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

[JPINFV]

however you do have to be a doctor in order to become an anesthesiologist. Is this not another level in the medical field?

Apples and oranges. You complete medical school and you specialize. The era of the 'GP' (no speciality and just completing an intern year to become fully licensed) is essentially long gone and most primary care physicians practice a sub-specialty of internal medicine (which is a specialty in itself) or the specialty of Family Medicine. In general you won't see a physician go through an IM or FP residency and then after practicing for 10 years go through a second residency to become a surgeon, anesthesiologist, other other specialty. . So, no, anesthesiology is a specialty, not another "level" of care.

 

[curraheemed]

Are you certain that they do not need that EKG? Really, what if they had a history of vertigo prior to fall? Ever heard of Sick Sinus Syndrome? IV's.. pain med.'s.. Really, you maybe a tough one but Granny might like that analgesic for a comminuted fracture, and yes I am sure they would like it IV in lieu of I.M..... yes, even just 3' in height. Again, the reason why ALS should be on each every call to assess and treat. The reason many basics assume calls are so simple, is because they have not been taught it might NOT be as simplistic as it seems...

R/r 911

How about this for the scenario? It was a five year old girl who was pushed off the porch by her 7 year old brother! You automatically assumed something worse.

I've read multiple posts from you, and it seems like you think that everyone who is not the same level of training as you must be an idiot. There are reasons that some of us start out where we do. I can't currently get any advanced training. I am stuck at this level due to the bureaucratic BS that is the military. I fully agree that there should be ALS at all calls, but that doesn't mean that there is no need for basics.

 

[CFRBryan347768]

How about this for the scenario? It was a five year old girl who was pushed off the porch by her 7 year old brother! You automatically assumed something worse.

I've read multiple posts from you, and it seems like you think that everyone who is not the same level of training as you must be an idiot. There are reasons that some of us start out where we do. I can't currently get any advanced training. I am stuck at this level due to the bureaucratic BS that is the military. I fully agree that there should be ALS at all calls, but that doesn't mean that there is no need for basics.

What if the girl sustained an undected head wound and SHTF in the rig (sorry I cant be more specific I couldn't come up with any severe condition, that would most likely occur) and their were no ALS providers on board then what? I think in EMS you HAVE NO CHOICE but to assume the worse, it is your rear end on the line if YOU fault some where.

Secondly, because you can't obtain a higher level of training right now what gives you the right to assume that their is nothing wrong? Shouldn't you be trying to learn from people like Rid who have so much more knowledge? If the ALS providers had cleared and said she will be fine in BLS care then that would be a diffrent story.

 

[curraheemed]

Secondly, because you can't obtain a higher level of training right now what gives you the right to assume that their is nothing wrong? Shouldn't you be trying to learn from people like Rid who have so much more knowledge? If the ALS providers had cleared and said she will be fine in BLS care then that would be a diffrent story.

What gives me the right is the fact that I was on this call, I am very close with the family, and I got to read the doctors reports from the ER where she was given a CAT scan, and was cleared from any head injuries. The treatment that they gave her was nothing more than a cast, and a sticker.

P.S I was on a BLS/ALS combined rig

 

[JPINFV]

As for levels being a diluted curriculum I think that is a arrogant comment to make. It is not about diluting the curriculum it is about allowing a person to grasp the knowledge being handed down to them. Any good medic knows you use your basic skills before your advanced skills and a lot of the time basic is what is needed. LOC! ABC!

"Preface
...
The EMT Basic curriculum is a core curriculum of minimum required information, to be presented within a 110-hour training program. It is recognized that there is additional specific education that will be required of EMT Basics who operate in the field, i.e. ambulance driver training, heavy and light rescue, basic extrication, special needs, and so on. It is also recognized that this information might differ from locality to locality, and that each training program, or system should identify and provide special training requirements. This curriculum is intended to prepare a medically competent EMT Basic to operate in the field. Enrichment programs and continuing education will help fulfill other specific needs for the EMT Basic's education.

Curriculum

History
...
The following priorities from the 1990 consensus workshop recommendations played a directing role in the revision of this EMT Basic Curriculum:

...

Revise basic course to be no more than 110 hours in length.

-NHTSA National Standard Curriculum
http://www.nhtsa.dot.gov/people/injury/ems/pub/emtbnsc.pdf

Is it really that arrogant to believe that there's something wrong with thinking that you can teach someone to provide competent emergency care in 110 hours? Is it really that arrogant to think that if the goal of a curriculum rewrite was to trim it down to 110 hours that something was going to be diluted?

And there being no levels in the medical field...That is again an arrogant comment to make. Here is a list of levels in the medical field (I am sure I will miss a few):
EMR
EMT-Basic
EMT-Advance
EMT-Paramedic
EMT-Critical/Fligh Medic
LPN
RN
RPN
NP
Doctor-General Practictioner
Doctor-Surgeon/Specialist


All these levels require different amounts of training and even more when you specialize. So before you say there is no levels in the medical field maybe ask around.

EMS levels are irrelevent as 'evidence' since the entire point of the discussion is about those levels. Nursing is not medicine, but nursing. Sorry, both very related and intertwined, but not the same thing. Finally, as I mentioned in my prior post (I'm replying out of order), 90+% of GPs are specialists and most physicians don't practice for a while and then go back to residency. Thus you can't say that one speciality is higher than another. There are just different skill sets that are used to treat different diseases. This is not the case in EMS where paramedics have the entire EMT-Basic skill set and education (regardless of if they went through EMT-B or not) plus additional education and skills.

My problem is that everyone always picks on the litle guy. We are all equal! Sure we have a different knowledge base but that doesn't mean you are a better medic then me. Just means you went and got more education that I have and can provide different medical treatment then me. That is a good thing.

1. This isn't about "picking on the little guy"
2. If there are different knowledge bases and one knowledge base contains all of the information in the second plus additional information, then how is it equal?

 

[JPINFV]

As for the topic though, 90% of all calls are BLS.

How many of those calls don't even need an ambulance?

 

[CFRBryan347768]

What gives me the right is the fact that I was on this call, I am very close with the family, and I got to read the doctors reports from the ER where she was given a CAT scan, and was cleared from any head injuries. The treatment that they gave her was nothing more than a cast, and a sticker.

P.S I was on a BLS/ALS combined rig

Last time I checked we can't perform CAT scans, so that was done AFTER our care. What is done AFTER our care is nolonger my problem once the forms have been signed.

 

[hitechredneckemt]

First NREMT does not include any level of nursing.The last time i checked national curriculum stated that a person could not become a paramedic with out being at least a basic. I dont understand why Rid is so against basic EMTs. Im a basic and am very proficient in my skills. All of my EMS training has been trough a state accredited school. I get very offended when people say that basics are not necessary in the EMS field.

 

[Hastings]

How many of those calls don't even need an ambulance?

Many 911 calls in general don't need ambulances. Nature of the job.

 

[JPINFV]

First NREMT does not include any level of nursing.The last time i checked national curriculum stated that a person could not become a paramedic with out being at least a basic. I dont understand why Rid is so against basic EMTs. Im a basic and am very proficient in my skills. All of my EMS training has been trough a state accredited school. I get very offended when people say that basics are not necessary in the EMS field.

1. Don't get offended, especially if you don't defend EMT-Basics. What does a basic bring to an emergency scene that isn't done better by a paramedic?

2. Plenty of states allow health care professionals to challenge or take truncated classes. For example, California:
http://www.emsa.ca.gov/paramedic/faq.asp See question/answer 10.

3. Knowledge is more important than skills and most EMT-Bs and EMT-B programs are very ignorant of biology and medicine, in large part because it is neither expected or required of them.

 

[JPINFV]

Many 911 calls in general don't need ambulances. Nature of the job.

So isn't saying that EMT-Basics are good for 'BLS' calls kinda of misleading since someone with zero medical training/education can handle them just as easily?

 

[triemal04]

MDKEMT-
Come, get the chip off your shoulder, really, why is it there in the first place? This is a US-based site with 99% of the people here being US providers. So when a level of care is talked about, it's the US level of care, not Canadian. Just keep in mind that the Canadian PCP is well beyond what an EMT-B is, not neccasarilly in skills, but in what you get taught. The assumptions are not really assumptions, just what most of us have seen of US EMT-B providers. Seriously, nobody is talking about anyone north of the border, so calm down.

For MD specialties...no no and no. The original point is that if you want to be a doctor, you go directly to that level, you don't have to be a PA first; same for RN's...no need to be an LPN or CNA. RT's are the same. Once you are there you may choose a specialty, but you got to that level without any initial training to speak; directly from Joe Blow on the street to Dr. Joe Blow.

Sure, you can say we are all equal as people, that's fine, but not applicable. As patient care providers, we are NOT all equal, we are NOT all the same, and education IS one of the things that makes a higher level provider better than a lower one. (granted, not all the time, but the majority of the time...yes) A paramedic does not just have a different thought process than an EMT-B (US system here, take note), they do almost an entirely different job. Is a CNA equal to an RN? Nope. PA to MD? Nope. Why should there be a difference in EMS?

In the US, an EMT-B really can't do much that a well-trained Boy Scout can't. Really, that's the case. Hell, they can't do much more than a certified first responder can.

It definetly can be hard to get the funding and time to advance to the next level. But, if this is your choosen profession, and you really care about it and your patients, you find a way (not you in particular, just a general you). How long it takes doesn't matter, it the doing it that counts.

 

[Vizior]

OK, there are way too many people here, who are basics, talking about being very advanced basics, and therefore good providers. That is an awful attitude to have, I don't care how much you've studied in addition to the curriculum, there is absolutely no excuse to not pursue advanced training. If you are not happy that people only want to entrust patients to a higher level of training, either leave the profession, or work to pursue the higher level of training. If you have to wait a time period, and work, and that basically means driving, I feel bad about your situation, however, just study hard and you'll eventually reach your goal.

I'm not gonna argue the BLS vs ALS argument, I just don't understand why someone would take it personally that there are individuals out there that would rather have ALS on every ambulance. At least at that point every patient is seen by an ALS provider prior to transport. If you wanna BLS a call, by all means, I mean after all, not every patient gets an IV and monitor at the hospital.

But tell me, aside from COST, what is an argument towards having a purely BLS ambulance running emergency calls, as opposed to an ALS ambulance?

 

[Jon]

Ok folks.

We all know that this is a real hot-button issue. Please keep it civil... you are doing an OK job so far.

 

[Jeremy89]

Unlike Rid, I chose to skip the Medic until I can master the basic skills. For some people, jumping right into the Medic is fine but I'd rather take my time, go for the nursing, and get the medic later. I heard from my instructor and some other guys in my class that preceptors and others in the field do not like medic students who came straight from basic school and in fact look down on them for doing so. How would it feel to be in an ambulance for the first time on your medic clinicals? What do you do when your preceptor asks you to perform a basic skill but you've never actually done it before?

Like I said, it works for some people but not for me. Just some food for thought.

 

[Vizior]

Unlike Rid, I chose to skip the Medic until I can master the basic skills. For some people, jumping right into the Medic is fine but I'd rather take my time, go for the nursing, and get the medic later. I heard from my instructor and some other guys in my class that preceptors and others in the field do not like medic students who came straight from basic school and in fact look down on them for doing so. How would it feel to be in an ambulance for the first time on your medic clinicals? What do you do when your preceptor asks you to perform a basic skill but you've never actually done it before?

Like I said, it works for some people but not for me. Just some food for thought.

That's why you're a 3rd rider, as opposed to the sole provider. You are there to learn... most of your opportunities for clinicals do not bar you to only do the bare minimum. If you're having trouble with skills, basic or advance, you can normally keep working at it until your preceptor says that you are well trained in it. Most medic classes involve a lot of clinicals for a reason, it ensures that you are a competent provider, because some employers don't want to take the time to ensure that you learned what you needed to in-class, thats why you got certified by the state.

I hate to keep going back to the RN analogy, but it's one of the few available to us: is an RN student expected to have already mastered the techniques behind moving a patient, and caring for a person's basics needs(such as placing someone on a bed pan) before starting his or her clinicals? However, to completely the analogy: yes, someone who has done the skills before will spend less time working on the basic techniques, and spend more time focusing on the more advanced skills, possibly cutting down on the amount of time it takes to be proficient, however, it does not make the student who never worked as a basic any less proficient as a provider.

 

[Ridryder911]

How about this for the scenario? It was a five year old girl who was pushed off the porch by her 7 year old brother! You automatically assumed something worse.

I've read multiple posts from you, and it seems like you think that everyone who is not the same level of training as you must be an idiot. There are reasons that some of us start out where we do. I can't currently get any advanced training. I am stuck at this level due to the bureaucratic BS that is the military. I fully agree that there should be ALS at all calls, but that doesn't mean that there is no need for basics.

I call BS... If you really wanted training it is available. There is private institutions is there not? You chose to be in the military (which I honor you) but that again was your choice and no one else's. So yes, there is always always o get education and training. It is again, how much sacrifice and desire one wants to pursue to get it.

I worked full time (72 & 96 hr. work week) when I went to Paramedic & Nursing school, and was married with a newborn.. never not worked during school. If I can do it, anyone can... Now, if you want the military to pay for it or it to be a military sanctioned course that is something entirely different... but again, the training and educations is available.

I never called EMT's idiots. People assume that because you describe the facts and challenge to break the myths that has been ingrained in them, you are wrong. Compare advanced first aid courses, even the official medical first responder course curriculum with the EMT Basic level. Now, tell me the difference in a EMT & a MFR. ... Again, as a medical professional, one needs to understand medicine and the required knowledge in providing care to an acute illness or injured patient. Something they do not teach in the Basic EMT curriculum. Yes, I am very aware of it..

Again, nothing personal... just the EMT level is not qualified enough, with the current training. Unfortunately, most do not understand that because they again do not understand true medical care.

To your scenario.. your darn right I assume the worse. That is what they pay me for and what I went to school for. Any EMT that does not is worth their weight. You acclaim to be trauma specialist.. so here is one for you. Do you know how to perform a thorough neurological exam on a child? ... What is unique in the neuro test & trauma of a cervical spine in a child < than 7 years old? And why do physicians not even trust X-rays? ... Yes, I assume the worse, I have seen the worse.. You know what they call EMT's that don't?... Defendants...

R/r 911

 

[emtsteve87]

I agree with Rid, even as a Basic. I know that there is a lot that I need to learn to give proper care to patients. I'm not content knowing advanced first aid, I want to and will learn all that I can in regards to this field. Which is why I'm a medic student and eventually a nursing student.

In regards to the scenario, why wouldn't you assume the worst? Even if it is a family that is close to yours, I would still assume the worst so then I know that EVERY base is covered.

 

[mdkemt]

Alrighty,

This is the last I will speak on this topic because I feel we have nit picked at every angle. From now on I will assume you are referring to US standards. I also understand that my level of training is higher then the basic in the states.

I still feel it is important that we do not discourage people from becoming EMT-Basics and seeing if this is a career they can do. I do not in Canada only drive. That is not a standard of practice here. Sure some people may want ALS but when you are injured and need help you will almost all the time take what you can get. If ALS is available and I feel there is a need I will call.

I do have extensive A&P from school. Something they stress on in our curicculum here. And yes they do have work requirements here before you can go to the next stage in training. I think this is a great thing because I think it is important to make you know your basic skills and not forget to use basic skills first and then move into your advance skills once you get them. Our instructors here say that is the best system they have seen. That is their view. I agree because so easily do we get tunnel vision and go only one direction. Often we find one problem and ignore the rest. It happens. I am not saying anyone on this community chat does this but it happens.

I am looking forward to taking my advance training and here when you complete it you can challenge the RN in which I also plan on doing. To all those EMT-Basics keep up the good work!

MDKEMT

 

[Jon]

How would it feel to be in an ambulance for the first time on your medic clinicals? What do you do when your preceptor asks you to perform a basic skill but you've never actually done it before?

Like I said, it works for some people but not for me. Just some food for thought.

Jeremy,

This is a problem with several local paramedic programs... they are run as for-profit operations that don't care what the student's history is... so long as the school is getting money for having the student in class

Some of these schools run students from "Zero to Hero"... they start as nothing, get a fast-paced EMT-B class, and then on to medic school. At least one of the schools has Paramedic students preform ride time functioning at the BLS level.

I think that although a rare person can come out of that program and be successful... many, many more drop out and fail to complete the course.