EMT-B/BLS care is there a point??

[firemedic7982]

Yes, I have had several partners that were Basic and were very highly educated, but it did not matter in regards to clinical care.. they could diagnose an "Widow Maker AMI" but could not do squat for it because they were not licensed to. In the same regards I am cautious for anyone that is supposed to be so educated not realizing this.

Here you go making presumptions again. You presume that just because I state that Im educated beyond my patch that I dont recognize my clinical boundaries. My clinical boundaries are what frustrates me, and thus why we further our education, and our clinical certifications. I do not, nor will I practice beyond my patch. Its illegal, and it's unethical.

 

[skyemt]

gosh... sooo many bruised Basic egos out here...

how about this... why don't we all just practice our skills, and advocate for the patient to the best of our abilities within the scope of our levels.

if we feel we want to do more, than we can get a higher level of certification.

all of the "worth less", "worth more", "first aid", etc comments are just a waste of time, and mean nothing to the patient.

if you take a step back, until the system changes, it is pretty simple. be the best you can be at your level, and if you want to do more, move up, instead of trying to "redefine" the perception of what the level is in the first place.

just remember, the patient doesn't give a hoot about any of this... they just want the best care possible.

 

[Ridryder911]

Here you go making presumptions again. You presume that just because I state that Im educated beyond my patch that I dont recognize my clinical boundaries. My clinical boundaries are what frustrates me, and thus why we further our education, and our clinical certifications. I do not, nor will I practice beyond my patch. Its illegal, and it's unethical.

No one was making assimptions, if you know you do not, then there will be no issue. Although, there has been numerous postings here and other forums that many do exceed and want to obtain the "skill" before obtaining the knowlege portion.

Not all in EMS is worried about illegal procedures or ethics. I wished I could say it was different.

R/r 911

 

[BossyCow]

No one was making assimptions, if you know you do not, then .........R/r 911

Now, if we could just get you to work on your spelling....... a-s-s-u-m-p-t-i-o-n-s

 

[NREMT08]

I will tell you why. Basic levels have held EMS back for decades now! The curriculum was watered down in the mid 90's to not to have teach "too much medical & technical" reading. Even now, the Basic EMT text is written at a 6'th grade level. NO where else in medicine does one read about BLS vs. ALS because MEDICINE is MEDICINE. There is NO levels.. You deliver PATIENT CARE!. Period!

As well, all the levels EMT-I, EMT/CC, EIOU, etc.. ALL are again in lieu or being compared to the gold standard of the Paramedic. Excuses and that is it! Seriously, it has been over 40+ years and many communities still do not have the advanced care provided by TV's Johnny & Roy Emergency from the 70's. Why? Because the public assumes EMT's & Paramedics are the same.. the same comparison as one comparing CNA & RN's.. ludicrous. The public is usually duped assuming one that has taken a little more than a 150 hour advanced first aid class is actually administering medical care. Misleading.

Look at other countries.. Yes, we started the ball in the early 70's unfortunately we dropped it in the early 90's. We should had eliminated the Basic Level altogether except for MFR, as they are solely designed for. Yes, keep the Basic Level for those that are going to first respond, very remote areas where skill deterioration and ALS is nil to none. Again, don't confuse the public and medical community though, it is medical care. Look at our neighbors towards the North and other countries such as Australia & South Africa.

Unfortunately, we teach EMT's that after a 150 course that is much more than what it is . It is only & only a ENTRY level. The very basics.. anything less would never be considered anything related medically.

I believe what aggravates most professionals on this site (if you notice, very few stay here) is for some reason many posts that they are already experts in this profession, just after taking the entry level course.. and some have not done that! When in reality they have less than 5 years experience or less than a thousand patient contacts, in which most professional EMS services consider being a novice.

We will always have Basic Levels... what and where they are used is currently changing. We need to emphasize in the EMT curriculum, this is ONLY the beginning. One can have an opinion about EMS, but in reality until you have became educated, experienced then you research instead of basing upon emotions.

Am I mad? You bet! Communities are placing their patients in jeopardy. Communities that could have ALS but place BLS instead. Placing BLS units where ALS should be. Patients having AMI's without proper diagnostics and treatment, fractures without analgesics, vomiting with aspiration, eclampsia deliveries without magnesium, etc...

Only in EMS and EMS forums will you find posts on how we should lowering our standards or attempting to justify lower care.

R/r 911

I used to think you were an intelligent person, I used to value your opinion, and I used to look forward to reading your replies, but now, not any more, I simply cannot believe you wrote this, have you forgotten where you came from?

you once were a EMT-B as well, you have to start from the bottom to get to the top, that is how skill and mastery are learned, from the bottom up, and this is true in everything, you don't start out a master carpenter, you start by building treehouses and bike ramps as a kid, see the point here?

wherever you are and whatever you are doing, you always learn the basics first, the people with more knowledge are the ones that teach and share their knowledge with you, and if there is no one to teach, then no one will learn, therefore, those people with greater knowledge; more is expected from,

you have a lot of letters behind your name, and someone had to "show you", so please do not look down on those of us who are young into our journey, I am not just an EMT, I am a damn fine EMT, as one of my instructors said,

and I will be attending Paramedic school after I complete my Fire cert. I did not get this far in my journey without people to "show me" I cannot learn this alone, and there are things that some of my FF/Paramedic friends can teach me that I could NEVER learn in a book,

you can also be like that for someone, imagine all the experience and knowledge you could share with the "young ones" if you just softened your heart a bit and remembered, all of us start from the basics.

God Bless

 

[mikeylikesit]

I used to think you were an intelligent person, I used to value your opinion, and I used to look forward to reading your replies, but now, not any more, I simply cannot believe you wrote this, have you forgotten where you came from?

you once were a EMT-B as well,

God Bless

Rid has posted several times that he was never a basic i believe. yes most start from the bottom and thats one thing...but staying at the bottom just looking up and the top and not willing to take the journey is another.

 

[VentMedic]

you once were a EMT-B as well, you have to start from the bottom to get to the top, that is how skill and mastery are learned, from the bottom up, and this is true in everything, you don't start out a master carpenter, you start by building treehouses and bike ramps as a kid, see the point here?

wherever you are and whatever you are doing, you always learn the basics first, the people with more knowledge are the ones that teach and share their knowledge with you, and if there is no one to teach, then no one will learn, therefore, those people with greater knowledge; more is expected from,

you have a lot of letters behind your name, and someone had to "show you", so please do not look down on those of us who are young into our journey, I am not just an EMT, I am a damn fine EMT, as one of my instructors said,

and I will be attending Paramedic school after I complete my Fire cert. I did not get this far in my journey without people to "show me" I cannot learn this alone, and there are things that some of my FF/Paramedic friends can teach me that I could NEVER learn in a book,

you can also be like that for someone, imagine all the experience and knowledge you could share with the "young ones" if you just softened your heart a bit and remembered, all of us start from the basics.

God Bless

Rid and I are from the same generation where EMS was meant to be a higher education and we were encouraged to get our Associates degree. That was in the 1970s. Nursing was as that time making the transition from diploma to degree. It was actually thought that the Paramedic would emerge as the stronger profession for awhile. In my degree program, the EMT was meant to be a certification like CNA so one could get some experience or extra money working on the ambulances while FINISHING their degree. It was not to be an end all profession. FFs were required to have EMT but initially Fire Fighting was the primary focus of their careers. Later did it become a requirement to also have the Paramedic cert to be a FF in some areas as Fire Based EMS grew in popularity and many mergers occured.

I believe that once you finish your Paramedic cert you will understand some of this.

None of the comments made by those with "fancy letters" are meant to demean anyone in anyway. Rather, one should see that there it is still alot of learning to do. I've been practicing my education skills for over 40 years and plan to continue working on them for another 40. 150 hours is just one small drop in a large ocean of knowledge.

 

[NREMT08]

Rid and I are from the same generation where EMS was meant to be a higher education and we were encouraged to get our Associates degree. That was in the 1970s. Nursing was as that time making the transition from diploma to degree. It was actually thought that the Paramedic would emerge as the stronger profession for awhile. In my degree program, the EMT was meant to be a certification like CNA so one could get some experience or extra money working on the ambulances while FINISHING their degree. It was not to be an end all profession. FFs were required to have EMT but initially Fire Fighting was the primary focus of their careers. Later did it become a requirement to also have the Paramedic cert to be a FF in some areas as Fire Based EMS grew in popularity and many mergers occured.

I believe that once you finish your Paramedic cert you will understand some of this.

None of the comments made by those with "fancy letters" are meant to demean anyone in anyway. Rather, one should see that there it is still alot of learning to do. I've been practicing my education skills for over 40 years and plan to continue working on them for another 40. 150 hours is just one small drop in a large ocean of knowledge.

I agree, and I have always planned on continuing my education, who knows, maybe some day I will be a Doctor, but the point I was trying to make is that everyone has to start somewhere, I would not stay an EMT, but I would like to practice as one for a while before I go and get my Paramedic, as I said before, it is just another step along my journey, and I will be a student for life , I am a master of NO skill and No trade, when I think I am, then I have a problem, and I sincerely hope no one has taken offense to my previous post, because it was written in a non-hostile manner, at least thats what I was aiming for anyways.

 

[NREMT08]

Rid has posted several times that he was never a basic i believe. yes most start from the bottom and thats one thing...but staying at the bottom just looking up and the top and not willing to take the journey is another.

Mikeylikesit, I have never, ever, in any post whatsoever, said anything to the effect of not wanting to continue my education, and I am definitely not the type of person who just looks up at the top and never takes the journey, thats not my style, I am a go getter, a survivor of many many things, and if there is something I want to know, a skill or whatever, I go looking for the answer, I also would appreciate it if you would not cut my posts into pieces when you reply with a quote, as it defaces the meaning of the sentence, one single sentence taken out of a paragraph and re-posted can appear to have a very different meaning than what the writer originally intended, and this is how disagreements begin, when one persons thought is twisted into another meaning, therefore making it look like a person had said something that they have actually not.

 

[CFRBryan347768]

Mikeylikesit, I have never, ever, in any post whatsoever, said anything to the effect of not wanting to continue my education, and I am definitely not the type of person who just looks up at the top and never takes the journey, thats not my style, I am a go getter, a survivor of many many things, and if there is something I want to know, a skill or whatever, I go looking for the answer, I also would appreciate it if you would not cut my posts into pieces when you reply with a quote, as it defaces the meaning of the sentence, one single sentence taken out of a paragraph and re-posted can appear to have a very different meaning than what the writer originally intended, and this is how disagreements begin, when one persons thought is twisted into another meaning, therefore making it look like a person had said something that they have actually not.

I do not think that Mikey was saying that directly to you, I think what he was trying to say, correct me if I am wrong Mikey is that from Rid's point of view you are supposed to provide the best care, and that a 150hr. class isn't cutting it. Like Vent explained, it was a diffrent time period when they started, which is where their opinions, and mine are coming from.

 

[mikeylikesit]

I do not think that Mikey was saying that directly to you, I think what he was trying to say, correct me if I am wrong Mikey is that from Rid's point of view you are supposed to provide the best care, and that a 150hr. class isn't cutting it. Like Vent explained, it was a diffrent time period when they started, which is where their opinions, and mine are coming from.

Thanks Brian...exactly my point. no it was not directed at you but i did use your post as a referance point.

 

[VentMedic]

I really wish EMS could have held its momentum from the 1970s. It was an exciting time. I may have noticed it more because Miami was part of the initial EMS movement. It also had a large Diploma nursing school. The talk was centered on education as degrees and professionalism were in the spotlight. If the Paramedic degree had stayed its course to become the standard for entry into EMS, who knows what this profession could have evolved into. Rid's Paramedic Practitioner model that he supports could have been a reality a decade ago.

Many of the healthcare professions you see in the hospital today were not established at that time. Most were OJT or nurses picked up radiology, RT and lab skills. Respiratory Therapy was certified by a national organization but did not achieve licensure in many states until the mid-late 1980s. Radiology, Radiation, HBO and Nuclear Med Technologist were also part of the OJT movement that finally started to get recognition with licensure when their education levels increased. They also realized that their weakest links by education and certification were harder to fit into a work schedule as technology and patient care demands increased. People had to have advanced education and skills to work in many of the patient care areas.

When you look at the big picture of healthcare and its advancements, EMS is not young when compared to other professions including nursing. Yet, it has made the least advancements as a profession when compared to all the others. One could even include Phlebotomy which is now getting its own certification and more states are pushing to make it the standard. Massage Therapy has even become a recognized and licensed healthcare profession with solid reimbursement recognition. Massage Therapists have the option for a 2 year (Associates) degree complete with A&P, Microbiology, English and Math for prerequisites. Many states are considering raising their entry requirement to at least 1500 hours or eventually the Associates. And yes, they are strongly represented by State and National organizations for legislative power.

 

[Ridryder911]

Now, if we could just get you to work on your spelling....... a-s-s-u-m-p-t-i-o-n-s

You got me! No excuse, I was working as Supervisor and on a truck and was typing in between calls and business.... as they now say..."my bad".

I used to think you were an intelligent person, I used to value your opinion, and I used to look forward to reading your replies, but now, not any more, I simply cannot believe you wrote this, have you forgotten where you came from?

you once were a EMT-B as well, you have to start from the bottom to get to the top, that is how skill and mastery are learned, from the bottom up, and this is true in everything, you don't start out a master carpenter, you start by building treehouses and bike ramps as a kid, see the point here?

wherever you are and whatever you are doing, you always learn the basics first, the people with more knowledge are the ones that teach and share their knowledge with you, and if there is no one to teach, then no one will learn, therefore, those people with greater knowledge; more is expected from,

you have a lot of letters behind your name, and someone had to "show you", so please do not look down on those of us who are young into our journey, I am not just an EMT, I am a damn fine EMT, as one of my instructors said,

and I will be attending Paramedic school after I complete my Fire cert. I did not get this far in my journey without people to "show me" I cannot learn this alone, and there are things that some of my FF/Paramedic friends can teach me that I could NEVER learn in a book,

you can also be like that for someone, imagine all the experience and knowledge you could share with the "young ones" if you just softened your heart a bit and remembered, all of us start from the basics.

God Bless

As a veteran healthcare provider and educator, I have used many methods to attempt to change attitudes. In the past I used the "softer" approach and it has not worked. The new younger generation appears to have to have the more direct "in your face approach". Many will not respond unless they are motivated to change things.

I know I have irritated many on this forum. Good! I do not so much care for one to see my exact point but to really think! Now, I hope you look and go beyond go past what you were taught and have been exposed to. Again, look beyond your box! Examine other successful health care professions that have increased their role in patient care & outcomes, increased standards as well upward growth.

Again, I have seen and studied many different approaches of EMS, not just in patient care but again as a whole system. In the way many of those in EMS do not approach or ever look at. Yes, patient care should be our utmost important goal, but just only one part and we should be looking towards ways that will developing and producing the best for not just the patient care, but the system as well.

As Vent describes, we come from a different generation. I can tell you it was an exciting era; we where just coming out of the "ambulance driver" mode to oh they are just a "technician" phase to WOW they are educated and actually know what they are doing! Yes, as Vent described this is something we fought hard to overcome. We wanted more and we knew that they only way to do this was to keep striving for better and more improved standards. This meant more education. We looked at other professions and examined & seen that their role was increasing in patient care, they were getting recognition in the form of respect from peers, patients and pay with benefits. We too wanted the same. We knew the only way to do so was change in our system and that was going forward through a formal education.

One can be the "best" the "greatest" EMT, Nurses Aide, or Environmental Technician (Janitor) but it still does NOT change the current curriculum or the way you were taught. Nor does it change the limitations of this position because of the poor requirements and again the poor associated curriculum. Again, just because one has mastered this entry level does not make them or allow them to provide the needed and required care for the critical or those requiring emergency medicine.

Again, I do wish readers would quit taking such statements personally and out of context. Again my opinions are based upon the "system" and the education or lack of in that system. EMT's should evaluate that their training was only the tip of providing care. Anything less would be considered non-medical, and with this minimal training, one does NOT have the education and knowledge needed to evaluate how EMS and details of what patient care should be delivered. Again using my analogy; one would not ask a nurses aide on how & what the nursing profession should consist of. Nor what type of interventional therapy methods should be sought also what type of educational standards should be in place. As one, I can assure you they probably would listen and then inform you that you lack the required knowledge to see the "whole picture" as well lack the educational and clinical background needed to make such decisions. Which would be only correct. I feel the same only being that being in the EMS profession.

Many fail to understand the only reason we ever had multiple levels was we were in the infancy of a profession. It was NEVER meant or intended to keep such lower levels. There was not many zero to Paramedic programs. In fact my practical testing was evaluated by specialized physicians in those areas because there were not Paramedics to evaluate. Yes, I took and became a NREMT Basic test after my Paramedic course. The NREMT Paramedic test was not developed until the early 80's. We naturally assumed the education process would continue upwards and the lower levels would finally be phased out or be abolished. Not ever considering we would or even want to continue to remain in our infancy mode. Don't believe me? Look other countries EMS systems. They took our ideas and proceeded and built upwards where we failed and did not.

Unfortunately, we have continued to install the same propaganda that is taught in almost all EMT courses. The same thing we have been doing now for nearly forty years. We want to encourage and motivate students therefore; we do install a false doctrine that they actually represent more a medical provider than they really are. When in fact, it should be stressed and emphasized over & over that they are just the entry point of the profession and have very limited knowledge in providing care to a patient. Again, just a little above first aid. Does this mean that position is less important or not have weight? No. Again the role needs to be changed. In reality the Basic EMT is just one part of EMS (albeit an important part a very small part) and definitely not the role as an expert in care or the system.

How much emphasis was placed in your training that your primary role was just to stabilize them until further help arrived or was it taught for you to be able to treat and transport the patient? Well, if your instructor was following the curriculum, it would be the later.. Again, not the fault of the instructor or student or even the text, rather the system. Yes, the current system needs to be eliminated and revamped. Apparently what we are doing is failing and will continue do so until it is changed.

I ask how much were you taught in your EMT class about EMS as a system? How much discussion of professionalism was taught, billing and compensation issues, what legal topics was covered, rules of certification processes versus licensure, managing personnel, and of course EMS research and development? Was this topic covered in one hour, one class, one semester, one year, four years...more?

See where I am going?

 

[Foxbat]

How much emphasis was placed in your training that your primary role was just to stabilize them until further help arrived or was it taught for you to be able to treat and transport the patient? Well, if your instructor was following the curriculum, it would be the later.

This is what PA protocols say:
http://www.dsf.health.state.pa.us/health/lib/health/ems/bls_protocols_2004.pdf

2. If transport time by BLS to an appropriate receiving facility can be accomplished before ALS
can initiate care, then the BLS service should transport as soon as possible and should not
request or should cancel ALS.
3. BLS services should not delay patient care and transport while waiting for ALS personnel.
If ALS arrival at scene is not anticipated before initiation of transport, arrangements should
be made to rendezvous with the ALS service.
_____________________________________________
Notes:
1. BLS personnel should initiate patient care and transport to the level of their ability following
applicable BLS protocol(s).
2. In the case of a long BLS transport time with a nearby ALS service coming from the opposite
direction, it may be appropriate to delay transport for a short period of time while awaiting the
arrival of ALS if this delay will significantly decrease the time to ALS care for the patient. When
BLS transport time to a receiving facility is relatively short, this delay is not appropriate.