? Not to mention, as far as basic skills go, we certify our competency all the way through. If we do not possess the skills that the program requires for the particular place we are in clinical, we are given one chance to remediate, after that, we are gone.
> 
> Is that why some of the best flight teams are composed of an RN/RN configuration? You are delusional or severely misinformed.





Do you or do you not agree that a proficient care provider must have good Basic skills?

Competency is one thing, proficiency is a different matter.


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## JCFE-Medic2112

ffemt8978 said:


> Sure, I'll even highlight them in bold for you.
> 
> 
> 
> 
> And I am not a Doctor, nor do I play one on TV.



I will stand by those statements as being blanket statements, regardless of State or Country. They do apply. You have no business doing any patient care if you cannot be proficient in Basic skills.


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## medicRob

JCFE-Medic2112 said:


> Thank You Doctor.



What an arrogant, peacock you are. You come in talking about ParaGod's needing their licenses revoked, yet you come up with arrogant statements like this. You sound an awful lot like someone with "ParaGod Syndrome" to me. Also, you master your basics as part of your competency in paramedic and in nursing school, even in transition. 

Do you honestly mean to tell me there is a Paramedic out there that does not know how to use a BVM??


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## ffemt8978

JCFE-Medic2112 said:


> I will stand by those statements as being blanket statements, regardless of State or Country. They do apply. You have no business doing any patient care if you cannot be proficient in Basic skills.



Maybe to a certain extent, in certain circumstances, but let me point out one of your blanket statements that utterly fails.



JCFE-Medic2112 said:


> *To be a good Paramedic, you need to first be a great Basic.*


By your statement, you can't be a good paramedic without being a great basic first.  So what about this member, RidRyder911, who was never a basic but first entered EMS as a medic.  The same RidRyder who has help write the very textbooks that teach your "great basics" or "good medics", who lectures EMS providers around the country, and writes/reviews test questions for the NREMT.

That was my point about not making blanket statements, because somebody here will prove you wrong on them.


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## JCFE-Medic2112

ffemt8978 said:


> Maybe to a certain extent, in certain circumstances, but let me point out one of your blanket statements that utterly fails.
> 
> 
> By your statement, you can't be a good paramedic without being a great basic first.  So what about this member, RidRyder911, who was never a basic but first entered EMS as a medic.  The same RidRyder who has help write the very textbooks that teach your "great basics" or "good medics", who lectures EMS providers around the country, and writes/reviews test questions for the NREMT.
> 
> That was my point about not making blanket statements, because somebody here will prove you wrong on them.



You do not need to have been an EMT-Basic ever, to be a good "Basic", meaning, having a grasp of Basic Life Support.


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## ffemt8978

JCFE-Medic2112 said:


> You do not need to have been an EMT-Basic ever, to be a good "Basic", meaning, having a grasp of Basic Life Support.



That may have been what you meant, but to several of us reading your posts in context, it appeared as if you were referring to EMT-Basic.


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## JCFE-Medic2112

medicRob said:


> What an arrogant, peacock you are. You come in talking about ParaGod's needing their licenses revoked, yet you come up with arrogant statements like this. You sound an awful lot like someone with "ParaGod Syndrome" to me. Also, you master your basics as part of your competency in paramedic and in nursing school, even in transition.
> 
> Do you honestly mean to tell me there is a Paramedic out there that does not know how to use a BVM??



Do you define Basic Life Support with "monkey skills"?

Paragods have no business in this line of work. 

Being a good EMT-Basic, or proficient in Basic Life Support is by no means defined by the monkey skills.


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## JCFE-Medic2112

ffemt8978 said:


> That may have been what you meant, but to several of us reading your posts in context, it appeared as if you were referring to EMT-Basic.



I thought it was clear, but my apologies if it wasn't.


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## ffemt8978

JCFE-Medic2112 said:


> I thought it was clear, but my apologies if it wasn't.



Especially with this post:


JCFE-Medic2112 said:


> Do you define Basic Life Support with "monkey skills"?
> 
> Paragods have no business in this line of work.
> 
> Being a good EMT-Basic, or proficient in Basic Life Support is by no means defined by the monkey skills.


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## Sasha

> The rest of you should look in the mirror and ask yourselves what makes you feel like a man when you see your face in the morning.



Gosh, I hope nothing makes me feel like a man in the morning...


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## Shishkabob

JCFE-Medic2112 said:


> Are you a great Basic?



I would assume not considering I worked for a whole 5 shifts as an EMT,with EMT level education (read: minimal) and no experience before going to Paramedic school and finishing at the top of my class.   But clearly medic students never do any 'basic' stuff during clinicals, or while working in the field as a medic, right?



I can't objectively tell you how good or bad I am, but a couple of people here have seen me work, so they can vouch for how good or bad I am.  For all I know I'm a horrible provider and am extremely lucky I haven't killed half my patients.


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## medicRob

JCFE-Medic2112 said:


> Do you define Basic Life Support with "monkey skills"?
> 
> Paragods have no business in this line of work.
> 
> Being a good EMT-Basic, or proficient in Basic Life Support is by no means defined by the monkey skills.



As ffemt pointed out, your post appeared to have absolutely nothing to do with basic skills, it appeared that you were talking with regard to "EMT-Basics". Yes, I agree that the basics are the foundation upon which our care is delivered and is in a lot of cases the thing that saves our asses, but as far as "RN's to Paramedic" not being "****" as you call it, I take offense. This might be the case in your area, but don't try to apply it to all areas, this is certainly not true in my area here in TN, and I am willing to bet that it is not true in many other areas as well. 

Whether your coming to that conclusion is based on the definition of skill set or on the basis of  general education, I will have to implore you to look further into both counts. 

Our programs are all accredited, if you are not accredited you do not test. We have along with our skill set, a foundation in general education to include Anatomy & Physiology (Not the little abbreviated paramedic version either), General Biology, Chemistry, Microbiology, English Composition (which many paramedics severely lack skills in), Pharmacology (An individual class dedicated in its entirety to the study of drugs and their interactions from the molecular/cellular level up), Pathophysiology, and more. Our programs have to prepare us to enter a variety of fills whereas your EMS programs prepare you for only one mindset, Emergency Medicine. Our programs have to be able to prepare us to be entry level in various specialties (Dialysis, OB/GYN, Med/Surg, Critical Care, Clinic). We are given the fundamental knowledge and understanding of the intricacies of the human body that most EMS providers lack, don't tell me an RN to Paramedic cannot be a good provider. As a matter of fact, I would have to say the reverse of that, MOST (Not All) paramedics that transition to RN can't cut it because they don't have the proper fundamental (basic education which you so readily preach) behind their practice.


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## usalsfyre

What's humorous is I know far more crappy medics who spent a significant amount of time as a basic than those who didn't. The ones who were long-term basics learned bad habits by the bucketful. 

The attitudes about lower level providers from the newer straight-through medics does often suck though. I think a lot of it's youth, some of it's never having been dumped on by a medic and a little of it is never having had anything "bad" happen on their watch.

My feeling, and that of most of my coworkers, is that the medic should be able to do anything as well as or better than the basic. If your going to give direction and provide correction than you better know what your talking about.

On a P/B truck, at the end of the day, the medic is responsible. Full stop. If I have an attitude at times, it's for that reason, not because I think a basic is less of a person.


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## lightsandsirens5

Sasha said:


> Gosh, I hope nothing makes me feel like a man in the morning...



Post of the week right there. ^_^


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## Bieber

We run dual paramedic trucks, and in the system I'm in, I prefer that.  If it were paramedic-EMT, I'd end up running all the calls; we're just too busy, and most of all calls are code yellows (intermediate triage).

Fire is dispatched to all calls and they serve as BLS backup.  Really, aside from CPR, ventilation, vitals and patient movement, there's really nothing else they provide.  The extra set of hands is helpful, but outside of lifting assistance and CPR, I could do without them just fine.  And I try not to think in terms of BLS versus ALS, I think in terms of "what medical care does this patient need?"

Sorry if that offends you.


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## CAOX3

usalsfyre said:


> What's humorous is I know far more crappy medics who spent a significant amount of time as a basic than those who didn't. The ones who were long-term basics learned bad habits by the bucketful.



You hit the nail on the head there.  Education at all levels is pathetic.  I'm not going to get into what my EMT class consisted of but you needed college level anatomy and physiology just to get a seat and the patient assessment segment was about 120 hours.  We gave multiple medications, intubated amongst other things. Today I have to take an in-service to use an epi-pen.   Then EMT class then along with experience was an educational foundation to be built upon.  There was two levels EMT and medic educated to work autonomously but able to compliment one another when the need arose. 

Back then if you were a paramedic you had at least three years of education, autonomous providers who rarely if ever picked up a phone for a doctors opinion.

Those classes don't exist anymore, why would they.  They have been replaced by three week and six moths zero to hero classes taught in someones garage.

Today you have a three week super hero punting to a six month know it all who is attempting to diagnose and treat CHF without a college level physiology class, its a joke.  

We had it right, we dropped the ball, now its time to clean up the mess.


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## Veneficus

NVRob said:


> If you are so anti-EMS Dr. Parasite, why do you stick around this site? If EMS was not useful, you'd think that they would have done away with it years ago. We must make a difference, otherwise why pay us to do this job?



I would be careful about using this argument.

The question on whether ALS care is worth the price is being raised not only by doctors but politicians as well.

Unless you can present some evidence beyond anecdotes and dogma, this is not a spectre you want to raise in defense of ALS EMS.


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## Bieber

Veneficus said:


> I would be careful about using this argument.
> 
> The question on whether ALS care is worth the price is being raised not only by doctors but politicians as well.
> 
> Unless you can present some evidence beyond anecdotes and dogma, this is not a spectre you want to raise in defense of ALS EMS.


What specific parts of ALS are being questioned?  Also, do you have any links that you might like to share regarding the issue?

I agree that in this era of evidence-based medicine, we have to very strongly reevaluate our practices all across the board and determine which ones are actually worth their cost and have been shown to be effective, and which ones just simply aren't meeting the cut, however I also think that while many of us can agree that we need to increase educational standards, that it may come into conflict with the same push to eliminate wasteful spending.  The political answer will always be train to the minimum standards and cut out those skills found to be ineffective to reduce the cost; effectively minimizing education and turning EMS providers into skill monkeys while at the same time cutting out those skills that haven't proven their worth.

How pervasive is this movement towards cost effectiveness?  A quick google search turned up some mention about the cost effectiveness of physician-based anesthesia, but what about other areas of medicine?  Are physicians themselves being evaluated for their cost effectiveness versus other care delivery models (PA or NP led, for example)?


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## Zodiac

But is anything in health care really worth the price? Not agreeing or disagreeing with what anyone has said so far, just curious. Having been without any kind of health insurance since I was 16, it's been something I've thought about for a while.


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## Veneficus

Bieber said:


> What specific parts of ALS are being questioned?  Also, do you have any links that you might like to share regarding the issue?
> 
> I agree that in this era of evidence-based medicine, we have to very strongly reevaluate our practices all across the board and determine which ones are actually worth their cost and have been shown to be effective, and which ones just simply aren't meeting the cut, however I also think that while many of us can agree that we need to increase educational standards, that it may come into conflict with the same push to eliminate wasteful spending.  The political answer will always be train to the minimum standards and cut out those skills found to be ineffective to reduce the cost; effectively minimizing education and turning EMS providers into skill monkeys while at the same time cutting out those skills that haven't proven their worth.
> 
> How pervasive is this movement towards cost effectiveness?  A quick google search turned up some mention about the cost effectiveness of physician-based anesthesia, but what about other areas of medicine?  Are physicians themselves being evaluated for their cost effectiveness versus other care delivery models (PA or NP led, for example)?



I think you are missing my point. 

All aspects of US medical care are now under a microscope in order to reduce medical spending. That microscope includes cost/benefit ratios.

EMS has not created any hard numbers, even if flawed, to compete with the hard numbers, even if flawed, against them. 

Without these numbers, there will not be a leg to stand on when it comes to demonstrating effectivenss. EMS providers must start quantifying their positions, not simply state them. That is not good enough anymore.

As to the last part, physicans constantly demonstrate their benefits quantitatively. With multiple measures. Even where NPs and PAs operate, the question is not whether a physician is superior, it is a question of whether the consumer base can afford or recruit the necessary physicians.

My point to the what I was quoting is that EMS particularly paramedic level providers in the US, have to start quantifying their positions. Their value is comming under question from multiple avenues and all they have to refute it with is self serving speeches. That is a losing strategy.

Providers argue against education, even though that is a measurable value throught all societies in the world. They now argue against questions of their effectiveness with the exact same tactics. 

It isn't going to work any longer. There are too many people who have to protect their slice of the pie in the inevitable cuts. 

Pointing out this information doesn't protect my job.


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## Bieber

Veneficus said:


> I think you are missing my point.
> 
> All aspects of US medical care are now under a microscope in order to reduce medical spending. That microscope includes cost/benefit ratios.
> 
> EMS has not created any hard numbers, even if flawed, to compete with the hard numbers, even if flawed, against them.


Exactly what numbers are you talking about?  There's numerous studies across the board regarding treatments commonly used in EMS.  If you're talking about a comprehensive study of the efficacy of EMS as a whole, I agree there's none that I've yet found and somebody ought to do one, but that would be quite an undertaking.



> Without these numbers, there will not be a leg to stand on when it comes to demonstrating effectivenss. EMS providers must start quantifying their positions, not simply state them. That is not good enough anymore.


I agree.



> As to the last part, physicans constantly demonstrate their benefits quantitatively. With multiple measures. Even where NPs and PAs operate, the question is not whether a physician is superior, it is a question of whether the consumer base can afford or recruit the necessary physicians.


To be honest, I don't think anyone is safe anymore.  I briefly noticed a study comparing nurse-led clinics to traditional ones the other day.  Without reading real deep into it, I believe the results weren't grossly different.  I'm not trying to make a big debate over the efficacy of physicians or their cost-benefit, I'm just saying that I don't think any medical profession is inherently "safe" in the political and economic environment we're in right now.  People want more for less, which is exactly why PAs and NPs are becoming more prominent in all fields of medicine at the moment.



> My point to the what I was quoting is that EMS particularly paramedic level providers in the US, have to start quantifying their positions. Their value is comming under question from multiple avenues and all they have to refute it with is self serving speeches. That is a losing strategy.


I don't disagree with you that we have to quantify our positions, but can you send some links for the rest of us?  I haven't really heard about certain agencies questioning the value of paramedics in se, and I'd be interested in learning more about this issue.



> Providers argue against education, even though that is a measurable value throught all societies in the world. They now argue against questions of their effectiveness with the exact same tactics.
> 
> It isn't going to work any longer. There are too many people who have to protect their slice of the pie in the inevitable cuts.
> 
> Pointing out this information doesn't protect my job.


Increasing our education is one of several solutions we need to implement in order to improve our care and ability to competently treat patients.  It's not the end-all, but it's the crux upon which all other solutions to the EMS system rests.  We're finding out more and more that we are prehospital providers are not as able as we once thought to handle the most critical patients (or that medicine simply isn't advanced enough to treat them), and that the most successful treatments we CAN provide are those administered to non-critical patients (pain control, for example).


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## clibb

Why do some agencies make their Paramedics wear badges? It looks retarded.


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## Sasha

To intimidate their patients into thinking theyre the cops.


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## medic417

clibb said:


> Why do some agencies make their Paramedics wear badges? It looks retarded.



Yes it does just as bad as the badges the basics wear at the same company.  My theory is the badges are for the mad patients to have a place to aim at.  :unsure:

As to research.  The hard part is how to conduct a study.  There was a study that concluded that Paramedics should not decide who rides in the ambulance.  The way they came to that conclusion was if a Paramedic decided that a patient did not need an ambulance yet the patient was admitted to the hospital the Paramedic was wrong.  That is very flawed.  If we are honest most patients could travel with a family member safely to the hospital.  There has to be a way to determine true *immediate* life threats rather than just using admission as the criteria.  Sorry can not find that study right now but seems like it even made it into JEMS or one of the other toilet paper mags EMS has, sometime in the past 2 years.  

And then as any study data gathered can be interpreted multiple ways depending on what you are hoping to prove/disprove.


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## MontanaEMT

Ah the ParaGod syndrome. I work with a few of them, and the best advice is to just wow them with your abilities. Everything starts with BLS and when ALS fails, they should fall back to BLS. I have noticed the medics that don't like BLS are the ones who did not have strong skills before going into ALS!


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## medic417

MontanaEMT said:


> Ah the ParaGod syndrome. I work with a few of them, and the best advice is to just wow them with your abilities. Everything starts with BLS and when ALS fails, they should fall back to BLS. I have noticed the medics that don't like BLS are the ones who did not have strong skills before going into ALS!



Nope it all starts and ends with patient care.  No more no less.


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## jgmedic

I wonder how this thread would go if posted the other way "How do medics deal with EMT's who have "EMT's save medics" syndrome?"


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## Veneficus

jgmedic said:


> I wonder how this thread would go if posted the other way "How do medics deal with EMT's who have "EMT's save medics" syndrome?"



look at them as if to say:

"The poor creatures, they don't know any better."

It does no good to argue with people who think everyone else is less informed than they are.


----------



## usafmedic45

jgmedic said:


> I wonder how this thread would go if posted the other way "How do medics deal with EMT's who have "EMT's save medics" syndrome?"



Despite Venie's sage advice, I think we should give that thread a shot.


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## mcdonl

Who cares about the title anyway? *IF* the person is a know-it-all jerk, they would be that way if they were any profession.

MEDIC's care about EMS enough, and care about their careers enough to go for the highest level you can achieve in this field. Good for them. I am not in the position to do so, but I am not jelous. I am happy to have them. Sure, I have worked with MEDIC's who were jerks... but I have worked with BASIC's, FF's, Drivers and chief's who were jerks too.

And, with 15 years of Hospital Administration under my belt don't even get me started on MD's and RN's....


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## Shishkabob

jgmedic said:


> I wonder how this thread would go if posted the other way "How do medics deal with EMT's who have "EMT's save medics" syndrome?"



Or the "My decade of experience at the lowest level overshadows your education at the highest level and less years of experience"


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## firetender

*Barf!*

All this Level This and Level That talk makes me sick to my stomach.

In the moments you have at the scene with your patient you have the situation and your training and skills. Logic says that if you're going to respond to emergencies for your living or as an aspiration you'd want to know as much as you could about every aspect of emergency medical care and management of a traumatized person.

...and anyone who has been in the field a while knows that such things as Scene Management, although supposedly a "Basic" skill is something you are ALWAYS learning more about and finding different ways to do.

Everything -- all the Levels -- are going on at the same time.

The medics with attitudes on either side of the BLS/ALS fence all share one thing in common; they think they know but they don't. 

The ones who really DO know either keep their mouths shut or share that knowledge with their colleagues in such a way that it is useful rather than antagonistic. If they get resistance, they just go elsewhere rather than wasting their energy on people who really DON'T want to learn more and become better at what they do..


----------

