# Question for the medics: What do you expect from EMT's?



## Anonymous (Apr 23, 2012)

What do you guys expect out of your EMTs? Seems like every medic is different and it depends on which way the wind blows that day. Do you want your EMT to jump in and handle the assessment or do you feel you should be the one doing it? Do you want your EMT taking initiative and setting up a 12 lead or grabbing a blood sugar without you asking, or just wait until you ask them? This would be for guys that run with different people all the time so you are not too familiar with the EMT. Wondering if there is some kind of general consensus.


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## Shishkabob (Apr 23, 2012)

It totally varies from call, and from partner.  My last EMT partner and I had a working relationship so good that we never really spoke on scene to get my wants across as we were always on the same page.  Working with a new medic every day is going to be much harder than having one consistent partner.  


I like to tell my partners that they have their own certification, therefor they do what they think needs to be done, within their scope, with the exception of giving medications as I may be going down a different path than they are.  I want them to have some form of autonomy so I don't have to voice every single wish.





My one rule, that I'm sure all here share, is if it's my call, I do the question asking and make the decisions on what gets done.  Don't call out my decisions unless what I want done is dangerous to the patient.


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## NYMedic828 (Apr 23, 2012)

Here in NYC we run dual medic/dual EMT so my experience is not the same as most folks here.

That said, if I had an EMT partner who I don't know, work with once or twice tops then id expect everything within their scope to be done by them. Anything beyond and within mine done by me. If I had an EMT partner who I work with regularly and knew to be a competent provider, there would be no problem with them spiking bags, checking glucose levels and drawing up meds if I was doing something else or starting an IV etc etc.

It would have to be a person I was pretty confident in though considering if we had a needle stick incident there would be some splaining to do.


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## STXmedic (Apr 23, 2012)

If it's a partner that I work regularly with and they've proven their competence to me, I'll let them do as much of the assessment they want. 

If you're new to me, jump in and get vitals, let me do the talking. Know how to spike bags, put on 3-leads and 12-leads, D-sticks, etc. Also, be willing to learn with an open mind. Especially if you can't do the aforementioned skills.



Linuss said:


> My one rule, that I'm sure all here share, is if it's my call, I do the question asking and make the decisions on what gets done.  Don't call out my decisions unless what I want done is dangerous to the patient.


Yes. My call, my ultimate decision. Do not argue with me about the patient needing oxygen because that's what you were taught. If I have or have not done something, there's a reason for it*

*Unless an intervention, or lack thereof, is posing an immediate life threat to the patient


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## Handsome Robb (Apr 23, 2012)

Pretty much the same as above. When I work as an intermediate I do all the assessments and my medic stands back and will step in once he seems the call ALS or I ask for help. We have a great working relationship and good trust between the two of us. Now if we walk in and it's an obvious ALS call that needs intervention now I go straight to getting the appropriate stuff in place so he can do his job.

Personally it's easier for a medic to step in during the assessment to take over rather than them doing the assessment the dishing it to me when we get to the truck. 

As an intern I do all the assessments then give the EMT a quick run down if I deem it BLS/ILS because that's the way my preceptor and program director want it done.  The EMT on my internship shifts is newer so I try and let him do all the skills and attend ILS or BLS patients to help him learn as well.


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## fast65 (Apr 23, 2012)

Eh, depends on my partner, a couple partners I've had, I hardly trusted them to get a BP. 

However, my current partner, I pretty much let him handle anything within his scope. I handle the assessment, and in the end, it's my call and I make the final decision. That being said, I'm open to suggestions from my partner based on how much I trust them, and most of the basics here are phenomenal, so it works out pretty well.


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## Christopher (Apr 23, 2012)

As I tell any EMT riding with me:


> *I'm just here for the narc keys.*


Every patient needs BLS care, only a very few need ALS care _in addition_.

The only difference between an EMT and a Paramedic is education, and I've met plenty of EMT's who have closed that gap.

You're operating as a team and happen to represent the only part of the team who has a job to do on every call. I expect EMTs to develop a plan of care with me, often times in parallel to my actions. We're both clinicians, but with a different scope of practice.

When the EMT/Paramedic team is working properly, the EMT shouldn't have to wait on the go-ahead from their Paramedic partner to apply oxygen or setup a nebulizer or acquire a BGL or a 12-Lead or vitals or administer aspirin, etc.

When you decide who is lead on the call, they take the history while the other "performs skills".

*Patient assessment and history taking is not a Paramedic skill.*

However, on an ALS call it is usually best to let the Paramedic handle the talking so they can gather a plan of care in their head. I don't personally care if an EMT takes the lead with questioning, just be prepared to keep asking the questions 

I think a lot of EMTs are worried about being corrected, but being corrected is Ok. We may disagree on a treatment plan and likely the Paramedic has a reason for their plan. Sometimes you may be the one who is correct! There is a right way to handle differences in a treatment plan, and usually it is best to offer your plan as a question a Paramedic can answer.

What is a bad thing is when a partner is not willing to admit they don't know something. A lot of EMS ends up being On the Job Training, so admit when you need instruction early.

Hopefully you get a like-minded paramedic partner so that you can practice to your fullest and learn to operate as much as an individual but as a team.


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## Anonymous (Apr 23, 2012)

Some differences of opinions as I expected. My partner and I are both EMT-B, but we run with fire/medics on every call. Some will say things like "okay load him up and continue with paramedic level assessment (being facetious and implying that we should have been doing the assessment). and others feel you are stepping on their toes if you try and handle the assessment. 

So far my very limited experience has been every city and truck guys do things differently, some are cool and willing to teach and others think your just a taxi service/water boy.

appreciate the responses!


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## johnrsemt (Apr 24, 2012)

I always told my EMT-B partners that the basics I wanted done was:

  O2;  whatever they thought was right, remembering that it doesn't matter what school said  not everyone gets Hi flow via NRB.

  on a monitor:  3 or 4 lead  and/or 12 lead.  depending on how they presented.

  Vital signs:

  Set up an IV.

  I told them to see what I was doing and do one of the others, and then the next, etc.    That way if I was setting up a neb treatment they wouldn't waste time by putting the pt on a NC.


   While working IFT:  After working with the same partner longer I would teach them how to assess a patient, and when I went to find the nurse and get a report, they would go and assess the patient.   When I came into the room either we would decide together if they needed to be ALS (their assessment and what the report from the nurse stated) or BLS.   or if I walked into the room and the patient was on a monitor, IV set up VS given to me  etc  I would take them.   (I would complain that my partner wanted me to work way too much for given shift   LOL).


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## johnrsemt (Apr 24, 2012)

And I tried very hard not to do things that made my partners feel like idiots:  if they put them on hi flow O2 and I didn't feel like the patient needed it, I would lower it or change them to NC during transport  or if it was BLS I would comment that the vitals looked better,  lets drop O2 and see if the patient tolerated it well.

   If my partner put a BLS patient on a monitor, I would document a note in the run report about it.    Sometimes we caught something that made the pt ALS; when up to that point it was going to go BLS


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## abckidsmom (Apr 24, 2012)

I try really hard to always teach, and always include my partner in decision making, but I work with a different person nearly every day.  There are only a couple of partners I have worked with enough to have them run the show.

We run Paramedic/EMT medic units, with a long transport time, and I like to get the show on the road as soon as possible every call, especially at night.  I hate wasting time on scene, so this is what I expect out of my partners on scenes:

When we get off the truck, I really prefer for them to be responsible for all radio traffic after that, so I don't have to have my ears torn between the radio and the scene.  Our dispatch checks us after 5 minutes of being on scene and if we don't say we're ok, they send a "no contact mayday" response, so we really don't want to be paying attention to the ramblings of a little old lady and miss that.  I prefer to do the talking until we make a decision about who's riding in with the patient, and only about 20% end up for my partner, if that, so it starts as me.

I like to get the bag and set it on the stretcher and pull that to the door, every time.  I firmly believe that getting complacent and not bringing what you need for the sickest people, just because "this is just BS" brings on evil spirits and you WILL get caught with your pants down, and it will be awkward for one of us while the other goes out to get some stuff, unnecessary steps in their day.

When we get deep enough into the interview that it's time to get vitals (cause it's not time until after you have a little bit of a clue of what's going on), I say something like, "My partner is going to check your blood pressure and listen to your lungs, let me write down that list of meds."  Even when I am working with someone I've never met before, I've never done that and had it look anything other than seamless like we have worked together forever and had a plan for this.

In the truck, if it's ALS, one of us is going to get the IV stuff set up, one of us is going to get the patient on the monitor.  I want the monitor person to get the patient out of his shirt and into a gown as a part of that process.  Makes things easier for lots of people down the road to start that now. I don't care which is which.

If I don't need anything from my partner, or I'm in a hurry to get moving, when we are loading the patient, I go around to the side door and get in on that side, and before he's closed the back doors, I tell him we're good to go.  I really expect that he believe me when I say that and go drive.  I hate when a partner tries to get in and do stuff after I deliver the "OK lets drive away now" message.

What a ramble.  I'll stop now.


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## Veneficus (Apr 24, 2012)

Christopher said:


> *Patient assessment and history taking is not a Paramedic skill.*



While there is some level of truth to this statement, generally, the more education you have, the more experience you have, and the more adjunctive findings you can add to your exam and history, the more useful a physical and history is. 

A paramedic who is doing the same quality of exam as a basic has failed somewhere.

Not to take away from a motivated basic, but as a medic if you do not advance your knowledge, then you are coasting(read going backwards) while everyone else is advancing.


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## Christopher (Apr 25, 2012)

Veneficus said:


> While there is some level of truth to this statement, generally, the more education you have, the more experience you have, and the more adjunctive findings you can add to your exam and history, the more useful a physical and history is.
> 
> A paramedic who is doing the same quality of exam as a basic has failed somewhere.
> 
> Not to take away from a motivated basic, but as a medic if you do not advance your knowledge, then you are coasting(read going backwards) while everyone else is advancing.



Perhaps the intent of my post was lost, being on the ALS board. That was meant to let the EMT-Basic know that there is no difference in an assessment for EMT, EMT-I, and EMT-P beyond the education and experience.

A Paramedic assessment has the same components as an EMT assessment (at least in NC, besides the interpretation of a 12-Lead or 3-Lead). An EMT should not need a Paramedic to make an assessment.


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## Veneficus (Apr 25, 2012)

Christopher said:


> Perhaps the intent of my post was lost, being on the ALS board. That was meant to let the EMT-Basic know that there is no difference in an assessment for EMT, EMT-I, and EMT-P beyond the education and experience.
> 
> A Paramedic assessment has the same components as an EMT assessment (at least in NC, besides the interpretation of a 12-Lead or 3-Lead). An EMT should not need a Paramedic to make an assessment.



I don't think the intent was lost, but since knowledge is what guides and helps one interpret physical findings, as well as ask more directed history questions, under the current educational curriculums, a basic probably (exception for extenuating circumstances such as non EMS health education) does not have the same physical exam abilities as a paramedic.

I agree the basic has a similar skill check off sheet, but the ability to perform a physical exam extends well beyond a few check off boxes that need to be accomplished.


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## abckidsmom (Apr 25, 2012)

I just want to put a triple what he said under Vene's post. 

I don't know how many times over my career that I had presented all of my findings to a physician, who immediately knew exactly what the problem was. I love when that happens because I learn so much. 

Same with BLS providers I encounter. I went to a lady the other day, BLS providers thought she had a big CVA: down on one side, pupils big and slow, unresponsive with cold, clammy skin. She was really sick...with hypoglycemia. 

You can assess people all day but if you don't have something to do with your findings, you've wasted your time and the patient's.


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## Christopher (Apr 25, 2012)

Are you in an area where BLS providers are not allowed to assess BGL? Acquiring a BGL in a suspected CVA patient is the standard of care. The only difference in assessment for this case will be...nothing. I'll concede that 3-Lead and 12-Lead interpretation is decidedly not an EMT assessment in the US.

I stand by my assertion that the standard of care for patient assessment does not differ as you go from an EMT to a Paramedic. Instead, the standard of care for your treatment differs. You're no less responsible for identifying life threats as an EMT than as a Paramedic. If you miss a hypoglycemia case because you thought it was a CVA, you've fallen beneath the standard of care no matter what certification is in your wallet.

I guess if our advice to EMTs is, "you're a technician, ALS will handle the tough stuff," then sure there is a difference in patient assessment. But that's simply not the case, or if it is, it surely is not the way it should be.


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## abckidsmom (Apr 25, 2012)

"should" and "is" are very different. Especially when dealing with people who got there initial 140 hour certification and then 6 hours a week of staffing an ambulance in a super rural area. They maybe do 30 calls a year.


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## Milla3P (Apr 29, 2012)

My FT gig is double ALS with the same partner every day and we work well together, but my volly service is everything from ALS/ALS to ALS/BLS down to a "driver" and if I'm coming from home it's a crap shoot to see what I'm gonna get. 

In my opinion the best BLS partner knows the way around the truck, CAN do things automatically and is calm like me. 

Try to look at things from your perspective and add what you can at your level. 

"What do you want me to do?"
VS
"Do you want a BGL/Limb Lead/12 Lead."

A good basic knows what needs to be done, but ask first. I hate hate HATE when a partner spikes a bag without asking, ESP before a line is established.


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## Anonymous (Apr 30, 2012)

Milla3P said:


> My FT gig is double ALS with the same partner every day and we work well together, but my volly service is everything from ALS/ALS to ALS/BLS down to a "driver" and if I'm coming from home it's a crap shoot to see what I'm gonna get.
> 
> In my opinion the best BLS partner knows the way around the truck, CAN do things automatically and is calm like me.
> 
> ...



very helpful, thank you for the post.


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## Brandon O (Apr 30, 2012)

christopher said:


> i'll concede that 3-lead and 12-lead interpretation is decidedly not an emt assessment in the us.



Jerk!


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## TheLocalMedic (May 1, 2012)

My father was a paramedic for many years, and when I started he gave me a ton of advice.  One of the best things he told me was "For the first few years, just understand that you don't know anything.  Tell your partner when you arrive that you are 'new' and want to know how they like to run their calls."  

And that is exactly what I did.  If I hadn't worked with someone before I'd ask them what they wanted from me and what they expected.  That way we'd be on more or less the same page, because many medics like to do things a little differently than everyone else.  

I still do this to some extent even now; if I haven't worked with my partner before I let them know how I expect things to flow.  I even have a little phrase I use:  VOMIT.  Vitals, Oxygen, Monitor, IV, Transport.  Pretty easy to follow, right?


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## Handsome Robb (May 1, 2012)

Milla3P said:


> I hate hate HATE when a partner spikes a bag without asking, ESP before a line is established.



May I ask why?

I'm pretty confident in my ability to establish IVs. Plus if it's a smaller line I'd like to run it TKO rather than a saline lock so it doesn't clot off.

Personal preference I guess.

Also I tend to voice my treatment plan as we are loading into the truck. "Mike can you get an IV for me please while I do a 12-lead and do more assessment." Maybe it's just me but I like doing my own 12-leads so I know it's placed correctly plus it's easier for me to talk to someone while I place the leads than it is for me to talk and listen while I start a line. My EMT partner is excellent though. He always nabs a sugar for me when he does the line and I'll usually have a bag spiked and waiting for him to connect and I tell him if I want a bolus or a TKO rate. 

I also like to talk so maybe that's what all this planning stems from. I've learned it's easier to develop a plan and lay it all out rather than try to micro-manage everything but I trust my partner a lot.

When I am working as an Intermediate with a medic I have never worked with before I always ask how they like things to be done at the beginning of the shift.


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## Melclin (May 1, 2012)

For the relatively well patient, I expect my partner to do nothing, unless I ask for it. 

For sicker pts, I expect them simply to do what I ask in a timely manner. Nothing  s**ts me more than when you're trying to run a scene and you turn to your partner and say, "Hey can you hang a bag and then get the bed please?", and then you turn around a minute later and they're writing down a med list or something. There is a reason I've asked for the bag and bed. If someone isn't leading and the rest aren't following then things can go pretty pear shaped. Mostly I've worked with some pretty great people and they can predict what I want when I want it and half the time I don't even have to ask. Thats the partner I try to be. I figure out how they like to do things and fit in with it, whether or not its what I would have done had I been running the show. Legs raised? Sure, I'm not ganna start an argument about the literature for and against passive leg raising at a scene. I would expect the same from them if I chose not to raise their legs. The bloke I'm working with right now is great at that. We have a couple of things that we differ on and we have fantastic arguments over piles of text books and articles, but on a scene, whoever is running the show gets what they want, no questions asked. 


As far as clinical decision making goes, I expect my partner to keep up with whats going on, so I can bounce a decision off them if needs be. Ultimately, I'm the boss, but I like plenty of input so long as its given in the right way. Ie not deriding my decision in front of a patient, not argumentative etc.


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## Christopher (May 1, 2012)

Brandon Oto said:


> Jerk!



Sorry bro, it's the only assessment tool not taught at the BLS level! I certainly wish it were (and if you rode with me, I'd _expect_ you to interpret them).

EMS should start with a 2 year degree with an expanded EMT-B scope, including 3-lead and 12-lead interpretation; and we'd just all be known as Paramedics. Paramedic would simply add to that with skills and the additional required education, but fundamentally we'd all have the current paramedic level of education. Anything less would be CPR/First Aid, since that saves just as many lives (and has the literature to back it up, unlike most of what Paramedics do).


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## Brandon O (May 1, 2012)

Christopher said:


> Sorry bro, it's the only assessment tool not taught at the BLS level! I certainly wish it were (and if you rode with me, I'd _expect_ you to interpret them).



Say what you want, we're not friends anymore.

Seriously though, capnography would also fall in that category. I tend to feel that any non-invasive assessment is up for grabs at all levels, but a realistic addendum to that might be "unless it requires equipment you don't carry and aren't allowed to use."



> EMS should start with a 2 year degree with an expanded EMT-B scope, including 3-lead and 12-lead interpretation; and we'd just all be known as Paramedics. Paramedic would simply add to that with skills and the additional required education



I like it, but good luck covering this big old country with degreed providers.


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## Sasha (May 1, 2012)

It depends. 

I've been burned more than a few times trusting my partners to get me manual vitals and I've walked in to someone doing the needle jump and one who held the meter in one hand, the bulb in the other, and wedged his scope all the way under the cuff. 

I've had partners who scream for o2 on a patient whose awake alert and oriented and in no distress with an spo2 in the low 90s with cold fingers and nail polish. 

If you've proven to me you're not freaking retarded then I would love you to get my vitals, do a little assessment, set up monitor and set up my lock or spike a bag. 

If you fall into the dumb category, just set up the stretcher. It's easier to do everything myself the first time then to have to go behind you and repeat it. 

Im also smart and I like to share my information and teach. Medicine and the human body is my passion. If you are open minded I'm far more likely to trust you then if you roll your eyes and tell me they don't pay you enough to know that.


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## Christopher (May 1, 2012)

Brandon Oto said:


> Say what you want, we're not friends anymore.


h34r:



Brandon Oto said:


> Seriously though, capnography would also fall in that category. I tend to feel that any non-invasive assessment is up for grabs at all levels, but a realistic addendum to that might be "unless it requires equipment you don't carry and aren't allowed to use."


But capnography *is* BLS, at least in NC...



Brandon Oto said:


> I like it, but good luck covering this big old country with degreed providers.


An associates isn't exactly that much more work over a current Paramedic certification. I also don't really care if it's an AA, just that the minimum level of education for the certification is the current Paramedic educational standard.

I would say that an AA may increase pay for providers...but fancy degrees doesn't make GE pay you any more, so in reality it's a mixed bag.


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## mycrofft (May 1, 2012)

*Does "What does a nurse expect from his med techs in the field?" count?*

1. Don't start a debate over what's happening unless it has real clinical significance in the more likely situations. (IE, let's talk about your zebras later over MRE's).

2. Know how to multitask and in what precedent order to pursue the needed tasks (Take vitals while you get me woken up, stop emergency bleeding before you take blood pressure, get the heat victim a canteen of water be3fore you start your hundred questions history and physical).

3. Start learning more from day one. I'll teach you, I'll listen to your suggestions and more-recent schooling as you remember it. The point is not only to make you more satisfied with your knowledge, but knowing at least some of what's on the next shelf up makes it easier to interdigitate during a crunch scene (you will know what help I will need, what I will give you, and what we need to hand off with the pt to the next level up).

4. For the first six months, don't try too hard to anticipate help I will need. Just know where stuff is and how to use it. I'll tell you.

3. Never be a filter between me and the patient. Maybe between me and the bystanders and concerned friends and family....


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## the_negro_puppy (May 1, 2012)

Our system is different here we wrok Paramedic/Paramedic or Paramedic/Student paramedic

If you are with a newer student their skill set is much like an EMT-B as the progress its more like having a medic partner, so you have to tailor your treatment etc to what level they are at.

For low acuity calls I expect my partner to obtain vitals while I get a hx and formulate a treatment plan. The person doing 'patient care' for the job generally cannulates here so the other person usually sets the gear up for them, spikes a bag, draws up any drugs or does a 12 lead. Once this is done I expect my partner to start organising extrication, setting up the stretcher etc.

I am about to qualify as a paramedic in around 2 months so will have to work with new & student by myself. Not sure how this is going to go initially, whether I can trust people I havent worked with before as if you are with a student, the buck stops with you.


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## ZootownMedic (May 14, 2012)

I gotta agree on the EMT vs Paramedic assessment. I just graduated from Paramedic school and it is ridiculous how much more in depth an assessment I do if it warrants it. We have AMAZING EMT's in our system and it is very progressive but Paramedic school is what it is and unless you go through it then you are unlikely to have the same quality of physical exam. There are obviously exceptions to this rule on both sides but generally speaking like Vene said....if your assessment/focused physical is on the same level as a lower level provider than your just doing it wrong.


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## Akulahawk (May 14, 2012)

Although it is been a while, what I expect from a Basic is a conversation with them at the beginning of the shift, if I have never worked with them before. The reason I want this conversation is to give the Basic an idea of how I expect each call to go. It also gives me a chance to get a feel for the general level of knowledge that the Basic has.

From there, like Sasha, I basically divide my partners into 2 categories: with a clue and without a clue. Those that "have a clue" are the ones that I trust to do a basic patient assessment and report the finding to me and to anticipate what I am going to need. I also expect this kind of partner to keep an ear open, an eye open, and an open mind. In short, I expect to do very little direction of this kind of partner. I tend to do a lot of teaching with this kind of partner. The other kind of partner is nothing more than a task monkey. This particular kind of partner I expect to do a lot of direction, and very little teaching. With this particular kind of partner, I very much enforce the chain of command between EMT and Paramedic. I expect that my directions be followed and done quickly and efficiently. I do not like having this kind of partner at all. They require too much direction and followup. 

If I have worked with a certain partner, we already know what each other's role is and can get to work quickly, easily, and with minimal fuss, especially if my partner is the type I prefer to work with. 

The other thing is that I generally prefer to be off-scene in less than 10 minutes, if at all possible. The reason I do this is because there's often little that I can do on scene that I can't do in the ambulance, and it gets the patient moving toward the expected destination quickly. I gather what info I need, do an assessment, and get rolling. I'm not hurrying through, just being efficient, no faster nor slower than necessary. I expect my partner to keep up with me though. 

As abckidsmom has said before, sometimes reporting the findings w/o understanding what their significance is can lead to a diagnosis. Sometimes, if you know what the diagnosis is, you can also better describe to the next person up the chain, what is going on with the patient. That can lead to a diagnosis. I have had this happened more than a few times.


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## DrParasite (May 14, 2012)

Maybe the bar is just higher in NJ, because there is no way any paid 911 EMT would have a job for longer than a week if they were unable to do an assessment.  As screwy as NJ is, I shudder when I hear stories from other posters on EMTlife who have EMTs who can't do assessment without a medic holding their hand, can't do vitals, can't think for themselves and are basicly just muscle who should have been fired a long time ago but weren't because their replacement would be just as bad.

Yes, some of the IFT EMTs who haven't seen a sick patient since they completed EMT class, and some volunteers who only go on one call every week, but if it's your full time job to be on an ambulance answering 911 calls, it's expected that you know what to do.

While I understand that a paramedic is more educated than emts, how is the assessment different?  Paramedics can do cardiac monitoring, and can check BGL, so if something requires those two items, yes, an EMT can't definitively "diagnose" a patient's condition that requires it, but that doesn't mean an EMT can't say "hmm, based on multiple factors, i think this patient is having a serious cardiac episode or a diabetic emergency."   Yes I have done it, no, I didn't have a paramedic unit available, we just transported to the hospital (less than 15 in transport time), advised the ER of what we had, and they were ready and waiting with a bed assigned when we got there

btw, I've been burned by retarded EMTs, newbie EMTs, 30 year veteran EMTs (including one dinosaur who was the inspiration for my dinosaur thread), and by stupid paramedics that I wouldn't want to assess my worst enemy (or my idiot brother) (in both NY, NJ, and PA).  There are retards everywhere.


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## Christopher (May 14, 2012)

DrParasite said:


> Paramedics can do cardiac monitoring, and can check BGL, so if something requires those two items, yes, an EMT can't definitively "diagnose" a patient's condition that requires it...



Man, the single craziest thing about EMS that I've learned since joining EMTLife is that BGL and pulse oximetry are considered "ALS" in some states. They're considered less than BLS, instead layperson first aid.

North Carolina is pretty backwards (just read the news, we still can't), but at least we're held to a useful standard of care for BLS providers. BGL, SpO2, EtCO2 (qualitative, quantitative, and waveform)...I really take our minimum competence for granted sometimes!


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## ZootownMedic (May 14, 2012)

Christopher said:


> Man, the single craziest thing about EMS that I've learned since joining EMTLife is that BGL and pulse oximetry are considered "ALS" in some states. They're considered less than BLS, instead layperson first aid.
> 
> North Carolina is pretty backwards (just read the news, we still can't), but at least we're held to a useful standard of care for BLS providers. BGL, SpO2, EtCO2 (qualitative, quantitative, and waveform)...I really take our minimum competence for granted sometimes!



Colorado EMT's are excellent as well with almost all systems requiring IV training to work the streets. BGL's and Pulse oximetry are also basic skills but while i think some, understand the concept and physiology behind EtCO2 I don't think MOST do.


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## DrParasite (May 14, 2012)

btw, i think EMTs should be able to do BGLs, and even pulse ox, but the state disagrees so we aren't educated on it, and as such it isn't expected of us.  but what we are educated on, we are expected to know what do do.  and cardiac monitoring (3/4 lead and 12 lead, not just a psO2) is still a paramedic assessment tool.

out of curiosity, for those that allow the other stuff, how long is your EMT class?


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## ZootownMedic (May 14, 2012)

DrParasite said:


> btw, i think EMTs should be able to do BGLs, and even pulse ox, but the state disagrees so we aren't educated on it, and as such it isn't expected of us.  but what we are educated on, we are expected to know what do do.  and cardiac monitoring (3/4 lead and 12 lead, not just a psO2) is still a paramedic assessment tool.
> 
> out of curiosity, for those that allow the other stuff, how long is your EMT class?



EMT School here in Colorado is 1 semester or 2.5 months in the summer and 3.5 in the fall/spring semesters. You aren't taught anything invasive in school but you are taught pulse oximetry. Once you have your state EMT license you can take a 16 hour IV course. This is two days of classroom training specifically on vasculature, obtaining intravenous access, basic drip rate calculations, using a glucometer, pharmacology of NS/LR/D5W/Naloxone/Dextrose which are all EMT-B drugs in the state of Colorado. Once you pass the classroom test and get two live sticks on classmates you have to get 10 live sticks in the ER to get your certification. You are then technically a EMT-B IV in the state of Colorado but it is more of a 'attachment' to your EMT-B license versus a separate level of provider. It should also be mentioned that this certification only allows you to start peripheral lines as other access areas are still a Paramedic or hospital provider skill. In the end when I got my IV cert I pretty much still sucked at starting IV's and it wasn't until many many many IV's later that I felt comfortable and proficient. It is a motor skill that requires 'skill', proper technique, and practice but once you have it down it is just like getting out of bed. Hope this helps!


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## Tigger (May 15, 2012)

SmokeMedic said:


> EMT School here in Colorado is 1 semester or 2.5 months in the summer and 3.5 in the fall/spring semesters. You aren't taught anything invasive in school but you are taught pulse oximetry. Once you have your state EMT license you can take a 16 hour IV course. This is two days of classroom training specifically on vasculature, obtaining intravenous access, basic drip rate calculations, using a glucometer, pharmacology of NS/LR/D5W/Naloxone/Dextrose which are all EMT-B drugs in the state of Colorado. Once you pass the classroom test and get two live sticks on classmates you have to get 10 live sticks in the ER to get your certification. You are then technically a EMT-B IV in the state of Colorado but it is more of a 'attachment' to your EMT-B license versus a separate level of provider. It should also be mentioned that this certification only allows you to start peripheral lines as other access areas are still a Paramedic or hospital provider skill. In the end when I got my IV cert I pretty much still sucked at starting IV's and it wasn't until many many many IV's later that I felt comfortable and proficient. It is a motor skill that requires 'skill', proper technique, and practice but once you have it down it is just like getting out of bed. Hope this helps!



BGLs are taught in the EMT-B curriculum now, or at least they were taught in my class and I was allowed to do them before getting my IV "cert." As mentioned it is not really a certification, it's a certificate that you can show your medical director and then he or she decides whether or not to accept it.


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## Christopher (May 15, 2012)

DrParasite said:


> out of curiosity, for those that allow the other stuff, how long is your EMT class?



160-200 hours. 160 classroom and 24-48 hours of clinical time.


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## ZootownMedic (May 15, 2012)

Christopher said:


> 160-200 hours. 160 classroom and 24-48 hours of clinical time.



Clinical time is the same here in CO for EMT's.....usually 1 or 2 rotations in the ER and 1 or 2 rotations on a ambulance.


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## marcus2011 (May 22, 2012)

Usually when I work with a medic that I know, I take the patient assessment and the lead until it is seen to need something that I can not give. Even then since I am precepting for my Paramedic I usually discuss it with my partner and then go ahead with the intervention.

When I am working with an EMT on a ALS truck I expect them to know all their skills and not be scared of them. If its a cardiac and I am starting a line, hook up a 12-lead. The only time anyone gets asked to do something is usually that call where your doing an intervention to see. For example a 12-lead on a non cardiac patient.


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