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

[enjoynz]

Well what does the patient think about all this?????

I bet you a large percentage of them wouldn't have a clue what the difference between a EMT-B, I or P is! Unless we were to say to them, we need a person with a higher skill level to give them pain relief, etc,etc.
They are just pleased to see you pull up, in the hope that you can help them!
If the call is one that a BLS can't control, they call for back up or load and head for the back up!
It's a waste of resources, time and money sending a ALS to a ETOH that has fallen over and needs a help up, or little Johnny with a cut finger, when they should be heading towards say, a Cardiac Arrest in the opposite direction!

Cheer Enjoynz

 

[Ridryder911]

Well what does the patient think about all this?????

I bet you a large percentage of them wouldn't have a clue what the difference between a EMT-B, I or P is! Unless we were to say to them, we need a person with a higher skill level to give them pain relief, etc,etc.
They are just pleased to see you pull up, in the hope that you can help them!
If the call is one that a BLS can't control, they call for back up or load and head for the back up!
It's a waste of resources, time and money sending a ALS to a ETOH that has fallen over and needs a help up, or little Johnny with a cut finger, when they should be heading towards say, a Cardiac Arrest in the opposite direction!

Cheer Enjoynz

Again, are you sure? Sorry, do you really know how to perform a detail neuro exam on a drunk, ever heard of that "drunk" turning out to be a diabetic? Of course you realize 20% of alcoholics have some form of chronic illnesses, & that they have a 15% chance of having a head bleed because alcoholism causes blood vessels to rupture more easier? Ever see a physician not order a CT on a drunk that fell & struck their head? .. Johnny with a cut finger does not need EMS or an ambulance, they need to be telephoned triaged by proper 911 communications dispatcher, and if necessary send a squad to place a band-aid on them. But every true patient needs to be evaluated by a Paramedic to determine injuries.

Yes, EMT's can handle majority of the calls after it is determined that there is no indication for ALS intervention or in need of more intense intervention. Yet it is the Paramedic that needs to make that determination. Sorry folks; a 15 page chapter of A & P (U.S.) is not enough knowledge to know about the body. Would you really would want your hospital staff to only have that much.. really think about it.

Would you want a nurses aide to perform the assessment of your child in a ER to determine if you need a Dr. or not? The same applies here...

In regards to the public will take what they can get & don't care is total bologna.! People assume they get a Paramedic on every call. That is what they see on t.v. They do not know the difference & from what I have seen most EMT's sure do not attempt to clarify either. You don't think they expect more then read the EMS News web site where they are suing everyday because a Paramedic did not do this or that...

Two EMS units instead of one, talk about wasted of resources. Now you have two EMS units for one patient? A roving Paramedic unit.... yeah been there, done that & it too was a waste of money. If I had just been initially on the truck, I could assess, treat, and transport all at one time. Don't sacrifice the patients health because the system is too weak to provide enough coverage. It is all in regards to money, not the patients health. ..something we all agree on.

R/r 911

 

[mikeylikesit]

Again, are you sure? Sorry, do you really know how to perform a detail neuro exam on a drunk, ever heard of that "drunk" turning out to be a diabetic? Of course you realize 20% of alcoholics have some form of chronic illnesses, & that they have a 15% chance of having a head bleed because alcoholism causes blood vessels to rupture more easier? Ever see a physician not order a CT on a drunk that fell & struck their head? .. Johnny with a cut finger does not need EMS or an ambulance, they need to be telephoned triaged by proper 911 communications dispatcher, and if necessary send a squad to place a band-aid on them. But every true patient needs to be evaluated by a Paramedic to determine injuries.

Yes, EMT's can handle majority of the calls after it is determined that there is no indication for ALS intervention or in need of more intense intervention. Yet it is the Paramedic that needs to make that determination. Sorry folks; a 15 page chapter of A & P (U.S.) is not enough knowledge to know about the body. Would you really would want your hospital staff to only have that much.. really think about it.

Would you want a nurses aide to perform the assessment of your child in a ER to determine if you need a Dr. or not? The same applies here...

In regards to the public will take what they can get & don't care is total bologna.! People assume they get a Paramedic on every call. That is what they see on t.v. They do not know the difference & from what I have seen most EMT's sure do not attempt to clarify either. You don't think they expect more then read the EMS News web site where they are suing everyday because a Paramedic did not do this or that...

Two EMS units instead of one, talk about wasted of resources. Now you have two EMS units for one patient? A roving Paramedic unit.... yeah been there, done that & it too was a waste of money. If I had just been initially on the truck, I could assess, treat, and transport all at one time. Don't sacrifice the patients health because the system is too weak to provide enough coverage. It is all in regards to money, not the patients health. ..something we all agree on.

R/r 911

Hence the fact that you see this quote in all the Basic books "call ALS immediately after arriving on scene." now i am not a basic hater i think that it is great that you want to help and that you do have skills that help injured people and people that need help in general. however like Rid stated if you want to be respected for having a skill and a profession then go out and get your training! You will never understand why medics will defend to the death the fact that EMT's are no where as important then medics unless you have paid your dues and went through medic school. the funny thing is that medic school wasn't even that bad. so if you want to get up on a high hoarse like you all of said then preach from it...but don't go through less intense training and expect room to complain. to answer the original question, Yes i think that BLS is important in the EMS field but not for the reason that some EMT's think and that is that EMT's and medics are the same or that actually believe that they save medics who don't remember their basics cause "their all full of that advanced stuff". No, we remember how to splint and apply gauze don't worry. you guys do help when a patient needs care and help and we can't attend to them because were loading drugs or reading a rhythm or have another patient that were working on while your doing CPR or Dfibing another patient. In the end though i still like having BLS or EMT-B or even FR around.

 

[Hastings]

Again, are you sure? Sorry, do you really know how to perform a detail neuro exam on a drunk, ever heard of that "drunk" turning out to be a diabetic? Of course you realize 20% of alcoholics have some form of chronic illnesses, & that they have a 15% chance of having a head bleed because alcoholism causes blood vessels to rupture more easier?

Just to jump in for a second, those actually ARE things that EMT-Bs here, in the US, and trained to do. They can perform a detailed neuro exam, as well as check their blood sugar. They have the knowledge and ability to, for instance, differentiate between a CVA and a diabetic emergency. The difference isn't in the assessment, but in treatment. Just treatment.

And while EMT-Basics may lack the education to know that drunks have a higher chance of having a head bleed, they have the skills to recognize where the problem is, and how serious it is. And really, when it comes down to it, that's what matters. The medic can't do any better, as diagnosis and treatment of that is impossible in the field.

 

[enjoynz]

Well as far as NZ goes, we don't follow the same protocols as the States.
Maybe if I was a little younger and had a spare $40.000, I would have looked at going to university for 3 years to become an Advanced Paramedic (EMT-P).
In New Zealand, most of our EMT-P's have been trained from the bottom of the field, and have had on-road experience, and many have started as volunteers. Either that, or they have done their advanced trained in other countries like England and South Africa for instance, and decided to come and live in NZ.
I don't know the figures, but there is only a small pertcentage of them compared to the majority of Ambulance personal in New Zealand.
So when they are needed for a job, you'd better really need them.

As far as the scenario I used before, we had a Etoh patient to deal with a few weeks ago. If we had called for ALS or even transported this person, we would have been in for a severe butt kicking. Of course the patient was assessed to ensure they were ok to stay at home.
We could split hairs all day over hear say.
I will say one thing though, about a case I heard about of a patient that ER hospital staff thought was Etoh. They left him sitting in the waiting room. He was having a hypoglycemic episode, which was picked up by a passing FR who thought he looked pretty sick and went to question him!

We all serve a purpose in EMS, in one way or another.
I couldn't see an EMT-P wanting to sit on station in a rural town with 4 calls a month. That would be a waste!!!

Cheers Enjoynz

 

[LE-EMT]

wow I don't show up for 24 hours and everyone goes crazy...... LOL

Ok I am not sure you all understood what I was going for or really ranting about. It was not a who's better then who and it sure as hell wasn't for all medics to jump on the bandwagon ( even some basics ) and start belittling the lower level of care. I was not looking to draw the lines and start an all out war here. although it makes me giggle a little because of all the heated back and forth.

Is it not true that Basics are needed? I am going to explain something with my limited knowledge and you all can retort.
I can almost assure you most of your als/medics aren't going to want or need to do an interfacility transport for a doctor visit, return from said doctor visit, returning to a nursing home from a higher level of care with no EQ or special precautions.
EMS- Do you medics want to or need to respond to every sick person, headache, and runny nose that gets a 911 call.
I am a dispatcher and I know for a fact that I have sent units on "BS" calls but I am not allowed to make that designation professionally because every call we receive we dispatch and as we should. I also know that working for one of the largest ambulance companies if not the largest in the greater southwestern region how short on medics we are. Which would lead to me to believe this is a nation wide trend.
I posed this same question to my trainer and supervisor and his answer went as fallows.... It would be impractical to send ALS on every call. Considering cost and man power its just impossible. It is far more expensive to equip a ALS unit then it is a BLS. the equipment and Meds alone are extremely expensive. Not to mention then you need the Medics to fill the units. You can see how many ALS units we have and how we are often short. There are times when BLS will suffice and ALS would be better posting for the next call we can utilize their abilities.

I agree with rid the standards are far to low for basics, especially considering the profession. I agree that education and the continuing of it should be very important to everyone in the profession.
Maybe its just the softy in me saying that we should all sit around the camp fire holding hands and singing kumbya. But I do believe that if there was a better relationship between all of us these issues would reach a conclusion. I also do agree there are numerous people out there making themselves out to be more then they are with their limited titles. Giving everyone a bad reputation and making it difficult to close these gaps.

 

[Ridryder911]

Just to jump in for a second, those actually ARE things that EMT-Bs here, in the US, and trained to do. They can perform a detailed neuro exam, as well as check their blood sugar. They have the knowledge and ability to, for instance, differentiate between a CVA and a diabetic emergency. The difference isn't in the assessment, but in treatment. Just treatment.

And while EMT-Basics may lack the education to know that drunks have a higher chance of having a head bleed, they have the skills to recognize where the problem is, and how serious it is. And really, when it comes down to it, that's what matters. The medic can't do any better, as diagnosis and treatment of that is impossible in the field.

I am sorry, but I do doubt that your Basics were trained to do a detailed neuro exam.. even your Paramedics if you describe it is the same. I am not talking about PEARL & grips, etc. I am discussing nystgmus differential, cranial nerves II-VII with EOM, Cardinal Movements, ataxic movements, etc.

If your Paramedics are not performing any more detailed assessment than you Basic EMT's your program or Paramedics are lacking a lot. Especially when Basic EMT neuro assessment is barely one paragraph to a chapter long.

This is getting more scary!...

R/r 911

 

[firecoins]

People assume they get a Paramedic on every call. R/r 911

I generally agree with your point but most people don't know what a medic is. People's impression ranges from ambulance driver to doctor. I have seen people tell us (includedes responding medic units) they had no previous medical hx but all of a sudden they have AIDS/cardiac when they speak to the triage nurse.

When I work as an an EMT-B some patients may not see medics but all see doctors. Or at least a PA. Medics are not always available or the hospital is closer than the medics.

 

[Littlebit]

A perfect world

In less populated areas if you want ALS plan on waiting 20-40 minutes. In the meantime BLS is the answer. They are trained to respond to emergencies- and most competent EMT-B's can recognize a critical or life threatening injury just as quick an EMT-P. Then the EMT-B begins his/her training with the ABC's. With no ALS available - what do they do- they contact the rural hospital to inform them- the hospital is then ready - and if a helicoptor needs to be called thats done. Or they could wait and say " we aren't educated and trained enough so we'll wait for ALS"
In a perfect world lets put an Ortho in the ambulance if dispatch states "broken leg" or a neuro on board if dispatch states "head injury" or a geratric specialist on board if the call comes out "elderly individual who does not feel well or is not acting right"
Also in the perfect world - all volunteer ambulance members will be "educated to the highest level- the citizens or if owned by the city will pay for all that education. Meanwhile the employers will allow the volunteers to leave work early to attend clinicals and school and someone will pay those volunteers top notch wages for providing ALS skills.

 

[MMiz]

Lets remember to keep the discussion on topic and keep the insults and name-calling to a minimum

 

[VentMedic]

I generally agree with your point but most people don't know what a medic is. People's impression ranges from ambulance driver to doctor.

One would have to have been living in a cave for the last 30 years not to have some idea about what a paramedic is. The public may not know the exact job description but do know paramedics are capable of providing life saving therapies. We've also have to cut the public some slack if they are not up to speed on all 48 different EMS certification or the varying scopes of practice from one region to another such as EMT-Bs intubating. I think it is obvious by just the posts on this forum that the education, training, skills and abilities are all over the map even within one title in one state.

EMS has been in the public eye for over 30 years starting with Johnny and Roy. We have had a Paramedic, EMT and/or ambulance appear on almost every show. My old ambulance company even made guest appearances on Miami Vice. Jessica McLure put Paramedics in the public eye with the numerous news articles and a movie. It was even relived years later in the hearts of many when the Paramedic, Robert O'Donnell, committed suicide attributed to PTSD.

Even the recent Air Medical transport crashes have put Paramedics on the national and international news giving the public another view of the profession.

No other profession has gotten so many leading roles and many are positive. Nurses have been stereotyped in Soap Operas and X-Rated movies. While they may cringe, they don't constantly whine even when some read the very negative posts on EMS forums bashing them. Most EMS providers have no clue what a nurse or any other health care professional does and what type of education they must complete to just get an entry level position. Even on the medical shows, you don't see all the healthcare workers that make a hospital run efficiently and are vital to the resuscitation/recovery of every patient the comes into the hospital.

What other profession watches the news almost daily to see if they are shown at any scenes or mentioned? And then, they critique every little thing the reporter says as the story is all about them and not the actual news item. How many articles have we had critiqued on the forums and most probably can not remember what happened to the patients or persons rescued. They just know someone called them an "ambulance driver" or "fire fighter". Who cares if some toddler was shot dead in the street when there is a "bigger story".

I have seen people tell us (includedes responding medic units) they had no previous medical hx but all of a sudden they have AIDS/cardiac when they speak to the triage nurse.

You actually find this hard to believe? In the still very macho world of EMS and the FD, discrimination against people with some diseases is still alive and well even against our own. I suppose some would say that is a very sexist thing for me to write. I would be happy to debate that on another thread.

How much privacy are you giving the patient when asking very personal questions? Usually an ambulance attracts a crowd. If it is just loved ones and friends, has the patient disclosed their health problems to them? Even in the hospital for a routine nebulizer tx or PFT, I have to be careful and not mention anything about the patient's medical condition if family is present. The patient may be familiar with the healthcare system which stresses privacy and does not want the world to know their health problems. The patient may also be hesitant to disclose something that is not related to the what they have called you for. They may also know that you ARE AN EMT-B and know that you will not be giving meds or doing invasive procedures. You may also have been asking the wrong questions.

 

[firecoins]

One would have to have been living in a cave for the last 30 years not to have some idea about what a paramedic is.

There must be a lot people living in caves. They have little interest in our profession until they need us.

EMS has been in the public eye for over 30 years starting with Johnny and Roy.

I have never seen whatever that show was with Johnny and Roy. I suspect most other people haven't.

What other profession watches the news almost daily to see if they are shown at any scenes or mentioned? And then, they critique every little thing the reporter says as the story is all about them and not the actual news item.

We pay attention to the stories. That doesn't translate into the general public doing so.

You actually find this hard to believe?

where did I say I found this hard to believe? I just mentioned it happens.

Despite perceived public eye, many people have little interest in what a paramedic or emt do until they need one.

All I am saying is that there is a range of perceptions. To some we ambulance drivers and to some we are doctors.

 

[mikeylikesit]

They are trained to respond to emergencies- and most competent EMT-B's can recognize a critical or life threatening injury just as quick an EMT-P.

you do have a point except for where you state that a Basic can recognize a life threating injury as fast as a medic...sorry but i have to correct that to " a Basic can recognize some external injuries as fast as a medic". not to nit pick but there is no way a Basic who has no A&P or more than 150 hour of class room time that can recognize things that are not as direct as a impaled object but rather the fact that you have to do other tests and evals to determine a ton of hidden to the naked eye life threatening injuries. now i do agree with the rest of your post you do mark a valuable point. Basics are trained in stabilization in most instances and do like you said support people until Life Flights or ALS arrive or you arrive at the ER doors.

 

[VentMedic]

There must be a lot people living in caves. They have little interest in our profession until they need us.

I don't give surgeons, plumbers or electricians much interest either even though I might need one some day. People should live their lives to the fullest without thinking about "the day they'll need a Paramedic". Of course, most of us tax payers are usually reminded about EMS and Fire services at least once a year for some election. The campaigns for those elections will bombard us with "What paramedics, ALS services, enhanced 911 and trauma systems do" for months prior to that election.

I have never seen whatever that show was with Johnny and Roy. I suspect most other people haven't.

Too bad. But, in all fairness to you that was over 30 years ago. You were probably too young to remember that show even though it was on some stations throughout the 80s.

You didn't comment about the other examples I mentioned. Did you not know anything about them either?

We pay attention to the stories. That doesn't translate into the general public doing so.

Most people watch the news to see the current events and not if the reporter photographed the EMT's good side and used the correct title.

Despite perceived public eye, many people have little interest in what a paramedic or emt do until they need one.

Do you actually care what nurses, RRTs, RTs, OTs, PTs or even MDs do unless you need one?


You complain about your department, your city, the pay and the patients. You also complain that no one knows what you do, the public doesn't recognize you're an EMT, and you feel you get no respect from the public.

Why do you stay in EMS? You don't have that much EMS education time invested in the job. There are probably a lot more jobs that pay better where you don't have to worry about patients in any way. You might even find the respect you think you deserve doing something else.

There are some of us that know we make a difference one patient at a time. We don't need our pictures on the evening news every night to know what we do and who we are. There are hundreds of different health care providers who all have an important job but don't expect to be recognized at the donut shop or even in the halls of their own hospital by many of the patients they have taken care of. They know what their contribution was to that patient's recovery and don't need a news reporter to announce it to stroke their egos.

 

[MJordan2121]

Good Quote

I've heard many Medics I work with say... ""Medics save people and basics save medics..." I think its a partnership and you work together for a unified team effort to help save another's life or to help improve their quality of life. Let's all be friends

 

[JPINFV]

I've heard many Medics I work with say... ""Medics save people and basics save medics..." I think its a partnership and you work together for a unified team effort to help save another's life or to help improve their quality of life. Let's all be friends

Name me one thing that a competent basic can do that a competent medic can't. You know, I wonder if there's a saying in the emergency room that goes, "Emergency physicians saves lives. Emergency PAs save physicians." I honestly doubt it.

 

[firecoins]

Too bad. But, in all fairness to you that was over 30 years ago. You were probably too young to remember that show even though it was on some stations throughout the 80s.

yes I am too young for that show.

Most people watch the news to see the current events and not if the reporter photographed the EMT's good side and used the correct title.

you brought it up.

Do you actually care what nurses, RRTs, RTs, OTs, PTs or even MDs do unless you need one?

People have different perceptions of them too. I am not sure people even know what RRTs, RTs, OTs and PTs are.

You complain about your department, your city, the pay and the patients. You also complain that no one knows what you do, the public doesn't recognize you're an EMT, and you feel you get no respect from the public.

Your reading waaaaaay to deep into my comments. The public reconizes different thinks depending on their perceptions. Some think I am doctor and some an ambulance driver. Nothing your saying is going to change that. Its just the way it is.

Why do you stay in EMS? You don't have that much EMS education time invested in the job. [There are probably a lot more jobs that pay better where you don't have to worry about patients in any way. You might even find the respect you think you deserve doing something else.

=Its very simple you seem to complicate things way too much. I am a medic student. I have enough education to stay in this. And I get more than enough respect from my patients. Patients aren't the problem reguardless of their good and bad perceptions they may have. Your taking this WAY too personally is more of a problem. You need to chill.

There are some of us that know we make a difference one patient at a time. We don't need our pictures on the evening news every night to know what we do and who we are. There are hundreds of different health care providers who all have an important job but don't expect to be recognized at the donut shop or even in the halls of their own hospital by many of the patients they have taken care of. They know what their contribution was to that patient's recovery and don't need a news reporter to announce it to stroke their egos.

Again I have no clue where you get this from. All I said was the pubic has range of perceptions. I have been called doctor and ambulance driver in the same shift. I do my best with both.

 

[mdtaylor]

Now, really inform me what "medical care you provided? What difference did you make, that a common laymen with good advanced first aid training could not? Splinting?.. No Hmm maybe controlling hemorrhaging? No ..Okay, how about CPR? No.. Assisting in administration of NTG, EpiPen? No. Wow! A common laymen can give much more than a Basic EMT, they are far more restricted. Okay, maybe taking a set of vitals? That it's it ! Oops that is not treating, rather assessing.. Begin to see a trend?

What I am beginning to see is an entirely different side of a forum member that I had respected...

 

[el Murpharino]

I've heard many Medics I work with say... ""Medics save people and basics save medics..." I think its a partnership and you work together for a unified team effort to help save another's life or to help improve their quality of life. Let's all be friends

Many medics say that to make the basics feel like they aren't completely useless in the realm of EMS. Most basics complete their class with this bravado that quickly diminishes once they realize how little they can actually do. Of course they do serve a purpose in the grand scheme of things and their assistance is very useful, especially in bad patients. But I can't think of one instance in the last 5 years that I have been "saved" by a basic....but I can think of multiple times where the opposite could be true.

 

[CFRBryan347768]

Originally Posted by Ridryder911
Now, really inform me what "medical care you provided? What difference did you make, that a common laymen with good advanced first aid training could not? Splinting?.. No Hmm maybe controlling hemorrhaging? No ..Okay, how about CPR? No.. Assisting in administration of NTG, EpiPen? No. Wow! A common laymen can give much more than a Basic EMT, they are far more restricted. Okay, maybe taking a set of vitals? That it's it ! Oops that is not treating, rather assessing.. Begin to see a trend?

Originally Posted by mdtaylor
What I am beginning to see is an entirely different side of a forum member that I had respected...

I think you have to look at it from the point that what Rid is saying is that to provide the absolute best care to your pt's you need more then just an EMT-B class. I don't think hes trying to discourage any one but show people that basic skills just dont cut it, you need more EDUCATION to provide better care.