paramedics and basics working together or separate?

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i work in two systems, NYC and Central new york. down in the city basics and medics are on separate trucks... when i work in cny, we work on the same truck, one paramedic and one basic.... i prefer having dual trucks, you don't have to wait for als and its good for the basic to learn ALS assist skills, i feel it makes a stronger basic... what do you guys prefer? dual or separate?
 
Some days I work with a medic, other days I'm with bls.
Other days I'm with myself and a driver.

I don't mind either. I have a medic within minutes if need be
 
I like working with an intermediate. No offense to basics but I like being able to go one for one during shift. I rarely work with another medic but that's nice when it happens too


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I don't care much one way or another, but I really think that it's not the level of care of the partner, but the quality of the partner. If they're a good time, good at their work, and safe in their practice, I'll prefer them 10 to 1 over That Other Kind.

I typically work with BLS partners, and the difference between a fun basic partner who knows what they're doing and a PITA basic partner who needs coaching at every step is just not comparable.
 
I used to work in Queens, I've worked in Charleston SC, and now in Virginia.

I overwhelmingly prefer NYC's double medic tiered system. The latter two systems are mostly medic/basic, with my current employer also featuring some double medic units for rookie training.

The EMT/medic thing is good if you're experienced, but an all-ALS system is no good for a new medic to gain experience. You're running too many BLS and VOMIT calls (vitals, O2, monitor, IV, Txp), and not using your protocols much. In an EMT/medic all-ALS system, the EMT more often than not gets told what to do by the medic, and doesn't get much of a chance to exercise any critical thinking.

I might run two or three truly sick patients a month in an all-ALS system, where I could see more than that every day in NYC. I would love to take a per diem medic job back up there, and travel there once a month to work a few tours back to back, just to see sick patients again.
 
TransportJockey said:
I like working with an intermediate. No offense to basics but I like being able to go one for one during shift. I rarely work with another medic but that's nice when it happens too


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Yeah, riding the seat every call, and being responsible for all the reports get really old after a while. Working with a basic, in a system where they will do the BLS calls, it's difficult to work out a 50/50 split due to ALS and BLS call types.
 
abckidsmom said:
I don't care much one way or another, but I really think that it's not the level of care of the partner, but the quality of the partner. If they're a good time, good at their work, and safe in their practice, I'll prefer them 10 to 1 over That Other Kind.

I typically work with BLS partners, and the difference between a fun basic partner who knows what they're doing and a PITA basic partner who needs coaching at every step is just not comparable.
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Then you have the BLS who only want to do fire, and have no use for EMS txp
 
46Young said:
I might run two or three truly sick patients a month in an all-ALS system, where I could see more than that every day in NYC. I would love to take a per diem medic job back up there, and travel there once a month to work a few tours back to back, just to see sick patients again.
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Heavily saturated urban system vs stretched thin rural system: I see 3-5 truly sick patients a week. And then I get to spend an hour with them on the way to the hospital. Fun.
 
abckidsmom said:
Heavily saturated urban system vs stretched thin rural system: I see 3-5 truly sick patients a week. And then I get to spend an hour with them on the way to the hospital. Fun.
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Sounds like my tours. I work a 48/96 rotation and in my 48 can see multiple truly sick patients.


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I have worked in CNY and NJ....

In my experience (as well as what I have read here), EMTs in EMT/Paramedic crews tend to be more incompetent, because they don't know how to do an assessment or what do to with a sick patient without a paramedic there holding their hand and telling them what to do. Yes, I am generalizing, so you might be the exception.

They also tend to be more proficient in ALS assist skills (starting an IV bag or lock, assisting with intubation setup, applying the monitor stickies, etc), because they do it more frequently.

I prefer the tiered system myself; BLS deals with BLS (and assist with ALS) patients, ALS deals with ALS patients and don't get stuck dealing with the BS patients. BLS (in theory anyway) gets really good at determining sick vs not sick, and knowing when ALS is needed and when they aren't. And ALS only deals with sick patients, and doesn't spend most of their shift dealing with ambulatory taxi rides and patients who would not benefit from ALS care, since they can't help them.

I do think paramedics and basics should work together, just not on the same ambulance.
 
abckidsmom said:
Heavily saturated urban system vs stretched thin rural system: I see 3-5 truly sick patients a week. And then I get to spend an hour with them on the way to the hospital. Fun.
Click to expand...

An hour can either be very challenging, or very monotonous. You see more sick people than I do on a regular basis, that's for sure. I think 30% of our patients just need a hug (anxiety, or generally soft people), and 60% are just taxi rides for the most part.

The thing about NYC is that many of our ALS patients would wait to call before they were well behind the eight ball, where it was reasonable to work them in their residence before moving them to the bus. There was the possibility of having them decompensate during the trip to the bus. It was typical to have a three floor (or more) walk-up, or be deep into a high rise, where you need to wait for elevartors, or navigate to different parts of the building through an underground labyrinth, so we would typically do all our interventions, then move the pt, and leave for the hospital as soon as we got the pt loaded in. We would be crucified if we just did some vitals, and moved the patient out to the bus to do ALS, and had the pt crap out somewhere in between.

This is how we got good ALS experience, even with short transport times - we often needed to do everything in the apartment, then leave the scene as soon as we loaded the pt up, as compared to NOVA, where we typically get a quick set of vitals, take the pt to the bus, and do ALS there if we're not too close to the hospital.

Medics in NYC typically don't run injuries, MVA's, fall jobs, sick jobs, postictals, conscious drunks, EDP's, the flu, or abd. pain. That's like 95% of my call volume down here. That's where the problem lies in getting good ALs experience. IMO, most of the better medics in our department previously worked as medics elsewhere, and then got a job here. Our incumbent ALS upgrade people are very weak medics, more often than not. These are typically intelligent people, so I think that it's due to not seeing many sick people, and not the training/internship per se.
 
DrParasite said:
I have worked in CNY and NJ....

In my experience (as well as what I have read here), EMTs in EMT/Paramedic crews tend to be more incompetent, because they don't know how to do an assessment or what do to with a sick patient without a paramedic there holding their hand and telling them what to do. Yes, I am generalizing, so you might be the exception.

They also tend to be more proficient in ALS assist skills (starting an IV bag or lock, assisting with intubation setup, applying the monitor stickies, etc), because they do it more frequently.

I prefer the tiered system myself; BLS deals with BLS (and assist with ALS) patients, ALS deals with ALS patients and don't get stuck dealing with the BS patients. BLS (in theory anyway) gets really good at determining sick vs not sick, and knowing when ALS is needed and when they aren't. And ALS only deals with sick patients, and doesn't spend most of their shift dealing with ambulatory taxi rides and patients who would not benefit from ALS care, since they can't help them.

I do think paramedics and basics should work together, just not on the same ambulance.
Click to expand...

Spot on, IMO. The basics will get their experience in dealing with sick patients that were initially dispatched as BLS, which will make them call for ALS, manage that patient until ALS gets there (or they depart for the hospital), and then they can help the medics with a serious/critical patient. Setting up IV's, 12 leads, spiking bags, etc, do nothing to develop critical thinking. I can take almost anyone off the street, and train them to do all that stuff without a problem.
 
46Young said:
Spot on, IMO. The basics will get their experience in dealing with sick patients that were initially dispatched as BLS, which will make them call for ALS, manage that patient until ALS gets there (or they depart for the hospital), and then they can help the medics with a serious/critical patient. Setting up IV's, 12 leads, spiking bags, etc, do nothing to develop critical thinking. I can take almost anyone off the street, and train them to do all that stuff without a problem.
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I think part of it is the paramedic's unwillingness to "let go" of some of the responsibility and have the EMT handle it. We routinely are P/B with a 3rd person who is probably brand-spanking new. Rather than an increased workload for me, it ends up being an opportunity to exercise each of your resources adequately. You can delegate it on the fly via micromanagement, but I've not found that to be as useful unless they're crazy new.

That being said, our B's and I's get the chance to run without paramedics and experience life without the fancy dancy ALS help too. I think both are formative.
 
I personally would rather work with a basic. Don't like working with paragod's.
 
I work BLS IFT's but however I do ride out at my local fire station with paramedics and they let me do a multitude of things (within my scope of course) but they also show me some advanced stuff like how to read a strip, explain how they start IV's, ect. I like having a EMT partner and doing pt assessments but I prefer working with medics.
 
How about the best of both worlds? Dual medic for the beginning of the call or if things are particularly hairy, but then transporting as a single medic with one EMT 99% of the time.
 
We work dual unless we have enough for double medic (read never).

I like it but essentially as basics we are limited to vitals, spo2, and setting up IV stuff. Cant apply the monitor. Cant check a BGL. We progress more and more to being drivers.

Even though the state allows it we no longer are allowed to transport a patient with a pump, including a personal Insulin pump with a BLS complaint.
 
We try to put a medic and am EMT on each truck, personnel allowing. If each truck is staffed with both, then we can just rotate calls. And depending on what the call is, the EMT or medic can be AIC. We do have some volunteers that are driver only, and they run only with basics or with addict who is precepting since medics can only practice ALS skills if there is a basic or higher on the truck. I like our system, and all of the medics I choose to work with are great about teaching me and we talk through calls after.
 
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