EMT-B/EMT-P crews

[xterrabuzz]

Hi, Everybody. New to the forum and new to EMS. Just started working as an EMT while going through RN school. I work for an organization that runs EMT-B/EMT-P crews. I have a couple questions for the forum. 1. How many of you work with this same platform for crews. 2. What is the role of the EMT-B I've been told a good EMT-B can really really help the EMT-P but I'm not really seeing how? Mostly the EMT-B drives and works the cot. Would love to hear from others working with the same crew format.

-Xterra, Northern WI

 

[EpiEMS]

Hi, Everybody. New to the forum and new to EMS. Just started working as an EMT while going through RN school. I work for an organization that runs EMT-B/EMT-P crews. I have a couple questions for the forum. 1. How many of you work with this same platform for crews. 2. What is the role of the EMT-B I've been told a good EMT-B can really really help the EMT-P but I'm not really seeing how? Mostly the EMT-B drives and works the cot. Would love to hear from others working with the same crew format.

-Xterra, Northern WI

First and foremost - welcome! This is a great question, and I know I was concerned about it when I started.

In many cases, where a system runs EMT/Medic (a.k.a. B/P, etc.), the BLS provider is going to be primarily a driver and assistant to the ALS provider. However, a really good medic may very well let you take the lead, and only jump in where there's something you cannot do (i.e. interpret a 12-lead, or administer certain medications). Hopefully, you can develop this kind of relationship with your partners. If the medic is the primary provider on a call, you can often help by assisting within your scope of practice - doing your BLS interventions helps them focus on what they can do beyond that. For example, if a patient is having difficulty breathing, you as a BLS provider can do a lot: O2, vital signs, BVM, airway adjuncts, etc. while the medic is starting to do his/her assessment and interventions. Beyond the BLS side, you can also assist (depending on your agency, state, and partner) in setting up ALS procedures, such as by spiking an IV or placing leads for an EKG.

I've worked Medic/EMT, AEMT/EMT, and EMT/EMT. Frankly, I prefer EMT/EMT (with a medic in a fly-car), because then we can really evenly swap calls.

 

[DesertMedic66]

I have worked in an EMT/Medic system as both an EMT and as a medic. From the EMT side it may seem like all you do is gurney mechanics and drive (while that may be true) there are a lot of other benefits that a good EMT partner has.

I have been working with the same partner for almost 2 years now. She is able to anticipate what I am going to need and will get it all set up. Do I need a saline lock for my IV, do I need a full liter bag? She will lay out the medications that I need on the bench seat with the appropriate sized syringe so all I have to do is draw them up. She is able to assist me in placing the patient on CPAP. She obtains vitals as soon as we make patient contact while I am conducting the patient interview. If I run into a situation where I am not able to call the hospital to give them a heads up she is able to do that for me. Also just simple things such as moving stuff inside the house to get the gurney in and out.

She is very helpful when it comes to female patients (can't remember the last time I placed a 12-lead on a female patient).

If we run into a call where we have more than 1 patient I know that I can trust her to run an assessment on the patients that I delegate to her. We will then quickly meet up and find out which patient is the most critical.

 

[NysEms2117]

Hi, Everybody. New to the forum and new to EMS. Just started working as an EMT while going through RN school. I work for an organization that runs EMT-B/EMT-P crews. I have a couple questions for the forum. 1. How many of you work with this same platform for crews. 2. What is the role of the EMT-B I've been told a good EMT-B can really really help the EMT-P but I'm not really seeing how? Mostly the EMT-B drives and works the cot. Would love to hear from others working with the same crew format.

-Xterra, Northern WI

I work super part time, 12 hrs about every 2 weeks, sometimes 12 hrs a week. I work in a 3 person system on a CCT rig(1/2 for the whole county). It is usually staffed EMR*emergency first responder, or 10 different other titles here**(driver), myself(EMT-B), and a CC-Paramedic (90% of the time). I tend to agree with Epi for the most part. Epi has a different experience then i do per say, because we only go out when explicitly told (sometimes we just provide normal ALS,but thats rather rare). I help my medic partner by "prep" work mainly, what i mean by that is that i spike bags for him, i set up the lifepak (12 lead), and do various other things *I DO NOT TOUCH THE NARC BOX*. I work part time for a sheriffs office EMS unit so the fancy hiring LEO's part time, so i'm also another set of eyes for scene safety ect. I lay out some meds for my partner, but i'm still getting to know exactly what he needs and how he reacts. I do 90% of communications with dispatch and the hospital, (he does 10% if he needs explicit ALS instructions: ketamine use stuff like that). But if he does Off-line ALS procedures i call that in. I also do "typical" BLS things, such as vitals, and bagging(as you may know is one of the most important skills to learn, and LEARN WELL!!). Also as desertmedic said, I can do assessments, usually he will double check, but he has more faith then not in me. However if your good at being an EMT, you can REALLY help your paramedic partner you can really cut some serious time off some of the procedures and interventions they do.

 

[VentMonkey]

So the flip side to this is how much your paramedic partners actually trust you. Being new it may take a while to develop a flow, and find a partner you jive best with.

I have worked with countless EMT's and paramedics, and sadly many seem disinterested in learning. Admittedly, I am not a huge fan of "let's plan this out at the beginning of the shift" because I guarantee over the years the ones who try and "plan" are almost undoubtedly the ones who forget their own plan when stuff hits the fan. I am more of "let's just get to the call and keep your ears and eyes open" with these types of folks.

My advice? Follow your experienced partners lead until things click; granted some may have "years on", but this doesn't necessarily equal experience if you catch my drift.

FWIW, I have had partners that truly were interested in learning how to do their job (and mine), and those ones I typically had no problem helping out. Also, know that every partner is different and some may want something completely different from the last. Don't take it too personally, but I know it can be somewhat frustrating at times.

 

[phideux]

I've worked Basic/medic, in both transport and 911, I was also blessed by the Medic Gods to have some of the best EMT partners you could ever wish for. We would usually split the to scene driving, working the back depended on the call. A vast majority of EMS and transport calls are Basic/Non-emergent, so alot of the patient care in the back was my partners and I drove alot. If it was an ALS call, my partners were great at setting up stuff, hooking up the pt to monitors, whatever needed to be done. It it was a critical case and I needed hands in the back, I would recruit a Fire-guy to drive and keep my partner in the back.

Noah and Robbie, thanks partners. The 2 best EMTs on the face of the earth.

 

[StCEMT]

I have been working on a P/B truck as the EMT for a while now and you can do more than you think. I have run through initial assessments while my partner gets something else done, set up stuff from meds to IV's and if need be I can set up intubation equipment or other ALS equipment, split assessments if there are multiple patients and divide it up accordingly, and plenty of other things I cant think of. I try to keep everything my partner will need ready when he needs it. I will sometimes give the unofficial interpretation of a 12 lead, if they concur then great. Once you know your partner really well, you don't really have to ask as much about what they want to do, you just get it ready. All part of working together to make things go efficiently.

 

[xterrabuzz]

Thanks for all insightful replies. Reading these make me feel a bit better about it. I'm looking forward to learning both sides of the gig in order to be a better basic and anticipate and react to what the medic may need. Understanding I've only been a basic a few months but do not like being idle and would rather learn to do more on the rig than just drive. Thankful to find this great forum as a resource. If you are on duty or off duty hope you guys have a great Thanksgiving. Thanks gain for the input. -xterra

 

[BobBarker]

I think P/B trucks would be great. I don't work for my local FD, but because we are in LA County, in order to be ALS you have to have 2 medics on the ambulance(only exception for a P/B is an IFT ambulance if you apply for a waiver from the EMS agency). Our FD has 2 medics on each ambulance and a minimum of 1 medic on each engine/truck(in reality 85% of the firefighters are paramedics, so each medical call probably has 3-4 paramedics). I just don't see the reasoning behind LA County not allowing P/B trucks for 911 calls.
As for the EMT-B, his/her role on a P/B truck would be to assist the paramedic. Also, the medic might let you take over patient care and drive if it's a BLS call. If an EMT-B is put on a P/B truck, I hope it's an EMT that has at least a couple years experience, because they will be assisting the paramedic with some interventions.

 

[VentMonkey]

Thanks for all insightful replies. Reading these make me feel a bit better about it. I'm looking forward to learning both sides of the gig in order to be a better basic and anticipate and react to what the medic may need. Understanding I've only been a basic a few months but do not like being idle and would rather learn to do more on the rig than just drive. Thankful to find this great forum as a resource. If you are on duty or off duty hope you guys have a great Thanksgiving. Thanks gain for the input. -xterra

Op, the fact that you're concerned enough to seek advice from your peers outside of work says a lot. I think you'll do just fine, and be the exception, and not the rule just like the techs on this forum, a few of who have replied to this thread already.

I think P/B trucks would be great. I don't work for my local FD, but because we are in LA County, in order to be ALS you have to have 2 medics on the ambulance(only exception for a P/B is an IFT ambulance if you apply for a waiver from the EMS agency) I just don't see the reasoning behind LA County not allowing P/B trucks for 911 calls.

I miss home for many reasons, except prehospital medicine. I use the term "prehospital medicine" very loosely for LA County, and there is no reasoning, but one thing many fire departments (particularly there) are good at, it is being rich in "tradition", so if it worked great in '75, them why change it?

 

[BobBarker]

Op, the fact that you're concerned enough to seek advice from your peers outside of work says a lot. I think you'll do just fine, and be the exception, and not the rule just like the techs on this forum, a few of who have replied to this thread already.

I miss home for many reasons, except prehospital medicine. I use the term "prehospital medicine" very loosely for LA County, and there is no reasoning, but one thing many fire departments (particularly there) are good at, it is being rich in "tradition", so if it worked great in '75, them why change it?

Although I would like to see P/B trucks, I like ALS on the rigs because the calls everyday in this city are high acuity. There are probably 6 nursing homes, 3 urgent cares and 1 hospital(stemi, neuro and trauma transfers) that FD gets called to a lot, so they do need some paramedics in the city. But then again, when I had to call them for my dad, although they were the nicest medics I ever met and were very knowledgeable, I got a $1200 bill. Didn't like it very much then

 

[BobBarker]

Although I would like to see P/B trucks, I like ALS on the rigs because the calls everyday in this city are high acuity. There are probably 6 nursing homes, 3 urgent cares and 1 hospital(stemi, neuro and trauma transfers) that FD gets called to a lot, so they do need some paramedics in the city. But then again, when I had to call them for my dad, although they were the nicest medics I ever met and were very knowledgeable, I got a $1200 bill for a 1/2 a mile transport. Wasn't too happy then

 

[VentMonkey]

when I had to call them for my dad, although they were the nicest medics I ever met and were very knowledgeable.

Good to know, and hear.

I like ALS on the rigs because the calls everyday in this city are high acuity.

Where exactly is this? You can PM me if you don't want to share, most calls are low acuity, and they roll code ("hot") to the ED's on all calls. The problem with so many of them being paramedics is skill degradation for starters. I spent my first 5 years among them. Many of them, while paramedics, are paramedics in name only. When I first started doing this job I wanted to be like them; after a few months I wanted to be nothing like them.

 

[EpiEMS]

Our FD has 2 medics on each ambulance and a minimum of 1 medic on each engine/truck(in reality 85% of the firefighters are paramedics, so each medical call probably has 3-4 paramedics). I just don't see the reasoning behind LA County not allowing P/B trucks for 911 calls.

LA County wants to protect high-paying union jobs, perhaps...?

Even though more medics doesn't necessarily improve outcomes, and is certainly more expensive, it makes no sense for firefighters unions to say "we want less medics!"

Although I would like to see P/B trucks, I like ALS on the rigs because the calls everyday in this city are high acuity.

Therein lies the problem, the statement that "the calls everyday in this city are high acuity" is probably not strictly true. Most calls are not high acuity, nor do they really even require an ambulance, but that's a topic for another thread.

 

[NysEms2117]

I hope it's an EMT that has at least a couple years experience, because they will be assisting the paramedic with some interventions.

My very first day working as an EMT(only been a few months now) was on an ALS rig, not to mention a CCT rig. Myself and a CC-P in the back with an EMR driver. I didn't burn anything down, granted i probably was not as helpful as i could have been, but that was corrected after each call. To the OP just ask your medic partners if they would have wanted anything done differently on each of your first few calls, they shouldn't get mad. For example after our first call was a routine Respiratory depression/arrest for him, but i had no clue what was going on. He did 95% of the call, and i just did whatever he explicitly told me to do. After the call i asked, and he said "for these types of calls if you could get xyz ready, and do prepare xyz, that'd make it run smoother" (iv set, and prep his ALS airway gear). In the long run a paramedic should be diverting every BLS capable skill to the EMT, so they can focus on what they can do, and we can't. He shouldn't be spiking an iv bag, and starting a line while im standing there looking pretty(as i always do ofc ) Hope this helps!

 

[BobBarker]

LA County wants to protect high-paying union jobs, perhaps...?

Even though more medics doesn't necessarily improve outcomes, and is certainly more expensive, it makes no sense for firefighters unions to say "we want less medics!"



Therein lies the problem, the statement that "the calls everyday in this city are high acuity" is probably not strictly true. Most calls are not high acuity, nor do they really even require an ambulance, but that's a topic for another thread.

Oh believe me, I'm not advocating every FF should be a medic in the city(Im sure my property tax and ambulance bill would go up too if that happened). I do think we need more BLS providers, but another reason is there is only 2 ambulances in the city to transport patients, and my best guess would be at least once a day they have to call for backup from LAFD or from a private company because both ambulances are tied up, which could be an extra 20minutes. Having the medic on the engine when both ambulances are tied up can come in handy if your other ALS backup is 20+minutes away. Now, I think the city should spend money on another ambulance rather than trying to get every FF to a paramedic, but that's another story.

 

[Jim37F]

Oh believe me, I'm not advocating every FF should be a medic in the city(Im sure my property tax and ambulance bill would go up too if that happened). I do think we need more BLS providers, but another reason is there is only 2 ambulances in the city to transport patients, and my best guess would be at least once a day they have to call for backup from LAFD or from a private company because both ambulances are tied up, which could be an extra 20minutes. Having the medic on the engine when both ambulances are tied up can come in handy if your other ALS backup is 20+minutes away. Now, I think the city should spend money on another ambulance rather than trying to get every FF to a paramedic, but that's another story.

Let's see, a transporting FD that uses their own RA's, only has two, and uses LAFD for backup, rules out County and anyone else who has private ambulance transport, rules out Verdugo system....Culver City or maybe Beverly Hills?

 

[VentMonkey]

Let's see, a transporting FD that uses their own RA's, only has two, and uses LAFD for backup, rules out County and anyone else who has private ambulance transport, rules out Verdugo system....Culver City or maybe Beverly Hills?

Someone's been in the LA AO game way too long.

 

[GBev]

I'm reminded of the old adage, "Paramedics save lives, but EMTs save paramedics." From my experience, working in the B/P setup keeps a paramedic closer down to the earth. For example, why intubate a PT when a BLS King Tube will secure an airway for PPV just as effectively and save the PT some time in the ICU? The majority of my PTs need an ALS assessment but can be treated with a BLS intervention and I think paramedics forget that sometimes.

While EMTs are subordinate to paramedics, remember that you're a competent healthcare provider (hopefully) and are allowed to work within your scope of practice even with a paramedic. As said before, anticipating what your medic partner might need will help with efficieny, which will help your partner and help your PT even more. The B/P setup is great for those aspiring to practice at higher levels in the future because you learn how a paramedic thinks and operates. Even for those not looking to get a disco ball patch, the setup makes an EMT a better clinician in my opinion.

 

[VentMonkey]

I'm reminded of the old adage, "Paramedics save lives, but EMTs save paramedics." From my experience, working in the B/P setup keeps a paramedic closer down to the earth.

Quite the contradictory statement ya got going on there...