JPINFV
Gadfly
- 12,681
- 197
- 63
You just illustrated my point. A podiatrist instructing paramedics on the scene of a call (provided it isn't foot related) is about as stupid as a paramedic telling a radiologist how to interpret a CT scan.
EMT-B/BLS care is there a point??
- Thread starter LE-EMT
- Start date
You just illustrated my point. A podiatrist instructing paramedics on the scene of a call (provided it isn't foot related) is about as stupid as a paramedic telling a radiologist how to interpret a CT scan.
JPINFV
Gadfly
- 12,681
- 197
- 63
The problem isn't necessarily the companies, but the structure. Sure, companies tend to hire on the cheap side and you get the "Requirements: cert and pulse. pulse optional" routine, but how the levels are structured enable that action. Yes, there's "medical control" (my area didn't have online medical control as an option to EMT-Basics) and yes there's CME requirements. Unfortunately, a lot of what counts for CMEs are embarrassing. When a CME ("Sick/Not Sick Patient Assessment) essentially dumbs down assessments to 'position, pulse, respirations, LOC, skin signs and if there's more in the sick column than in the not sick column, then your patient is serious,' it's a sure sign that the system is doing something drastically wrong.
If you want a good illustration of the reading level (someone show this author "Conjunction Junction" of School House Rock fame) and level of understanding expected of EMT-Basics, see this column and the associated comments. http://www.jems.com/news_and_articles/columns/Edgerly/Lets_Talk_Shock.html Pay particular attention to comments 7 and the authors reply in comment 7.
daedalus
Forum Deputy Chief
- 1,784
- 1
- 0
The sad part is that I learned none of this in my Basic class, but this is on par with Mosby's paramedic text, Mosby seems to go into more detail but its negligible.
After reading 12 or so pages of this I think I'm ready to jump in.
The whole Basics save paramedics is wishful thinking. I'm a basic in Indiana. I'm currently finishing clinicals for EMT-BA which is BLS + IV access and 3-5 lead ECG monitoring involving 7 very basic rhythms. IMHO, EMT-B should be the BA scope, with further training. Without IV access or any form of monitoring, EMT-Bs are really just glorified first aiders.
Is a good, experienced and calm EMT-B an asset on scene? You bet. Should they be the standard of care? Hell no. In counties with limited ALS availability they work as first on scene responders who can perform a basic assessment on the patient, perform basic interventions, O2, simple adjuncts, maybe a NVA, AED, bandaging, splinting, etc. Package the patient, and possibly transport to reduce time to ALS. Should ALS be first response on every scene, yes, however that is more an issue of funding and politics, and not so much the responders themselves.
The whole Basics save paramedics is wishful thinking. I'm a basic in Indiana. I'm currently finishing clinicals for EMT-BA which is BLS + IV access and 3-5 lead ECG monitoring involving 7 very basic rhythms. IMHO, EMT-B should be the BA scope, with further training. Without IV access or any form of monitoring, EMT-Bs are really just glorified first aiders.
Is a good, experienced and calm EMT-B an asset on scene? You bet. Should they be the standard of care? Hell no. In counties with limited ALS availability they work as first on scene responders who can perform a basic assessment on the patient, perform basic interventions, O2, simple adjuncts, maybe a NVA, AED, bandaging, splinting, etc. Package the patient, and possibly transport to reduce time to ALS. Should ALS be first response on every scene, yes, however that is more an issue of funding and politics, and not so much the responders themselves.
BossyCow
Forum Deputy Chief
- 2,910
- 7
- 0
They have decided that their bread and butter are the transports, not 911 response. A review of call volume showed that the best use of the available rig was for transporting pts the Civil ALS has downgraded to BLS. So, the only available rig will be BLS. This means that the rig will be in service at the station, and the medic will have to go to it. I asked if it were possible to have the medic respond directly to the scene, because we generally transport in our rig with their medic, but was told that the liability for a medic responding in the middle of the night, POV to an ALS call was cost prohibitive.
Free-B-EMT
Forum Probie
- 14
- 0
- 0
Rid,
I'm a volunteer EMT-B and I will agree with you 100% that the training is wholly inadequate for the job we are expected to do. Even though it goes beyond the 150 hours that you mention because of on-going education requirements, it is still severely lacking. I personally would love to be able to be trained to the Paramedic level but, as a volunteer, I just can't justify it financially. Thousands of dollars and thousands of hours are hard to come by when you are working full time, supporting a family and dealing with the rest of life just to give it all away at the end. So what is the answer? Raise the training level requirements of EMT-B to allow them to provide better care? That would be a workable solution as long as the State training funds for volunteers could support it, but I'm not sure that's possible. Drop the volunteer municipal BLS - paid regional ALS system that my area now uses and force all municipalities to implement their own ALS systems? I don't think this could be done without major tax increases. That is something that probably won't happen either since we already pay some of the highest property tax rates in the country. Or do we just keep going on, status quo, because there doesn't seem to be a good answer? It's a question that has been debated around here for a long time and so far no good answers. I would love for someone to come up with a better way, that is realistic, that could remove the whole question of who gives better care, ALS or BLS and bring us all to the same level. For now, it is what it is and we do the best we can with what we have.
I'm a volunteer EMT-B and I will agree with you 100% that the training is wholly inadequate for the job we are expected to do. Even though it goes beyond the 150 hours that you mention because of on-going education requirements, it is still severely lacking. I personally would love to be able to be trained to the Paramedic level but, as a volunteer, I just can't justify it financially. Thousands of dollars and thousands of hours are hard to come by when you are working full time, supporting a family and dealing with the rest of life just to give it all away at the end. So what is the answer? Raise the training level requirements of EMT-B to allow them to provide better care? That would be a workable solution as long as the State training funds for volunteers could support it, but I'm not sure that's possible. Drop the volunteer municipal BLS - paid regional ALS system that my area now uses and force all municipalities to implement their own ALS systems? I don't think this could be done without major tax increases. That is something that probably won't happen either since we already pay some of the highest property tax rates in the country. Or do we just keep going on, status quo, because there doesn't seem to be a good answer? It's a question that has been debated around here for a long time and so far no good answers. I would love for someone to come up with a better way, that is realistic, that could remove the whole question of who gives better care, ALS or BLS and bring us all to the same level. For now, it is what it is and we do the best we can with what we have.
Jeremy89
Forum Captain
- 290
- 0
- 16
See, I never really understood the I. I'm just curious- If you're gonna go that far, why not go for the medic?
Alright I was going to try and NOT get in on this because I am very opinated but you set me off.
I am an EMT-Basic in Indiana and under my protocol I can carry an Epipen in my back pocket and ADMINISTER it to anyone I see needs it. That doesn't mean I'm going to walk up to Joe-Schmo and nail him in the leg though. I know the signs and symptoms of anaphalaxis because of my MEDICAL training. Oh and what do yuo call oxygen? It's a medication. I can administer it. AND Activated charcol AND ASA. And all that is a BLS skill set.
I don't know where you are from for an EMT-Basic class to be 2 weeks long. Mine was 6 months 3 nights a week and we did almost 100 clinical hours. I know that's nowhere near what a medic does but don't go telling me that I don't know what I'm doing. Yes on a scene you are better than me BUT with out a basic you wouldn't get to the scene. Ever medic I have worked doesn't know jack about where things are. Medics without basics are lost.
As for the "I'm better than you because I'm better trained" bull crap. Your cert is EMT-P mine is EMT-B. What are the same 3 letters? We all do the same thing. Why does a medic need to respond to most calls. Do you start an IV on EVERY run? Do you print an EKG strip EVERY run? Do you administer meds EVERY run? No. Most responses don't need a medic. I'll admit that some do. I've done a BLS response and called a medic before but they are not ALWAYS needed. Hell.... I've even done a few BLS codes. You know what?? I actually brought one of them back. I'd like to see a medic do that. The other codes I've worked with a medic we never brought the pt back.
Ok I'm done ranting for now.
http://www.in.gov/dhs/files/emscertlevels.pdf
According to the Indiana statutes your class may not be the norm as far as EMT-B goes which states it as 144.5 hours. Your state does have a "plus" cert to add on which is still "hours" and "skills" without much solid education.
So, did you go straight through the "plus" course as well as the EMT-B? Judging by the "skills" you listed I would say that is the case. If so, that is not a fair comparison. The EMT-B for your state is in line with many other states that require 150 hours or less.
As far as the length of the class, 3 hours per night x 3 nights x 24 weeks is still only 216 hours. The number 24 is used since there are holidays that must be taken into consideration. At the standard EMT-B minimum for your state, 144.5 hours could be easily done in just a little over 3 weeks by most "mills". There's probably as intensive class like that in your state. You can also stretch out any class based solely on "hours" to as many months you want to make it seem impressive but it is still "hours".
To judge a call by just the number of procedures and meds pushed is a very good illustration that more education is needed to understand what and why procedures are being done and not because one can according to certification. There are times based on a Paremedic level of assessment that agressive treatment is not appropriate. If this is your argument for your "skills" abilities, then you may have missed the what and why to clinical assesment and treatment.
Your statements about medic codes and BLS codes have left me speechless. I have no words for your remarks.
Last edited by a moderator:
JPINFV
Gadfly
- 12,681
- 197
- 63
EMT-Basic, per NHTSA, is a 110 hour course. There are plenty of 2 week accelerated courses around the country (I can link one if you'd like) and they all get the same license as someone who takes 2 years to finish their basic.
Every response requires a paramedic response because you don't know the severity of the call till you arrive. It makes zero medical sense to send someone who can later call for paramedics while doing minimal interventions. A medic should be on every call simply because of the increased education. Does an IV need to be started on every call? No. ECG? No. Heck, I'd even bet that you don't really need an EMT-B on most calls either. Why not just start sending MFRs to calls who can then, if need be, call for an EMT-B who then can, if need be, call a paramedic? That's absurd, especially when systems who value their residents could just send a paramedic in the first place.
As far as codes? Congrats on using probably the worst metric for system efficacy possible. Just wondering, though, are you defining as "brought back" as "return of spontaneous circulation" or "survival to neurologically intact discharge?" Also, are we talking witnessed vs unwitnessed arrest? Bystander CPR?
Why don't we just create a new level? EMT-D sounds like the minimal necessity under your theory.
mikeylikesit
Candy Striper
- 906
- 11
- 0
There is an EMT-D level. it stands for EMT Defibrillator. it is very common to see in NJ.
Ridryder911
EMS Guru
- 5,923
- 40
- 48
That is all it is .....ranting. You did not prove any point. Again NO one here disclaimed the need of EMT's rather the education and responsibility level. God forbid, some one challenge the current systems that everyone agrees is failing.
I almost find it humorous on some of the responses, thank you for responding. Usually such posts just point & proves my facts even more. Thank-you.
Now, consider this. An RN still has to go through an extensive triage training program to be able to perform triage. In fact most prefer not to work the "tree'... because it is one of the most hardest and difficult positions. Determining that the N & V was really not an AMI or pancreatitis that can be lethal, or that so called abdominal pain that was no big deal was really an perforated bowel or incarnated hernia.. Now, really let's be serious. Do you really &honestly think that your 240 hour didactic course & those whopping 100 hour of clinical's trained you well enough? .. you, yourself is not aware what is currently required or is taught within your own local region, yet.. you acclaim to be knowledgeable about EMS? Again, what is partly wrong with EMS... assumptions is made, that everything and everyone else is the same or that their class was the best.. yet they have nothing to compare it to. My nutrition class alone was longer than that. Just to tell people on what to eat. As well check your state on the length to be a beautician and compare class hours ... I'll be awaiting your response.
All those "medicines" that you described can be administered by the common laymen without any special training. That is why the EMT Basic can give them too. Seriously, within reason it is hard to screw up oxygen and ASA.. and Epi-Pen is no brainer.
Now in regards to your save.. I am impressed. Do I doubt that they were in special circumstances yes.. and as well would you like to compare save rates? ...
This has never attempted to be a measuring contest, rather an attempt to educate and enlighten & to recognize some of our problems in EMS. If you do not think there is a problem then that itself is a problem. Discussion with other EMT's their view of their EMT training almost all have agree that it was very lacking.
Do we actually believe that the current curriculum is adequate enough and responsible enough to properly assess and treat those with acute illnesses and injuries. Then to be able to stabilize and continue treatment en route to the appropriate facility?
Hopefully, we have discussed this to death as the answer is no. Again, it nothing personal but as a profession as a whole we to be unified enough to say enough is enough. Review the new curriculum, is there really that much difference for their to be a change so professional benefits can be achieved such as increased knowledge in patient care, or professionalism? What I have read and interpreted ... no.
Does this mean we raise our arms up and surrender? Heck no! Again, part of our problem is we give up too easy and allow others to mandate for us. A little effort for a positive change can & could occur, if we all participated.
If you are not currently supporting local & national organizations to support change, or working locally with local, state & federal regions, then you are part of the problem as well.
R/r 911
p.s. Here is how you correctly spell anaphylaxis and charcoal, of course the word "you". Next time you are going to tell fellow peers on how smart you at least check your spelling.
Well then let's not confuse the current levels of care.... make that EMT-MD.
JPINFV
Gadfly
- 12,681
- 197
- 63
Why? There's already EMS fellowships available to emergency medicine trained physicians.
For anyone out there who is still second guessing the pressing issue present, you just cleared up any and all confusion. Your post was the perfect epitomy of why there is a need for change. After 15+ pages of posts, you decide to puff your chest out and make some of the most ignorant statements I have read in recent times. Not only do your comments not hold water, a couple are flat out not true.
I'm so glad you are proud of your ability to administer an Epi pen, Oxygen, and Aspirin. Guess what???? So can any lay person, hell they are personally prescribed them. So what did that comment prove? Nothing!
You should be more sure of yourself before making assumptions. Not all Paramedics are EMT-P's. Some are Licensed. Some are Practitioners (predominantly outside of the U.S.).
Why does a medic need to respond on every call. Because everyone deserves a thorough and proficient assessment by someone with the ability to utilize some critical thought processes', not an attribute found routinely at the EMT-B level.
Just as the others are awed by the comment about codes, I for one will comment. You are so far wrong on every account. There are services in the U.S. that have a statistically significant survival rate. Now, I am not talking ROSC (which by the way, my agency's current rate is around 75%, not bad for an ALS system). I am referring to being discharged neurologically intact. The national average runs about 5%. Some agencies are achieving near 20% for all codes, not just the ones meeting Upstein criteria. ALL OF WHICH EMPLOY ALS PROCEDURES AND PROVIDERS. So sorry speedy, your wrong!
Don't let your passion for EMS cloud your better judgement, read before you post..........
Ridryder911
EMS Guru
- 5,923
- 40
- 48
You know I would say to lock this thread, but in retrospect apparently there is still a lot of confusion. I have to say I have seen some that are beginning to understand that none of this is at a personal level. This is at a professional level within our system and the problems it is facing.
Debate is good, being ignorant and throwing emotions into something before really making an informed decision is not.
Again, what I have seen (and that is a lot) is pure unawareness and ignorance on what many people assume. I know I thought my first EMS instructor was great until I started learning more & more, then one day in an informal setting I really listened to what he said. How surprised I was to realize what a dufus he was! Did he have a stroke, was it Alzheimer's? Sadly, someone pointed out to me that he had always been stupid and that I had nothing to really compare him to so he came across as brilliant and well diverse. Earlier he could had said anything and I would had believed him.. !
Even those that have worked in the field for years still prescribe to what they were supposedly taught as correct and become chiseled into stone as "pure facts". After 31+ years in EMS, I have learned there is no such thing. Most of what we assume is an assumption based upon .."this is they we always done it" mentality. Something many in EMS (i.e. Bledsoe) has attempted to remove.
Many do not realize that the "older" EMT program was more in-depth and detailed. One learned types of fractures, more anatomy & physiology.. yes more but did not cover as many materials as needed now. Part of the problem, we watered it down to make "everyone" feel special. Something they (those that had the contract) felt that was lacking. They actually described people were "scared" of the equipment. Suggestions of holding hands around the stretcher and touching each piece of equipment could lessen tension & anxiety. I do wish I was joking...
So when many of us criticize the programs (again NOT the individual itself); we know what should be taught, what is NOT effective & what IS effective. Again, you have to be above to see below.
Now, I as well believe before anyone makes flaming remarks one should at least attempt to consider the other side (yes, I have) and not remove doubts about your credibility by spouting erroneous comments.
R/r 911
Debate is good, being ignorant and throwing emotions into something before really making an informed decision is not.
Again, what I have seen (and that is a lot) is pure unawareness and ignorance on what many people assume. I know I thought my first EMS instructor was great until I started learning more & more, then one day in an informal setting I really listened to what he said. How surprised I was to realize what a dufus he was! Did he have a stroke, was it Alzheimer's? Sadly, someone pointed out to me that he had always been stupid and that I had nothing to really compare him to so he came across as brilliant and well diverse. Earlier he could had said anything and I would had believed him.. !
Even those that have worked in the field for years still prescribe to what they were supposedly taught as correct and become chiseled into stone as "pure facts". After 31+ years in EMS, I have learned there is no such thing. Most of what we assume is an assumption based upon .."this is they we always done it" mentality. Something many in EMS (i.e. Bledsoe) has attempted to remove.
Many do not realize that the "older" EMT program was more in-depth and detailed. One learned types of fractures, more anatomy & physiology.. yes more but did not cover as many materials as needed now. Part of the problem, we watered it down to make "everyone" feel special. Something they (those that had the contract) felt that was lacking. They actually described people were "scared" of the equipment. Suggestions of holding hands around the stretcher and touching each piece of equipment could lessen tension & anxiety. I do wish I was joking...
So when many of us criticize the programs (again NOT the individual itself); we know what should be taught, what is NOT effective & what IS effective. Again, you have to be above to see below.
Now, I as well believe before anyone makes flaming remarks one should at least attempt to consider the other side (yes, I have) and not remove doubts about your credibility by spouting erroneous comments.
R/r 911
daedalus
Forum Deputy Chief
- 1,784
- 1
- 0
A little off topic, but after reading an article by Bryan Bledsoe, it seems that care for cardiac arrest will soon be "drugless" and defibrillation and good CPR will become the AHA guidelines for treating an arrest. This will come with the advent of induced hypothermia...It would be very interesting for me to see a comparison of ALS vs. BLS (w/ AED) codes with survival to neurologically intact discharge.
It is very cool to see evidence based medicine show that some of the things we do in the field are not necessary of even beneficial to patient outcome. In the future, hopefully all 911 response will at least initially include paramedic response, although I still advocate for BLS as an acceptable level of care after a patient has been examined by the paramedic.
Ridryder911
EMS Guru
- 5,923
- 40
- 48
Part of becoming educated is to understand the scientific process. As I have also been on the other hand reading great controversy of hypothermia induced resuscitation measures. That maybe we are not gathering enough data to even suggest changes. In fact some of the new literature suggests that simply it is too new and that not enough is known.
As well alike anything else not all facilities will be equipped to perform such type of measures, if and after success occurs.
Yes, it will be interesting to see the outcomes..and possible treatment changes. Yet, as one that has seen many, many, studies that was going to "be the one".. I will not hold my breath. Alike the saying: "Remember the Alamo"; I say :remember Bretylium!".. the drug that was going to stop all needless arrhythmias and convert v-fib.. yeah, still waiting.
That is why medicine is an endless shuffle of ideas and research.. continuously moving.. sometimes reverting to the original treatment...
R/r 911
As well alike anything else not all facilities will be equipped to perform such type of measures, if and after success occurs.
Yes, it will be interesting to see the outcomes..and possible treatment changes. Yet, as one that has seen many, many, studies that was going to "be the one".. I will not hold my breath. Alike the saying: "Remember the Alamo"; I say :remember Bretylium!".. the drug that was going to stop all needless arrhythmias and convert v-fib.. yeah, still waiting.
That is why medicine is an endless shuffle of ideas and research.. continuously moving.. sometimes reverting to the original treatment...
R/r 911
Last edited by a moderator:
First I do know what is required. It is a 120 hr course and about 16hrs clinical time. My instructor was a NAZI so we had to do much more.
Second I'm sorry my fingers move faster than I think. I'm not perfect and I'm so glad you are. Please oh great master teach me to be perfect! And also I am new here so I'm still figureing out all the controls so the "spell check button" wasn't first priority on my list to find.
Last edited by a moderator: