# What's the point of dual medic?



## CAR1 (Aug 20, 2012)

In NYC 911 is mandated that ALS units must be dual medic. I think they should 

split them up and give every ALS unit one EMT and one Medic. Eitherway for  

the serious calls that require two medics on the patient here in NYC they send 

one BLS and one ALS (2 EMT & 2 Medic). the advantage of my proposal is simple 

you are spreading out your ALS providers providing a shorter response time to 

ALS care.


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## Jambi (Aug 20, 2012)

The best purpose of dual medic on a transport unit is to, (1) split tasks on scene, and (2) split spread the daily call load between 2 people.

IMO


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## terrible one (Aug 20, 2012)

LA county mandates a minimum of two paramedics on every rescue as well. I believe there reasoning is 2 > 1, so it must = better patient care. Honestly though I'm not sure.


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## Jambi (Aug 20, 2012)

There was research and a graph somewhere where someone correlated number of paramedics to patient outcomes.  

Essentially, Pt outcomes peak at 2 paramedics, declines at 3, and stays flat at 4.

I'll see if i can't dig it up.


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## CAR1 (Aug 20, 2012)

Jambi said:


> There was research and a graph somewhere where someone correlated number of paramedics to patient outcomes.
> 
> Essentially, Pt outcomes peak at 2 paramedics, declines at 3, and stays flat at 4.
> 
> I'll see if i can't dig it up.



That would be interesting. I guess the two minds are better than one theory has some truth.


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## NJEMT95 (Aug 20, 2012)

Same in NJ. In our back-asswards system, all ALS providers are hospital-based. Unless a city's 911 service is contacted with a hospital-based ALS service, all primary ambulances to a scene are BLS only. On ALS calls, the dispatcher can dispatch an ALS crew (2 medics in either a rig or an SUV) at the same time as the BLS crew or the BLS crew can request ALS on scene.

It's a waste of resources and adds to on-scene time on our most critical patients while we wait for ALS to arrive or attempt to meet them enroute to the hospital.


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## terrible one (Aug 20, 2012)

Jambi said:


> There was research and a graph somewhere where someone correlated number of paramedics to patient outcomes.
> 
> Essentially, Pt outcomes peak at 2 paramedics, declines at 3, and stays flat at 4.
> 
> I'll see if i can't dig it up.



I guess we don't need two paramedics on a squad, one on an engine, and one on a truck then? If we are talking tiered response a more effective system would be one on an engine and a P/B transport rig.


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## Jambi (Aug 20, 2012)

Not what I was looking for, but it's a good article

http://www.emsnetwork.org/artman2/publish/article_28849.shtml


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## Schroeder (Aug 20, 2012)

I've been led to believe that a dual Medic system lends to an internal checks and balances feature (for lack of a better term). It is much more likely that the second medic would catch a mistake, or see something the other one missed. If they were paired with an EMT-B, you lose some of the checks and balances.

Out here in king county, we run dual medics. The system runs pretty well if you ask me.


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## Jambi (Aug 20, 2012)

terrible one said:


> If we are talking tiered response a more effective system would be one on an engine and a P/B transport rig.



That is what I see most of around here in riverside county.  It works fine as long as there no or little inter-agency conflict.

If there's more than one patient I just don't see the need to have more than one or two paramedics on scene because it's easy for the whole thing to degenerate into too many chiefs and not enough indians...


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## nocoderob (Aug 20, 2012)

Spoken like a true EMT. Our system is slowly moving single ALS provider sadly enough. The county mandates two medics on scene which means only one of us is needed if fire is ALS. Having two medics lightens the workload, add's a second opinion if needed, is there for multiple pts, and can assist with _any_ care needed.


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## NYMedic828 (Aug 20, 2012)

nocoderob said:


> Spoken like a true EMT. Our system is slowly moving single ALS provider sadly enough. The county mandates two medics on scene which means only one of us is needed if fire is ALS. Having two medics lightens the workload, add's a second opinion if needed, is there for multiple pts, and can assist with _any_ care needed.



50% of the time I despise being dual medic. The 50% I like is when I have a competent partner.

Checks and balances only work when your partner is not an airhead... The time that they are, it hinders care because I have to argue to perform treatments the patient should receive but partner doesn't want to administer.


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## Jambi (Aug 20, 2012)

nocoderob said:


> Spoken like a true EMT. Our system is slowly moving single ALS provider sadly enough. The county mandates two medics on scene which means only one of us is needed if fire is ALS. Having two medics lightens the workload, add's a second opinion if needed, is there for multiple pts, and can assist with _any_ care needed.



Like NYMedic said. It can be a blessing or a curse.  It's easier to deal with a crappy EMT partner than it is to deal with a crappy medic partner that feels entitled to his or her opinion and feels compelled to constantly share the fact.


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## nocoderob (Aug 20, 2012)

Sure but, thats not a "dual medic" thing, that is a crappy partner thing. I have found EMT's to be more mouthy and opinionated than other medic's.


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## abckidsmom (Aug 20, 2012)

NYMedic828 said:


> 50% of the time I despise being dual medic. The 50% I like is when I have a competent partner.
> 
> Checks and balances only work when your partner is not an airhead... The time that they are, it hinders care because I have to argue to perform treatments the patient should receive but partner doesn't want to administer.



Right but then you're being the check and balances...isn't it fantastic?

I prefer having a bls partner and doing all the calls myself. I hate doing mobile on the spot QA, so even if my partner is ALS, I offer to do all the calls. Save me some headaches.


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## johnrsemt (Aug 20, 2012)

I have been on trucks with Dual medics; doesn't make much difference.   I alway made sure that my FT partners knew the protocols ALS and BLS and could check me on protocols  (just like check and Balance).  Worked great.

  Problem with 2 medics is when you really need the 2nd medic he/she is driving and it was harder to get an extra set of hands from fire:   "you already have 2 medics, what more do you need"


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## firetender (Aug 20, 2012)

Functionally, when we used to run two paramedics, we'd alternate. One was the "Patient-man" the other Assist, the idea being clarity on who's in charge with the partner's job to BE the checks and balances but in an advisory capacity while making sure all the other non-ALS wheels turn properly.

Of course, this means knowing how to cooperate like adults!.


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## medicsb (Aug 20, 2012)

Potential pros:
 - "Checks and balances"
 - New medics can learn from the more seasoned medics (default mentoring)
 - More patient pathology seen per medic (you don't have to be in the back to get experience evaluating and initiating treatment).
 - Extra set of hands (and brain) for critical patients.
 - Switching responsibilities from call to call.
 - Possibly, the crew can complete more procedures than a lone medic (this was a finding in an Australian study a few years ago).

In my opinion it is an ideal set-up for a tiered system in dense, high volume areas.  (In low density, low volume areas, a single medic responder would probably be better.)  

In my opinion, this is an area in need of research.  Staffing and practitioner experience is intrinsically related to patient care.  Most likely too little is bad (can't get to patients in a reasonable amount of time) and also too much (only very rarely see sick patients or the costs go up while benefit plateaus).  So which is the right amount?


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## the_negro_puppy (Aug 20, 2012)

Whats the point of even having EMTs?  

Why not all Paramedics?


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## STXmedic (Aug 20, 2012)

the_negro_puppy said:


> Whats the point of even having EMTs?
> 
> Why not all Paramedics?



That way it's easier for 18yo Ricky Rescue to go woowoo down the street to save somebody's life...


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## OzAmbo (Aug 20, 2012)

PoeticInjustice said:


> That way it's easier for 18yo Ricky Rescue to go woowoo down the street to save somebody's life...


:lol::lol:


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## nocoderob (Aug 20, 2012)

PoeticInjustice said:


> That way it's easier for 18yo Ricky Rescue to go woowoo down the street to save somebody's life...


:lol:


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## OzAmbo (Aug 20, 2012)

the_negro_puppy said:


> Whats the point of even having EMTs?
> 
> Why not all Paramedics?


I would have thought EMT would be an excellent base from a first responder point of view, but as far as crewing an ambulance or non emerge IFT truck.... i have to wonder....


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## DPM (Aug 20, 2012)

OzAmbo said:


> I would have thought EMT would be an excellent base from a first responder point of view, but as far as crewing an ambulance or non emerge IFT truck.... i have to wonder....



One argument is that if someone has to drive (and thus while driving cannot provide patient care) then that person doesn't require as high a level of training.


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## NYMedic828 (Aug 20, 2012)

DPM said:


> One argument is that if someone has to drive (and thus while driving cannot provide patient care) then that person doesn't require as high a level of training.



Then why not just hire a CPR certified ambulance driver.


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## DPM (Aug 20, 2012)

NYMedic828 said:


> Then why not just hire a CPR certified ambulance driver.



I'm not saying I agree, I'm just saying that's the argument.


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## medicsb (Aug 20, 2012)

DPM said:


> One argument is that if someone has to drive (and thus while driving cannot provide patient care) then that person doesn't require as high a level of training.



I do not get this argument.  At all.  For this argument to be true would mean that the sum of patient care is performed during transport and that next to nothing is done on scene.  Is this how EMSers tend to work?  Throw the patient on the stretcher and haul-*** to the hospital?  Suspend all thought until the patient is in the ambulance? 

(PS: DPM, I'm not picking on you, just the argument.)


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## NYMedic828 (Aug 20, 2012)

medicsb said:


> I do not get this argument.  At all.  For this argument to be true would mean that the sum of patient care is performed during transport and that next to nothing is done on scene.  Is this how EMSers tend to work?  *Throw the patient on the stretcher and haul-*** to the hospital?  Suspend all thought until the patient is in the ambulance? *
> 
> (PS: DPM, I'm not picking on you, just the argument.)



Do you really want the answer to that question? People don't think we are ambulance drivers for nothing...


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## DPM (Aug 20, 2012)

medicsb said:


> I do not get this argument.  At all.  For this argument to be true would mean that the sum of patient care is performed during transport and that next to nothing is done on scene.  Is this how EMSers tend to work?  Throw the patient on the stretcher and haul-*** to the hospital?  Suspend all thought until the patient is in the ambulance?
> 
> (PS: DPM, I'm not picking on you, just the argument.)



That's alright. When viewed as a cost analysis, the extra expensive EMT-P training isn't needed while driving... so EMT-B is a good compromise. They have a good, basic level of training which they can use to assist the medic, and then drive the medic & PT to hospital...

Obviously lots of flaws in there, but that's what the argument is.


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## Jambi (Aug 20, 2012)

medicsb said:


> Throw the patient on the stretcher and haul-*** to the hospital?



as evidenced by numerous studies, our patients in urban areas would benefit from this process.


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## STXmedic (Aug 20, 2012)

Meh. Removed.


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## medicsb (Aug 20, 2012)

Jambi said:


> as evidenced by numerous studies, our patients in urban areas would benefit from this process.



For penetrating trauma, which is a rather small subset of patients (who also are easily identifiable - not much guessing involved) to base a silly practice of load-and-go upon.  Not saying that you should not treat on the go or that you have to pitch a tent, but what is the rush outside of a few relatively rare cases?


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## Jambi (Aug 20, 2012)

medicsb said:


> For penetrating trauma, which is a rather small subset of patients (who also are easily identifiable - not much guessing involved) to base a silly practice of load-and-go upon.  Not saying that you should not treat on the go or that you have to pitch a tent, but what is the rush outside of a few relatively rare cases?



There is no rush, but I believe, as least in my area, that we spend way too much time on scene.

I agree that trauma is really where ALS doesn't make much of a difference overall, but it's more than just a small subset of penetrating trauma patients.  It's trauma in general.

http://www.ncbi.nlm.nih.gov/pubmed/8611068

CONCLUSIONS:
Patients with severe trauma transported by private means in this setting have better survival than those transported via the EMS system

and

http://journals.lww.com/jtrauma/Abs..._Prehospital_Advanced_Life_Support_on.10.aspx

Conclusion: ALS procedures can be performed by paramedics on major trauma patients without prolonging on-scene time, but they do not seem to improve survival.


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## Shishkabob (Aug 21, 2012)

It's been my experience that Intermediates are the worst partners with the worst attitude as they have the education of an EMT with the arrogance of a Paramedic.   :blink:


When you have a dual-medic truck where the partners get along, and they switch off every call, it's great.  I had that kind of truck for the past 6 months, where my partner and I traded each call, splitting the load, and one runs the call while the other helps with the physical tasks, and bouncing ideas off each other when needed.  


Having said that, I prefer M/B with a basic first response.  That way, only one can ever be viewed as 'in charge', and let's be honest, most calls don't require two Paramedics.  (Though I'm lucky at my agency where if such a call pops up, I can have a second Paramedic, either another truck, a supervisor, an advanced Paramedic, or heck even a physician on scene in minutes)


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## DrParasite (Aug 21, 2012)

PoeticInjustice said:


> That way it's easier for 18yo Ricky Rescue to go woowoo down the street to save somebody's life...


you mean vs a 20 yo Ricky Rescue who completed a paramedic course and can now go woowoo down the street and end up killing someone?





NYMedic828 said:


> Then why not just hire a CPR certified ambulance driver.


exactly why you need to have regulations that state you need two EMTS or two paramedics on a truck.  Otherwise every for profit private ambulance company will do just that, hire an emt or paramedic and just have a taxi driver drive them around.

B/P is a great concept, but there are calls that having 2 paramedics on the truck can make the job go smoother, especially when you have incompetent paramedics (as judged by NYMedic828, not me) who shouldn't be allowed to be the sole provider in charge of a patient.

when you have a dual medic crew, and they only see life threatening patients, studies have shown that they are better clinicians, and a P/P or B/P that deal with a call volume that is 80% BS and doesn't need their advance skill or education.


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## NYMedic828 (Aug 21, 2012)

DrParasite said:


> B/P is a great concept, but there are calls that having 2 paramedics on the truck can make the job go smoother, especially when you have incompetent paramedics (as judged by NYMedic828, not me) who shouldn't be allowed to be the sole provider in charge of a patient.
> 
> when you have a dual medic crew, and they only see life threatening patients, studies have shown that they are better clinicians, and a P/P or B/P that deal with a call volume that is 80% BS and doesn't need their advance skill or education.



You do raise the excellent point that I left out of the issue with NOT being dual medic. The other half can't be left alone...

I had a patient the other day who ate fish at a sketchy Jamaican restaurant and 30 minutes later was vomiting to no end. Patient was hyperventilating, and complained of "itching." She was obviously experiencing an anxiety exacerbation along with presumed food poisoning. My random partner for the day began to draw up benadryl... Story ends with giving the patient 4mg of zofran and everything started to feel better. A good example of checks and balances, and at the same time, a good example why single medic probably would fail.


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## DrParasite (Aug 21, 2012)

NYMedic828 said:


> I had a patient the other day who ate fish at a sketchy Jamaican restaurant and 30 minutes later was vomiting to no end. Patient was hyperventilating, and complained of "itching." She was obviously experiencing an anxiety exacerbation along with presumed food poisoning. My random partner for the day began to draw up benadryl... Story ends with giving the patient 4mg of zofran and everything started to feel better. A good example of checks and balances, and at the same time, a good example why single medic probably would fail.


I know I'm not a paramedic, but my little EMT brain (which is a DBP brain more than EMT nowadays) never knew that excessive vomiting was a sign of an allergic reaction, esp when you eat sketchy fish.  

But then again, I'm not a paramedic, so apparently I am pretty useless in an emergency until I get my P card, right?


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## EpiEMS (Aug 21, 2012)

NYMedic828 said:


> You do raise the excellent point that I left out of the issue with NOT being dual medic. The other half can't be left alone...



Do you think that this is a consequence of the educational system? More directly, what do you see as the cause of the problem of incompetent providers (especially at the level where they can actively kill somebody rather than sit by and let them die)?




DrParasite said:


> I know I'm not a paramedic, but my little EMT brain (which is a DBP brain more than EMT nowadays) never knew that excessive vomiting was a sign of an allergic reaction, esp when you eat sketchy fish.



DBP = death by powerpoint?


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## NYMedic828 (Aug 21, 2012)

DrParasite said:


> I know I'm not a paramedic, but my little EMT brain (which is a DBP brain more than EMT nowadays) never knew that excessive vomiting was a sign of an allergic reaction, esp when you eat sketchy fish.
> 
> But then again, I'm not a paramedic, so apparently I am pretty useless in an emergency until I get my P card, right?



I know your sarcasm by now, but I also know you either worked for, in or with NYC at some point. (I think?) You know what goes on here...

Mind you this partner is 3x my senior.




EpiEMS said:


> Do you think that this is a consequence of the educational system? More directly, what do you see as the cause of the problem of incompetent providers (especially at the level where they can actively kill somebody rather than sit by and let them die)?



It is primarily consequence of the educational system, be it original teaching or the standards in general, and a consequence of quality improvement systems.

Ultimately it all falls back to the fact that to be a paramedic, is 10 months or so out of your life, maybe longer depending on how many days a week you attend your program. My program was 8 months at 40 hours a week. It isn't long enough to teach what needs to go along with the ability to properly provide the treatments we do. I am pretty certain I would be another incompetent mindless drone if I didn't spend half of my shift on my iPhone self educating.

Only those who care to improve themselves, become competent. This holds true everywhere, but in EMS we have a much higher majority of people who just don't care or already believe they are the best of the best, the masters of pre-hospital care. The doctor on wheels at 60mph. The ones fending off the reaper himself. They are all sadly mistaken...


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## firecoins (Aug 21, 2012)

NJEMT95 said:


> Same in NJ. In our back-asswards system, all ALS providers are hospital-based. Unless a city's 911 service is contacted with a hospital-based ALS service, all primary ambulances to a scene are BLS only. On ALS calls, the dispatcher can dispatch an ALS crew (2 medics in either a rig or an SUV) at the same time as the BLS crew or the BLS crew can request ALS on scene.
> 
> It's a waste of resources and adds to on-scene time on our most critical patients while we wait for ALS to arrive or attempt to meet them enroute to the hospital.



Why wwould you wait ? Transport. I did when I worked jersey.


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## firecoins (Aug 21, 2012)

I prefer dual medic. while I get an I've he can draw  meds or call med control.  I like having 2 sets of hands on serious calls.  am not there to babysit bad medics.


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## DrParasite (Aug 21, 2012)

EpiEMS said:


> DBP = death by powerpoint?


Dirty Button Pusher, assigned to communications.



NYMedic828 said:


> I know your sarcasm by now, but I also know you either worked for, in or with NYC at some point. (I think?) You know what goes on here...
> 
> Mind you this partner is 3x my senior.


actually, I have never worked in NYC.  I was offered a position with a hospital in NYC, but when I heard the crews complaining the got slammed when they did 6 calls in 8 hours (did that in 6, and still had 6 more hours of work ahead of me), I decided that it wasn't for me.  Plus the tolls and the pay cut weren't worth it for me. 

But I know quite a few FDNYers, work with several former FDNY medics (they crossed the Hudson for better pay), as well as have worked with some NYCers who work part time in NJ for better pay.  In fact, many NJ people go to NYC for their medic training (since it's 10 months in NY, and 2 years in NJ), and many NYC people come to NJ because they want to make more money, and find working 12 hours vs 8 hours make better financial sense.

and I've dealt with my share of bad EMTs (from NY and NJ), as well as some paramedics that waste time setting up camp or that can't assess and figure out a definitive treatment plan.  It's really scary, but I know there are some EMTs and Paramedics that can run circles around me as well.  It all depends on the person, and sometimes the popular EMTs and Paramedics aren't as good as people think they are, but they are well liked or in the clique

Side note: as an EMT in NJ, the only times I will wait on scene for ALS is for a known diabetic whose sugar has dropped, or on a cardiac arrest.  Other than that, I can do almost every intervention in my toolbox (as well as most of my secondary assessment) while enroute to the ER, meeting ALS on the way or notifying the ER of what I have and let definitive care manage the patient, instead of delaying that care by waiting for the MICU to assess, start their IV, push some meds, and then transport to that same definitive care (in my urban and suburban experience, I never worked rural EMS in the sticks).


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## NYMedic828 (Aug 21, 2012)

firecoins said:


> I prefer dual medic. while I get an I've he can draw  meds or call med control.  I like having 2 sets of hands on serious calls.  am not there to babysit bad medics.



Thats the other issue... in NYC, as you know, calling medcom can be quite a long ordeal.


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## nocoderob (Aug 21, 2012)

DrParasite said:


> I know I'm not a paramedic, *but my little EMT brain* (which is a DBP brain more than EMT nowadays) never knew that excessive vomiting was a sign of an allergic reaction, esp when you eat sketchy fish.
> 
> But then again, I'm not a paramedic, so apparently I am pretty useless in an emergency until I get my P card, right?



Not to pick on you but, this type of attitude is common among EMT's. You do not have a "little EMT brain" but, come on, are you truly in a place to make a judgement on how many medic's may or may not be needed on a call? 

An EMT has virtually no responsibility when working with a medic. Maybe it's different where you are. Where I am at, the medic has to perform a full assessment on every pt before he can turn over care. And the pts the EMT can take are very limited. The medic also has to do the initial portion of the run ticket and has to audit said paperwork as well. And if _anything_ detrimental occur's enroute to the pt, the medic is on the hook. The medic is responsible for the rig check out, monitor tests, glucometer testing, and narcotics log. 

As far as being useless on a call, you are not. But, to even suggest that an EMT is anything more than a supportive role and extra set of hands is ridiculous. When you get a "P" card you will see thing's in a whole new light.


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## bahnrokt (Aug 21, 2012)

How many of these calls where a 2nd medic is beneficial do we see daily vs normal ish calls that are BLS or fine with 1 medic?  1%?  .5%?  

Hell, let's staff every rig with 2 ER docs. Even better for the pt.  This would make sense if all our calls were emergencies.  But we deal with a lot of BlS calls that are taxi rides and there is no reason to spend the money on dual medics.


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## NYMedic828 (Aug 21, 2012)

nocoderob said:


> Not to pick on you but, this type of attitude is common among EMT's. You do not have a "little EMT brain" but, come on, are you truly in a place to make a judgement on how many medic's may or may not be needed on a call?
> 
> An EMT has virtually no responsibility when working with a medic. Maybe it's different where you are. Where I am at, the medic has to perform a full assessment on every pt before he can turn over care. And the pts the EMT can take are very limited. The medic also has to do the initial portion of the run ticket and has to audit said paperwork as well. And if _anything_ detrimental occur's enroute to the pt, the medic is on the hook. The medic is responsible for the rig check out, monitor tests, glucometer testing, and narcotics log.
> 
> As far as being useless on a call, you are not. But, to even suggest that an EMT is anything more than a supportive role and extra set of hands is ridiculous. When you get a "P" card you will see thing's in a whole new light.



Well you certainly are a humble one aren't you. Why don't you join the rest of us at ground level and get off that pedestal.

EMT is meant to be a supportive role in the presence of a higher certified person capable of delegating duties, that doesn't make them otherwise worthless as you make it out to be. Technically we are all in a supportive role. We support the wishes of the medical director. 

If you want to see things in a different light, take it even further.


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## nocoderob (Aug 21, 2012)

bahnrokt said:


> How many of these calls where a 2nd medic is beneficial do we see daily vs normal ish calls that are BLS or fine with 1 medic?  1%?  .5%?
> 
> Hell, let's staff every rig with 2 ER docs. Even better for the pt.  This would make sense if all our calls were emergencies.  But we deal with a lot of BlS calls that are taxi rides and there is no reason to spend the money on dual medics.



Take the emotion out of it. By your way of thinking, why have ALS at all?
Why have EMT's? Have two driver's that can give O2 and that are CPR cert'd. This entire job is based on small percentage's. The number's of actual emergencies _is_ small. No different than having PD or FD. The actual percentage that you may actually need either is small but, you do feel them necessary do you not?


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## nocoderob (Aug 22, 2012)

NYMedic828 said:


> Well you certainly are a humble one aren't you? Why don't you join the rest of us at ground level and get off that pedestal.
> 
> EMT is meant to be a supportive role in the presence of a higher certified person capable of delegating duties. It is not only a supportive position.



Ha, no pedestal. Not my intention. The point being made is that a BLS provider should not be one to say how many ALS provider's are necessary.


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## NYMedic828 (Aug 22, 2012)

nocoderob said:


> Ha, no pedestal. Not my intention. The point being made is that a BLS provider should not be one to say how many ALS provider's are necessary.



There happen to be quite a few EMTs on this forum who are more knowledgeable than a large handful of the medics I know. Just because I don't have a card that says I know something, doesn't mean I don't.

Not to knock the service, but the most common denominator of paramedics are usually not that knowledgeable... or accurate in their knowledge anyway.


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## Hockey (Aug 22, 2012)

I never used to understand the double medic thing until I started working in an area with it.  

I absolutely love it.  Not only does it help me out drastically on calls (hands not as full), I feel it gives the patient better care.  If I can't get an IV, my partner can (vice versa).  Less likely to make mistakes.  One person isn't "swamped" with all the calls all day and won't be as tired or what not.

I work in another area that allows us to run EMT/Medic for ALS.  When I work there, I feel "dirty" and anxious on calls for some reason.  Like I have to hold my partners hand sometimes.

Medic/Medic is where its at


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## bahnrokt (Aug 22, 2012)

nocoderob said:


> Take the emotion out of it. By your way of thinking, why have ALS at all?
> Why have EMT's? Have two driver's that can give O2 and that are CPR cert'd. This entire job is based on small percentage's. The number's of actual emergencies _is_ small. No different than having PD or FD. The actual percentage that you may actually need either is small but, you do feel them necessary do you not?



Necessary, yes. But there is a cost benefit that starts to slide off where pumping more money into advanced providers only nets a minimal increase in the care. Putting more police on the street and having all of them SWAT trained with AR15s and full body armor would slow down an active shooter like in Colorado.  But it is not cost effective.  In a world of limited budgets and resources it is not feasible to staff everything for the worst call possible. 

What is better for a city?

A) 10 dual medic rigs running their balls off to keep up with call volume.
or 
B) 12 medic/emt rigs that have some breathing room.


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## the_negro_puppy (Aug 22, 2012)

NYMedic828 said:


> You do raise the excellent point that I left out of the issue with NOT being dual medic. The other half can't be left alone...
> 
> I had a patient the other day who ate fish at a sketchy Jamaican restaurant and 30 minutes later was vomiting to no end. Patient was hyperventilating, and complained of "itching." She was obviously experiencing an anxiety exacerbation along with presumed food poisoning. My random partner for the day began to draw up benadryl... Story ends with giving the patient 4mg of zofran and everything started to feel better. A good example of checks and balances, and at the same time, a good example why single medic probably would fail.



If the patient had suspected food poisoning would it not be beneficial for the patient to be vomiting? Unless the patient had already vomited up their stomach contents and was retching/producing bile?

Itching and vomiting could also be a sign of G.I disturbance/allergic reaction however i'm guessing the patient didn't have any urticaria or other symptoms?


----------



## nocoderob (Aug 22, 2012)

NYMedic828 said:


> There happen to be quite a few EMTs on this forum who are more knowledgeable than a large handful of the medics I know. Just because I don't have a card that says I know something, doesn't mean I don't.
> 
> *Not to knock the service, but the most common denominator of paramedics are usually not that knowledgeable... or accurate in their knowledge anyway*.



I am sure you do. But, how does this translate to their job? They still only have the ability to do what their classification allow's.

The bolded is funny. Seemingly by your argument, paramedic's are usually less knowledgeable than many EMT's?


----------



## NYMedic828 (Aug 22, 2012)

the_negro_puppy said:


> If the patient had suspected food poisoning would it not be beneficial for the patient to be vomiting? Unless the patient had already vomited up their stomach contents and was retching/producing bile?
> 
> Itching and vomiting could also be a sign of G.I disturbance/allergic reaction however i'm guessing the patient didn't have any urticaria or other symptoms?



I figured it would be more beneficial for her to vomit up the substance causing the disturbance, but she was mostly dry heaving at this point. She vomited a substantial amount prior to our arrival and was just feeling extremely nauseous. 

When I asked her if the "itching" felt more like a bug bite or pins and needles, she said the latter. My assumption was paresthesia 2nd to hyperventilation/anxiety.



nocoderob said:


> I am sure you do. But, how does this translate to their job? They still only have the ability to do what their classification allow's.
> 
> The bolded is funny. Seemingly by your argument, paramedic's are usually less knowledgeable than many EMT's?



I think you merely think too highly of your abilities, or anyone's abilities for that matter as a paramedic. Sure, an EMT can do even less but we can't really do all that much either in the grand scheme of things.

Not sure how you translated my statement into EMTs are more knowledgeable than paramedics. I stated many paramedics aren't as knowledgeable as their god complex makes them think they are. That would usually imply EMTs being less knowledgeable. I said a small amount of EMTs can best a handful of paramedics. Hardly substantial numbers.


----------



## bahnrokt (Aug 22, 2012)

nocoderob said:


> I am sure you do. But, how does this translate to their job? They still only have the ability to do what their classification allow's.
> 
> The bolded is funny. Seemingly by your argument, paramedic's are usually less knowledgeable than many EMT's?



I believe his point was that having a "P" on your card does not automatically mean you know more than every "B" on earth.


----------



## nocoderob (Aug 22, 2012)

bahnrokt said:


> Necessary, yes. But there is a cost benefit that starts to slide off where pumping more money into advanced providers only nets a minimal increase in the care. Putting more police on the street and having all of them SWAT trained with AR15s and full body armor would slow down an active shooter like in Colorado.  But it is not cost effective.  In a world of limited budgets and resources it is not feasible to staff everything for the worst call possible.
> 
> What is better for a city? 10 dual medic rigs on duty or 12 medic/emt rigs?



So now it's a money thing? I thought this discussion was "why have dual medic units?" Many have stated supportive facts/thoughts/opinions and yet you try and argue against it for financial sense.

What is better for a city? Well, if you have 10 dual medic unit's and 10 BLS unit's roaming the streets, in the case of disaster you could split the dual's with the BLS and have 20 medic/emt unit's.


----------



## nocoderob (Aug 22, 2012)

bahnrokt said:


> I believe his point was that having a "P" on your card does not automatically mean you know more than every "B" on earth.



I got his point. Mine is that knowing a lot does not translate to being able to do a lot. My wife is a RN and _know's_ much more than I do but, I can _do_ more than she can. If that make's sense.


----------



## NYMedic828 (Aug 22, 2012)

nocoderob said:


> I got his point. Mine is that knowing a lot does not translate to being able to do a lot. My wife is a RN and _know's_ much more than I do but, I can _do_ more than she can. If that make's sense.



Which is completely *** backwards and in such lies a major problem with EMS.


----------



## bahnrokt (Aug 22, 2012)

nocoderob said:


> So now it's a money thing? I thought this discussion was "why have dual medic units?" Many have stated supportive facts/thoughts/opinions and yet you try and argue against it for financial sense.
> 
> What is better for a city? Well, if you have 10 dual medic unit's and 10 BLS unit's roaming the streets, in the case of disaster you could split the dual's with the BLS and have 20 medic/emt unit's.



Because it is a fiscal issue in most cities and towns.  Go ask your ops director this question and the first word from their mouth is money.  Most agencies I know would love to run dual medics on beautiful type 3 rigs but can only afford BLS vans and ALS fly cars. 
I'm not questioning the fact that 2 medics are better than one.


----------



## nocoderob (Aug 22, 2012)

NYMedic828 said:


> Which is completely *** backwards and in such lies a major problem with EMS.





bahnrokt said:


> I'm not questioning the fact that 2 medics are better than one.



Agreed.


----------



## nocoderob (Aug 22, 2012)

NYMedic828 said:


> I think you merely think too highly of your abilities, or anyone's abilities for that matter as a paramedic. Sure, an EMT can do even less *but we can't really do all that much either in the grand scheme of things.*



For sure. Most is just a "band-aid" to get them to the ED in the best possible condition.



NYMedic828 said:


> Not sure how you translated my statement into EMTs are more knowledgeable than paramedics. I stated many paramedics aren't as knowledgeable as their god complex makes them think they are. That would usually imply EMTs being less knowledgeable. I said a small amount of EMTs can best a handful of paramedics. Hardly substantial numbers.



Maybe I misunderstood your point. I guess mine is, the smartest EMT can still _do_ less than the dumbest medic, if that makes sense.


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## JPINFV (Aug 22, 2012)

nocoderob said:


> I got his point. Mine is that knowing a lot does not translate to being able to do a lot. My wife is a RN and _know's_ much more than I do but, I can _do_ more than she can. If that make's sense.



Define "do." Procedure wise, medication wise, diagnostic wise, standing orders vs patient specific orders, etc?


----------



## JPINFV (Aug 22, 2012)

nocoderob said:


> Maybe I misunderstood your point. I guess mine is, the smartest EMT can still _do_ less than the dumbest medic, if that makes sense.



Well... not always.


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## Aidey (Aug 22, 2012)

Definitely not always!!!


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## NYMedic828 (Aug 22, 2012)

nocoderob said:


> For sure. Most is just a "band-aid" to get them to the ED in the best possible condition.
> 
> 
> 
> Maybe I misunderstood your point. I guess mine is, the smartest EMT can still _do_ less than the dumbest medic, if that makes sense.



This quote gets tossed around a lot on this forum


> *The delivery of good medical care is to do as much nothing as possible*



Many times, the best thing you can do is gather information/clues at the scene that is otherwise unavailable to the receiving facility. Doesn't take any certification to do that...


----------



## JPINFV (Aug 22, 2012)

NYMedic828 said:


> This quote gets tossed around a lot on this forum
> 
> 
> Many times, the best thing you can do is gather information/clues at the scene that is otherwise unavailable to the receiving facility. Doesn't take any certification to do that...




Ehh, I take that as "Just because you can doesn't mean you should." One of my pet sayings is "Skills without knowledge is dangerous, knowledge without skills is impotent."


----------



## NYMedic828 (Aug 22, 2012)

I am not literally interpreting it as we should do nothing if a true need presents itself.

My means of using it was to imply that just because the dumbest medic can do more than the smartest EMT, on paper, doesn't necessarily mean he truly can or should. I guess the point I am making is not everything is about toys. 

Knowledge is power. (preaching to the quire i'm sure)


----------



## Jambi (Aug 22, 2012)

JPINFV said:


> " One of my pet sayings is "Skills without knowledge is dangerous, knowledge without skills is impotent."



QFT

And I'm using it


----------



## Jambi (Aug 22, 2012)

NYMedic828 said:


> I am not literally interpreting it as we should do nothing if a true need presents itself.
> 
> My means of using it was to imply that just because the dumbest medic can do more than the smartest EMT, on paper, doesn't necessarily mean he truly can or should. I guess the point I am making is not everything is about toys.
> 
> Knowledge is power. (preaching to the quire i'm sure)



I got what you meant. Here in socal I'm a "do as little as necessary" medic surrounded by a sea of "agggressive" medics. I believe it's knowledge that makes the difference. It's easy to just do everything...


----------



## DrParasite (Aug 22, 2012)

nocoderob said:


> Not to pick on you but, this type of attitude is common among EMT's. You do not have a "little EMT brain" but, come on, are you truly in a place to make a judgement on how many medic's may or may not be needed on a call?


You know, your right.  I should just shred by Bachelors Degree.  After I finished my degree, I took some more classes.  6 credits of Biology, 6 of Inorganic Chem, 3 of Organic Chem, 6 credits of Anatomy and Physiology.  All those college classes were a waste, since i'm just an EMT.  

I'm curious, how much organic chem education do you have?  how much A&P do you actually have?  not the two weeks that some programs have at the beginning of class, and how much of it do you remember? how much do you really know about the lymphatic system?  What do you know about the hypothalamus?  what about the liver and kidney, are you familiar with the inner structure of both organs?  do you even have a degree?

oh and lets not forget, 15 years as an emt, the last 7 as a career provider in an urban 911 system.  I've seen strokes (actual Brain Attacks where time is of the essence), major traumas, found more unconcious diabetics than I can count, overdoses, cardiac arrests, MVAs, MIs, and other calls where the patient was actually sick, and many that did require ALS interventions to either reverse their condition or prevent their condition from deteriorating further.  Can you say the same?  Does experience count for anything?  and I've worked side by side with paramedics, usually getting their before they did and intiating treatments and getting information for them to do their job.  But again, I'm just an EMT, so I must not know or do anything without a paramedics there to hold me hand, right 


nocoderob said:


> An EMT has virtually no responsibility when working with a medic. Maybe it's different where you are. Where I am at, the medic has to perform a full assessment on every pt before he can turn over care. And the pts the EMT can take are very limited. The medic also has to do the initial portion of the run ticket and has to audit said paperwork as well. And if _anything_ detrimental occur's enroute to the pt, the medic is on the hook. The medic is responsible for the rig check out, monitor tests, glucometer testing, and narcotics log.


and people wonder why their EMTs are useless, need their hands held at every step, and can't do anything without a medic.  If I worked with you, there is a good chance I wouldn't be able to do anything either.



nocoderob said:


> As far as being useless on a call, you are not. But, to even suggest that an EMT is anything more than a supportive role and extra set of hands is ridiculous. When you get a "P" card you will see thing's in a whole new light.


You know, it's attitudes like yours that make me not want to ever get my P card.  Well, one of the reasons.  

You're right, you can do a lot more than I can.  you can perform more interventions, give me drugs, and both apply and interpret cardiac monitors.  But I'm pretty good at knowing if my patients need any of your fancy toys, or if nothing you do will help them, and they really need rapid transport to the hospital where a doctor can fix what's wrong with them.  

And I sure as :censored::censored::censored::censored: don't need you to hold my hand to tell me how to do my job, and if I have a sick patient and you aren't anywhere to be found, I can do what's within my scope (which more often than not is give oxygen which most of the time won't do anything) and rapidly transport to the ER, letting the ER know what is going on so once I get in the door, the patient can get the definitive care they will need to actually get better.

oh, and I think you can surmise from this post how much I care about what you think of my attitude.


----------



## DrParasite (Aug 22, 2012)

I've worked in 2 states.  one had was B/B and P/P, and the other was Senior P/P and Senior P/B.  A senior P was an experienced P who could help a new P with any job.

I prefer tiered systems 100%.  dual medic and dual EMT.  this way the lone medic doesn't do all the work, has someone to bounce ideas off of, has someone else to try to start the IV when the first person can't get it.  Not only that, but if regulations don't require it, cheap companies won't pay for the 2nd equally trained provider.

The other thing that you need with a dual medic system is for them to only go on high acuity calls that are likely to need ALS.  NJ might be screwy, but in theory you don't have two highly trained paramedics being tied up on a minor MVA, or a child with a fever, or a boil on a person's butt.  Letting ALS only deal with ALS patients means they deal with sick people only, so they get really good at dealing with sick people.  and if you have a tiered system, you have two vehicles, so if you have a really sick patient, you can have the two EMTs driving both trucks, allowing both paramedics to be in the back of the truck treating the patient (I know, crazy idea right?).

in a perfect world, BLS gets there first, does there thing, and when ALS gets there, take over and BLS assists with what is needed.  if ALS can't get there, but BLS gets there first, pt is loaded and taken to the ER.  is it perfect?  absolutely not.  is having a BLS truck taking the patient to the ER better than no ALS ambulance at all?  I like to think so.  Plus your BLS providers get good at performing assessments, identifying sick vs not sick, and the whole "i don't know what do to without a paramedic telling me exactly what to do" mentality goes away.  And sometimes all you can do is perform a really good assessment, document it well, go to the hospital, and tell the doc what you found and let them do their thing.


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## Bullets (Aug 22, 2012)

I truly believe that the dual Medic hospital based ALS is the one thing NJ EMS got right.
I transport truly sick patients BLS to hospitals all the time if I am closer then the medics. Usually freaks the nurses out


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## nocoderob (Aug 22, 2012)

DrParasite,
Too much to quote there so let me hit some highlights;
Nope, no degree. I do have some AP, chem, etc from several years ago when I was going to do nursing. 
As far as experience and "seeing the same," yea, in 20 years working in two of CA busiest counties, I have seen a few things myself.
Like I stated earlier, maybe you can perform more tasks where you work than can an EMT where I work. Ours can give O2, CPR, AED, basic first aid, and drive code three if needed. 
There is no tiered system. _Every_ 911 call gets a minimum of an ALS rig with one or two medics and an engine with one or more medics. Sending a BLS rig to decide whether an ALS rig is needed seems more like a waste of resources to me. But, maybe you do not have a fire dept response in your area like we do.
I doubt attitudes like mine keep you from getting your card. There must be more to it if you have not done so in 15 years.

In summary, this thread is, again, about why should there be dual medic units. I, and others, have already stated why we think it is a better system.  I gave reasons as to why I think that way based on my experiences. You on the other hand had to tell me all about your degree, experience, and all the cool calls you have seen over the years. 
Then you state, "I prefer tiered systems 100%. Dual medic and dual EMT. _This way the lone medic doesn't do all the work, has someone to bounce ideas off of, has someone else to try to start the IV when the first person can't get it."_ These are a couple of reasons I feel dual is better. So why are you all bent out of shape again?

I don't consider myself an "aggressive" paramedic. But, I do treat the pt as much as necessary. To me, it is far better for pts to recieve an ALS rig and not need ALS than it is to recieve a BLS rig, actually need ALS treatment, and only recieve a fast BLS ride instead.


----------



## Aidey (Aug 22, 2012)

DrParasite said:


> You know, your right.  *I should just shred by Bachelors Degree.  After I finished my degree, I took some more classes.  6 credits of Biology, 6 of Inorganic Chem, 3 of Organic Chem, 6 credits of Anatomy and Physiology.  All those college classes were a waste, since i'm just an EMT.  *
> 
> I'm curious, how much organic chem education do you have?  how much A&P do you actually have?  not the two weeks that some programs have at the beginning of class, and how much of it do you remember? how much do you really know about the lymphatic system?  What do you know about the hypothalamus?  what about the liver and kidney, are you familiar with the inner structure of both organs?  do you even have a degree?
> 
> ...





DrParasite said:


> I've worked in 2 states.  one had was B/B and P/P, and the other was Senior P/P and Senior P/B.  A senior P was an experienced P who could help a new P with any job.
> 
> I prefer tiered systems 100%.  dual medic and dual EMT.  this way the lone medic doesn't do all the work, has someone to bounce ideas off of, has someone else to try to start the IV when the first person can't get it.  Not only that, but if regulations don't require it, cheap companies won't pay for the 2nd equally trained provider.
> 
> ...




How interesting since you said this in a thread asking how old you are a few weeks ago. 



DrParasite said:


> *20*, and networking is the most important part of getting a job.
> 
> no, wait, I should rephrase that.... networking is the most important part of getting a GOOD job.



You also posted calling yourself uneducated when you asked why we don't just give everyone narcan. Odd question for someone with so much education and experience who claims they are good at knowing when their patients need any of the "fancy toys" ALS carries. 



DrParasite said:


> *Question from the uneducated....
> *
> what would be the medical consequences to giving every patient we  treated  narcan?  Aside from giving an intervention that isn't indicated  (hello, every ALS patient gets an IV?), and the obvious cost involved,  would there be any negative outcomes to giving narcan to patient's who  haven't taken opiates?  Yes, you would kill the highs of people who had  taken opiates, and they might not be happy, but are there side effects  for the people who haven't taken them?
> 
> ...



You know what is worse than a paramedic who underestimates an EMT? A provider who is a god in their own mind who overestimates themselves.


----------



## STXmedic (Aug 22, 2012)




----------



## DrankTheKoolaid (Aug 22, 2012)

Wow imagine my surprise when I awoke this morning to this post!  Let the day begin


----------



## Handsome Robb (Aug 22, 2012)

Edit: Dammit i spent too much time looking for the one I wanted and poetic beat me to it.


----------



## STXmedic (Aug 22, 2012)

NVRob said:


> Edit: Dammit i spent too much time looking for the one I wanted and poetic beat me to it.



:rofl: :rofl: :rofl: 

I'll share my front row seat with you... but NOT my popcorn!


----------



## Handsome Robb (Aug 22, 2012)

PoeticInjustice said:


> :rofl: :rofl: :rofl:
> 
> I'll share my front row seat with you... but NOT my popcorn!



What if I bring beer? Then will you share? :beerchug:


----------



## Jambi (Aug 22, 2012)

This will do just fine...


----------



## STXmedic (Aug 22, 2012)

:beerchug:


----------



## nocoderob (Aug 22, 2012)

Aidey said:


> How interesting since you said this in a thread asking how old you are a few weeks ago.
> 
> 
> 
> ...



UH OH................:rofl:

And here I thought I was done with this thread. Its gettin' good now!


----------



## Bullets (Aug 22, 2012)




----------



## DrParasite (Aug 22, 2012)

nocoderob said:


> DrParasite,
> Too much to quote there so let me hit some highlights;
> Nope, no degree. I do have some AP, chem, etc from several years ago when I was going to do nursing.
> As far as experience and "seeing the same," yea, in 20 years working in two of CA busiest counties, I have seen a few things myself.


so you don't even have a degree?  so now you are talking down to non-degree providers without having one yourself.   do you realize how hypocritical that makes you?





nocoderob said:


> Like I stated earlier, maybe you can perform more tasks where you work than can an EMT where I work. Ours can give O2, CPR, AED, basic first aid, and drive code three if needed.


it's not about skills.  I know you can do more.  others understand that.  you don't.  end of story.





nocoderob said:


> There is no tiered system. _Every_ 911 call gets a minimum of an ALS rig with one or two medics and an engine with one or more medics.


how many times last month did you intubate someone?  CPAP someone?  transport a penetrating trauma?  deliver a baby?   remember, studies show that the more medics you have the poorer the individual medic's skills are.





nocoderob said:


> Sending a BLS rig to decide whether an ALS rig is needed seems more like a waste of resources to me. But, maybe you do not have a fire dept response in your area like we do.


we don't have fire dept response.  I don't like fire department response, as I think EMS should be able to handle their own calls without needing the FD to stop the clock because we don't have enough resources.  I have been pretty consistent in my opinion on this for years.





nocoderob said:


> I doubt attitudes like mine keep you from getting your card. There must be more to it if you have not done so in 15 years.


yeah, the pay sucks, I don't want to work 3 jobs when I have kids, the job can only be done until your body fails you, the pay sucks, and all too often management treats you like crap because you are replaceable.  did I mention the pay sucks?  note nowhere did I say I couldn't do it, I just chose not to.  Plus depending on where I worked I might have to take a pay cut, or getting the $2 raise isn't worth it for 2 years of my life.





nocoderob said:


> In summary, this thread is, again, about why should there be dual medic units. I, and others, have already stated why we think it is a better system.  I gave reasons as to why I think that way based on my experiences. You on the other hand had to tell me all about your degree, experience, and all the cool calls you have seen over the years.
> Then you state, "I prefer tiered systems 100%. Dual medic and dual EMT. _This way the lone medic doesn't do all the work, has someone to bounce ideas off of, has someone else to try to start the IV when the first person can't get it."_ These are a couple of reasons I feel dual is better. So why are you all bent out of shape again?


if you haven't figured it out by now, then i won't waste any more with you.  maybe I can give you some coloring books which are more your speed?


nocoderob said:


> I don't consider myself an "aggressive" paramedic. But, I do treat the pt as much as necessary. To me, it is far better for pts to recieve an ALS rig and not need ALS than it is to recieve a BLS rig, actually need ALS treatment, and only recieve a fast BLS ride instead.


you know the deep dark secret of EMS?  the one the studies have shown?  ALS doesn't save lives, and all too often the majority (but not all) of your patients just need a fast BLS ride to the hospital.  





Aidey said:


> You also posted calling yourself uneducated when you asked why we don't just give everyone narcan. Odd question for someone with so much education and experience who claims they are good at knowing when their patients need any of the "fancy toys" ALS carries.


I'm uneducated because I'm not a paramedic, not because I'm uneducated in the grand scheme of things.  There is a difference.  And it's not the first time I have called myself uneducated.  or just an EMT.  But just because I am just an EMT, doesn't mean you should make the assumption that I am uneducated.   





Aidey said:


> You know what is worse than a paramedic who underestimates an EMT? A provider who is a god in their own mind who overestimates themselves.


That would be a paragod.  i'm just an EMT, remember?

hey NVRob, since I'm done with this thread, can I have one of your beers?


----------



## Aidey (Aug 22, 2012)

No explanation for the fact that you said you were 20 in a recent post, which undermines pretty much everything you posted in this thread?

And it is pretty obvious EMTs can have a paragod complex too.


----------



## Handsome Robb (Aug 22, 2012)

DrParasite said:


> hey NVRob, since I'm done with this thread, can I have one of your beers?



No, you're only 20. I don't contribute to the delinquency of minors. 

I'll drink one or two for you while I float down the river today though. How's that sound?

In an effort to keep this thread remotely on topic, I like working dual medic *if* the second medic understands that if it's my call it's my call and don't second guess me unless I ask for your input or I'm doing something that could potentially be wrong or harm the patient and I'll act the same way when it's your call. 

With that said I don't mind the P/I combo at all. My intermediate can start lines, push drugs do most of the stuff a paramedic partner could do as long as I "order" them to do it. They can also take a fair share of calls so the workload seems like it gets distributed better than P/B trucks. I've never worked P/B though so I'm not sure.


----------



## nocoderob (Aug 22, 2012)

DrParasite said:


> so you don't even have a degree?  so now you are talking down to non-degree providers without having one yourself.   do you realize how hypocritical that makes you?it's not about skills.  I know you can do more.  others understand that.  you don't.  end of story.how many times last month did you intubate someone?  CPAP someone?  transport a penetrating trauma?  deliver a baby?   remember, studies show that the more medics you have the poorer the individual medic's skills are.we don't have fire dept response.  I don't like fire department response, as I think EMS should be able to handle their own calls without needing the FD to stop the clock because we don't have enough resources.  I have been pretty consistent in my opinion on this for years.yeah, the pay sucks, I don't want to work 3 jobs when I have kids, the job can only be done until your body fails you, the pay sucks, and all too often management treats you like crap because you are replaceable.  did I mention the pay sucks?  note nowhere did I say I couldn't do it, I just chose not to.  Plus depending on where I worked I might have to take a pay cut, or getting the $2 raise isn't worth it for 2 years of my life.if you haven't figured it out by now, then i won't waste any more with you.  maybe I can give you some coloring books which are more your speed?
> you know the deep dark secret of EMS?  the one the studies have shown?  ALS doesn't save lives, and all too often the majority (but not all) of your patients just need a fast BLS ride to the hospital.  I'm uneducated because I'm not a paramedic, not because I'm uneducated in the grand scheme of things.  There is a difference.  And it's not the first time I have called myself uneducated.  or just an EMT.  But just because I am just an EMT, doesn't mean you should make the assumption that I am uneducated.   That would be a paragod.  i'm just an EMT, remember?
> 
> hey NVRob, since I'm done with this thread, can I have one of your beers?




So, are you 20 years old or what? Is your "15 years of experience" bullsh%t or not? Is your BS degree real or is that BS as well? BTW, how did you attain a degree when your writing, spelling, and grammar skills are so poor? All questions inquiring minds are dying to know. By the way you answer, juvenile type attacks just like my kids would do, makes me think you are FOS. Provide some answers and maybe, just maybe, this discussion will continue. Hey Rob, I will take his beer. And yes, I _am_ plenty old enough


----------



## Pavehawk (Aug 22, 2012)

Aidey said:


> No explanation for the fact that you said you were 20 in a recent post, which undermines pretty much everything you posted in this thread?
> 
> And it is pretty obvious EMTs can have a paragod complex too.



You go girl... :beerchug:


----------



## DrParasite (Aug 22, 2012)

Aidey said:


> No explanation for the fact that you said you were 20 in a recent post, which undermines pretty much everything you posted in this thread?


oops, that should be 30.  see what happens when you don't proofread your age on a post that you send at 2am.......


----------



## NYMedic828 (Aug 22, 2012)

DrParasite said:


> oops, that should be 30.  see what happens when you don't proofread your age on a post that you send at 2am.......



Not to take sides but, 30-15= 15. You Can't be an EMT at 15.


----------



## Aidey (Aug 22, 2012)

In some states you can start EMT class at 15, as long as you turn 16 within a certain amount of time after finishing. 

That being said, I think people are going to need a lot of convincing for Dr. Parasite to get any credibility back.


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## nocoderob (Aug 22, 2012)

DrParasite said:


> oops, that should be 30.  see what happens when you don't proofread your age on a post that you send at 2am.......



So you have been an EMT since you were 15? Interesting. Didn't think one could be 15, an EMT, and work on an ambulance.


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## Jambi (Aug 22, 2012)

Some places have explorer programs, but do you all think it legitimate to include explorer time as true experience or time-in-field?


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## JPINFV (Aug 22, 2012)

Jambi said:


> Some places have explorer programs, but do you all think it legitimate to include explorer time as true experience or time-in-field?


You mean I can't include volunteer time to my experience as a "physician" (even though I'm a 3rd year medical student)?


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## Jambi (Aug 22, 2012)

JPINFV said:


> You mean I can't include volunteer time to my experience as a "physician" (even though I'm a 3rd year medical student)?



Well, It's my opinion that such time shouldn't be included.  I was just talking to a guy that told be he had 17 years in the fire service, but was including 8 years as an explorer and volunteer.  I don't think it counts and to include it is at best disingenuous, and at worst fraudulent.

On a side note: People that try and buff their experience is such ways are compensating for something...:lol:


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## nocoderob (Aug 22, 2012)

Jambi said:


> Some places have explorer programs, but do you all think it legitimate to include explorer time as true experience or time-in-field?



Nope. Thats just one step above staying at a Holiday Inn Express:lol:



Jambi said:


> Well, It's my opinion that such time shouldn't be included.  I was just talking to a guy that told be he had 17 years in the fire service, but was including 8 years as an explorer and *volunteer*.  I don't think it counts and to include it is at best disingenuous, and at worst fraudulent.
> 
> On a side note: People that try and buff their experience is such ways are compensating for something...:lol:



I think a volly should count as you are actually "working" albeit for free or little compensation.


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## Bullets (Aug 22, 2012)

Jambi said:


> Some places have explorer programs, but do you all think it legitimate to include explorer time as true experience or time-in-field?



In the great state of NJ you could have started the EMT program at 15 as long as you turn 16 by the time the course was scheduled to end. Most squads around here have cadet programs for members 14+. 

Our squad has 3 cadets, all of which are currently 17 but obtained a CPR card at 15 and rode jobs as a 3rd person. They are allowed to perform CPR but are generally "gophers" and "pilots" at that age. However they do get to see the pointy end of prehospital care at a young age. Our insurance company requires drivers to be 21 to be covered, so in theory if you start at 15 1/2 yrs old, you are running calls 6 1/2 years before you touch the steering wheel. You could be primary care provider for 4 years

The state has since changed the rules and now you must be 16 at the start of the program, but i know a few high school that offer the EMT course as an elective for gym/health class as a junior or senior

Would you say that this would not count towards your experience?


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## Handsome Robb (Aug 22, 2012)

nocoderob said:


> Hey Rob, I will take his beer. And yes, I _am_ plenty old enough



Deal, would you like the both of them? But only because we have the same name :lol:


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## NYMedic828 (Aug 22, 2012)

NVRob said:


> Deal, would you like the both of them? But only because we have the same name :lol:



Its beer not a twix bar!


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## Jambi (Aug 22, 2012)

Bullets said:


> Would you say that this would not count towards your experience?



It depends.  It's different than working 2000/hrs a year or more, thus I wouldn't count 4 years of cadet/volunteer work as 4 years of experience, but rather prorate it based on number of hours worked.  To do anything else is a misrepresentation.

If I'm talking to a 30 year old (since that's the popular number today) and he or she tells me that he or she has 15 years of experience, I'm going to be suspicious.  It would be more correct to say I have 10, or, 11, or 12 years of experience, with 4, or 5, years of explorer/volunteer work before that.

I'm a skeptic because people often throw around years of experience like a bully instead of relying on demonstrated competence and reputation.  This MO is especially rampant among members of unions...(yes I belong to a union, so no freaking out)


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## Jambi (Aug 22, 2012)

NVRob said:


> Deal, would you like the both of them? But only because we have the same name :lol:



It's not nice to talk about beer while I'm at work!  So close yet so far...


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## NomadicMedic (Aug 22, 2012)

Jambi said:


> It's not nice to talk about beer while I'm at work!  So close yet so far...



wait! I'm a Rob too! Save a beer for me!


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## Jambi (Aug 22, 2012)

n7lxi said:


> wait! I'm a Rob too! Save a beer for me!


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## nocoderob (Aug 22, 2012)

NVRob said:


> Deal, would you like the both of them? But only because we have the same name :lol:



Heck yea! I don't turn down beer. I had the name first, FYI


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## Handsome Robb (Aug 22, 2012)

n7lxi said:


> wait! I'm a Rob too! Save a beer for me!



There's always a beer in my fridge with your name on it Rob 



nocoderob said:


> Heck yea! I don't turn down beer. I had the name first, FYI



Any requests? I'm about to take my half-sunburned self to the store. 

You had it first and made it partially awesome, but I finished the awesomeness.


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## NomadicMedic (Aug 22, 2012)

I'll drink just about any IPA if it's cold. 

I'm sitting at the station, working nights tonight, and the mere thought of a frosty IPA, with that delectable hoppy bite, is making me salivate like one of Pavlov's dogs.


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## Handsome Robb (Aug 22, 2012)

n7lxi said:


> I'll drink just about any IPA if it's cold.
> 
> I'm sitting at the station, working nights tonight, and the mere thought of a frosty IPA, with that delectable hoppy bite, is making me salivate like one of Pavlov's dogs.



I'm not an IPA type of guy but would you settle for a Lagunitas IPA?


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## nocoderob (Aug 22, 2012)

Lagunitas is pretty good. If you can find Stone IPA, do try. I am not a big IPA fan either but that stuff is gooooood.

Oh, and thanks for making the name pure awesomeness


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## NomadicMedic (Aug 22, 2012)

Done!

We should probably get back on topic.

Uh, we run exclusively dual medic trucks. It's a good system. We like it. 

How's that?


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## nocoderob (Aug 22, 2012)

I think this topic coded long ago


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## OzAmbo (Aug 22, 2012)

n7lxi said:


> Done!
> 
> We should probably get back on topic.
> 
> ...


i like it too.

-----------------------------

Partner : im exhausted, can you drive this job

Medic : no, because this patient is sick and needs a higher level of knowledge and assessment in the back

............................................

Medic : im exhausted, can you drive this job?

Partner :  no, because this patient is sick and needs a higher level of knowledge and assessment in the back

.............................................

Medic : What do we have here.. is this APO, exacerbation of COPD, APA and COPD? Shoul'd i manage this guys as COPD or go for the nitrates?

Partner : what are you talking about?

..............................................

Half baked reasons aside (including drivel like "not all patient are ALS etc etc etc) Being able to share the decision making workload and fatigue of driving during the night :censored::censored::censored::censored:s as well as having a sounding board for decision making comes up trumps in my opinion and makes dual medic superior no matter what excuse you have cooked up against it

Its not aways about patient care, sometimes its about caring for yourselves


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## JPINFV (Aug 22, 2012)

nocoderob said:


> I think this topic coded long ago


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## truetiger (Aug 22, 2012)

It's great being able to alternate calls....especially in a busy system.


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## DrParasite (Aug 22, 2012)

Bullets said:


> In the great state of NJ you could have started the EMT program at 15 as long as you turn 16 by the time the course was scheduled to end. Most squads around here have cadet programs for members 14+.


thanks for explaining that.  I was going to, but it is more credible when someone else does.  

that's also why I said this:


DrParasite said:


> oh and lets not forget, 15 years as an emt, the last 7 as a career provider in an urban 911 system.


so if you don't want to count my volunteer time, that's ok, i do have 7 years getting paid for answering 911 calls.  but i'm only an EMT, so you might not count that at all.


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## Handsome Robb (Aug 22, 2012)

nocoderob said:


> Lagunitas is pretty good. If you can find Stone IPA, do try. I am not a big IPA fan either but that stuff is gooooood.
> 
> Oh, and thanks for making the name pure awesomeness



I can't take all the credit. It was a joint effort sir!



DrParasite said:


> that's also why I said this:
> so if you don't want to count my volunteer time, that's ok, i do have 7 years getting paid for answering 911 calls.  but i'm only an EMT, so you might not count that at all.



I absolutely count volunteer time. Especially if you are active in training and not just "the good stuff". 

I've got a lot of respect for dispatchers. We are required to do a certain amount of hours each year observing in dispatch. I couldn't work in there. I don't have the patience and I'd go nuts in that little room. With that said, I personally don't believe that dispatch time, be it paid or volunteer, substitutes as experience when talking about the "field".


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## Handsome Robb (Aug 23, 2012)

Pt was negative for meningitis! Thank goodness. I feel like I jumped to conclusions but she said too many keys for me to not consider it as a possibility. I learned a lot from that situation, even though I didn't like it.


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## DrParasite (Aug 23, 2012)

NVRob said:


> With that said, I personally don't believe that dispatch time, be it paid or volunteer, substitutes as experience when talking about the "field".


Good, neither do I.  

that's why up until 6 months ago, I was working part time on an ambulance at my side job.  Communications just paid a lot more for me to give it up.  and as of Sept 16th, I will be back on an ambulance, as it was one of the conditions I had for accepting a new part time job (which I get paid surprisingly well) to answer 911 calls.

any other questions or comments you have about me?


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## Handsome Robb (Aug 23, 2012)

DrParasite said:


> any other questions or comments you have about me?



The whole world doesn't revolve around you. Except in the case of this thread...then it does.

Edit: disregard the meningitis post. Definitely was meant for a different thread.


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