# EMT-B Certification



## crazycajun (Aug 11, 2011)

My question is this. Should the EMT-B certification continue to exist or should it be done away with? It seems every year the training gets shorter and the incoming number of EMT's gets larger. Is it time to get better organized and require a more advanced program?


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## tickle me doe face (Aug 11, 2011)

This is an interesting topic.

I was just reading the Ontario Prehospital Advanced Life Support study, which found that ALS had no better long term outcomes than BLS with respect to heart attacks.

Actually, they found that the few cases where ALS had a better outcome of any sort , were when the patient was in respitory distress, chest pain, or diabeetes.



> Therefore, in an EMS system that already has optimal rapid
> defibrillation, advanced life support interventions did not improve patient survival.



Here is the link to the study!


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## mcdonl (Aug 11, 2011)

Due to education and geography we need to have the ability for volunteers in rural communities to get EMT-B licenses. But, there needs to be a minum standard of field and hospital time in order for it to be succesful. No field time is a recipe for disaster, particuraly in environments like I mention, where the EMT-B is likley to be in the thick of it right off the bat.


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## Melclin (Aug 11, 2011)

*Excuse my slur...I just got home from the pub, but...*



tickle me doe face said:


> I was just reading the Ontario Prehospital Advanced Life Support study, which found that ALS had no better long term outcomes than BLS with respect to *heart attacks.*
> 
> Actually, they found that the few cases where ALS had a better outcome of any sort , were when the patient was in respitory distress, chest pain, or diabeetes.
> 
> ...



In cardiac arrest. Not MI.

It also doesn't take into account the value of good post-ROSC management, which is a decidedly ALS ball game. 

OPALS tells us that intubation and ACLS meds do little to augment the basics of compressions/RRD. Thats it. Its doesn't say "Advanced prehospital care in general, has no benefit".


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## tickle me doe face (Aug 11, 2011)

Melclin said:


> In cardiac arrest. Not MI.
> 
> It also doesn't take into account the value of good post-ROSC management, which is a decidedly ALS ball game.
> 
> OPALS tells us that intubation and ACLS meds do little to augment the basics of compressions/RRD. Thats it. Its doesn't say "Advanced prehospital care in general, has no benefit".



right, it said ALS does not improve survival rates in resescitation.


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## fast65 (Aug 11, 2011)

While I think EMT-B's are very valuable, I do believe we need to start moving towards a more advanced level of initial care. The training seems to be dwindling down to merely "give oxygen and transport". Sure, some might not like the idea, but the fact of that matter is that we need to start advancing our education if we want to start being seen as health care professionals.


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## tickle me doe face (Aug 11, 2011)

I think that option 1 "Do away with it all together and make EMT-A the minimum?" is the leas feasible of all


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## fast65 (Aug 11, 2011)

tickle me doe face said:


> I think that option 1 "Do away with it all together and make EMT-A the minimum?" is the leas feasible of all



And why do you believe that?


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## tickle me doe face (Aug 11, 2011)

fast65 said:


> And why do you believe that?



It seems like it allows for people to advance there clinical skills, without advancing clinical knowledge.

Like when EMT-I's call themselves medics.


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## fast65 (Aug 11, 2011)

tickle me doe face said:


> It seems like it allows for people to advance there clinical skills, without advancing clinical knowledge.
> 
> Like when EMT-I's call themselves medics.



I think the general inference is that with an advanced level of care and skill set, they get the education to supplement it. We are talking about just advancing the level of care, we're talking about advancing the education to go along with it. We don't need a more advanced skill set, we need to more A&P, pathophysiology, pharmacology, etc, then we can look at advancing the skill set.


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## Shishkabob (Aug 11, 2011)

The thing is, EMTs are taught the wrong stuff for what their job ends up being most of the time:  Help to an ALS provider.   Very rarely is an EMT actually in charge of a scene to where an ALS provider will not be available, but much of EMT class is teaching them about how to run such calls.




So, if we were to go off of what their role ends up being, yes, the education is adequate, however it should still be changed to reflect the true role.   But if we were to go off of what EMT classes teaches them their role is (in charge of emergency scenes), then no, what they are taught is not adequate.



In my world, it would be an AEMT (Intermediate) on the truck with a Paramedic.


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## tickle me doe face (Aug 11, 2011)

I understand that lots of EMT's are not kept on a medic's leash.

I also know for fact that local services run trucks with 2 emt's and no medic!


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## Shishkabob (Aug 11, 2011)

And I'm going to assume they are a first responder organization that waits for the ambulance which has a Paramedic, no?


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## Backwoods (Aug 11, 2011)

Linuss said:


> The thing is, EMTs are taught the wrong stuff for what their job ends up being most of the time:  Help to an ALS provider.   Very rarely is an EMT actually in charge of a scene to where an ALS provider will not be available, but much of EMT class is teaching them about how to run such calls....



In a urban area/a dept. that actually has medics, this would be true. But in a rural area with a department like mine all you have is EMT-Bs.


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## MrBrown (Aug 11, 2011)

There is no level analogous to EMT here, we have 3 day trained first responders who work on the nana taxi (PTS) or at private hire events and above them are Technician level Ambulance Officers who require a Diploma and sit somewhere more toward the Advanced EMT level but without IV cannulation

Should the 120 hour wonder be retained? Sure, as a first responder


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## Shishkabob (Aug 11, 2011)

Backwoods said:


> In a urban area/a dept. that actually has medics, this would be true. But in a rural area with a department like mine all you have is EMT-Bs.



Rural BLS departnement that transports without ALS ever, EVER, being on a call?  How many calls a year do you get?


I work in a rural county where all the VFDs are first responders / EMTs.  Still transported by an ALS ambulance.   I don't expect the volles to be able to do much in the wait they have till I get there, because, well... they can't.




(PS, my thing doesn't hold true for places that do a tiered response with an EMT ambulance and Paramedic fly car... which is why I said MOST of the time)


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## Tigger (Aug 11, 2011)

tickle me doe face said:


> I understand that lots of EMT's are not kept on a medic's leash.
> 
> I also know for fact that local services run trucks with 2 emt's and no medic!



I work on a double basic truck, and from a pre-hospital care perspective, it sucks. For the IFT side of things, it's generally fine. I would have appreciated more information on dialysis, radiation, and other topics associated with IFT transfers in class to be sure. But suck knowledge is not really required for one to become a proficient horizontal taxi tech.

When we get an actual EMS call, being a double basic truck sucks. We can do so little at most medical calls to alleviate any pain or discomfort it's almost embarrassing. Wait, actually it is embarrassing. We don't really have the ALS option here either, even being in a metro area. I'd rather just get the patient to the ER then wait around for one of the few ALS units. My company does not currently keep any medic trucks in the city, and we are not going to use one of the city's six medic trucks unless we absolutely have too since most of the time they are just going to transport to a nearby, acclaimed hospital. Even with all the hospitals in Boston, we can still have twenty minute transports where the patient lies there and suffers.


Sent from my out of area communications device.


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## AK_SAR (Aug 11, 2011)

Linuss said:


> .....Very rarely is an EMT actually in charge of a scene to where an ALS provider will not be available....


That depends on where you are.  Urban....rural with slightly longer access to ALS...or really rural where ALS might be many hours away?  

In Alaska, only the larger communities have full time ALS available.  Even on the road network, many smaller communities have only a local, volunteer EMS.  It is very difficult (often impossible) for them to maintain a 24/7 ALS service.  The nearest paramedic can be hours away by road.  Even helicopter medevac can be an hour or more away, assuming the weather is good enough to fly.  In addition, there are many tiny villages which are only accessable by air or water.  In bush Alaska, the reality is often not the "golden hour", but rather the "golden 24 hours".

Granted, rural Alaska is probably an extreme situation.  However, I have no doubt there are many areas, particularly in the western states, with similar issues.


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## BEorP (Aug 11, 2011)

tickle me doe face said:


> This is an interesting topic.
> 
> I was just reading the Ontario Prehospital Advanced Life Support study, which found that ALS had no better long term outcomes than BLS with respect to heart attacks.
> 
> ...



Can you please tell me how the Ontario PCP training compares to EMT-B if we're putting them both in the "BLS" basket?


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## tickle me doe face (Aug 11, 2011)

BEorP said:


> Can you please tell me how the Ontario PCP training compares to EMT-B if we're putting them both in the "BLS" basket?



I thought we were comparing comparable training levels?

the study said als did not equate to bigger survival rates in cardiac arrest


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## crazycajun (Aug 11, 2011)

mcdonl said:


> Due to education and geography we need to have the ability for volunteers in rural communities to get EMT-B licenses. But, there needs to be a minum standard of field and hospital time in order for it to be succesful. No field time is a recipe for disaster, particuraly in environments like I mention, where the EMT-B is likley to be in the thick of it right off the bat.



So why would it be a problem for them to get an A cert instead of a B cert? It seems the PT's in that area would benefit more have ALS personnel than BLS personnel.


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## crazycajun (Aug 11, 2011)

tickle me doe face said:


> Like when EMT-I's call themselves medics.



If this is in reference to my info screen, IT says EMT-I Medic Student which means I am in Medic school.


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## tickle me doe face (Aug 11, 2011)

crazycajun said:


> If this is in reference to my info screen, IT says EMT-I Medic Student which means I am in Medic school.



No, not a pot shot at you.

I've seen EMT-I's refer to themselves as medics in blog posts, articles, threads, etc. though


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## crazycajun (Aug 11, 2011)

tickle me doe face said:


> No, not a pot shot at you.
> 
> I've seen EMT-I's refer to themselves as medics in blog posts, articles, threads, etc. though



I have seen basics do the same. It really doesn't bother me one way or the other. When I first got certified in the 80's I was considered an EMT-A which was a paramedic back then. When we switched to NREMT certs I didn't have time to go through the transition so I just kept the EMT-I. Now I wish I would have done it back then.


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## tickle me doe face (Aug 11, 2011)

crazycajun said:


> I have seen basics do the same. It really doesn't bother me one way or the other. When I first got certified in the 80's I was considered an EMT-A which was a paramedic back then. When we switched to NREMT certs I didn't have time to go through the transition so I just kept the EMT-I. Now I wish I would have done it back then.



Oh.  thought there was a difference, like paramedic was the be all end all


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## Backwoods (Aug 11, 2011)

Linuss said:


> Rural BLS departnement that transports without ALS ever, EVER, being on a call?  How many calls a year do you get?



A neighboring township does have medics but we normally dont call for them. And we get about 120ish calls a year


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## Aprz (Aug 11, 2011)

This is just a list I compiled thinking about what an EMT can do where I live. Obviously this varies slightly depending on where you live, but for the most part, I believe it should be mostly similar.

 MIs/Atraumatic Chest Pain
    º Cannot
         Cannot do 3-leads.
         Cannot administer ASA.
         Cannot administer NTG.
    º Can
         "Assist" with NTG.
         Adminsiter oxygen.
         Put in position of comfort.
         Transport to nearest appropriate facility.
 Asthma/SOB
    º Cannot
         Cannot administer albuterol.
         Cannot nebulize.
    º Can
         "Assist" with albuterol.
         Administer oyxgen.
         Put in position of comfort (semi or high Fowler's).
         Transport to nearest appropriate facility.
 Diabetes
    º Cannot
         Cannot check BGL.
         Cannot administer glucose.
         Cannot administer glucagon.
    º Can
         Can "assist" with glucose, or order them to eat/drink.
         Administer oxygen.
         Put in position of transport.
         Transport to nearest appropriate facility.
 Anaphylaxis
    º Cannot
         Cannot administer epinephrine.
    º Can
         Can "assist" with epi pen.
         "Assist" with epi pens.
         Administer oxygen.
         Put in position of comfort.
         Transport to nearest appropriate facility. 
 Trauma
    º Cannot
         Cannot administer any drug for pain management.
         Cannot start an IV.
    º Can
         Rest
         Ice
         Compress/Splint
         Elevate
         Backboard
         Put on a c-collar.
         KED
         Traction splint
         Put on gauze.
         Direct pressure.
         Tourniquet.
         Administer oxygen.
         Put in position of comfort.
         Transport to nearest appropriate facility.
 Opiate OD
    º Cannot
         Administer naloxone.
    º Can
         PPV
         Administer oxygen.
         Put in position of comfort.
         Transport to nearest appropriate facility.

This list isn't about what an EMT can/can't do, especially compared to an AEMT, Paramedic, RN, Physician, etc; it's about whether an can handle most common emergencies. I believe they can't.

The curriculum for an EMT is so contradicting and lacks. EMTs are tested on various conditions like emphysema, acute bronchitis, pulmonary embolus, myocardium infarction, angina pectoris, abdominal aortic dissection, ectopic pregnancies, etc., yet they are often told they cannot diagnose. Like JPINFV has mentioned over and over, how can you treat without diagnosing? I may have an answer for that.

In my opinion, EMTs alreadly lack the ability to treat (for most situations). If you didn't notice, they usually go through the same treatment algorithm: oxygen, position, transport. Unfortunately, EMTs aren't even very well educated in usually the only drug they can administer, oxygen. They often believe it's benign, it can only benefit the patient, and sometimes students are even told that it serves as a placebo for pain management! A lot of EMTs I've met are confused about the name of positions, don't know the name of positions, and cannot speculate what's the best position for patients. Generally they know that the patient should be sitting up (semi-Fowler's or high-Fowler's) if they are short of breath, or lying down (supine) if they are in shock. They may possibly even be incorrectly taught to place the patient in the supine position with their legs lifted up (a modified trendelenburg position, "the shock position") for shock. If the patient is pregnant or vomiting, place the patient on their side ((left) lateral recumbent, or the "recovery position" post ROSC or spontaneous respiration in their AHA CPR class). A lot of EMTs aren't introduced to the V/Q ratio, yet we think about blood pooling back from the thighs in the modified trendelenburg position only, or that it won't compromise airway because airway only has to do with the mouth, right?

A lot of EMTs know how to do vital signs (V/S), but often they aren't aware of other values such as mean arterial pressure (MAP) or pulse pressure, which both can be either rapidly estimated or figured out, or on an NIBP, it'll be the third number. A lot of EMTs are confused on the normal V/S for pediatrics and geriatrics, don't know how to choose the correct size sphygmomanometer for their patients, believe that the bell of the stethoscope is for pediatric patients (if you have a smaller iPod, smaller head phones are appropriate for it), will not consider/speculate the possible rhythms when taking a pulse (something a Paramedic can do... what are you going to think if you palpate a fast irregular rhythm?), etc. Some programs don't introduce their EMTs to different respiratory rhythms like Cheyne-Stokes, Biots, Kussmaul, Apneustic, etc., they cannot visually associate that with conditions. I don't believe it's in the curriculum to teach the late sign of respiratory distress, often cyanosis is mentioned, but not as a late sign, and EMTs can barely value SpO2 <sarcasm>other than some sort of game of trying to get 100%.</sarcasm>

Essentially an EMT is person that is CPR certified with a little bit of training in first aid, can backboard, push gurneys, drive an ambulance, ask questions, and relay the answer to those questions. This is both why EMT should be trashed, and a reason why you shouldn't waste time waiting to go to medic school so you can gain "experience" as an EMT (however, a benefit of waiting is observing Paramedics, experience sitting in an ambulance, and see if that's what you want to do, which is a benefit I like, but I don't believe it should be enforced).

I believe an AEMT more closely matches somebody who can manage most emergencies, and I think it's a near acceptable minimum, however, I wish we'd start mimicking nursing by requiring chemistry, biology, anatomy, physiology, etc., even if it wasn't the entire class, but rather what pertained to our drugs, the patient's condition, why you need to size an NPA or OPA, etc.

I believe an AEMT more closely matches somebody who can manage most emergencies, and I think it's a near acceptable minimum, however, I wish we'd start mimicking nursing by requiring chemistry, biology, anatomy, physiology, etc., even if it wasn't the entire class, but rather what pertained to our drugs, the patient's condition, why you need to size an NPA or OPA, etc.


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## BEorP (Aug 12, 2011)

tickle me doe face said:


> I thought we were comparing comparable training levels?
> 
> the study said als did not equate to bigger survival rates in cardiac arrest



PCPs in Ontario have at least two years of college education. This is very different from the 120 hour minimum for EMT-B.

But you are correct that ACLS has not been shown to improve survival to hospital discharge.


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## Aprz (Aug 12, 2011)

BEorP said:


> PCPs in Ontario have at least two years of college education. This is very different from the 120 hour minimum for EMT-B.
> 
> But you are correct that ACLS has not been shown to improve survival to hospital discharge.


In California, the minimum is 110. The 3-month program I went to raised the bar, 119 hours.


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## Chief Complaint (Aug 12, 2011)

tickle me doe face said:


> It seems like it allows for people to advance there clinical skills, without advancing clinical knowledge.
> 
> *Like when EMT-I's call themselves medics.*



EMT-I's are absolutely medics in some parts of the country.  If the state uses the I-99 standard they are medics if you ask me.

I'm an Intermediate and I, as well as every single agency in Virginia, refers to us as medics.  My protocols are exactly the same as a Paramedic's protocols in my county.


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## Tigger (Aug 12, 2011)

Chief Complaint said:


> EMT-I's are absolutely medics in some parts of the country.  If the state uses the I-99 standard they are medics if you ask me.
> 
> I'm an Intermediate and I, as well as every single agency in Virginia, refers to us as medics.  My protocols are exactly the same as a Paramedic's protocols in my county.



So then what's the difference between you and a paramedic, and why bother even having paramedics at all?


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## tickle me doe face (Aug 12, 2011)

Chief Complaint said:


> EMT-I's are absolutely medics in some parts of the country.  If the state uses the I-99 standard they are medics if you ask me.
> 
> I'm an Intermediate and I, as well as every single agency in Virginia, refers to us as medics.  My protocols are exactly the same as a Paramedic's protocols in my county.



but you aren't a paramedic?


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## tickle me doe face (Aug 12, 2011)

BEorP said:


> PCPs in Ontario have at least two years of college education. This is very different from the 120 hour minimum for EMT-B.
> 
> But you are correct that ACLS has not been shown to improve survival to hospital discharge.



oh. thanks. I didn't realize the article menioned PPC's, or even what they were.


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## tickle me doe face (Aug 12, 2011)

Chief Complaint said:


> EMT-I's are absolutely medics in some parts of the country.  If the state uses the I-99 standard they are medics if you ask me.
> 
> I'm an Intermediate and I, as well as every single agency in Virginia, refers to us as medics.  My protocols are exactly the same as a Paramedic's protocols in my county.



If we are going to play that game, then I am a Flight/Trauma  Nurse Practitioner.


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## JPINFV (Aug 12, 2011)

tickle me doe face said:


> but you aren't a paramedic?


...some states call their EMT-I/99s "EMT-Paramedic." Well, one state... Iowa.


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## fast65 (Aug 12, 2011)

tickle me doe face said:


> If we are going to play that game, then I am a Flight/Trauma  Nurse Practitioner.



Would you like to offer an explanation?


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## Chief Complaint (Aug 12, 2011)

Tigger said:


> So then what's the difference between you and a paramedic, and why bother even having paramedics at all?



The only real difference, and its an important one if you ask me, is that Paramedics have a better understanding of advanced pathophysiology.  Other than that, no real difference.  

The counties want people with the highest level of certification/education, so they prefer P's to I's.  Paramedics are given priority when there are jobs to be had.



tickle me doe face said:


> but you aren't a paramedic?



Thats correct.  



tickle me doe face said:


> If we are going to play that game, then I am a Flight/Trauma  Nurse Practitioner.



Im not following.


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## 8jimi8 (Aug 12, 2011)

tickle me doe face said:


> If we are going to play that game, then I am a Flight/Trauma  Nurse Practitioner.



Interesting.


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## coastiewifejenna (Aug 12, 2011)

*From a student perspective*

So I know that I am fairly new to the EMS field but I have noticed a few things that may have been overlooked.  So I came from Central Illinois where it is all rural communities and volunteer departments.  However, I am from one of the two larger towns in the area so we have a municipal fire department and we also have private services.  Now where I live all of the firefighters are required to have their medic licenses. This is a new change and so most of the guys dont have very much experience.  There are two private services in my town also.  These two services switch who is on 911 each week. But the fire dept goes out for evey call.  95% of the time they leave in the first 2 minutes they are there but they get to say that they went "on the call". I went to a call and the private service asked the FD guys if they knew how to splint this ankle with a pillow and they hesitated and said no and then closed the door to the back of our rig. Now we were going to give these individuals the opportunity to learn a skill and they opted not to.  And these guys have their medic licenses??? I looked at my other medic and said OMG. We tried I guess. I just think that it speaks volumes about why you get into this. They were forced to keep their jobs at the FD and we do this because we wana help people.  So I dont think it necessarily has to do with time persay as much as it would be experience.  # of runs of a list of things you have to observe before you get your EMT license not just the # of hours you sat at the shop. Quality over quantity.


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## MrBrown (Aug 12, 2011)

8jimi8 said:


> Interesting.



Very


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## coastiewifejenna (Aug 12, 2011)

*Another example*

Where I come from there are several community colleges that offer the EMT basic class.  Now one system requires 40 hours of ride time, the other class only required 25.  The class that required 40 hours also showed up on our rigs and in our ERs and had a list of skills that they had practiced and signed off on and were allowed to preform.  The class that only required 25 was told they were just to observe.  Now I understand that it is based on the student and their willingness to try to learn new things.  But how can these two programs that are literally 30 miles from each other with the likelyhood of having to work on a rig with these people make their teachers feel comfortable.  If one of my students sat in a chair in my ER and just watched, there would be reprocussions.  So I think that the system does need to be more uniformed in their requirements.  I would be glad to work with one of the new basics that came from the 40 hour school but I would be skeptical of the 25 hour school.


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## FrostbiteMedic (Aug 12, 2011)

I must stick my head in the discussion here. I think that we should do away with the EMT-B level and require the -A standard. Why do I think this? Because, at least in my state, the minimum license you will have and find work on an ambulance out here is EMT-IV (I/85 more or less). In fact, to my knowledge there are no colleges that offer the EMT-B standard out here, just a few (and I mean very few in the entire state) fire departments that offer it. I feel that even this (EMT-IV) standard left me somewhat unprepared for the situations I would face when I went to work, even after my clinicals. We are to upgrade to the EMT-A standard here soon, which, for us EMT-IV's, will mean 8 hours of upgrade training. 

But the heart of the issue is education, education, education. To me, that is one thing that cannot be taken from a person.


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## Aprz (Aug 12, 2011)

MrBrown said:


> Very


Ask Tommerag. I made a bet with him two days ago about this! And he said "nope!"


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## DrParasite (Aug 13, 2011)

why get rid of it?  

is the education lacking?  yes, in many areas.

however, if you make everyone become a paramedic, you end up having the problem California is in; everyone is a paramedic, no one does critical skills (intubation, RSI, chest decompression, etc) more than once a year.  so you have a major dilution of skills.

I would guess that for everyone here, every 911 call they go on, 50% of them are either refusals or taxi rides to the hospital.  And by taxi ride, i mean take patient from location, put in ambulance, and transport to ER.  of the the other 50%, maybe half are treated by the acronym VOMIT (Vitals, oxygen, monitor, I/V access, and transport).  and the final 25% require more, either a drug is administered, electricity, or some other ALS skill.

so using those rough numbers (which are guesses, i would guess the numbers is great than 50% for taxi rides and refusals), if the majority of your calls don't require ALS, why require an ALS provider to be there?

What I think most EMTs need is more experience before they get their cert.  Paramedics need to do how many hours of ride time?  if the EMT program is 120 hours, lets double that for 240, with the latter 120 hours being ride time on a BLS and ALS ambulance, where you are graded and need to know how to operate to pass.

also, a lot of these skills need practice.  so if you don't work as an EMT, volunteer as an EMT, and never see a sick patient, you are not going to know what to do when one drops in your lap.  maybe a requirement of 100 calls a year, 50 of them being your chart, so it can be verifying that you are putting into practice what you learn?


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## JPINFV (Aug 13, 2011)

DrParasite said:


> why get rid of it?
> 
> is the education lacking?  yes, in many areas.
> 
> however, if you make everyone become a paramedic, you end up having the problem California is in; everyone is a paramedic, no one does critical skills (intubation, RSI, chest decompression, etc) more than once a year.  so you have a major dilution of skills.



I think that's the big problem. As it stands right now, you either have the choice of someone who can't do much more past oxygen and a ride, or you get the special forces. The problem is how do you completely reform the levels so that every ambulance (I'll reiterate here that non-emergent and emergency transport (including from health care facilities) should be separate. "Emergency" being defined as "going to the emergency department") has a provider educated and equipped to handle the 95% of calls that require either no intervention or high use, low risk (e.g. IV, IV dextrose, cardiac arrests, CPAP, naloxone, anaphylaxis, etc) so that the remaining 5% of calls that require low use, high risk interventions are covered by providers who have experience providing low use, high risk interventions.


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## okiemedic (Aug 14, 2011)

Instead of waiting for NREMT to make us learn more. Why don't we do it ourselves? I do that every day. If you are an EMT-b you should have a general understanding of what a Paramedic needs, wants and is thinking. that just makes a better team..

I've talked to Paramedics who've said their EMT's have saved their asses. on Multiple occasions.....

If you became an EMT, You got your certs and you do your CEU's just to retain that cert. You belong in an IFT truck...

If you became an EMT, You continually bush yourself to learn more, understand the signs and symptoms of certain illnesses...If you can communicate to Paramedics, nurses and doctors in a way that helps them get a leg up..You belong in a real EMS gig..

Its not whether we need more hours..Its whether we choose to be cracker box (cert) EMT's or real EMT's....It doesn't take long for an employer to figure out you know or don't know your stuff..

eliminating EMT-b is a bad idea...I don't want unconscious incompetent Paramedics in the field working IFT or 911..You can have all the hours of training in the world..But if you get in the field and freak...That is bad...

If you are in the field as an EMT-b for a year or two...You are conditioned for alot more....If you do what I said (understand the abilities of a Paramedic and what they need to do) You'll be a better paramedic because of it...

I'm not interested in playing the game of defacing the guy under me....We are (should be) all professionals here..We should know our jobs and understand how the guy under or above me can assist in the EMS process....Reread the chapter (introduction to the EMS system) "Roles of the EMS system...

I don't want to work with an EMT or Paramedic who thinks they know all..and wants everybody to know that...They are usually the ones to screw up first...I want to work with somebody who KNOWS the job and does it...


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## crazycajun (Aug 14, 2011)

okiemedic said:


> Instead of waiting for NREMT to make us learn more. Why don't we do it ourselves? I do that every day. If you are an EMT-b you should have a general understanding of what a Paramedic needs, wants and is thinking. that just makes a better team..
> The whole point of furthering education and clinical hours (Ride Time) is to do just that.
> 
> I've talked to Paramedics who've said their EMT's have saved their asses. on Multiple occasions.....
> ...



My answers are in red. Might I ask what your current certification level is?


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## okiemedic (Aug 14, 2011)

crazycajun said:


> My answers are in red. Might I ask what your current certification level is?



*I have also seen many EMT-B's cause major havoc at a scene.
*

Why? lack of experience? lazy? 

*So you would rather have an EMT-B by your side in a MCI than an EMT-A with more clinical knowledge and a larger scope to help the PT's?*

This goes back to the Roles of the EMS system..If dispatch sends a BLS truck to an accident with severe trauma..That is a breakdown of the system..

*
Again, you would rather have an EMT-B that has 110 hours of training compared to a Paramedic who has 2 years of schooling plus 650 hours of field clinicals?*

I want a Paramedic who's had REAL LIFE experience in the field as an EMT..Plus their Paramedic training....

650 hours can't really prepare you for everything you are gonna see..I've been dispatched to calls where guys have tried to have sex with a hole in a pool..Got his wiener stuck...That isn't a great example...But the more field experience the better...

*I know EMT-B's that have been in the field for several years and still don't grasp the concept. By eliminating the EMT-B and going to a more in depth education, many of the problems we have today with newbies will be weeded out in school and not on the street*

How will that help that particular kind of individual? Even if you upgrade the learning process..That person still passes..But is still not getting it..How does that help anything? I've met really smart EMT's and really dumb EMT's..I've also met really smart paramedics and really dumb ones...At some point..The turnover process effects those individuals...

I've noticed that where people end up in EMS correlates to how smart they are..Take where I currently work for example..We've got an EMT - B that you can't hardly understand when he talks..He sounds like boomhaur from king of the hill..But worse...We've got guys who don't tuck their shirts in..They never wash their cloths..They are always late to work or don't show up..They only do minimum so they can maintain their certifications and they choose to never further their education...

These same individuals complain why they can't get hired onto a 911 service..

Then you see the EMT-B's go on to work with 911 services and make more money....This has more to do with who you are and what you CHOOSE  to learn and know rather then your certification status...

My point is..You are ALWAYS gonna have stupid people..Whether that is a Police officer...EMT, Paramedic or Firefighter...The laws of supply and demand weed those folks out..Some it may take longer then others..

If you want to change the roles of EMS..Why not just eliminate Paramedics and put nurses in Ambulances? or no..lets just put Doctors in Ambulances instead....

Lets go head and eliminate the door breach guy from swat too..Just use C4...Why even use Swat...lets just use snipers...No lets eliminate snipers too and just carpet bomb the area....


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## okiemedic (Aug 14, 2011)

Before I forget...I've seen posts on here saying as an EMT B you won't see severe trauma cases...

I worked as a  Volunteer Firefighter/MFR...I saw hundreds of Trauma incidents that we had to deal with before Paramedics got on the scene..I've seen people completely severed in half that was still alive...They are still alive today because of the work we did on them....I've also been on the scene of a Bus VS train collision...We managed to stabilize the few survivors..Spent the latter half recovering body fragments... 

*
You need to learn and understand the scope of care the person ahead of you knows and is able too do..Because they won't always be around..By knowing that it'll make you a better EMT....*


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## Shishkabob (Aug 14, 2011)

Wait, so because I had no practical field experience before I did Paramedic school... I'm more of a liability on scene and of less help to my patients?


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## okiemedic (Aug 14, 2011)

If you want to eliminate EMT-B why not eliminate MFR too? 

I am an EMT-I student....


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## crazycajun (Aug 14, 2011)

okiemedic said:


> *I have also seen many EMT-B's cause major havoc at a scene.
> *
> 
> Why? lack of experience? lazy?
> ...


It sounds like you are very upset that you did not get an offer from 911


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## crazycajun (Aug 14, 2011)

okiemedic said:


> If you want to eliminate EMT-B why not eliminate MFR too?
> 
> I am an EMT-I student....



MFR IMO is great for teens, lifeguards and hose monkeys. Not for EMS


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## okiemedic (Aug 14, 2011)

crazycajun said:


> It sounds like you are very upset that you did not get an offer from 911



:lol: Not at all...

I am just returning back into EMS after 8 years out of it...I don't expect to go straight into 911...It is a goal eventually though..

The only reason I took this crap IFT job i got now is to get experience....I don't hold myself to the same standards as those employees i talked about...I come to work clean and pressed..I get more respect from patients and staff of facilities.....I know that my current position is only temporary...

I completely understand where you are coming from. I think we both want the same thing..Better EMT's...The current system is fine in my eyes. EMT-B EMT I/Advanced and Paramedic....Obviously the ones who can't pass to the advanced level won't..They'll be stuck at low pay IFT positions...

Keep in mind. It costs more to employ a paramedic. So that may mean there will be less coverage on the streets...


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## traumaluv2011 (Aug 14, 2011)

I don't know if it has already been mentioned, but I know that NJ state EMT testing is requiring another 30 hours, I believe, and will have added topics like finger sticks for blood glucometers and basic intubation instruction. I know in some states where the time to the hospital is at least 20 minutes, the EMT-Bs are ttrained to intubate. Not quite an EMT-I/EMT-A, but they know a little more than EMT-Bs. The refersher course is also going from 24 to 30 hours as well. 

So as for the poll, they are not doing away with EMT-A, just adding a bit to the EMT-B core topics.


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## traumaluv2011 (Aug 14, 2011)

traumaluv2011 said:


> So as for the poll, they are not doing away with EMT-B, just adding a bit to the EMT-B core topics so that it is a little more advanced.



Correction*


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## DrParasite (Aug 14, 2011)

traumaluv2011 said:


> I don't know if it has already been mentioned, but I know that NJ state EMT testing is requiring another 30 hours, I believe, and will have added topics like finger sticks for blood glucometers and basic intubation instruction.


those are proposed changes... whether or not they actually happen has yet to be seen.


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## Tigger (Aug 15, 2011)

I am a basic, and I know that my job should not exist. The level of care I can provide independently for my patients is almost laughable, quite frankly. Honestly, what is the point of sending someone to a true medical emergency who is unable to even partially secure an airway. A basic isn't even really fit for working in an IFT setting, how much time did anyone's class spend on IFT related topics?

I think Tennessee has it right. The lowest level provider spends a semester in school and hopefully builds the necessary clinical knowledge base to start an IV and give basic medications. But they aren't just skill monkeys, they received an education in prehospital care, not training on set skills. Even the lowest level provider needs to be able to make real, autonomous clinical decisions based on knowledge of human anatomy and disease process.

If it were up to me, EMT basic classes would still exist, but they would be renamed as MFR and the minimum certification to set foot on an ambulance would be some sort of EMT-A/I-85/I-99 type certification, probably without intubation.


Sent from my out of area communications device.


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## jjesusfreak01 (Aug 15, 2011)

Linuss said:


> Wait, so because I had no practical field experience before I did Paramedic school... I'm more of a liability on scene and of less help to my patients?



Probably for a little while once you started working in the field...UNLESS...you were working in a system with a thorough field training program. 

Personally, I think the EMT basic education (at least in my state) is alright where it is. Here is why. As an EMT-Basic, your role in EMS is going to be determined by the way your system is set up. In some places, you may be little more than a driver, and in some places you may be qualified to use advanced airways and allowed to attend on patients. The point is that above the standard EMT-B education it ought to be the role of the medical director and system administrators to finish training you to the role that they expect you to take in their system. 

This is not to say that I don't think having an I/P combination on each truck would be a much better idea, but if a state wants to keep the EMT-B level and system administrators want to employ EMT-Bs, there is no problem with that.


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## traumaluv2011 (Aug 15, 2011)

I think it depends on the area your in. Some place rural like Tennessee where the hospital may be 30 minutes or more away, yes. Suburban and urban places can live with BLS care support for the 10-15 minute drives to the hospital. Ultimately, its getting to the hospital as quickly as possible that will save those critical patients. And for the non-critical patients in rural areas, the medics can make sure they stay that way.


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## MrBrown (Aug 15, 2011)

traumaluv2011 said:


> Suburban and urban places can live with BLS care support for the 10-15 minute drives to the hospital. Ultimately, its getting to the hospital as quickly as possible that will save those critical patients.



While time is a factor and should not be under appreciated in context of the larger clinical picture the American mentality of throw everybody on a spine board and race them to hospital because that is what our poorly written textbook told us to do is not really the best approach.


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## Tigger (Aug 15, 2011)

traumaluv2011 said:


> I think it depends on the area your in. Some place rural like Tennessee where the hospital may be 30 minutes or more away, yes. Suburban and urban places can live with BLS care support for the 10-15 minute drives to the hospital. Ultimately, its getting to the hospital as quickly as possible that will save those critical patients. And for the non-critical patients in rural areas, the medics can make sure they stay that way.



Sorry, but I don't think it's ok for someone in significant distress to have to wait an additional 15 minutes to be seen by a provider that can actually figure out what is wrong, and then maybe start to treat. There is nothing sadder than loading someone with significant abdominal pain or an isolated orthopedic injury and telling them that there is absolutely nothing you can do for them except to take them to the hospital. And please, no one give me the "put them on high flow o2, it'll make them feel better" spiel, I've about had enough of that mindset.

I love my job and I do everything I can for my patients, but at my present level it isn't usually anywhere close to enough. 

Though there is that idea from The House of God that doing nothing is doing something....


Sent from my out of area communications device.


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## traumaluv2011 (Aug 15, 2011)

And a paramedic can diagnose every call they can get? They can start an IV and give them fluids or meds as needed, but can't they do the same exact thing in the hospital while a doctor figures out the problem? And yes, the hospital can get busy, but they prioritize most patients based on the seriousness of their condition. 

I'm not bashing paramedics, I think they are very useful, but if a person requires surgery, psychiatric evaluation, etc. it is better to get them to the hospital as quick as they can. Yeah, I guess having a paramedic is a safe route should the patient's condition worsen en route. I think having ambulances with a Medic and at least one Basic would be the optimal crew.

The paramedic can do what is needed and the basic can assist the medic or drive.


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## JPINFV (Aug 15, 2011)

traumaluv2011 said:


> And a paramedic can diagnose every call they can get?


The question is not if a diagnosis can be made or not, but how specific of a diagnosis can be made, and with what accuracy. Absent the ability to work up a patient further, an EMT can surely diagnose a patient with chest pain. Similarly, what's just as important, if not more so, than any specific working diagnosis are the differential diagnoses that are also being considered. 




> I'm not bashing paramedics, I think they are very useful, but if a person requires surgery, psychiatric evaluation, etc. it is better to get them to the hospital as quick as they can. Yeah, I guess having a paramedic is a safe route should the patient's condition worsen en route. I think having ambulances with a Medic and at least one Basic would be the optimal crew.


Whether speed matters depends on the condition, and the condition cannot be determined without an assessment.


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## Handsome Robb (Aug 15, 2011)

In my county an ambulance has to have an I/P or P/P onboard to be on the street. From the intermediate stand point, I liked it because I could reduce the medic's workload by drawing up meds, starting an IV and so forth which *most* basics can't do. From the Medic standpoint, it's nice to have a partner who can do more than drive/bag/lift/pass me things. No offense meant, just my .02


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## Tigger (Aug 15, 2011)

traumaluv2011 said:


> And a paramedic can diagnose every call they can get? They can start an IV and give them fluids or meds as needed, but can't they do the same exact thing in the hospital while a doctor figures out the problem? And yes, the hospital can get busy, but they prioritize most patients based on the seriousness of their condition.
> 
> I'm not bashing paramedics, I think they are very useful, but if a person requires surgery, psychiatric evaluation, etc. it is better to get them to the hospital as quick as they can. Yeah, I guess having a paramedic is a safe route should the patient's condition worsen en route. I think having ambulances with a Medic and at least one Basic would be the optimal crew.
> 
> The paramedic can do what is needed and the basic can assist the medic or drive.



The point of having the paramedic around is not as a precaution against the patient getting worse. The purpose of having providers in the field with an actual clinical knowledge base is to make people better. I hate being unable to call for ALS because the patient is "stable." Does anyone think nana doesn't want those pain meds after she slipped in the bathroom and broke her hip? Hopefully not, but unless nana is also circling the drain or dead on the floor, it's unlikely that ALS will be paying us a visit anytime soon.

And yes, she will be getting the same treatment in the hospital, but why should she have to wait when there are providers available to actually help her? Aren't we supposed to be "bringing the hospital to the patient" with our "mobile emergency rooms?"

Sent from my out of area communications device.


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## MrBrown (Aug 15, 2011)

Tigger said:


> Does anyone think nana doesn't want those pain meds after she slipped in the bathroom and broke her hip? Hopefully not, but unless nana is also circling the drain or dead on the floor, it's unlikely that ALS will be paying us a visit anytime soon.
> .



So if you ring up for ALS (ICP) for pain relief they will not come?


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## Handsome Robb (Aug 15, 2011)

It's not an issue where I work seeing as all the trucks have pain management, wether it be nitrous or narcotics, but from friends and people who I have talked to who work in BLS/ALS systems, no. If the system is busy, and/or there isn't a truck available you won't get it unless it is a patient who meets that system's ALS criteria.


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## MrBrown (Aug 15, 2011)

NVRob said:


> If the system is busy, and/or there isn't a truck available you won't get it unless it is a patient who meets that system's ALS criteria.



Gosh silly Brown for thinking "pain" was somehow criteria for requesting people capable of providing "pain relief".

Rob, do you haz teh entonox (nitrous)?


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## Tigger (Aug 15, 2011)

MrBrown said:


> So if you ring up for ALS (ICP) for pain relief they will not come?



I don't know if they would flat out deny me, but the ETA would be absolutely awful.

Seriously, there are more ERs in the city of Boston than are Boston EMS ALS units. My company's paramedics are all committed to a 911 contract far from Boston so we would have to request ALS from the city, and they are apt to probably just laugh at us unless the person is nearly dead. Pain managment? Hah we don't got no pain management.


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## medicdan (Aug 15, 2011)

Heh. I hear you. I work for a company that has more ALS resources in the city, but certainly get turned down for medics often enough. I've learned to be more forceful in my insistence with dispatch when I really need it.

At the end of the day, though, when there's nothing available all we can do is treat to our capabilities, transport and document our request for ALS. 

Sent from my DROID2 using Tapatalk


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## MrBrown (Aug 15, 2011)

emt.dan said:


> Heh. I hear you. I work for a company that has more ALS resources in the city, but certainly get turned down for medics often enough. I've learned to be more forceful in my insistence with dispatch when I really need it.
> 
> At the end of the day, though, when there's nothing available all we can do is treat to our capabilities, transport and document our request for ALS.



Are they declining you because there are no ALS resources in the grid free to send or because they do not feel the request (e.g. pain relief) is worthy of an ALS resource?

Here, if you ring up and request ALS (Intensive Care) you get it no matter what


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## Tigger (Aug 15, 2011)

MrBrown said:


> Are they declining you because there are no ALS resources in the grid free to send or because they do not feel the request (e.g. pain relief) is worthy of an ALS resource?
> 
> Here, if you ring up and request ALS (Intensive Care) you get it no matter what



Someone with more knowledge of Boston EMS will have to answer that. All I know is that if you call in with a cardiac arrest of something of similar nature, you usually get ALS quickly. If you call for pain control, it takes a lot longer. How they deploy their ALS is not something I yet understand. They will always give you an ETA, but the hospital is almost always closer, unless you have patient that is (nearly) dead, then suddenly the ETA is better.

Many providers are also quite afraid to call for ALS. The medics come with a city BLS basic truck as well (to drive the medic truck to the ER), so there are a lot of eyes theoretically judging you. It makes no difference to me if four city guys think I am crappy provider for calling ALS on a perceived BLS call, but it does to some people.

That all notwithstanding, this does expose a weakness of Boston's EMS system. There are so few ALS units that they are often tied up, so even serious cases become "scoop and screws." This makes pain control or even simpler things like Zofran for nausea all but impossible to get outside of the hospital. To be fair, city BLS crews go through a six month fulltime academy that includes an additional three months in the classroom, the basics are said to "assess at an ALS level."


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## usalsfyre (Aug 15, 2011)

I see it less of a weakness with Boston's system and more of a weakness with the EMT-Basic level of provider. There's no reason the AEMT level couldn't provide things like Zofran and sensible narcotic pain control given the appropriate education.


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## Tigger (Aug 15, 2011)

usalsfyre said:


> I see it less of a weakness with Boston's system and more of a weakness with the EMT-Basic level of provider. There's no reason the AEMT level couldn't provide things like Zofran and sensible narcotic pain control given the appropriate education.



But that's the thing, there are no AEMT level providers, even though I would bet a Boston basic has a knowledge base that is comparable, just without the skills. I am all about EMS not being dragged down with skill obsession, but with an increase in knowledge needs to come _some_ increase in scope. As it is now, only six trucks during the day and three at night are capable of delivering Zofran, as an example. At least they can give a neb or nasal nalaxone now, therefore not tying ALS up for these medications.


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## hippocratical (Aug 16, 2011)

Correct me if I'm wrong (and I probably am...) but isn't the role of EMS to basically stop people in emergency situations from dying?

Your level of training determines how 'good' you might be at this process, but essentially that's our purpose? Paramedics have more experience and toys than an EMT-B, but we all have the same aim: to press the pause button until they can be "cured" at hospital.

Sorry to be flippant, but I'd like to see any level of EMS provider actually heal a broken bone, remove a tumor, or de-crazy a first onset schizophrenia pt. That's why we have docs in hospitals.

One day they'll invent an Dr Horrible's freeze ray and then we're totally out of work


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## Shishkabob (Aug 16, 2011)

How about reverse an anaphalytic reaction?

How about cardiovert a lethal rhythm?

How about convert symptomatic SVT?

How about reversing respiratory arrest?

How about stopping an asthma / COPD attack?

How about reviving a diabetic?



There's plenty that EMS (namely Paramedics) can "cure" without the need for a hospital, all of those potentially lethal.


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## Chief Complaint (Aug 16, 2011)

Linuss said:


> How about reverse an anaphalytic reaction?
> 
> How about cardiovert a lethal rhythm?
> 
> ...



Nailed it.


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## hippocratical (Aug 16, 2011)

Linuss said:


> There's plenty that EMS (namely Paramedics) can "cure" without the need for a hospital, all of those potentially lethal.



so EMT-Bs _are _useful!

^_^


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## MrBrown (Aug 16, 2011)

Linuss said:


> There's plenty that EMS (namely Paramedics) can "cure" without the need for a hospital, all of those potentially lethal.



You are curing nothing, you are relieving symptoms or providing reversal of acute exacerbations of a chronic disease.  

Are you curing the diabetes or underlying heart disease or autoimmune disorder No.

Does that mean it is not important for Paramedics to be available to provide such service? No it does not.


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## Shishkabob (Aug 16, 2011)

Brown:

Then in all fairness, most doctors never cure anything either, by your definition.






hippocratical said:


> so EMT-Bs _are _useful!
> 
> ^_^



I don't see a single thing on that list that the average EMT can 'cure' /fix anywhere near the level that a Paramedic can, if at all.


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## tiffany9902 (Aug 16, 2011)

I had did more then enough ride along and hospital hours but some other schools i talk to said they did very little hours and they nothing the whole time... i had a few crazy ride along and had to do chest compressions on a man in the hospital i wish i had more time on my ride alongs and hospital hours... but i think it should stay the same just so people can get a taste of what they are getting them selfs into and if they dont like it they dont have to more forward in this career... 

just my opinion...


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## JPINFV (Aug 16, 2011)

hippocratical said:


> so EMT-Bs _are _useful!
> 
> ^_^



Of course. Everyone knows that EMT-B is actually a command to empty my trash, _____.


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## hippocratical (Aug 16, 2011)

EMT-Bs in my part of the world (EMRs) can;

*> How about reversing respiratory arrest?*

CPR & PPV isn't a bad idea... but nothing fancy that's for sure.

*> How about stopping an asthma / COPD attack?*

Assist with Salbutamol or Ipratropium admin. 

*> How about reviving a diabetic?*

Unconscious? _Pt. buggered. _Oral Glucose if lucid and Hypo (EMRs can take a glucose reading)
Hyper? _Pt. buggered. _

All other conditions mentioned? _Pt. buggered. _

That said, defending the utter minimal usefulness of an EMT-B (EMRs) wasn't really my point. I was just saying that EMS providers primary role is to not cure, but stop a pt. from deteriorating until they can get the variety of services available at their local care facility. 

Arguing about how much more a paramedic can do is beside the point.


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## MrBrown (Aug 16, 2011)

Linuss said:


> Brown:
> 
> Then in all fairness, most doctors never cure anything either, by your definition.



You are learning .... western medicine has not been corrupted by the pharmaceutical industry and other poisonous interests to "cure" people but rather, to maintain profit generating diseases

/soapbox


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## Shishkabob (Aug 16, 2011)

Actually I was going more for the fact that I have a different definition of "cure" than you do...


But you know, the conspiracy theory one works too.


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## usalsfyre (Aug 16, 2011)

There's a good bit or medicine that not focused on "cure" but rather "relieving pain and suffering". This is where there's a HUGE difference between a paramedic and a basic. 

What's unfortunate is many paramedics choose not to treat pain and suffering when they're entirely capable of it.


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## bstone (Aug 16, 2011)

Just for the record, it's "A-EMT" not "EMT-A".


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## DrParasite (Aug 16, 2011)

Tigger said:


> Many providers are also quite afraid to call for ALS. The medics come with a city BLS basic truck as well (to drive the medic truck to the ER), so there are a lot of eyes theoretically judging you. It makes no difference to me if four city guys think I am crappy provider for calling ALS on a perceived BLS call, but it does to some people.


wait what?  so Boston EMS has enough free units to send 2 on an ALS intercept when the patient is already in an ambulance?

I mean, I can see pulling over to the side of the road, both medics jump in, do an assessment and basic interventions, and once completed, one jumps out and drives the BEMS truck behind the BLS one.  or even both medics jumping in while the original treating EMT hopping out to drive the BEMS truck.

but tying up 3 trucks for an ALS call, esp when two are from a busy system like Boston EMS, is well, wooow


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## jjesusfreak01 (Aug 16, 2011)

Don't get the misguided idea that an ER doc really does anything more than what paramedics do. In most cases, an ER doc doesn't "fix" anything. The usefulness of the ER is in the resources and other professionals available to the patient. 

An ER doc can give a psychotic patient Haldol (just like a paramedic would), but he can also refer to behavior health professionals.

An ER doc could splint a fracture (although its more likely a CNA would do it) but if a break needs setting he has the benefit of radiology to assist.

An ER doc can diagnose a STEMI (just like a paramedic), but he's going to pass the buck to an interventional cardiologist to fix the problem.

An ER doc can diagnose thousands of problems using their advanced knowledge of physiology, but in the end their goal is to get the patient walking out the door. Everything past that gets handed off to other specialist medical professionals. As EMS providers, we act as an extension of the hand of the physician, FIXING emergent medical problems or sustaining the patient until they can be turned over to professionals with the greater resources needed to fix their problems.


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## Tigger (Aug 16, 2011)

DrParasite said:


> wait what?  so Boston EMS has enough free units to send 2 on an ALS intercept when the patient is already in an ambulance?
> 
> I mean, I can see pulling over to the side of the road, both medics jump in, do an assessment and basic interventions, and once completed, one jumps out and drives the BEMS truck behind the BLS one.  or even both medics jumping in while the original treating EMT hopping out to drive the BEMS truck.
> 
> but tying up 3 trucks for an ALS call, esp when two are from a busy system like Boston EMS, is well, wooow



Private ambulance employees are not permitted to drive the city's trucks. If they only need one medic in back of the private truck then all is well but if two are needed the BLS is coming. There quite a few more BLS city trucks around...


Sent from my out of area communications device.


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## Tigger (Aug 16, 2011)

usalsfyre said:


> There's a good bit or medicine that not focused on "cure" but rather "relieving pain and suffering". This is where there's a HUGE difference between a paramedic and a basic.
> .



Could not agree more. This is why I think American EMS needs to move away from using BLS units in 911 situations. Most of my patients do not have any "immediate life threats" but they do need medical care and the sooner the better.


Sent from my out of area communications device.


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## crazycajun (Aug 17, 2011)

jjesusfreak01 said:


> Don't get the misguided idea that an ER doc really does anything more than what paramedics do. In most cases, an ER doc doesn't "fix" anything. The usefulness of the ER is in the resources and other professionals available to the patient.
> 
> An ER doc can give a psychotic patient Haldol (just like a paramedic would), but he can also refer to behavior health professionals.
> 
> ...



Actually I have yet to meet and ER Doc diagnose a STEMI. When we took PT's to the ER every ER Doc I met would have someone come down and interpret the strip for the Cath lab and then make the decision that we had already given them. TAKE THE PT TO THE CATH LAB! Now we just go straight to the lab no questions asked.


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## Frozennoodle (Aug 17, 2011)

Who cares who can do what?  Paramedics use the knowledge and tools at their disposal to treat and care for their patients. Are they health care providers or are they skill monkeys?  I'm far more impressed by a medic who can articulate a patient's complaint and his history and give useful insight into that patient's current condition than I am by someone who can nail an IV every time.  

My goal is to do what's in the best interest of my patient's and give them the best care I know how to give with the tools I have.  This conversation has devolved into a debate as to what the role of EMS is and even the most staunchly pro-education posters on here are getting pulled into the skill-set debate.  

Give us another 2 years beyond Paramedic school and you'll be amazed what kind of care we'll start to see from our EMS providers.  I love my Basic partners but I don't think we need people with so little education on 911 trucks alone.  We need well educated ALS providers.


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## Anthony7994 (Aug 29, 2011)

okiemedic said:


> Instead of waiting for NREMT to make us learn more. Why don't we do it ourselves? I do that every day. If you are an EMT-b you should have a general understanding of what a Paramedic needs, wants and is thinking. that just makes a better team..
> 
> I've talked to Paramedics who've said their EMT's have saved their asses. on Multiple occasions.....
> 
> ...




This is exactly what I wanted to say. All through EMT school I would pride myself on learning and understanding MORE than the bare minimum. Not only because I enjoy it, but because it helps me and the paramedics we assist in my area. Through my ambulance and ER time (which for me was about 90 hours) I would continually watch the medics, ask them about everything I could and how I could further assist them.  Some health providers (not just basics) get their certs and figure it's the end of studying and education, which couldn't be further from the truth. I find new things to study all the time in order to stay on top of things. Because, if I can do good at my job as a basic, it will help the paramedics and everyone else in the long run. Especially around here, where we are first on scene before the medics quite often. Do I think I'm a medic, or that I'm above anyone else? Absolutely not. I couldn't even begin to say such a ridiculous thing. But, do I feel I'm a competent new basic and that I try to stay on top of my game? Absolutely.


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## Cohn (Aug 29, 2011)

A very good medic and RN told me once:


 "You know it’s the basics that save lives."


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## JPINFV (Aug 29, 2011)

Cohn said:


> A very good medic and RN told me once:
> 
> 
> "You know it’s the basics that save lives."



Yes, the basics do save lives. But does not health, preperation, assessment, long term treatment, and the skill of the surgeon not also save lives? One cannot save lives on CPR and defibrillation alone.


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## Anthony7994 (Aug 29, 2011)

Actually, scratch what I first said. I did some thinking about this tonight at dinner, and I realized that when I thought I was studying to be more competent as a basic, I was actually trying to FURTHER my education, since the scope of a basic class is so limited to the point where I feel like I'm providing an inadequate level of care. The idea of making EMT-B into first responder and the lowest level of EMT being Advanced makes complete sense. I just want to take an I or P class already, but since I'm going into the military, I don't have time. So, I will spend my time studying more and getting to understand more in the field, since the National B course really doesn't do much for you... :sad:


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## EMTSTUDENT25 (Aug 30, 2011)

Im going to agree 100% with Linuss on this one...The mindset in basic school was that WE (as basics) we going to be pushing the meds, doing this, doing that, and in all reality there should have been more emphasis on assisting ALS...

Most of what was brought up at any given time was the idea of an ALS INTERCEPT(not sure how much that really ever happens).  Im sure there are many BLS rigs in place in the US, but ALL of the clinicals I took part in were ran EMT-IV/Medic or Dual Medic rigs.  Meaning that the emt's responsibilty was grabbing cot, monitor, and first in bag.  I have no problem with that however not the picture we were painted in school.

To prove this point more, the shifts where the emt had been paired up with the same medic for long periods of time ran much more smoothly.  They knew how to assist ALS...


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## MrBrown (Aug 30, 2011)

EMTSTUDENT25 said:


> To prove this point more, the shifts where the emt had been paired up with the same medic for long periods of time ran much more smoothly.  They knew how to assist ALS...



The UK has done exactly this.  Each ambulance will have a State Registered Paramedic and a six week trained Emergency Support Worker (ECSW) who is basically the Paramedic's bag fetcher and driver with zero clinical autonomy.  This is at the expense of the model of Ambulance Technician/Paramedic which has worked well for more than 20 years where the Technicians had actual clinical skills e.g. LMAs and a range of intramuscular drugs.

A Paramedic needs another Paramedic or a good Ambulance Officer to work with them and bounce ideas off, not an "assistant" to fetch bags or drive.


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## mct601 (Aug 30, 2011)

Tigger said:


> Could not agree more. This is why I think American EMS needs to move away from using BLS units in 911 situations. Most of my patients do not have any "immediate life threats" but they do need medical care and the sooner the better.
> 
> 
> Sent from my out of area communications device.



Down south we may not be the brightest, but we can surprise you at times . In MS, it requires a paramedic to be in the back of the truck on a 911 transport. IFT is just fine with a basic, but that is the only time a basic gets to be "the man". Any BLS truck caught on a 911 call must call for ALS intercept. In Louisiana my friends can declare a call BLS and the EMT assumes all the duties while the medic drives. I think as long as a paramedic (not an EMT-I) is on the truck, its fit for 911 service.


To answer the OP, I actually just said in a different post that the EMT level needs to be revamped. Today's EMT classes are focused around getting you passed registry and that's it, and you do not get field competent entry level emts from that. I think a little more class time, more emphasis on ALS assist, and more time spent on a truck as a student.


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