If there were no EMT-B certification .....

[Guardian]

The progressive leaders are those who are trying to replace Basics with Paramedics. Seriously. How can you not see that doing so is the only way to provide the highest level of care to members of the community most efficiently? There is nothing a Basic can do that a Paramedic can not, and as such, having Basics on scene is not in fact necessary. No, there should be no starting point at EMT-B, and no one should be allowed to stop at that level. It should be all or nothing. Instead of one year for Basic, one year for Paramedic (or however individual systems work), it should be two years for Paramedic.

We're probably not going to agree on this one, but just to make myself clear; I'll put my opinion on the record. Then the readers can decide for themselves. Making everyone that is even remotely involved with ems a paramedic is overkill. All or nothing doesn't work in the real world. It never has and never will. If it did, everyone involved in medicine would be a doctor and graduate of Harvard medical school. My medical director once told me that a good rule of thumb in life was to always be suspicious of those who held extreme positions. And he said to be suspicious of their ideas, not the person. People can be sincere and wrong at the same time. The smartest people on the planet have no idea what makes up 99% of the universe. For this reason, they call it dark matter. My point is you really don't know very much, just like the rest of us on here. Lets just try and get the wheel moving again before we reinvent it. I do admire your optimism though.

 

[Guardian]

The problem is, as I have mentioned in other threads, lack of support from the providers. When the politicians and EMS leaders who do lobby for us come to a State or National seminar, out of 10,000 conference attendees, only 10 -20 may show up to listen to these people speak or to express an opinion. What interest in change does that show? The other 9,990 will be at the pool or lounge griping about how bad things are.

I agree and my intention was to inspire more people to take an active role. History has certainly shown the human tendency to be sheepish. People basically do what they're told. That's the way of the world. But there is plenty of blame to go around. I know from personal experience that they aren't always receptive to differing opinions.

 

[Outbac1]

Touchy Touchy Touchy!!! I didn't start this to be another place for "B"s and "P"s to bash and pick on one another. In the US you have a level EMT-B with 120 hours (+/_) of training. You don't have to like it but that's what you have. At least until you change it, which may never happen.

The point of the question, which was directed at the "B"s, was if there were NO "EMT-B" to take as an entry level to EMS and you had a course similar to our PCP, would you make the commitment?


daedalus
I am not trying to compare our PCP with EMT-B. They are not comparable.


bossycow
You wrote "The point of the post as I understand it is to determine if .. given the option of EMT-P or nothing.. would you enter EMS?"
Not quite right. I'm thinking of a level below EMT-P similar to our PCP. Although that is a good question as well.

mdkemt
Yes I am aware that not all provinces are totally on board with the National Occupational Competency Profile (NOCP) as put out by the Paramedic Association. I know that the skill set and meds available for use by a PCP in BC are not the same as for a PCP in NS as an example. The NOCP serves as a baseline for education and comparison. If I want to work in another province for example someone looking at my PCP will know to what standard I have been educated/trained. If that medical director wishes to add or subtract from that they may. As I said our systems here are not perfect. We certainly have room for improvement. However I believe we are more with it as a nation in EMS than the US.

Please keep the comments comming. But it's not a bash fest.

 

[Ridryder911]

I believe we are more with it as a nation in EMS than the US.
.

I believe this was the most important issue. Not only can we not unite as a profession, but we are fragmented state by state, and even in some states county/provinces, community by community.

Now, I agree there needs to be a standardization, but as well each area should be unique its own local medical community. Is there systems that need more advanced Paramedics than others .. yes, and is there areas that only need the bare essentials due to close proximity of multiple health centers.. yes. It does NOT mean though there should not be a standard of educational level. Remember, just because one can only perform at a level or function does NOT mean that one has to be ignorant or have lack of education.

It is much more advisable to be over educated (if there is such a thing) than the other. ...

R/r 911

 

[Outbac1]

but we are fragmented state by state, and even in some states county/provinces, community by community.


R/r 911

Yes there certainly is fragmentation. However if one were to look at Canadian EMS 10 - 12 years ago vs now. One would see a steady state of progress. We are getting much closer together in standards of care and even reciprocity. I believe I can see the day when my provincial tag (to NOCP std), will be accepted across Canada with little fuss. With steady work, by the dedicated few, the fragmentation is getting less and less.

 

[Ridryder911]

I did a talk show (podcast) with a Canadian Paramedic that is very active on another EMS forum(s). It was very informative on how your system changed in such a rapid response. At least you identified your problems and came with an approved solution, instead of attempting to make excuses or inventing multiple levels as an alternative, something we can learn from.....

R/r 911

 

[mikeylikesit]

the whole training process wouldn't be too smooth without some form of education before entering a medic program if the Basic didn't exist...is it essential to make a "shake and bake medic", no. It is however much easier to teach someone who has a little understanding than none at all. i don't mind if the Basic is a prerequisite into medic school with a break to work the field for a while in order to let their new knowledge sink in before attempting a more rigorous curriculum. i do however believe that there should be a mandate on how long a person should be able to hold a Basic cert. before being required to get out or move up. i think that Basics may have an easier time with patient care and the transition into a higher education than one without any what so ever...maybe thats why some places require A&P before even attempting Paramedic school.

 

[VentMedic]

If the Paramedic program was a two year degree like many other professions, one would get about 5 semesters of clinicals. That is way more than the 20 hours of clinicals an EMT gets now and possibly more patient contact than at many of their jobs. The clinicals should also be done under closer supervision to learn the "basic skills" such as BPs and assessments of many different patients rather than the usual coffee pot "ride time". The skills would be built upon with each semester as the "book learning" progresses. Even an introduction to IVs, EKGs and phlebotomy could be done within that first year to prep the student for the 2nd year of Advanced or Paramedic. There could be some type of provisional certification issued at the end of the first year that would allow the person to work for a limited amount of time while continuing through the 2nd year.

 

[daedalus]

Let me toss out some numbers:
source: http://www.emsresponder.com/survey/

Florida:

EMT-Basic 25,063
Paramedic 14,910


New York:

CFRs 13,136 (all are trained in defibrillation)
EMTs (below Intermediate level) 37,945 (all EMTs in New York state are trained in defibrillation)
Intermediate EMTs 2,033;
EMT-Critical Care technicians 2,773
Paramedics 4,297


California:

Basic EMT 70,000
EMT-I 119
EMT-P 14,500


Washington:

First Responder 1,336
Basic EMT 14,232
Intermediate EMT 862
Paramedic 1,723

What interesting about Washington is its levels:
EMT-Basic
IV Technician
Airway Technician
IV/Airway Technician
IV Intermediate Life Support Technician (ILS)
EMT-Paramedic

Correct me if I am wrong but the EMT-B numbers still reflect the other 3 different inbetween certs until ILS is reached?

With these ratios, you prove the need for EMTs. Our 1,700 paramedics need partners! I have never ran a call with a paramedic where I could not greatly assist them. I dont wipe noses, and I rarely hold hands. I assist my paramedic and drive my ambulance, and I do not argue that I hsould be able to do more, but dont reduce a EMT to a nose wiper.

 

[daedalus]

Personally, I have never stated that there was not a place for EMT Basics. In my "perfect EMS world" there would be three places.

1) MFR level. What they are trained and designed to do. Be the first on the scene, prepare for treatment and quickly initiate first line tx.
2) Very remote areas, where medical care will never be feasible, but will not be considered the "end all". Continuous action with documentation of that those areas are attempting to improve care & services.
3) While in Paramedic school, to assist Paramedic in care. Obtain experience on those so called .."B.S." calls. After a Paramedic has made the determination that the patient does not or will not need more interventional therapy. The EMT will be held accountable to detect such treatment or changes occur. This will allow those EMT's to come in contact with patients and clinical exposure. Certifications and license would be only good for two years.


R/r 911

Agreed. I think this is what most of us would want.

 

[wolfwyndd]

If there were no EMT-B certification as a starting point. Would you still try to get into EMS?

Here in Canada we have Primary Care Paramedic, (PCP), as our BLS level on ambulances. It is about a 1500 hour course with about 800 hours didactic/lab, 200 hours of hospital clinical and 500 hours as a student on an ambulance. The course costs about $12,000.00 (plus your living expenses) and takes about 10 months to complete.

If you knew you could get a job paying double the minimum wage plus benefits, would you quit your current job and make the time and monetary investment to be in EMS? Or does that kind of commitment scare you away?

Hard to say. You see, I only do it as a volunteer / part time thing. Even making double the minimum wage isn't much as an incentive for me since I make . . . . . probably close to three times the minimum wage now with my full time job. IF I could still do the training as an evening / weekend training class for about a year (or however long it took) I'd probably still do it.

 

[VentMedic]

With these ratios, you prove the need for EMTs. Our 1,700 paramedics need partners!

It also means a lot of people stopped their education at EMT and did not advance to Paramedic. In some areas there may be little choice but to run EMTs on all calls with or without a Paramedic.

If you really analyze the numbers and the methodolgy behind the "training" of EMS providers in the U.S., it is amazing that it is even a profession at all.

I guess it just amazes me that some in the profession continue to support the minimum amount of care to the patients. Do you expect that when you go into a hospital for yourself or a loved one? Why should EMS be any different? And, it is really sad that as the educational standards stand, it doesn't take that many "hours" to complete a Paramedic program. Its not like you have to even go to college, although recommended, like all the other health care professions. You also can't say because of the pay because those that are saying it continue to make a lower wage as an EMT. The wage for the Paramedic is higher than EMT. One can also talk about benefits and poor working conditions, yet, they continue with their EMT job.

Hospital professionals fought the idea of lower level providers in many areas and won. They helped professions push their entry level educational standards higher. They did this by providing solid arguments based on patient care.

 

[BossyCow]

They have a place. First aid. Wiping noses and holding hands, as was suggested.

But medical emergencies in the list above are not basic. And while Basics are great for simple hospital transfers, they have no place in that list. It's that simple.

Hastings, my question was regarding the comment that BLS providers are against furthering their education. I still have not seen an adequate response to that.

As to wiping noses, holding hands and first aid... I'm sure the drowning victim that made it to ALS breathing and with a pulse would disagree that my basic care was not better than wiping their nose. I'm sure the countless diabetics I've treated with glucose, insuring their arrival at the ER in more stable condtion than I found them, would also disagree.

Can all of that be done by a medic? Certainly it can, but since ALS is going away in my area, not increasing, I'm going to say that BLS has a place. By the time an ALS rig can get to my critical pt, which is often 15 - 30 minutes, the patient is getting O2, major bleeds have been stopped, injuries splinted, CPR in progress if needed, C-Spine precautions in place if needed, extricated from the vehicle. As a first aid instructor, I can tell you, our level of service far exceeds what is taught in first aid.

So, back to the topic of the thread.... if there were no EMT-B.... would you sign on for the more advanced certification like EMT-P or would you not enter EMS at all. I would really like to hear from EMT-B's on this.

 

[Buzz]

if there were no EMT-B.... would you sign on for the more advanced certification like EMT-P or would you not enter EMS at all. I would really like to hear from EMT-B's on this.

I probably would have not gotten into EMS. I was making far more at my old job (though I hated it). Taking a 1 semester class in something that I found highly interesting is far less of a commitment than actually entering a paramedic program where continuing on at the aforementioned job would have been impossible. After Basic, I decided that this is what I want to do and started preparing for my next step. It gets said around here quite a bit that EMS is not for everyone, and the Basic level seems to be a good way to be exposed to a small part of the profession to find out if it is right for you.

 

[T1medic]

I myself would probably have not gotten involved in EMS if it was not for EMT. I originally became an EMT just so I can get into fire school and try and become a firefighter. I had no ambition for the medical aspect of it. Since completing school and now acquiring a job with a private ambulance service I am diving head first into the "medical" aspect of being a firefighter. I am now contemplating going to medic school before fire academy.

 

[Foxbat]

Many of those "BS" calls spend weeks in the hospital or die because the EMS (BLS or ALS) provider did not fully assess or have enough education to recognize something very seriously wrong.

One of my first calls was for an elderly pt. requesting lift assist only. It turned out that the pt. was kind of week and lethargic for a last few days and that's what caused him to fall. My partner (medic) persuaded him to call his physician... The physician recommended him to go to the hospital by ambulance.
When we were transporting the pt. to the hospital, he went into V-Tach (not pulseless) and we ended up going lights and sirens...

 

[firecoins]

I support keeping the EMT-B but with alot more education. A&P 1 & 2 should be required for everyone. Add general psych, abnormal psych and medical terminology on as optional. And a hell of alot more clincal than 2 shifts split between the ER and ambulance.

 

[mikeylikesit]

I support keeping the EMT-B but with alot more education. A&P 1 & 2 should be required for everyone. Add general psych, abnormal psych and medical terminology on as optional. And a hell of alot more clincal than 2 shifts split between the ER and ambulance.

Agreed, but, where is the A&P knowledge going to applied by the Basic? They may be able to more clearly recognize a problem, but quite often the problem recognized is something that is treated by means outside of their scope. Would be good to know for splinting though.

 

[JPINFV]

You can't justify increasing the scope of practice of basics, though, untill they have an actual background to work off of.

 

[paccookie]

I started as a Intermediate. I don't think basic is a necessary step for EMS, but it's a nice idea for those who only want to volunteer.