No equipment: EMT vs Paramedic

[patzyboi]

How about the the patient care and assessment will be comparing an EMT and a paramedic when no equipment is involved?

 

[Shishkabob]

There is no reason that an EMT cannot be as knowledgeable when it comes to basic physical assessments as a Paramedic (or doctor, for that matter)... but alas, that tends to not be the case.


Just because you weren't taught it in school doesn't mean you can't learn it and apply it.

 

[Veneficus]

There is no reason that an EMT cannot be as knowledgeable when it comes to basic physical assessments as a Paramedic (or doctor, for that matter)... but alas, that tends to not be the case.


Just because you weren't taught it in school doesn't mean you can't learn it and apply it.

While this is certainly true, I will point out that what really exponentiates a physicians physical exam and history is the knowledge of basic clinical sciences. You cannot apply the physical exam as a "skill" as taught in EMS and come anywhere near the level of exam a physician is capable of.

As well, the more the physician knows about basic clinical sciences, the more capable they are. (not all doctors are equal)

As Linuss said, there is nothing that stops you from learning it. But it is both cost and time intensive.

 

[VFlutter]

There is no reason that an EMT cannot be as knowledgeable when it comes to basic physical assessments as a Paramedic (or doctor, for that matter)... but alas, that tends to not be the case.


Just because you weren't taught it in school doesn't mean you can't learn it and apply it.

I agree but I would still be cautious applying self taught knowledge in the field. Just because you read about advanced assessment techniques does not mean you can competently perform and intepret them in the field. You may get yourself into some trouble. Self teaching is great but sometimes it leads you to believe that you know more than you actually do.

 

[Veneficus]

I agree but I would still be cautious applying self taught knowledge in the field. Just because you read about advanced assessment techniques does not mean you can competently perform and intepret them in the field. You may get yourself into some trouble. Self teaching is great but sometimes it leads you to believe that you know more than you actually do.

Even if you do know it some things are limited by scope.

A field pelvic or digital vaginal/bimanual/rectal exams will certainly not go over well.

 

[leoemt]

There is no reason that an EMT cannot be as knowledgeable when it comes to basic physical assessments as a Paramedic (or doctor, for that matter)... but alas, that tends to not be the case.


Just because you weren't taught it in school doesn't mean you can't learn it and apply it.

Agree. Medics routinely hand me 12 lead strips. I go out of my way to learn as much as I can. I may not be able to do it but makes me able to give a better report to the hospital as well as understand patient condition.

 

[Handsome Robb]

Agree. Medics routinely hand me 12 lead strips. I go out of my way to learn as much as I can. I may not be able to do it but makes me able to give a better report to the hospital as well as understand patient condition.

Wait...time out. Medics are suspicious enough to put someone on the monitor and do a 12-lead? Then they dump it on a BLS crew? Where's the guy who was bragging about how KCM1 is "all that" and they don't dump patients on BLS crews? :huh:

Generally, a paramedic is still probably going to do a more thorough assessment even without equipment than an EMT is. Notice I said generally. There are plenty of EMTs capable of doing a great physical exam and plenty of medics who aren't.

 

[Veneficus]

Wait...time out. Medics are suspicious enough to put someone on the monitor and do a 12-lead? Then they dump it on a BLS crew? Where's the guy who was bragging about how KCM1 is "all that" and they don't dump patients on BLS crews? :huh:

This happens everywhere.

I have mixed opinions on it.

 

[Merck]

This is mainstream here. We have a targeted ALS system with a limited number of ALS resources (roughly 10 for ~1.3 million). BLS cars attend calls with ALS when indicated. The patient will be assessed by the ALS crew and if appropriate (unlikely to require ALS intervention) the patient is taken by the BLS crew and the ALS crew is available for the next call.

 

[Veneficus]

This is mainstream here. We have a targeted ALS system with a limited number of ALS resources (roughly 10 for ~1.3 million). BLS cars attend calls with ALS when indicated. The patient will be assessed by the ALS crew and if appropriate (unlikely to require ALS intervention) the patient is taken by the BLS crew and the ALS crew is available for the next call.

But as a whole, your ALS providers are a much higher mean than the US.

 

[Merck]

I think that the fact that you are targeted and respond only to high priority calls allows one to develop a good skillset, both for assessment and treatment.

As well, getting the opportunity to assess many calls in a shift (generally around 10-15) help practitioners to develop their insight. People that come here often have difficulty with the fact that they have to make that decision - carry or not? But most enjoy the targeted system and find that it pushes them to be better paramedics.

Our BLS also have a good range of protocols and can handle numerous scenarios such as asthmatics and narcotic ODs (all of course dependent on where the particular patient sits on the continuum of 'He's fine' ---> 'Oh crap').

 

[Shishkabob]

I agree but I would still be cautious applying self taught knowledge in the field. Just because you read about advanced assessment techniques does not mean you can competently perform and intepret them in the field. You may get yourself into some trouble. Self teaching is great but sometimes it leads you to believe that you know more than you actually do.

Then I fully expect you, as a nurse, to never learn beyond nor do anything that was not taught in your RN school, as that is not what you were taught. RNs learning the majority of their knowledge actually on the job be damned...

Nope. Don't learn about 12 leads and how to run a code if you're a cath lab nurse. Don't learn more about cancer if you're a radiation nurse. Nope. Medicine is static. Never changes. Keep with what you were taught and never progress unless you become a doctor.

 

[VFlutter]

Then I fully expect you, as a nurse, to never learn beyond nor do anything that was not taught in your RN school, as that is not what you were taught.


RNs learning the majority of their knowledge actually on the job be damned...

Learning on the job in a structured medical environment is different then googling something or reading it in a book then going off and trying it in the field.

An example. I was never taught how to pull an arterial sheath in school. There is a difference between A.) Being shown/instructed how to do it, pull a few under supervision, and then doing them myself. As opposed to B.) Teaching myself from a textbook and then telling people I know how to pull sheaths.

You mentioned 12 leads. Let's say I am an EMT-B and bought a EKG book and taught myself how to read 12 leads. I then go to a SNF call and look at the 12 lead provided and decide it is normal and proceed to transport the patient BLS. I totally missed the subtle changes from the posterior MI and now the patient codes and dies. Oops.

I am not saying self teaching is worthless or that you can never apply what you learn. I am just suggesting that people be cautious until they are proven to be competent and safe.

 

[Aidey]

I think what you're learning makes a difference in how much you can apply it. Learning about why a procedure is done, or the pathophys of a particular disease, or pharmacology doesn't require a ton of hands on experience. Learning how to perform a procedure properly does.

 

[Shishkabob]

And there is also a difference between an EMT learning what petechial hemorrhaging is, looks like, and is caused by, and an EMT going "I'm going to cardiovert this guy!"



You're confusing skills for knowledge.

 

[VFlutter]

And there is also a difference between an EMT learning what petechial hemorrhaging is, looks like, and is caused by, and an EMT going "I'm going to cardiovert this guy!"



You're confusing skills for knowledge.

You are right, the first example I provided was probably not the best since it is a skill and not knowledge.

 

[mycrofft]

How about the the patient care and assessment will be comparing an EMT and a paramedic when no equipment is involved?

I am not sure what you mean, the sentence does not parse. Not to be picky, but is this like a hypothetical "Could Godzilla beat King Kong in a fight" sort of deal, or are you comparing the education at each certification, or protocols, or ???

(That's gotta hurt!)


There is an overarching point to remember: these are technical positions (hence "technician" in their titles as promulgated by their parent agency, NHTSA) within today's PEMS environment, not professional ones. That means protocols and oversight are necessary, and will guide (regarding minimums and maximums) the training and activities for these positions' part of the EMS "system".

You can read about skills but if you don't use them, under preceptorship, you may learn them wrong, or at only half their potential, then not keep them honed or miss updates through professional channels. It is good to know about them, however, if only to facilitate helping someone with a higher degree. This is ignoring the logistical issues like buying, supplying and maintaining the tools to do some stuff like bronchoscopy, central circulatory monitoring and sampling, etc. Xrays, for that matter.

There are skills which, given time frames and epidemiology for your area, are not logical or are felt to unnecessarily delay definitive care.

Short answer after all that: the paramedic ought to have a better knowledge of assessment and diagnosis, but all emergency medical tech certifications have vital diagnostic/assessment skills which sometimes a basic will wield better than a paramedic.

 

[mycrofft]

1.) And there is also a difference between an EMT learning what petechial hemorrhaging is, looks like, and is caused by, and an EMT going "I'm going to cardiovert this guy!"



2. You're confusing skills for knowledge.

1. Right on. EMT documents it and moves on with vital data pulled out of the context and injected into the medical record/data stream, helping to speed and focus care at the hospital.

2. Skill stems from knowledge plus practice and feedback/preceptorship.

 

[leoemt]

Wait...time out. Medics are suspicious enough to put someone on the monitor and do a 12-lead? Then they dump it on a BLS crew? Where's the guy who was bragging about how KCM1 is "all that" and they don't dump patients on BLS crews? :huh:

Generally, a paramedic is still probably going to do a more thorough assessment even without equipment than an EMT is. Notice I said generally. There are plenty of EMTs capable of doing a great physical exam and plenty of medics who aren't.

I transport patients all the time that in any other system would be ALS. If a 12 lead shows somewhat normal rhythm and the MD okays it they are going in my rig. In my example the patient had inverted T-waves but nothing else out of the ordinary. MD ok'd the BLS transport.

 

[STXmedic]

I transport patients all the time that in any other system would be ALS. If a 12 lead shows somewhat normal rhythm and the MD okays it they are going in my rig. In my example the patient had inverted T-waves but nothing else out of the ordinary. MD ok'd the BLS transport.

An inverted T wave doesn't scream OMG ALS! to me... I wonder how many of these runs that "should absolutely be ALS and would be in any other system anywhere in the country but not here" are truly ALS runs and not just blown out of proportion...