Do all Paramedics Think they know all???

[trauma1534]

This is sort of a continuation to the other discussion with similar topic name. I would just like to add my view on this. I didn't not read all of the posts under that topic, however, I can add my view on the original post.

No, not all paramedics are "Know all, end all". I have ran into quite a few "paragod's". I come from a department where that seems to be a trend. My advice is, be better than them. They will fail. I didn't become a good seasoned provider by comming from a department where there was none of that, it was the exact oposite. I came from a department where there was much compitition. The medics back in the day there, where not so "paragodish". However, there was a great race between all of us to be better then the provider next to us. That my friend is what made us. We have all since gone on to do bigger and better things from that era of time. We call ourselves the "originals" (tougue in cheek). The ones there now, have the attitude that they are much better than anything else in EMS. I get a thrill out of prooving them wrong. People like that will hang themselves. Get it into your head that you will be the best in the department. If you are an EMT-B, then you will be the best damn EMT-B they have. Remember this... a paramedic is not a paramedic without the EMT. They were all BLS before ALS. They can't even practice without an EMT-B min. on the truck in our state. I am ALS myself and I don't think of myself higher than anyone. I just make it my mission to be the very best of the best and then make the best better. Take on that attitude and it will take you far. Don't get mad, just prove them wrong. Learn all you can, and outsmart them. It can happen. I take pride in that very thing. There is nothing no better than making a know it all paramedic look like an idiot because they think they are all that, and don't know the basics.

 

[jeepmedic]

I don't know everything. I only know how to look it up, and ask questions. Everyone's cert. says EMT. No matter if you are a basic, enhanced, intermedite, or Paramedic.

 

[Ridryder911]

Remember this... a paramedic is not a paramedic without the EMT. They were all BLS before ALS. They can't even practice without an EMT-B min. on the truck in our state. I am ALS myself and I don't think of myself higher than anyone. I just make it my mission to be the very best of the best and then make the best better. Take on that attitude and it will take you far. Don't get mad, just prove them wrong. Learn all you can, and outsmart them. It can happen. I take pride in that very thing. There is nothing no better than making a know it all paramedic look like an idiot because they think they are all that, and don't know the basics.

Okay, I can understand your point, and I actually agree to it somewhat. However; some of it is flawed... I Don't understand the following ..."Remember this... a paramedic is not a paramedic without the EMT."... All of our trucks have Paramedics.. If you mean titles.. nationally we are working on removing the technician title. Some areas already have.. such as the "CCP "title, notice no EMT, and the "They were all BLS before ALS".. as well is not true, I actually was a Paramedic before I was an EMT. At my service we have many Paramedics that never worked as a Basic... went straight to school and graduated from a Paramedic program, then went to work as a Paramedic. Actually, I feel these are some of our best Paramedics. They have no nasty habits to break, and the service can install the quality they want.. I'll take knowledge over experience any day. Anyone can get experience... not vice versa. As well basic performance and treatment should be simultaneously and does not take a rocket scientist to perform it ... however it take an idiot to forget it. Actually, it is the same treatment we teach common laymen. ( example.. CPR, bleeding, splinting, with the only difference is oxygen administration)

I agree, there should be no "Paragod" syndrome.. as well as there should no "EMT saves Paramedics" attitude. I have yet seen only heard of one EMT save a Paramedic.. that was when he went into cardiac arrest, and AED shocked him. This phrase was designed to sell T-shirts, belt buckles and inflate ego's. Can you imagine a ER physician having a ....." ER Doc saves Surgeons?"..

EMS is a multi-team approach, like a jig saw puzzle, remove one piece and you do not have a whole picture. Every-ones job, including the wrecker driver, the rehab nurse is important. What most medics fail to recognize we are only a small part of the large EMS system....

R/r911

 

[trauma1534]

Ridryder, how long have you been in EMS?

 

[trauma1534]

Ok. Let's break this down. Title means nothing to me. You can be a President of a company, but know nothing about specific jobs of the workers in that company. You stated that you were a Paramedic before you were an EMT... where did you go to Paramedic school at? Paramedic is the advanced life support certification of EMT. Did you not learn the basics before you learned advanced? I highly suspect that you had to. I think this is all a matter of opinion, however, seeing as how I am very opinionaited myself, here's mine.

BLS ALWAYS comes before ALS. Do you not perform a baseline vitals assessment prior to cracking open your drug box? If not, I don't want you to work on me, or anyone for that matter. Is not vital signs an EMT-B skill? What is the first thing that you do in an unresponsive patient? I highly doubt that you would pull out our AED pads and shock up front without assessing if you have a pulse... just as you would not intubate without assessing if your resps are not adaquate. Those are all EMT-B level skills. Would you just up and give someone Morphine without finding out what the patient is alergic to? That too, is a BLS skill. What about backboarding a patient... that is a BLS skill. No matter how big the paramedic wants to look, it all goes back to basics. Do you not on a rutine basis assess your patient for thier Hx, and all of that stuff? Guess what... another BLS skill.

One thing that I hate to see in the field, and I should know, I've been doing this for a little over 12 years, is to see a provider pop up on my truck, say he's a Paramedic and can't think outside the box because he went from zero to hero in 1 year. I can pick out those who have the knowledge without the experience a mile away. The book teaches you alot of basic knowledge, but it can not be compaired to the tricks of the trade that can only be learned in the field. You can have as many letters behind your name as you want, but if you don't know how to apply them, they are useless.

I know of a program right now here in my area. It is a 28 week paramedic accademy. You mean to tell me that you would hire that person who has gone through that training and only have 28 weeks under thier belt, verses a 5 or 10 year veterin in the field, and your determining factor for hiring that person is thier certification level? Get real!

I am an ALS provider myself. I know of many times I have been glad to have an EMT-B in the back of the truck with me. They think on that basic level that we as ALS providers often tend to forget when we get zoned in on what is going on with the patient. They are a great extra set of hands, and they will keep up with the vitals, and times when we would forget about it trying to get that patient tubed, or trying to get ready to give a drug, or that IV started. They are great to controle bleeding while you are working on thier volume. Most of all, most EMT-B's have that passion to learn all they can from us so that they can become better at thier skill level. Those Paramedics who think they don't need EMT-B's or consider themselves better than an EMT-B, because of thier title are just plane out dangerous. Always remember one thing... You are one patient away from killing someone. Yes, that EMT-B may very well save you from doing that. When you forget to recheck that B/P and you give the wrong drug and cause more problems than you had to start with, you will be wishing you had that EMT on the truck with you. When you hang a bag of fluid and you need that other bag right now, and you have to stop what you are doing and that patient is going down the drain, and you have to set up your second IV because you don't think you need that Basic on the truck, you will wish you had someone willing to set up your supplies for you.

I will always stand up for EMT-B's who are sincere and want to learn and want to do. I was once that EMT who wanted to learn myself. Thanks to the great medics of my time, I am the provider I am today. I have never been afraid to take any patient situation to the hospital. Being around good medics in the past when I got started in EMS is what made me that way. We all strived to be better than the next one, but we didn't want that other provider to be less than what we were either. We worked together, but compeated to be the best of the best!

Another thing, in case you didn't notice, you speak so lowly about EMT's, the name of this forum that you so often post your opinions on is called EMTLife. You must be in the wrong site!!!

For those EMT-B's out there reading this, keep doing what you are doing. Don't let people like this intimidate you. Strive to be that best of the best. Never let the paragods see you sweat. You are the future in EMS. Take your time and define your skills to be the very best you can be and don't stop there, make the best better!!! Even if you have no intentions of becoming an ALS provider, you be the very best EMT-B your department has. It will take you far!!!

 

[jeepmedic]

Not all just the ones from you know where

 

[Summit]

Ridryder, how long have you been in EMS?

dirt was young back then...

 

[trauma1534]

Yep Jeep, we won't mention any names or squads now will we? LOL I know a PA who used to be a Paramedic and he is not just the man, he is the damn man. He would arrive on the scene and say... "Have no fear, God is here". He was cocky as hell, but he could back it up. As cocky and old as dirt as he was in the field, never, and I mean never did he ever put BLS providers down. Infact, he made it his mission to make those providers the best that they could be. If I remember correctly, he was a CCRN, CCNREMT-P, Flight Nurse, and finally settled down to be a PA. VERY GOOD PROVIDER! If I were to need someone's help, if I were to pass out, I would hope when I wake up, he would be standing over me. That is the difference in all the letters in certifications in the world, and a damn good provider who has just gone far!

 

[BossyCow]

The question reads... "do ALLParamedics ....

I don't know if my experience differs from the norm but in my humble opinion, there are jerks in all lines of work. There are those whose main job is to make everyone who works with them feel uncomfortable, inferior, or impressed as hell just to have met them. Some of them are paramedics, some are ER DragonLady Charge Nurses, some are Doc's, some are family members of patients or bystanders watching how we got that car door open.

The answer to the question is No... ALL paramedics are not anything.. they are as varied as the human race. The mature thing, which often becomes difficult to manage after a particularly gnarly call or shift... is to remember that the jerk is not a jerk because of what he does.. or the title he holds.. but just because, quite simply, his inate jerkdom shows up in what he does.

 

[Guardian]

Ridryder, how long have you been in EMS?

he's a brand new emt

 

[Ridryder911]

FYI..You asked.. I went through my first Paramedic course there was no basic class until I had been a Paramedic for about a year. Yeah, NREMT only have had Paramedic level for about 25 years.. this was 4 years after I was a Paramedic. I went back and tested out the basic and then obtained a degree in EMS, over 20 years ago I have been an ER, RN with multiple board specialties for over 17 years. I currently have 3 degrees in Science and now working on my 4'th.. I hold Instructor titles in the usual alphabet courses...just pick one.. as well as have been a consult for many EMS education texts, as well as NHTSA, State Trauma Systems and the development of Trauma Centers.. so I do know a wee little about EMS but, hey I still continue to learn something new everyday!

Now, I am not against Basic EMT's, what I am against is those thinking that Basic EMT courses are up to par for comparison of any medical education. Do you realize the Basic EMT is written at a elementary level to an 8'th grade reading level and the one text book Paramedic course is written are at a 10'th grade level ... as well, most of your EMS magazines and journal will not publish any thing written again above 10'th grade level... want to know why?.. You guessed it.. average reading level is about 8'th grade to freshmen level.. High School. The whole system sucks...Can we really toot our horn now?

Now, you want to know some real facts.. take the NREMT testing (which is the national standardized EMS entry level tests) and see what science level it is written at and much more discouraging is the disappointing passing rate... Now, tell me how great the EMS education system is?

No where else do you see BLS stressed as much as from EMT's... okay, you performed ABC's (all patients should be assessed) this is your job.. how hard is that..? Really, again this is not rocket science. It is and should be part of assessment and treatment modality. You described not getting a baseline v.s prior to treatment... sorry, that should be performed simultaneously.. and after your first semester of EMT education one should not have to assess more than 30 seconds to see if someone needs to be intubated or not. A quick overview of 15 seconds will tell you if someone tidal volume is adequate or respiratory drive is decreased as well as adventitious lung sounds.
Again, this is simultaneously performed.. BLS is part of ALS NOT a separate Criteria!... It all goes hand in hand.. Assessing and concordance treatment should be done appropriately. Do you wait to get a b/p reading before applying oxygen ?... I hope not..

Compare the ARC Advanced First Aid to the Basic EMT curriculum and one will see that there is very LITTLE difference. The basic EMT curriculum has been diluted so bad, that there is little medical expertise or knowledge taught above the laymen level. Now, compare the current curriculum of that even 15 years ago.. yes more in clock hours, but definitely less in depth. (For example the 6 common types of fractures, basic medical terminology and charting.. etc.)

I personally would not hire or work at a service that employs "shake and bake" Paramedics. Even where I am, most have graduated through a 2 year AAS program, and most of us feel it is still way inadequate with today's healthcare dilemma.

Experience is nice, and I too you used to think it was essential, but I have since changed my mine. One can be doing something wrong forever and never know it. It does not take "experience" to be effective 100%. We place more emphasis on experience than we do having enough knowledge of knowing what to do. No other medical field requires different entry levels or as many levels as EMT's (last count per JEMS was over 140 acronyms for EMT's). Do you think that all physicians have been exposed or have experience in everything prior to practicing medicine ?

Give me a green medic with an exceptional knowledge base and eagerness to learn.. and we can get them the experience with time. Now, do a comparison.. one green and has a license to perform medic skills, the other has experience and cannot. Both will obtaining experience at the same time, only one will be progressing upwards.

Again, it is not I am against EMT's .. it is the system that is broke. There is a place for EMT's as first responders, and associates for rural systems.
Amazing, everyone assumes you are against EMT's if you want EMS to progress as a profession, and as well to remove the "training" mentality and to go to a formal education system, (Like every other health care profession has.) Don't like working odd shifts, requiring 2 - 3 jobs to make ends meet, and having a dead end career after 5 years in the field.. then change the system! It won't fix itself with a status quo attitude... as in the words of infamous Dr. Phil.. "You can't fix, what you don't identify and acknowledge"..

I am sure many assume at first I am a Paragod, I really don't care. I have plenty of Basic's on up request me to ride with for clinical and to teach their upcoming classes. I do expect more and I have found out most will & can do it, when only asked to and demanded to perform at that level. I as well, will tolerate ignorance (not knowing something) however; I will not tolerate be stupid (refusing to learn and change things for the better). My only business is to take care of the sick and injured... and so should everyone else's in EMS. Ego's need to be checked out at the door.. when you enter for work.. deflated or inflated. Nothing pisses me off more to see a Paradiva or Paragod no matter what level their patch is.

Like I described, I continuously learn something everyday.. I still study and review an re-review and practice.. my patients demand I be competent. I personally realize to be the better.. I have to learn everyday.. and do either by reading, or watching off others.

Yes, we need to "think outside the box'.. unfortunately most EMT's don't even know what their box is...

R/r 911

 

[Guardian]

I pretty much agree with everything trauma1534 wrote. Obviously "basics" come before advanced care. Obviously, you can't go around being mean to people just because they're an emt-b. And obviously, there are some ALS A-holes out there.

I would add that there seems to be an idea that you have to be an emt-b before you can be a paramedic. In reality, being a paramedic is not that hard and you can go from zero to hero in a year and be a competent paramedic. If I remember correctly, Johnny and Roy only had about 3 months worth of training. Also, there is a fine line between A-hole and AIC. Guess what, it is perfectly fine for a brand new paramedic to give an order to a 20 year veteran emt-b. Let me give you some examples,

go get the stretcher (that's ok)
go get the stretcher you stupid idiot (that's not ok)

you doing that wrong, do it this way instead (that's ok)
you doing that wrong dummy, do it this way instead (that's not ok)

If I had my druthers, emt-b wouldn't work on ems ambulances. In a perfect world, we would find a way to educate and pay for NR-Paramedics (notice, no emt) on every ambulance. I'm like rid, I'll take education over experience any day of the week and twice on sunday.

 

[Fedmedic]

Know it all, he**....I don't know anything. The only thing I know, is when I get in the back of the truck...I got mine! I have been called cocky in the past, but it really isn't cockiness, it is confidence. I know that whatever happens in the back of the truck, I can handle it...it doesn't mean I may not be scared or a little confused about what is wrong with the patient, but the patient won't know, the family won't know nor will anyone else of lower certification on the truck. Because above all else, my main function is to maintain control of the scene and you can't do that without having confidence in your knowledge and your skills.


This is to Ridryder, just out of curiousity, how large is the EMS service you work/worked for, annual call volume, how many ambulances on the road at one time, population of the area your agency services? There is a reason I ask these things.

 

[Ridryder911]

My main service has just recently went to 4/24 dual Paramedic coverage with an additional 12 hr dual Paramedic truck, 1 Field Supervisor Unit and a 1 wheelchair unit which will be going to probably 1 or 2 more. We are in discussion of adding more area (which, is controversial good and bad). Right now we cover about 1250 square miles. They placed a chopper about 7 miles away and we are their number 1 customer for scene flights, we are considered an urban/rural with a total population about little over 100,000. Some of our transports from scene may be up to 32 miles to a hospital and 50-60 to a Level I.

It appears our call volume is going to be about 10,000+ emergency calls with transports and growing intensely, as well we do a lot of critical care transports as well. We work a modified Kelly shift, 24/on 24/off for 3 shifts, then 4 off in a row.

Each truck is equipped with the usual CPAP, portable vents, IV pumps, etc.. we have a new young medical director so our protocols are currently in review and modification, dependent on new studies and research. There are only a very few "call in", all front line procedures including narcs, chest decompression, crich's, I/O's are standing orders.
Fortunately, we are just about 18-22 minutes outside the largest metro area in the state. Each day it appears we are becoming a suburb of the area.

We are experiencing growing pains, (which is good to grow) but keeping status -quo is hard enough in any EMS. Like every EMS we have good days and bad...

I have worked at large metro EMS where they average >75,000 calls a year to EMS that only ran 4,000 calls (which was the most advanced and agressive, as well hardest due to tranport time was an average at least an hour to a tietarary center) and as a trauma/ER nurse at multiple trauma centers.


* I see you are a Fed/Officer, we are about 35 miles from one of the largest "holding areas, processing areas" in OKC....

R/r 911

 

[jeepmedic]

If I had my druthers, emt-b wouldn't work on ems ambulances. In a perfect world, we would find a way to educate and pay for NR-Paramedics (notice, no emt) on every ambulance.

:wacko:

With out EMT there would be no Paramedic. Look the National Registery Patch. What does it say????

Say what you want you are just an EMT with a p instead of a b. You can not treat what you don't asses. And Assessment is an EMT-B skill.B)

 

[jeepmedic]

Do all Paramedics Think they know all???

Nope but I slept at a Holiday Inn Last night does that count?B)

 

[Fedmedic]

My main service has just recently went to 4/24 dual Paramedic coverage with an additional 12 hr dual Paramedic truck, 1 Field Supervisor Unit and a 1 wheelchair unit which will be going to probably 1 or 2 more. We are in discussion of adding more area (which, is controversial good and bad). Right now we cover about 1250 square miles. They placed a chopper about 7 miles away and we are their number 1 customer for scene flights, we are considered an urban/rural with a total population about little over 100,000. Some of our transports from scene may be up to 32 miles to a hospital and 50-60 to a Level I.

It appears our call volume is going to be about 10,000+ emergency calls with transports and growing intensely, as well we do a lot of critical care transports as well. We work a modified Kelly shift, 24/on 24/off for 3 shifts, then 4 off in a row.

Each truck is equipped with the usual CPAP, portable vents, IV pumps, etc.. we have a new young medical director so our protocols are currently in review and modification, dependent on new studies and research. There are only a very few "call in", all front line procedures including narcs, chest decompression, crich's, I/O's are standing orders.
Fortunately, we are just about 18-22 minutes outside the largest metro area in the state. Each day it appears we are becoming a suburb of the area.

We are experiencing growing pains, (which is good to grow) but keeping status -quo is hard enough in any EMS. Like every EMS we have good days and bad...

I have worked at large metro EMS where they average >75,000 calls a year to EMS that only ran 4,000 calls (which was the most advanced and agressive, as well hardest due to tranport time was an average at least an hour to a tietarary center) and as a trauma/ER nurse at multiple trauma centers.


* I see you are a Fed/Officer, we are about 35 miles from one of the largest "holding areas, processing areas" in OKC....

R/r 911

Thanks for the response. That explains a lot to me. Different providers have differing opinions on things related to EMS and I have often found that the main contributing factor seems to be the types of agencies you work for, which intern relates to call volume, system size, number of trucks on the road and etc., etc., etc.

Yeah, we have a large transfer center there in OKC...overall this BOP gig is pretty good...low stress, good money and good bennies...can't complain.

 

[fm_emt]

Ridryder, how long have you been in EMS?

I think he intubated Moses once.

 

[Ridryder911]

No, but you should have seen all the falls I worked while crossing the sea.....(p.s. where do you think the caduceus came from on the Star of Life)...LOL

R/r 911

 

[Flight-LP]

:wacko:

With out EMT there would be no Paramedic. Look the National Registery Patch. What does it say????

Say what you want you are just an EMT with a p instead of a b. You can not treat what you don't asses. And Assessment is an EMT-B skill.B)

Yes, assessment is a basic SKILL. Again, anybody can be trained to perform a skill. But to utilize a critical thought process and identify potential differential diagnosis' along with creating an optimal treatment plan is an action that few EMT-B's have the ability to do. 120 hours of an advanced first aid class is not nearly sufficient to instill that quality...............