Can EMT-B intubate or start IVs?

[Carlos Danger]

I thought this thread was dead, but apparently not. I find Remi's comment absurd. Some of the comments here show total close-mindedness. I.e., "it'll never work". Pretty final. As Paramagicz said, in the military, who are not paramedics, perform advanced skills. So there goes the " it'll never work" argument.

Over the course of this 7 page thread, you have been presented with several solid reasons why EMT's intubating is a ridiculous idea.

You have not yet responded to a single one.

Present a cogent response ("but, but....back in the AO we did it" does not qualify as cogent), or admit that you do not have one.

Start by addressing the problem of initial training that I outlined in my last post.

And as for studies, mentioned previously, some are good and some are bad. Just cause there's a study, doesn't mean it's correct.

Research is how science is done. It is how we know what does and doesn't work in medicine. You don't know anything about how an intervention works if you haven't examined it's effects systematically and objectively, and then had other experts look at your work and agree with your methods, findings, and conclusions.

This isn't just "a" study on prehospital intubation. There aren't just 5 studies. Or 10. Or 25. There are probably closer to 50 studies published in peer-reviewed medical journals in just the past 10 years or so. And not a single one that I can think of supports the idea of EMT intubation. Many even question the need for and effectiveness of intubation by paramedics. And in the face of that, you are really going to say "hey y'all, I think we should take people with even LESS training and have them give it a whirl".

You aren't allowed to just ignore published, peer-reviewed research. You can disagree with it if you want, but the onus is on YOU to justify your disagreement, not the other way around.

 

[Gurby]

This isn't just "a" study on prehospital intubation. There aren't just 5 studies. Or 10. Or 25. There are probably closer to 50 studies published in peer-reviewed medical journals in just the past 10 years or so. And not a single one that I an think of supports the idea of EMT intubation. Many even question the need for and effectiveness of intubation by paramedics. And in the face of that, you are really going to say "hey y'all, I think we should take people with even LESS training and have them give it a whirl".

This was the first thought that occurred to me, and I'm surprised nobody has mentioned it yet. I didn't bring it up because I was too lazy to go read the studies myself... But isn't there basically no evidence that says prehospital intubation is a good thing for even medics to be doing? In cardiac arrest (which is the only scenario I could see EMT-B's being allowed to intubate), patients statistically do better with BLS-only care. It's suspected that this is because paramedics might waste time worrying about IV's, drugs and airway when what the patient really needs is compressions and electricity, or they interrupt compressions to place a tube, spend too much time on scene, etc.

I don't want to turn this into a debate about whether or not paramedics should be intubating... But the fact that even that's already kind of a gray area makes the idea of adding intubation to EMT-B scope seem pretty silly to me.

 

[Carlos Danger]

This was the first thought that occurred to me, and I'm surprised nobody has mentioned it yet. I didn't bring it up because I was too lazy to go read the studies myself... But isn't there basically no evidence that says prehospital intubation is a good thing for even medics to be doing? In cardiac arrest (which is the only scenario I could see EMT-B's being allowed to intubate), patients statistically do better with BLS-only care. It's suspected that this is because paramedics might waste time worrying about IV's, drugs and airway when what the patient really needs is compressions and electricity, or they interrupt compressions to place a tube, spend too much time on scene, etc.

I wouldn't say there is no evidence in favor of it, but there is definitely much more unsupportive than supportive, and the supportive ones tend to show minimal benefit.

I definitely would not argue that paramedics should never be intubating, but I do think paramedic airway training and general approach to airway management should probably look quite different than it does now, and I think there is plenty of evidence to support that position.

I don't want to turn this into a debate about whether or not paramedics should be intubating... But the fact that even that's already kind of a gray area makes the idea of adding intubation to EMT-B scope seem pretty silly to me.

Yep, that's exactly the point, and the main reason (though certainly not the only one) why this whole idea is a non-starter.

 

[NomadicMedic]

There are a myriad of reasons why EMT basic's should not be allowed to intubate. Here's an important one to consider; when an airway goes bad, it goes very bad. It leaves even experienced paramedics (and other providers) with no option other than a surgical airway, and that's certainly not a skill an EMT basic should have.

Letting a basic intubate is on par with giving a 6 year old rudimentary instruction on driving, neglecting any instruction on how to use the brakes, then throwing them the keys and saying "go for it!"

hey, even experienced drivers crash all the time, but they have some skills to try and mitigate the damage.

 

[Chimpie]

This thread has been cleaned up. Some posts have been removed, either because they were off topic or violated one of our rules.

Keep it clean and on topic.

 

[kamran]

Hi
in our country,Iran,all EMTs eligible to take IV line,Intubation,and give drugs to the patients

 

[LACoGurneyjockey]

Hi
in our country,Iran,all EMTs eligible to take IV line,Intubation,and give drugs to the patients

How long is the education/training there for someone to be able to start an IV, push meds (oh, and what meds), and intubate?

 

[kamran]

associate degree is 2 years and bachlore is 4 years.
we can use all of emergency box drugs such as:epinephrin,atropin,naloxan.TNG,hydrochortison,aminophylin,phenytoin,lidocain,chlorpheniramin,dexamethason,asprin,...

 

[DesertMedic66]

associate degree is 2 years and bachlore is 4 years.
we can use all of emergency box drugs such as:epinephrin,atropin,naloxan.TNG,hydrochortison,aminophylin,phenytoin,lidocain,chlorpheniramin,dexamethason,asprin,...

The normal length of an EMT program in the USA is about 120 hours total...

 

[OnceAnEMT]

The normal length of an EMT program in the USA is about 120 hours total...

I think there is a little lapse in communication here. Our EMT-Basic program is 120 hours, yes, but there is no way that the EMT-Basic equivalent in Iran is still "Basic" after 2, let alone 4 years, and performing ACLS. @kamran what are the different levels of EMT there, if any?

 

[kamran]

Here is 3 level of EMT; EMT-B EMT-I EMT-p
it depends on your medical knwoledge

 

[OnceAnEMT]

Here is 3 level of EMT; EMT-B EMT-I EMT-p
it depends on your medical knwoledge

So just to clarify, are you saying that EMT-B, the lowest level, can execute ACLS protocols?

If yes, my follow up is what on earth is the difference between the 3 levels of EMT in Iran?

 

[LACoGurneyjockey]

So just to clarify, are you saying that EMT-B, the lowest level, can execute ACLS protocols?

If yes, my follow up is what on earth is the difference between the 3 levels of EMT in Iran?

And to add to that, is the lowest level of EMT still required to go thru 2 years of schooling?
I got my EMT in a 4 week, 5 day a week accelerated program. I wouldn't trust me to have any more than what my meager scope entails with that amount of training.

 

[kamran]

if a person want to work in EMS‌‌‌‌‌‌,at least should have 2 years academic course at Emergency medicine or anesthology, or 4 years in Emergency medicine, anesthology, nursing.
at one shift the highest level EMt is responsible and do the invasive procedure, but sometimes 2 basic are in a shift and they give all type of care to the patients.

 

[LACoGurneyjockey]

What can an EMT-I do that a B cannot, and what can a P do that an I cannot?
So 2 years is the minimum requirement to work on an ambulance?
I wish 'murrica would catch onto this eventually

 

[kamran]

actually, the rules are different between EMt B and EMt I and EMt p, but they train Acls in 2 years degree because of stuff shortage.
yes minimum level for working in ambulance is 2years

 

[Flying]

Are you finding that more foreigners are being hired because of the shortage? What is the average education level of those coming from outside the country?

Has this system been put in place throughout the entire country, or just the large cities?

Are many motorbikes used in your system?

(Admins, it may be best to move these posts to a new thread in international EMS.)

 

[kamran]

in fact, we haven't foreigner in our EMS system since payment is according our currency, rial, and is very low for foreigners.therefor,Im improving my English language for immigration to Canada or Australia.

 

[TimRaven]

Here in the Bay Area, CA, we EMT can't "de facto" perform any of mentioned procedures:

While King airway is on the approval list as optional, very few companies/service actually carry them.
Pulse Ox, finger sticks are still not approved in several counties, never mind IV.

One representative from my county EMS office clearly states that he doesn't trust EMT or AEMT (if there is any) even with just oral Aspirin on a suspect MI patient.

 

[EMT533]

I am in Ultrasound school right now and it is not enough for me. I go into the MA lab and practice drawing drawing blood on my best friend. I know IV is much more difficult considering all the variables. My question is are the mechanics the same? If I can draw blood do I have a basic understanding of an IV?