# ACLS - Do's and Don't?



## DV_EMT (Apr 22, 2009)

Just wondering,

I'm planning on taking an ACLS class soon and I was wondering the "scope of practice" for an EMT-B. Is it based upon a county or state "standing order/protocol"? 

and/or...does the certification allow you to push meds such as atropine or epi if they're on hand?

thanks,

-Dom


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## JPINFV (Apr 22, 2009)

No. Taking an ACLS course does not increase the scope of practice for basics.


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## Aidey (Apr 22, 2009)

The last time I took an ACLS class there was nothing except basic airway control that was within the scope of practice for an EMT basic. I'm talking about OPAs, NPAs and bagging, stuff that is already taught to EMT basics. As a basic you are still restricted by your standing orders. Even if you've taken an ACLS class I'm 99.99% sure you will not be able to do anything you've learned since none of it is within the scope of an EMT B.


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## DV_EMT (Apr 22, 2009)

i figured so,

especially here in our county. EMT-B's basically can't give any meds. No insulin, no epi, no nitro.we're really limited. only O2 here

but hey... it lowers pain, and N/V... and bumps up o2 sats!


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## VentMedic (Apr 22, 2009)

DV_EMT said:


> but hey... it lowers pain, and N/V... and bumps up o2 sats!


 
Maybe you should consider a couple of college level A&P classes which are probably the same cost at a community college as the ACLS class. Since you are in CA, both A&P classes may even cost a lot less than the ACLS class.


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## JPINFV (Apr 22, 2009)

DV_EMT said:


> i figured so,
> 
> especially here in our county. EMT-B's basically can't give any meds. No insulin, no epi, no nitro.we're really limited. only O2 here


Err, and your point is?

Besides, I doubt that your medics can give insulin.


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## DV_EMT (Apr 22, 2009)

JPINFV said:


> Besides, I doubt that your medics can give insulin.



I can't remember, but i'll double check. I think i meant to say po glucose. plus... insulin is supposed to be kept in the fridge and it expires 28 days late outside of one


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## DV_EMT (Apr 22, 2009)

VentMedic said:


> Maybe you should consider a couple of college level A&P classes which are probably the same cost at a community college as the ACLS class.



A&P? which is?


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## VentMedic (Apr 22, 2009)

Anatomy and Physiology


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## JPINFV (Apr 22, 2009)

Here, I'll help you out. 

http://www.sbcphd.org/documents/ems/Policy530Draft.pdf


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## AJ Hidell (Apr 22, 2009)

DV_EMT said:


> I can't remember, but i'll double check.


Trust me.  Don't waste your time.


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## DV_EMT (Apr 22, 2009)

ya know... i've been looking for that for weeks now and then ya just pulled it up like you had it on hand lol... 

yeah, I'm going to hit up medic school pretty quick here. I just need to get some hours workin as a basic for now. SBCC has saturated the EMT-B positions in SB county. its so hard to get a job here. I'm working on being able to do ride alongs with the NICU transport, but it doesnt look too promising.


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## JPINFV (Apr 22, 2009)

1. Google "Santa barbara EMS"
2. click on "Policy and Procedures"
3. "# Medical Control, Field Policies and Treatment Protocols"
4. 530 EMT-P Scope of Practice


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## DV_EMT (Apr 22, 2009)

ya. i just looked... thanks. you have no idea how much that helps!


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## maxwell (Apr 22, 2009)

ACLS is just education.  Doesn't let people do cooler things. That said, taking ACLS, PALS, NRP teaches you good tricks that your medics may not know during a code - you could be pretty helpful as an EMT-B with ACLS!


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## maxwell (Apr 22, 2009)

DV_EMT said:


> i figured so,
> 
> especially here in our county. EMT-B's basically can't give any meds. No insulin, no epi, no nitro.we're really limited. only O2 here
> 
> but hey... it lowers pain, and N/V... and bumps up o2 sats!



..oxygen does nothing for pain.


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## Scout (Apr 22, 2009)

It does if i say it does.


Thats all you need to think. The mind is a great trickster


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## Scout (Apr 22, 2009)

I'm actually going to put a disclaimer in her and say pharmacologically it has no impact on pain


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## firecoins (Apr 22, 2009)

I like to give placebos.


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## VentMedic (Apr 22, 2009)

Scout said:


> I'm actually going to put a disclaimer in her and say pharmacologically it has no impact on pain


 


maxwell said:


> ..oxygen does nothing for pain.


 
Can either of you back up your statements as an absolute from medical literature? 

There are quite a few studies that have been done and are being done as to the effect of oxygen on pain. It would depend greatly on the etiology of the pain. Migraines, tissue hypoxia, PVD and various autoimmune disorders all can respond differently to various therapies. As well, there are many scientists and physicians that believe in the value of hyperoxia for various wound care as well as HBO. In some places we do use a high FiO2 to do a nitrogen washout for a pneumothorax which can relieve pain as free air is removed. Oxygen has smooth muscle relaxing properties for the pulmonary arteries. Pulmonary hypertension can cause hypoxia which in turn can cause pain. Oxygen is required to generate ATP as a source of cellular chemical energy. Without it, the Kreb's cycle does not function and some system may suffer, causing pain.

I suggest a little basic college level A&P to review the principles of Oxygen and why it is considered a drug.


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## Scout (Apr 22, 2009)

Ok but if I'm off base here do tell. I haven't researched this it is mere personal opinion.


My understanding of O2 in those instances was that it relieved pain due to an effect on an underlying condition or a change of state occurs. This contrasts in with other pain relief as the pain relief we give does nothing for the the cause but depressant for the signals so you don't feel it.

Also I have found, all be it limited, that if you apply o2, and I'm assuming compressed air will work too, the pt often reports a decrease in pain. Coupled if you tell them it will help with the pain it helps quite a bit.


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## VentMedic (Apr 22, 2009)

Scout said:


> Ok but if I'm off base here do tell. I haven't researched this it is mere personal opinion.
> 
> 
> My understanding of O2 in those instances was that it relieved pain due to an effect on an underlying condition or a change of state occurs. This contrasts in with other pain relief as the pain relief we give does nothing for the the cause but depressant for the signals so you don't feel it.
> ...


 
Again, oxygen is a drug, not a placebo, regardless of the quantity you give it. It you are giving compressed air, you may still be providing a therapy. The flow itself is therapeutic. It is not like you are giving a placebo pill. 

CPAP at 21% can relieve alot of symptoms and it is from the mechanism of delivery that improves oxygen uptake. It there is a V/Q mismatch, varying flow gradients can make a big improvement. Thus, there are many basic priniciples that must be understood before making a blanket statement or the common EMS thing "I have seen this" but without any information to support their claim.


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## VentMedic (Apr 22, 2009)

I am going to continue a little further with this.

This is my post from the CP and O2 thread:
*Oxygen, oxidative stress, hypoxia, and heart failure*

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15765131


> Conclusions
> Oxygen, beyond its indispensable role in cardiac energy metabolism, plays a central role in other biological processes that can be determinants of cardiac function, including the generation of ROS and the determination of cardiac gene expression patterns. Although their role in the pathogenesis of clinical heart failure remains unclear, ROS have been implicated in most processes thought to have a significant effect on cardiac function, including hypertrophy, ion flux and calcium handling, EC coupling, extracellular matrix configuration, vasomotor function, metabolism, gene expression, and downstream signaling of several growth factors and cytokines. Clinical trials based on antioxidant therapies have been, however, generally disappointing. Whether this is a function of the particular antioxidants used is unclear, and planned trials with XO inhibitors and other alternative agents should help answer this question. The role of hypoxia-induced alterations in gene expression in the genesis of heart failure also remains unclear, although experimental data suggest that these changes in gene expression can be either adaptive or maladaptive, depending on context. Given the central role of oxygen in cardiovascular biology, further investigational focus on oxygen-related processes in the genesis of heart failure is warranted.


 
The research indicates that Oxygen does produce various changes in the body and that is why its use in different concentrations of various lengths of time is controversial.

We also know that various ethnic groups do have some differences in their cellular chemistry that make them susceptible to different diseases and they may also response to different therapies better or poorer than other races.

ex. The Asian or African-American race have a higher risk for Pulmonary Artery Hypertension due to a nitric oxide deficiency. They are also at a higher risk for asthma. Sickle cell trait and O2 carrying capacity will also be factors. Different treatment plans must take this into consideration. Thus, medications and therapies must take into consideration many factors and what you may perceive as a placebo effect may actually have some physiological effect on that particular person and not on another. 

You can use the intake of everyday vitamins as an example. If your body doesn't need the supplements, they are of little use and are excreted. If your body is deficient in something, then the may serve a purpose.


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## maxwell (Apr 22, 2009)

VentMedic said:


> Oxygen is required to generate ATP as a source of cellular chemical energy. Without it, the Kreb's cycle does not function and some system may suffer, causing pain.
> 
> I suggest a little basic college level A&P to review the principles of Oxygen and why it is considered a drug.



I'll be sure to mention this to the biochem class I'm TAing this semester.  Note: The big payoff for ATP isn't during the Krebs cycle..its the electron transport chain where O2 is the final oxygen acceptor.  Moreover, pain is generally not due to a lack of A3P!  And while all of this is really, really interesting... Oxygen as a pain relief is goofy!  Oxygen, of course, when pain is due to hypoxia, helps in the long run.  Pain mgmt should focus on early delivery of narcotics and consideration of anxiolytics.  We don't give O2 for pain, we give it to prevent systemic hypoxia (which can THEN lead to issues at the biochemical level).


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## JPINFV (Apr 22, 2009)

maxwell said:


> Note: The big payoff for ATP isn't during the Krebs cycle..its the electron transport chain where O2 is the final oxygen acceptor.


True, to an extent. While Krebs only produces one unit of GTP per cycle (2 cycles per unit of glucose that enters glycolysis), it does produce 3 units of NADH which is needed to run the electron transport chain. If ETC backs up (for example cyanide poisoning or hypoxia), then the cell will run out of free NAD+ which will shut down the Krebs cycle.


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## VentMedic (Apr 22, 2009)

maxwell said:


> I'll be sure to mention this to the biochem class I'm TAing this semester. Note: The big payoff for ATP isn't during the Krebs cycle..its the electron transport chain where O2 is the final oxygen acceptor. Moreover, pain is generally not due to a lack of A3P! And while all of this is really, really interesting... Oxygen as a pain relief is goofy! Oxygen, of course, when pain is due to hypoxia, helps in the long run. Pain mgmt should focus on early delivery of narcotics and consideration of anxiolytics. We don't give O2 for pain, we give it to prevent systemic hypoxia (which can THEN lead to issues at the biochemical level).


 
Again I would suggest some college level A&P to see how systems are related and further your studies. You are taking small pieces of info out of context of a bigger picture. After you finish the Biochemistry class you should have a better understanding of this. But, is this an "overview" class? If this is a regular college level Biochem class, you should have gotten more information in the prerequisite classes. 

If you have college level classes to your credit, especially in the sciences, you would know why making a blanket statement like this:


> Originally Posted by *maxwell*
> 
> 
> _..oxygen does nothing for pain._


is invalid. Support your statements. 

I have given you examples and you can do your own research.

Here are two decent search engines to look for medical literature. 

www.medscape.com 

http://scholar.google.com/



> We don't give O2 for pain, we give it to prevent systemic hypoxia


 
This applies only to an EMT or Paramedic level. Once again there is much more to medicine off the ambulances.


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## maxwell (Apr 22, 2009)

I'll leave the previous statements be as it will have no benefit to pt. care.  I just put "oxygen, pain" into NIHP-M, and got plenty of support for my statements.  O2 15L for pain, for all!  Oh, and I'm teaching the biochem class.  I'm good with my "big picture."


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## VentMedic (Apr 22, 2009)

maxwell said:


> I'll leave the previous statements be as it will have no benefit to pt. care. I just put "oxygen, pain" into NIHP-M, and got plenty of support for my statements. *O2 15L for pain, for all!* *Oh, and I'm teaching the biochem class.* I'm good with my "big picture."


 
Where are you coming up with this stuff? It seems like you are looking more for a "recipe" than scientific statements to support your claim. 

Yes I am aware the 15 L/m is in your protocols as you did mention that in another thread. Again, can you support this with scientific evidence. I'm not judging whether you are right or wrong but I would like to read things to form my own opinion of the research for the subject matter that these statements are made from.

You are teaching a biochem class? College level? Your profile says you are working on a BA in math. You do contradict your earlier statement and it seems one would not have mistaken "taking" for "teaching.


> I'll be sure to mention this to the biochem class I'm TAing this semester.


 
Your profile also says you want to get to med school. To be a physician one must also be a scientist. Making blanket opinionated statements and ignoring scientific literature will not do your patients any good. Your attitude is why a few ambulance services refuse to give up the MAST. 

Did you bother to read any of the references I stated? Probably not. 

As technology progresses we are able to study more concepts in medicine and how they affect the body. You need to open your mind to the world of science and medicine. At least when I get into a debate with JPINFV, Rid, MSDeltaFlt, Medic417, AKflightmedic, BossyCow, AJ, BLSboy, reaper and others, they put forth how they derived at their statements.


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## DV_EMT (Apr 22, 2009)

By Technicallity,

O2 is considered not to be a drug "prescription wise". I've never worker in a pharmacy that has yet to dispense "O2". It is, however, considered to be a drug because it can be purchased by the public without a prescription much like tylenol or motrin. 

so yes... it is considered a drug.

as for the pain portion of the discussion...

1. I learned that from a medic during my ride along. 
2. I double checked it with both my EMT instructor (a medic and fire captain for 20 yrs) and the ICU/CCU pharmacist at my hospital
3. documentation... heres just one:

http://majidali.com/the_oxygen_view_of_pain.htm


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## VentMedic (Apr 22, 2009)

DV_EMT said:


> 3. documentation... heres just one:
> 
> http://majidali.com/the_oxygen_view_of_pain.htm


 
Excellent! 

Actually, it is not just one reference. There are 41 references that went into the writing of that article.



> References
> 1. Ali M. Oxygen and Aging. (Ist ed.) 2000. New York, Canary 21 Press. Aging Healthfully Book 2000.
> 2. Darnell J, Lodish H, Baltimore D. Molecular Cell Biology. 1990. New York. Scientific American Books. Distribted by WH Freeman and Company. pp 784-802.
> 3. Katz B. Nerve, Muscle, and Synapse. 2nd. ed. 1966. New York. McGraw-Hill.
> ...


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## DV_EMT (Apr 22, 2009)

I was hoping that you'd catch that


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## syd (Apr 22, 2009)

Not to get off the subject of O2 and pain, but, can a EMT-Basic even get certed for ACLS? I heard that you can go through the class and learn the stuff but can't a cert for it...  I'm confused... maybe I need O2... does it help with confusion???


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## rmellish (Apr 22, 2009)

syd said:


> Not to get off the subject of O2 and pain, but, can a EMT-Basic even get certed for ACLS? I heard that you can go through the class and learn the stuff but can't a cert for it...  I'm confused... maybe I need O2... does it help with confusion???



If you pass the course then I'm fairly sure you can get your ACLS course completion card. This will not change your scope of practice as a basic.


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## reaper (Apr 22, 2009)

syd said:


> Not to get off the subject of O2 and pain, but, can a EMT-Basic even get certed for ACLS? I heard that you can go through the class and learn the stuff but can't a cert for it...  I'm confused... maybe I need O2... does it help with confusion???



They do not certifiy you for anything. They give you a completion card. No, they will not give an EMT a card, unless you are in Medic school at the time of the class.


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## NorCalMedic (Apr 24, 2009)

reaper said:


> They do not certifiy you for anything. They give you a completion card. No, they will not give an EMT a card, unless you are in Medic school at the time of the class.




This is true. I teach this class and some proavtive EMT's like to know that sort of stuff. Unfortuneately they will not give you a card, but they may give you the CE's for taking the class which could be equally as useful!


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## syd (Apr 24, 2009)

NorCalMedic said:


> This is true. I teach this class and some proavtive EMT's like to know that sort of stuff. Unfortuneately they will not give you a card, but they may give you the CE's for taking the class which could be equally as useful!



They won't give you which card?  The ACLS or the EMT?


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## NorCalMedic (Apr 24, 2009)

syd said:


> They won't give you which card?  The ACLS or the EMT?



They will not provide you with an ACLS card if you are an EMT taking the ACLS class.


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## Jon (Apr 24, 2009)

OK - My understanding of ACLS was that you needed to be a higher-level medical provider to be allowed to take the class... is that correct?


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## 8jimi8 (Apr 24, 2009)

no, i took ACLS and PALS as a nursing student and was given the certification card.


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## VentMedic (Apr 24, 2009)

8jimi8 said:


> no, i took ACLS and PALS as a nursing student and was given the certification card.


True. RT and Paramedic students will also be given a card as it is usually a requirement to complete their programs. It may be required for these professionals (to be) and not for the EMT-B.


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## NorCalMedic (Apr 24, 2009)

Jon said:


> OK - My understanding of ACLS was that you needed to be a higher-level medical provider to be allowed to take the class... is that correct?



Any medical provider can take the class. The only one they will actually give the physical ACLS card to are the providers that are Paramedic and higher. The others they may only provide CE's for, even that may not count towards an EMT recert though, it all depends on the county weather they will accept CE's for EMT's that take advanced classes.


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## reaper (Apr 24, 2009)

As Vent pointed out, If you are in Medic,RT, or RN school, then you will receive a card. You must prove that you are in school at the time of the class.


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## VentMedic (Apr 24, 2009)

As an EMT-B, one should focus on forming a solid education foundation.

Too much focus on too many certs too soon does not improve your overall knowledge base or quality of care.


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## NorCalMedic (Apr 24, 2009)

VentMedic said:


> As an EMT-B, one should focus on forming a solid education foundation.
> 
> Too much focus on too many certs too soon does not improve your overall knowledge base or quality of care.



I could not agree more with vent. There are so many EMT's out there that want to go right into medic school before they have formed a solid foundation on how to render care on a live human being. I will admit some to cut it and some do get through but more often then not when you have someone who fails out of paramedic school it is the person with the least expierince as an EMT, and does not have the interpersonal skils to render care to someone.


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## 8jimi8 (Apr 24, 2009)

I can understand the point that you all are making, but i didn't have to prove anything, I just told them i was a nursing student and they took my check and gave me a course guide to study before the class.  (They didn't even tell me there was a provider manual... that would have been so much more helpful, i ended up doing a TON of research in my medical surgical text and online as preparation)

This may be the way that the industry is moving, in that the course is now so much easier to pass (our megacodes were openbook / team collaboration ) the only portion that we had to pass alone was the final little test at the end of the class.

I know this may anger some of the old school people who really had a MEGAcode, but i will tell you this in my defense.  I was the only person there who actually studied for two weeks and actually KNEW all of my algorithms.  I was in a class with experienced RNs and MDs whose employers were paying for the class for them.  I'm not saying that they didn't know anything, but they were all very overconfident in that they admitted that they had not even cracked the book.  I learned a great deal from my experience, but I do see that the standards are sub-par from what they used to be. 

Also as a side note, i have, as of late on EMS applications, seen a check box for an "ACLS for Basics" certification class; albeit I've never seen one of those courses offered anywhere.


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## NorCalMedic (Apr 24, 2009)

8jimi8 said:


> I can understand the point that you all are making, but i didn't have to prove anything, I just told them i was a nursing student and they took my check and gave me a course guide to study before the class.  (They didn't even tell me there was a provider manual... that would have been so much more helpful, i ended up doing a TON of research in my medical surgical text and online as preparation)
> 
> This may be the way that the industry is moving, in that the course is now so much easier to pass (our megacodes were openbook / team collaboration ) the only portion that we had to pass alone was the final little test at the end of the class.
> 
> ...



The Basic class or BLCS they sometimes refer to it as, is just your basic CPR class.


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## JPINFV (Apr 24, 2009)

Negative Ghostrider. The ACLS for the EMT-Basic course is basically a medic assist course. It teaches basics all of the helpful things like putting a patient on the monitor and spiking a bag. All of those things that should take a basic all of 5 minutes to learn how to do.


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## VentMedic (Apr 24, 2009)

8jimi8 said:


> I can understand the point that you all are making, but i didn't have to prove anything, I just told them i was a nursing student and they took my check and gave me a course guide to study before the class.


 
Your nursing prerequisites did give you some educational foundation. As for the OP, the EMT-B does not adequately prepare one to take this course even as watered down as it is now. However, the course does expect one to have studied and be class ready. An EMT-B may not know where to begin to look for the information that is no longer in the ACLS book. The ACLS class for Basics would be more appropriate for an EMT-B to start with. Again, just collecting certs does not necessarily make on a better provider. 

I, myself, have sat through some classes that I couldn't even tell you what the class was about 10 minutes after it ended. Yet, I still got a certificate of completion.


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## AJ Hidell (Apr 24, 2009)

NorCalMedic said:


> VentMedic said:
> 
> 
> > As an EMT-B, one should focus on forming a solid education foundation.
> ...


You definitely misunderstood Vent's point.  And your experience seems to be quite different from the other instructors on this forum.

Vent was referring to EDUCATION, not experience.  There is no solid education foundation established through field experience as an EMT-B.  That foundation is established in the classroom.  Experience is not education.  Experience is building upon the foundation.  And there is no significant foundation established in a 110 hour first aid course.  Vent was advising our friend here to stay in school and take the scientific foundation courses that build the foundation necessary for competent paramedic practice.  She was not advising him to play ambulance driver for some IFT company for a couple of years just to have some worthless experience and bad habits to put on paper to impress some paramedic school admission committee who doesn't have the slightest clue about the fundamentals of adult educational theory.

And most intelligent instructors and co-ordinators that I know will tell you that they have much better luck educating those with less EMT experience than those with more.  That has certainly been my observation in the last twenty-five years.  Having lived there for years, I do understand that this is contrary to the conventional wisdom in California, where three decades of progress seems to have had no effect on their ability to do things they way they have always done them, blissfully unaware that there is a better way.  But this is a proven concept, and the only people who don't seem to see it are those who refuse to see it.


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## VentMedic (Apr 24, 2009)

Correct A.J.

People want to rush off and get as many letters behind their name without any real education to back them up. This includes ACLS, PALS and NRP instructor certs, CCEMTP and all the other fancy initials. 

We even have had Paramedics wanting to take an NRP Instructor Cert course solely based on the fact that was the only card they didn't have.

I fully believe the only length of time you should spend as an EMT-B is the time it takes you to finish Paramedic school. Of course, if that is done properly, you can still get at least a year on a BLS truck. But, you will be thinking about your patients with an advanced point of view. It does an EMT-B little good to just watch "cool" things being done if one does not understand the reasons behind them. At least as a Paramedic student you will be observing what you are studying. I also believe that at least one and preferably two college level A&P classes should be completed prior to EMT-B. Then that time spent on a BLS truck might mean something if you can better understand what parts of the body you are looking at. One might even recognize some of the medical terminology if they read more than the patient's face sheet to actually know anything about the patient they are transporting. 

Ex. dialysis patients: few EMT-Bs even know why the patient is one dialysis except for "kidney failure". Few also know what medical time bombs they are transporting and the many systems that could fail at anytime.

Link to the thread listing the many different extra certs:
http://www.emtlife.com/showthread.php?t=11279&highlight=certifications


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## 8jimi8 (Apr 24, 2009)

VentMedic said:


> Your nursing prerequisites did give you some educational foundation. As for the OP, the EMT-B does not adequately prepare one to take this course even as watered down as it is now. However, the course does expect one to have studied and be class ready. An EMT-B may not know where to begin to look for the information that is no longer in the ACLS book. The ACLS class for Basics would be more appropriate for an EMT-B to start with. Again, just collecting certs does not necessarily make on a better provider.
> 
> I, myself, have sat through some classes that I couldn't even tell you what the class was about 10 minutes after it ended. Yet, I still got a certificate of completion.



I definitely agree, that I had a base of education to help me through the class.  Again I completely agree that ACLS is completely out of scope for a Basic.  I was just commenting on the fact that there wasn't any "prove you are a nursing student, portion of my class."  In fact I tried to back out of the class and reschedule it for a few months down the line because I wasn't confident that I had learned all of the information well enough.  Funny because the teacher calmed me down and told me that I would do fine in the class and when I showed up, I was the only one who had prepared~

I even ran into one of my nursing instructors, taking the course, who told me I had a lot of nerve to show up to that class.  

In answer to the OP.  It is out of scope for a basic.  There is little more that you can do other than helping to apply the 12 lead and grabbing medications for your Medic.


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## AJ Hidell (Apr 24, 2009)

8jimi8 said:


> I even ran into one of my nursing instructors, taking the course, who told me I had a lot of nerve to show up to that class.


In what sense did she intend that?


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## VentMedic (Apr 24, 2009)

AJ Hidell said:


> In what sense did she intend that?


 
I don't know if this is the case here, but I do know there are some schools that do believe in a structured progression of learning/education and advanced procedures should be done after a solid foundation is finished. In a way I do agree as I have seen nursing students do a rotation through ICU too soon who had not quite gotten the hang of assessing a fairly healthy patient but are now put to task with a train wreck. 

This also happens when CCEMTP graduates ask to spend a day observing in one of our ICUs. I always hope we have ECMO running just so I can see the look on their faces. Also, few know what a real hypothermia protocol consists of until they see it done in an ICU. Sometimes I think some of these CCEMTP grads are just for my amusement and not really for taking care of patients on CCTs.


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## 8jimi8 (Apr 24, 2009)

I think she just meant that it was an advanced course and I was only a level 3 student.  (I hadn't even studied the cardiac module yet, we didn't learn that one until level 4).


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## AJ Hidell (Apr 24, 2009)

Right.  But did she mean it in an indignant, _"how dare you!"_ sort of sense?

Or did she mean it in an encouraging, _"good for you!"_ kind of way?


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## 8jimi8 (Apr 24, 2009)

Oh it was definitely a positive statment   This is an instructor that I had a great rapport with and I definitely feel that she was impressed with my drive to exceed the minimum education requirements.  I most definitely took it as a compliment.


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