# ALS/BLS interaction



## Bandaidbox (Mar 10, 2017)

Good day all. New here and have a question regarding a new employment experience. I come from a large city doing ems but I am currently moving out of state. I was just hired a company that runs one medic / one emt. I'm coming from a system where both als / BLS are in separate vehicles. Just curious as to the interactions between both levels on the same truck. Coming from the system I currently work, sometimes there is a bit of a rivalry between both levels. I'm well versed at my job and rarely have that issue with knowledge levels of the job where this issue seems to manifest its self in my current system.  So in a nutshell- ALS, whats your expectations for a BLS partner? BLS- what's some of your advise or experience in this type of system with an ALS partner?


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## FLMedic311 (Mar 10, 2017)

Answering from an ALS side I would say first and foremost I would say no different then a complete BLS truck I want a partner that I can get along with, Shifts are long and are made longer when you cannot even hold a basic conversation without arguing.  Granted I don't think that is something you can control in the sense of who you are..  You will find yourself with someone you don't see eye to eye with eventually and that's OK, just work on making sure that you can still have a clear line of communication when you're in the thick of it and work together for the good of the patient.  As far as expectations of knowledge and skills, that will probably vary from person to person.  You will find some Medics that have absolutely no expectations and some that are going to hold you to the highest standard, maybe even beyond that of what you think is in your scope.  In time you will also hold your Medic partner to a standard as well.  It's dynamic and the best thing you can do to prepare is to go in with a good attitude, be the best EMT you can be and maintain the thought of the Patient comes first.  Good Luck on your new adventure and let us know how it goes!


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## StCEMT (Mar 10, 2017)

I work a P/B truck. I'd say my main expectation of my partner (and this is a two way street) is to know where our stuff is, how to use it, and don't be a **** to people. 

Otherwise we balance out what we do. Some calls they will run the assessment and I just write things down, others I will jump on something that needs to be done and they facilitate, or often I will set something up while they do a 12 lead for example and we just divide up the work. Entirely dependent on what's going on. Just because my partners aren't medics don't mean I don't listen to what they say to do either. Many of them have done it for a while or are finishing medic programs and are familiar with what's going on. If they have a better plan, we go with that. Basically just working together to get whatever we need done.


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## GMCmedic (Mar 10, 2017)

Speaking from an ALS side, We rotate stations so I only have each EMT for 10 or so shifts a month, then i might not see them for 6 months.

I expect them to ask questions if they plan to advance. I hope they can carry on a decent conversation. 

Though I never expect them to know what I will do on every run, I do expect them to pick up on key words that should let them know when I may do certain things. I.e. syncope for 12 lead, shaky or AMS for glucose etc etc

Sent from my SAMSUNG-SM-G920A using Tapatalk


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## VentMonkey (Mar 11, 2017)

Bandaidbox said:


> So in a nutshell- ALS, whats your expectations for a BLS partner?


Don't be a tool.


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## LACoGurneyjockey (Mar 11, 2017)

I expect my partner to know the monitor, know the bags, and know where everything is in the unit. I'd like them to know the response area. I hope they know the basics of the paramedic protocols, when to expect a 12 lead, glucose, trauma activations, STEMI/stroke protocols etc. When I have a new partner I'll walk them thru my expectations for an arrest, intubation, or trauma activation. If they ask what's expected that's even better. Its nice when they restock ALS supplies or help with als checkouts, but not expected. But when it comes down to it, being able to get along with my partner for 24 hours makes up for a lot. And I'll always offer any help they want studying to medic school or any advancement.
Just don't be a ****, don't be arrogant, don't step on your medics toes, and be helpful. And for what it's worth, 99% of the time I'd rather work with a great EMT than a medic.


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## Ensihoitaja (Mar 11, 2017)

Along the lines of what *Vent* said:

Don't be a ****, don't get me yelled at, tell me if you're not sure how to do something/what to do.


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## VentMonkey (Mar 11, 2017)

The OP said in a nutshell, so my earlier post summed up what I typically "look for". Honestly speaking, I still do ground shifts when I have a chance, and more often than not no one has a clue who I am since I am technically a part-time field/ ground paramedic; most faces are as new to me as I am to them.

I base most of my shifts off hours that best suit my personal life on my days off. What I look for is really someone who knows how to navigate fairly well around town without a whole lot of guidance, and can get from anywhere in our response areas to our chosen ED.

As far as walking through my expectations with my EMT's, I say no. I don't know how many times over the years I have tried that only to find it all but fell on deaf ears when it was crunch time; just follow my lead on calls, nothing more, nothing less.

I stopped trying to "impart medic wisdom" on most EMT's because no matter how interested they seemed initially, it never really felt genuine. I have had a multitude of partners drive like a-holes; yeeeah, don't do that, that will end up with a very angry monkey, especially if he's having to swing from OSB to OSB; not a good shift.

Be reasonable, have common sense, show some initiative, but ask if you're uncertain. Don't try too hard, just do you and play it by ear. Every medic, EMT, man, woman, etc. is different and has a slew of different expectations.

If you can properly place 12 leads you get bonus points. I respect the back of the rig (my office) and will keep it clean/ pick up after myself on 98% of the calls because A) we're a team, and B) it isn't your job to pick up after me unless I am super inundated. I do expect you do the same to your side of the front cab.

Leave the on-coming crew with enough fuel to get through at least 1/2 the shift, preferably a full tank. Replace any O2 bottles (I have no problem helping here either) if they need it before or after shifts (especially the house), leave it nice and clean, and if you clean the floor of the unit on most/ all calls you are very much appreciated by me.

I'm sure there's more, but for now these are my top things. Take pride in your job as I do mine. People act weird around the flight paramedics here sometimes, so if they ask where I normally work I either tell them I am a CCT paramedic, or work at the airport. I'm not trying to impart any braggadocio upon the doe-eyed EMT's, that's just lame, IMO.


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## DrParasite (Mar 11, 2017)

Speaking from the BLS side here.....

It's like night and day, at least when I made the transition.  On a tiered system (ALS and BLS on separate vehicles), you are expected to know your job as an EMT, be able to perform an assessment, and are trusted to make the decision which patients needs ALS and which you can handle on your own. If you can help the paramedics with their job, that's an added bonus.  You need to be able to (and are expected to) make a decision, interact with other agencies, and also need to know when you need to call for assistance.  I was respected by coworkers for my clinical knowledge (IE, if I requested ALS to assess the patient, there was a good chance there was a reason), and if I had a sick patient who I needed to scoop and run to the hospital, I gave my report to the nurse (and on these, often the attending MD), and they actually listened.

When I went from a tiered system to an all ALS ambulance system, I became a paramedic helper.  I was no longer an EMT, my job was to make the paramedic's job easier, and drive them where they wanted to go.  They were the boss, they made all the decisions, and they wanted things done their way.  And if I worked with a different paramedic, I needed to learn what they wanted done, and how they wanted it done.  And heaven forbid you challenge the all mighty paramedic and tell them they are doing something wrong, or there is a better way to do something....  And if you were not a paramedic, you couldn't do anything except be on the ambulance (and the bike team).... no special ops, no promotions, no hazmat tech, no tac team, no supervisory roles, no FTO.... I think they let you become a EMS logistical/warehouse worker but that was about it.  The paramedics walked on water, and if you weren't a paramedic, well, you were beneath them.  

I might have just had a bad experience, but I did the exact same move you did, with the intent to go to paramedic school and make it a long term career... As it stands today, I work FT in the private sector making more money than I ever made in EMS,  work part time for a county fire department, still maintain my EMS credential, and now also teach once a week both newbie EMT students and EMS Con Ed through the local community college (making more money than I made on the ambulance).

My advice is if you want to make this your career, enroll in paramedic school.... today..... See if the new job will work with your schedule or pay for the program.... some will, especially if you are already a FT employee with them.  Keep your head down, do everything that they ask you to do, without question.  If you know a better way, that's great; keep it to yourself until you get your paramedic card.  Some medics WILL NOT impress you..... some will even scare you...... If you are moving from a big city EMS system to a not so big system, you WILL notice a difference in the experience levels, especially if you have zero to hero medics....  in any case, keep your head down, enroll in and finish paramedic school, and do everything the paramedic says, without question....  remember, the person with the P card is always in charge.


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## Bandaidbox (Mar 11, 2017)

From what I can tell, I will do just fine. Even though I do work for a tiered system now, we are expected to know what's what on an ALS call and why. I've been around for 8 years work for major systems where I am. I have worked with CCRNs and CCPs before on SCTUs before. I would imagine it's about that same when it comes to PT care (we also ran als for the area). I do have take no BS attitude just because of where I have worked and growing in the same area, im just hoping that there is no personality clashes. I don't get intimidated very easily just based on level of knowledge and functionality. I definitely don't drive like a moron, if anything twenty five stay alive; I'm definitely past the Wacker light and sirens part of my young days. I like to learn more, but I just want to get paid and go home. Thank you for your insight guys.


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## StCEMT (Mar 11, 2017)

@DrParasite, there are definitely medics like that, but not all. I realize my limitations being a new medic. If my partner has concerns or ideas, I definitely want to know. I still rely on having good partners I can lean on for help. That's not to say I haven't had partners I was less likely to listen to. Had one recently that I was honestly happy to not have any legitimately sick/injured people that entire day. My two regular partners though I absolutely would listen to if they wanted to bring something up.


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## DesertMedic66 (Mar 11, 2017)

I don't expect a whole lot from my EMTs. Get me safely to the scene, get me safely to the hospital, know their protocols, know their skills, know what their skills do not include, know how to get accurate vitals, know how to correctly lift/move patients and assist me in the process, and know what every piece of equipment is called (don't care if they don't know it's used for) and where it is at so that if I ask for they can go get it. 

If my partner wants to go medic and has a ton of questions for me I am more than happy to answer and assist them. If my EMT has no desire to ask questions then that is fine with me. I don't care or expect them to know the "medic protocols". Our protocols give medics a lot of room to treat patients however they want and I do enjoy that. I am pretty sure I am one of the medics who uses the backboard the least.


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## VentMonkey (Mar 11, 2017)

Bandaidbox said:


> From what I can tell, I will do just fine. Even though I do work for a tiered system now, we are expected to know what's what on an ALS call and why. I've been around for 8 years work for major systems where I am. I have worked with CCRNs and CCPs before on SCTUs before. I would imagine it's about that same when it comes to PT care (we also ran als for the area). I do have take no BS attitude just because of where I have worked and growing in the same area, im just hoping that there is no personality clashes. I don't get intimidated very easily just based on level of knowledge and functionality. I definitely don't drive like a moron, if anything twenty five stay alive; I'm definitely past the Wacker light and sirens part of my young days. I like to learn more, but I just want to get paid and go home. Thank you for your insight guys.


It's sounds like you'll do fine. Honestly speaking I shouldn't say I don't "teach" anything to EMT's anymore; any teaching I do now is more often indirect than direct. I just don't care to try and impress them like I have seen a lot of toolbag paramedics, and "paragods" do. I swore to myself I would never be _that_ paramedic.

Now, I have been a lot of things I am sure to a lot of people, but too good to practice proper BLS care when applicable? Hardly. 

The whole "don't take crap" attitude days are behind me. There's no need for me to prove anything to anyone any longer. I literally show up, check out my gear, do my job, and go home.

@DrParasite sorry you had some crappy experiences; I had a lot of them, too. It made me a better paramedic in the long run; I took what I learned not to do from those kind of paramedics, and didn't do it. I don't think just "keeping your head down" is ever an answer to learn how to become a member of a team or unit, which is essentially what a solid partnership should be, though I shudder to think of the service that fosters this type of behavior.

I have a handful of veteran EMT's I love working with, and if it was permitted would let them tech my BLS calls without a worry in the sky; my last EMT partner would be one of them, with that, many EMT's here want the "work ALS" to see cool stuff, and not do paperwork, or patient care (insert sigh here). 

The best part of my job is being able to put food on the table for my family, see that they never go without, and go home to them at the end of the day. My job won't define me as a person, it won't be on my headstone, it's merely a way of supporting my family; that matters more, and the fact that I like my job for the most part is pretty neat, too.

Most wouldn't know that though, I don't tend to blatantly open up to random EMT partners on a whim, but I do find it remarkable how quickly you can learn so much (often too much) about a persons self-absorbed personal life in a matter of 8-12 hours.


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## NysEms2117 (Mar 11, 2017)

Im an EMT-B on a Critical care rig. My medic partner expects that i can do anything in my job description + respect. If i don't know, I ask. Providing I don't ask the same question 25 times, that would aggravate him. Today at work(still waiting in the hospital as im typing this TBH) was a perfect example, we had one of the worst MVA's I have ever seen. Without him needing to tell me, I started setting up all of his gear where he needed it, placing 12 lead cables ect. I told him where I felt he needed to be and when he disagreed I kept working, didn't start going against his word ect. 
@VentMonkey said it best, 


VentMonkey said:


> The whole "don't take crap" attitude days are behind me. There's no need for me to prove anything to anyone any longer. I literally show up, check out my gear, do my job, and go home.


There's no need to prove your a paragod or a CCEMT-B, do what needs to be done, go home. You do your job to the best of your abilities, some days will you save somebodies life, im sure you will. However, the days where you talk to your patients and treat your partners with care and respect matter just as much . Plus you can meet some pretty cool folks in EMS and become friends outside of work as well


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## hometownmedic5 (Mar 11, 2017)

I expect my BLS partner(when applicable) to 

Get me to the call and from the call without crashing the truck.
Perform all BLS level procedures as appropriate for the call, including EKG acquisition, IV set up etc.
Communicate with me effectively.
Know the layout/stocking configuration of the truck.
Restock/reassemble the ambulance after a call.
Ask before they try to hack something together they only vaguely understand. 

Those are the basics. I love working with medic students because they(usually) legitimately want to learn. I hate working with basics who take shifts on the medic truck just so they don't have to do dialysis calls because mostly they could care less about the medicine. Basics that want to learn are treated as equally as possible given the circumstances. Basics who don't want to learn stand in the corner and carry my bags.

Understand going into a p/b system that working pb is great for the basic, but garbage for the medic. We do most of the work and assume all of the liability, all for little if any additional money. That can wear on a guy; so understand that even if you're a rockstar basic, you're going to have days where your medic is not having a good day and while its not your fault, you may well end up the lightning rod for that aggression. Imagine if it was legal in your state for a first responder to work with one emt on an ambulance, but naturally the emt has to tech every call. Same church, different pew.


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## VentMonkey (Mar 11, 2017)

hometownmedic5 said:


> Understand going into a p/b system that working pb is great for the basic, but garbage for the medic. We do most of the work and assume all of the liability, all for little if any additional money. That can wear on a guy; so understand that even if you're a rockstar basic, you're going to have days where your medic is not having a good day and while its not your fault, you may well end up the lightning rod for that aggression. Imagine if it was legal in your state for a first responder to work with one emt on an ambulance, but naturally the emt has to tech every call. Same church, different pew.


This is a pretty fair statement, and I had meant to touch on it earlier when someone mentioned for their partner "not to get them in trouble".

Honestly? For me, I take all responsibility, and always have told my partners this. If a supe or administrator needs to speak with us I have no problem eating it (short of a blatantly incompetent partner). I can honestly say I sincerely do not worry that my partner will get me in trouble, and seldom am I worried I will be sent to our supes office. If anything I pride myself on keeping my techs _out_ of trouble.

When I got my license it's pretty much what I was buying into, good day, bad day, indifferent day, it doesn't matter. My role is to see that the *unit* is ran efficiently; my partners role is to assist with such duties accordingly, and preferably harmoniously.

IMO, it doesn't matter how much, or how little, more I make. That part of the job should be a given for every paramedic, and the EMT shouldn't be made to feel less because of it, or chastised for the responsibilities one has decided to thrust upon themselves by obtaining their p card. 

Inherent risks, we're all subject to them differently, and accountability speaks volumes for someone's integrity. I'd much rather have that sort of person on a unit with me than the "easy-to-impress", or "call-driven" individual.

EDIT: this isn't digging at you, @hometownmedic5.


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## hometownmedic5 (Mar 11, 2017)

I was thinking in terms of maybe a dicey transport where there might be a borderline call to be made. With another medic as a partner, you at least have that option. With a basic, it's all me. I don't have the resource available to me. 

Further, on a p/p truck, you do a call, I do a call. Rinse, repeat. On a pb truck, I do a call, then I do a call, then I do a call, then I do a call...(do here having the meaning of tech/write. I get they are there with stuff to do too). To not the basics fault, but it can wear on your good nature pretty quick if you have a busy day. 

Also, while in some circumstances you hired on knowing you would be working pb, that's not always the case. When I worked a p/p als IFT truck, we got split and pb'd routinely. That can throw a hard left turn into your day.


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## VentMonkey (Mar 11, 2017)

I suppose, I think more and more I try and just roll with it. There are peaks and valleys at our service like anywhere. 

When the rest of the state dried up several years ago, we were still hiring paramedics. I worked dual paramedic for the better part of a year. It was ok, and I actually got along really well with a (then) very green paramedic now turned supervisor.

I honestly prefer/ preferred teching calls most nights; we rotated shifts, not calls. It was just my spin, everyone's got their own grooves and preferences. I will admit though, the nights I drove was some of the easiest money I've made. 

P/P is fine, P/B is fine so long as either one yields a mellow partner.


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## DesertMedic66 (Mar 11, 2017)

@CALEMT is pretty much my slave when we work together. When I want a foot rub he gets right to it. When I need to be shuttled around to a bathroom because of my racehorse like bladder he is on top of it.


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## CALEMT (Mar 11, 2017)

DesertMedic66 said:


> @CALEMT is pretty much my slave when we work together. When I want a foot rub he gets right to it. When I need to be shuttled around to a bathroom because of my racehorse like bladder he is on top of it.



Might be cheap but I ain't free.


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## hometownmedic5 (Mar 12, 2017)

VentMonkey said:


> I suppose, I think more and more I try and just roll with it. There are peaks and valleys at our service like anywhere.
> 
> When the rest of the state dried up several years ago, we were still hiring paramedics. I worked dual paramedic for the better part of a year. It was ok, and I actually got along really well with a (then) very green paramedic now turned supervisor.
> 
> ...



I also prefer teching. In fact, if i never drove an ambulance again until i die, i would be ok with that. That works fro me, right up until I'm on my fifth straight call, three reports behind, my doc is screaming at me for my report from two patients ago, i have a headache and my blood sugar is 60. Then, i would really like to have another paramedic on the box with me.

My partner and i also rotate in an unconventional manner. We each take half(12hr) of each shift as driver, then we switch. While one of us may get our teeth kicked in one day, in the end it evens out. I hate switching call for call. Every call you have to adjust the mirrors, move beverages, sunglasses, which radio am i responsible for, whose grabbing what and so on. 

Either way, I never work with a basic on my town truck. The chief would pop an aneurysm if he saw a basic hop out of a town ambulance; but I work OT on transfer/back up trucks and I'm usually p/b. It really does depend on the partnership to make it work.


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## NomadicMedic (Mar 12, 2017)

I work with a basic every shift. It's a great system. He and I get along great, he knows what I need/want on calls, is a safe driver and can help me with the stuff that I need. And, like me, needs coffee and food frequently. He's also about my age, which is a huge help. Nothing against a 20 year old, but it's nice to work with someone you have more in common with. 

Eventually I'll lose him to medic school and then I'll have to reevaluate if I want to go through the hassle of training a new partner. 

We run dual medics in cases where we have a green medic that needs some mentoring or we don't have a enough Bs or As to go around.


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## VentMonkey (Mar 12, 2017)

NomadicMedic said:


> I work with a basic every shift. It's a great system. He and I get along great, he knows what I need/want on calls. Eventually I'll lose him to medic school and then I'll have to reevaluate if I want to go through the hassle of training a new partner.


I had one of those, he also went on to become a good paramedic. They're almost like having kids: you hate seeing them grow up in front of your eyes so fast, but you're still proud of them.


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## DrParasite (Mar 12, 2017)

hometownmedic5 said:


> I was thinking in terms of maybe a dicey transport where there might be a borderline call to be made. With another medic as a partner, you at least have that option. With a basic, it's all me. I don't have the resource available to me.


Oddly enough, I worked with a medic who said that if we went from a P/B system to a P/P system (which was our director's intent) he was going to look to work for a new agency.  His line of thinking (and I don't agree with it) was on the ambulance, someone needs to be in charge, and with two paramedics, that doesn't always happen, because they are both equal.  if there is a disagreement about the treatment path, what do you do?  If its only one medic, than it's his call, and it's very clear who has the overall responsibility for the patient.  And that paramedic should be able to handle almost any all on his or her own, without needing to call another medic (but of course, could call the doc if he or she needed guidance).


hometownmedic5 said:


> Further, on a p/p truck, you do a call, I do a call. Rinse, repeat. On a pb truck, I do a call, then I do a call, then I do a call, then I do a call...(do here having the meaning of tech/write. I get they are there with stuff to do too). To not the basics fault, but it can wear on your good nature pretty quick if you have a busy day.


No offense, but I would hate that system.  your EMT doesn't even do the BLS calls?  if the patient doesn't need any ALS, just a ride to the hospital, it's still your chart?  Your type of system gives you a driver, not an EMT...  your EMTs probably make minimum wage too, and based on your description of what they have to do, it sounds like an appropriate wage. 

Throughout my career, if I'm on a truck with a similarly credentialed person, we typically alternate calls, or occasionally switch halfway through the shift.  If I'm on a PB truck, typically the EMT drives, but who writes the chart is dictated by if the patient is a BLS patient or ALS.


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## VentMonkey (Mar 12, 2017)

DrParasite said:


> No offense, but I would hate that system.*  your EMT doesn't even do the BLS calls?*  if the patient doesn't need any ALS, just a ride to the hospital, it's still your chart?  Your type of system gives you a driver, not an EMT...  your EMTs probably make minimum wage too, and based on your description of what they have to do, it sounds like an appropriate wage.


Idk about hometown's system, but in mine on an ALS rig, no they don't. There are times when it certainly would be nice for them to be allowed to. Now, if they work on a BLS rig then they're doing low-level 911 calls, sometimes (depending on system levels) higher acuity calls as well, if there's no ALS units available or closer; they also do all their own charting, assessments, and radio call-ins.

I have told many new EMT's (still do) how valuable it is to work BLS for preferably 6 months to a year. When I work with an EMT who is a seasoned BLS EMT, meaning they normally work BLS shifts, their skills often surpass most of the straight-to-an-ALS-shift EMT's because as you said, the ALS only EMT is essentially being paid to taxi the paramedics around; they have the option of doing BLS shifts, but far too many don't want to, and have a severely misguided notion that ALS is that much more exciting when in reality it almost parallels BLS low-level, low-acuity calls. I don't know how much learning they think they're doing on an ALS unit vs. what they actually are.

Again though, as a part-time field paramedic I just find it so much easier to treat it as such, play it by ear, and guide where I need them. Now, if they're asking insightful questions, then sure they get insightful answers, but more often than not the ALS EMT's are more than comfortable in their little routine. I will say now currently as it stands, and in their defense, we have so many EMT's that a lot do sit around, so I kind of understand how they get bored milling around at our main with little to do at times.


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## NomadicMedic (Mar 12, 2017)

DrParasite said:


> Oddly enough, I worked with a medic who said that if we went from a P/B system to a P/P system (which was our director's intent) he was going to look to work for a new agency.  His line of thinking (and I don't agree with it) was on the ambulance, someone needs to be in charge, and with two paramedics, that doesn't always happen, because they are both equal.  if there is a disagreement about the treatment path, what do you do?  If its only one medic, than it's his call, and it's very clear who has the overall responsibility for the patient.  And that paramedic should be able to handle almost any all on his or her own, without needing to call another medic (but of course, could call the doc if he or she needed guidance).



That doesn't happen. I came from a system with two medics on a squad. There was never a major disagreement about treatment or an argument over what to do. The medic that is leading the call writes the chart and will have to face the QI music if somthing untoward was done. 

Of course, two medics make it a LOT easier when you're unsure of a 12 lead, stuck for what to do next or need an extra pair of hands. I agree that just about everything, with the exception of RSI, can be done by one competent medic with an EMT partner.


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## StCEMT (Mar 12, 2017)

I like the days I get to run double medic. Usually don't need it for the reasons Vent Monkey already stated, but it is nice to be able to bounce ideas off another medic. That being said, I haven't ever felt overwhelmed having a basic partner. There is plenty that they can do that a medic would be while assessing.


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## DrParasite (Mar 12, 2017)

Oddly enough, coming from a system where it was always double medic or double EMT, I thought that was a little odd myself.  But it was the opinion of a senior paramedic / FTO at a former agency I used to work with (one that I think is in the minority among most providers).  

Please don't judge the messenger based on the message of another.


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## VentMonkey (Mar 12, 2017)

DrParasite said:


> Please don't judge the messenger based on the message of another.


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## hometownmedic5 (Mar 12, 2017)

DrParasite said:


> Oddly enough, I worked with a medic who said that if we went from a P/B system to a P/P system (which was our director's intent) he was going to look to work for a new agency.  His line of thinking (and I don't agree with it) was on the ambulance, someone needs to be in charge, and with two paramedics, that doesn't always happen, because they are both equal.  if there is a disagreement about the treatment path, what do you do?  If its only one medic, than it's his call, and it's very clear who has the overall responsibility for the patient.  And that paramedic should be able to handle almost any all on his or her own, without needing to call another medic (but of course, could call the doc if he or she needed guidance).
> No offense, but I would hate that system.  your EMT doesn't even do the BLS calls?  if the patient doesn't need any ALS, just a ride to the hospital, it's still your chart?  Your type of system gives you a driver, not an EMT...  your EMTs probably make minimum wage too, and based on your description of what they have to do, it sounds like an appropriate wage.
> 
> Throughout my career, if I'm on a truck with a similarly credentialed person, we typically alternate calls, or occasionally switch halfway through the shift.  If I'm on a PB truck, typically the EMT drives, but who writes the chart is dictated by if the patient is a BLS patient or ALS.



My town trucks are always without fail P/P; but my company also runs transfer trucks p/b. On those trucks, if the call is BLS, the basic techs it; however its not common for the pb transfer truck to be sent on a bls call. Those trucks exist to take als patients between facilities. And they work their butts off with call after call after call. While a bls call might sneak its way in there, its mostly als. Naturally, that means stacking calls on the medic while the basic makes the rack, drives, and puts the monitor back together.

There are places that require the highest card on the truck to attend. While I don't work there, if you're working a busy als IFT truck, that's pretty much your life.


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## hometownmedic5 (Mar 12, 2017)

In regards to treatment disagreements, it happens. There are all kinds of medics. Lazy, do nothing medics; high speed cowboys who do too much just because they can, and many shades of grey in between. Wel talk about this all the time here. Would you treat this complaint with these vitals and so on. Invariably, theres some disparity. Putting aside regional protocol differences, there is always opinions that will differ. Does this patient get pain meds? Are we slow belling this call with every line item in the protocol book or are we saddling up and going straight to line 13 because that's what will ultimatley keep the patient out of a pine box?

Some times, i like working pb for exactly the stated reason. I am the boss and you don't get a vote. Sometimes, when I'm hip deep in brown smelly stuff and I'm unsure of my next move. I like having another patched medic nearby to nudge us in a direction without having to debase myself before med control.

Back to the original point, all I'm saying is that if your a basic in a pb system where the medic routinely gets their teeth kicked in, don't be surprised or take it personally when someday the medic has a little meltdown.


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## Handsome Robb (Mar 12, 2017)

NomadicMedic said:


> That doesn't happen. I came from a system with two medics on a squad. There was never a major disagreement about treatment or an argument over what to do. The medic that is leading the call writes the chart and will have to face the QI music if somthing untoward was done.



Not here. If your partner does something dumb while you're both in the back before transporting or in the house you'll have to face the music as well for not stepping in. 


Sent from my iPhone using Tapatalk


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## NomadicMedic (Mar 12, 2017)

Handsome Robb said:


> Not here. If your partner does something dumb while you're both in the back before transporting or in the house you'll have to face the music as well for not stepping in.
> 
> 
> Sent from my iPhone using Tapatalk



Okay, fair enough. I think that's fair. However, 4 years at Sussex and that never happened to me, not did I ever hear about it. I think if you have a cadre of high speed, well educated, disciplined medics... it's less of an issue.

I could easily see that happening where I am now though.


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## hometownmedic5 (Mar 12, 2017)

Handsome Robb said:


> Not here. If your partner does something dumb while you're both in the back before transporting or in the house you'll have to face the music as well for not stepping in.
> 
> 
> Sent from my iPhone using Tapatalk




Same here. You might not be in as much trouble as the medic who did whatever wrong, but you're responsible for a piece of it because your name is on the chart right next to theirs. The only time your partner is completely absolved of responsibility on a call is when you're working pb. Obviously it would be unreasonable to expect the basic to be qualified to talk the medic out of doing something wrong.


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## NomadicMedic (Mar 12, 2017)

I guess I should mention, where I came from it was 2 medics on a squad but 9 out of 10 times only one did the patient care and transported. If you screwed up, it was on you. 

Most of the priority calls would have 2 medics working and the atmosphere was very collegial. Certainly never adversarial. "Hey, what do you think about some calcium?" "Sounds prudent." Or something like that. 

I really wish you guys could see how Sussex worked. It makes this whole discussion seem like EMS in a foreign country.


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## hometownmedic5 (Mar 12, 2017)

As I've mentioned in other threads, the biggest problem I deal with is lazy hacks. Medics who dont do their job out of ignorance or apathy. That's where the quarrels come from.


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## VentMonkey (Mar 12, 2017)

hometownmedic5 said:


> As I've mentioned in other threads, the biggest problem I deal with is lazy hacks. Medics who dont do their job out of ignorance or apathy. That's where the quarrels come from.


Perhaps start a thread?


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## NomadicMedic (Mar 12, 2017)

hometownmedic5 said:


> As I've mentioned in other threads, the biggest problem I deal with is lazy hacks. Medics who dont do their job out of ignorance or apathy. That's where the quarrels come from.



Those guys are in abundance here. When I work with one, I always tech every call.


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