EMT-Basic: Is 120 hours enough?

[Keith]

I only read through the initial post here, not most of the responces, so pardon my ignorance if I come across as a jackass.

In my opinion, if your training a basic to do basic transfers, and crap like dialysis runs and radiation runs, then yes, 120 is fine... BUT!!!!

If your on an emergency truck, doing 911 calls, specifically in a town (in MA, I dont know how everyone else works) that only has a BLS contract... then no way...

If you jump onto a 911 shift (or for some reason someone lets you), right out of the box in MA, your heads gonna spin. Im pretty sure that most people can agree with me on these points.

 

[JPINFV]

In my opinion, if your training a basic to do basic transfers, and crap like dialysis runs and radiation runs, then yes, 120 is fine... BUT!!!!

I'll agree with that. Of course those type of calls don't require an ambulance in the first place. Just a gurney, a van, and a tank of oxygen. The problem with the current system, though, is that those EMT-Bs often respond to "emergency" [nursing facility to ER transfer] calls that can run the gamut from "we can't place a foley" to "the patient is barely breathing."

To make a further note. Medical transportation shouldn't be associated with emergency service. That said, it is a vital service that should be done by people who actually care for patients. There are too many EMT-Bs that work on the ambulance as a cheap thrill and it's one of the things that both make medical transport and EMS look bad.

 

[Keith]

There are too many EMT-Bs that work on the ambulance as a cheap thrill and it's one of the things that both make medical transport and EMS look bad.

To evaluate in that...

When I was training for my basic, there was a medic who stopped in one day for a lecture, or something of the sort. He made a very simple statement to me, and the lass that I think about every single day...

"If you look at EMS as a job... just a 9-5, your gonna be a horrible EMT. If you don't look at this as your career, your passion, your way of life... walk out that door right now, because you'll never make it."

I live by that thought, plain as it may be, everyday... I wish more people did.

 

[Outbac1]

Burp? I don't think I've heard that acronym before. I doubt that it can be as stupid of an acronym as HAM [Hx Allergies Meds] though.

So what is it?
I'll be back Sun. night to look for the answer.

Summit
Sounds like you take your job really seriously. Good for you.

 

[VentMedic]

, and crap like dialysis runs and radiation runs, then yes, 120 is fine... BUT!!!!

quote by JPINFV

I'll agree with that. Of course those type of calls don't require an ambulance in the first place. Just a gurney, a van, and a tank of oxygen. The problem with the current system, though, is that those EMT-Bs often respond to "emergency" [nursing facility to ER transfer] calls that can run the gamut from "we can't place a foley" to "the patient is barely breathing."

You next statement contradicts the above quote:

To make a further note. Medical transportation shouldn't be associated with emergency service. That said, it is a vital service that should be done by people who actually care for patients.

And this contradicts Keith's next post:

"If you look at EMS as a job... just a 9-5, your gonna be a horrible EMT. If you don't look at this as your career, your passion, your way of life... walk out that door right now, because you'll never make it."

I live by that thought, plain as it may be, everyday... I wish more people did.

Do either of you have enough experience with either dialysis or radiation patients to understand what their disease process involves or that they are human beings that deserve not to be called "crap". For the nursing home patient, you are blowing off a whole set of disease processes by just identifying by a "skill" such as "inserting a foley catheter" without realizing why that foley is important and the consequences of repeated attempts or what happens if it is not inserted.

The dialysis patient is probably the one transfer patient that can go bad very quickly either before or after dialysis. Have you ever read their medical history, looked at their lab work or assessed their heart and lung sounds? The dialysis patient may be sicker than 90% of the 911 calls you get.

They do require assessing which EMT-Bs are capable of doing. But if an EMT or Paramedic insists on categorizing these patients as "crap" runs, it sends a bad message to younger EMTs or Paramedics and these patients may not get the proper assessment or attitude in the back of a truck. There are definitely reasons why some dialysis patients go by ambulance and some go by a community transfer truck. It is unfortunate that too many EMTs and Paramedic blow this patients off as "crap" and never look at the medical history or assessment of these patients to understand that reason. And no, it is not just a "fraud thing" cooked up by the doctors and ambulance companies. If an ambulance service did all the dialysis transfers in a community, there wouldn't be time for anyone else and there probably are not enough ALS and BLS ambulances in a city to do the job. A smaller moderate sized dialysis center can see well over 100 patients in a day.

I can definitely see a need for more education for both EMT and EMT-P in A&P and Disease Processes/Pathology. Maybe there should be a clinical rotation through a dialysis center so EMS students can get a chance to read very complex medical histories, learn to take BPs, avoid damaging the shunt, and see many different vascular access ports that could be useful in ALS as well. You could get the opportunity to see many complex disease processes in just one patient.

As far as radiation, have you ever known a woman who had to go through that for breast cancer 2 treatments per day? And then, after the second treatment they must call a cab for the ride home because they are just drained physically and emotionally. Unfortunately, they do not qualify for an ambulance because they are usually younger and not as many body systems are affected...yet. For an older pt or someone who is in an advanced stage of the disease can not and should not have to "call a cab". Are you qualified to "stage cancer"?

While there should be a system in place to not use the 911 ambulances, these patients deserve at the very least someone who can assess, initiate treatment and know where to divert to if the patient warrants it. There should be an EMT-B or someone with the equivalent even on the community transfer vans.

 

[JPINFV]

Do either of you have enough experience with either dialysis or radiation patients to understand what their disease process involves or that they are human beings that deserve not to be called "crap". For the nursing home patient, you are blowing off a whole set of disease processes by just identifying by a "skill" such as "inserting a foley catheter" without realizing why that foley is important and the consequences of repeated attempts or what happens if it is not inserted.

I think you misread the purpose of the post. I don't believe that the person driving a patient to the dialysis clinic needs to know all too terribly enough about medicine to accomplish that. This is similar to a transport tech in a hospital. They need to know where the patient needs to go and that the patient is stable for a non-monitored transport. Anything else is gravy. My entire post was about getting providers who look at providing transport as their job and not as something they have to put up with because they're on an ambulance.

The example of the foley cath was used for a varying degree of "emergency" calls. Is it important? No doubt, but the crew transporting such a patient to the hospital isn't going to exactly be doing much either during a transport. That was contrasted with a call that should have been a 911 call, yet nursing homes constantly decide to wait 20-30 minutes by calling the local friendly interfacility transport company.

The dialysis patient is probably the one transfer patient that can go bad very quickly either before or after dialysis. Have you ever read their medical history, looked at their lab work or assessed their heart and lung sounds? The dialysis patient may be sicker than 90% of the 911 calls you get.

When I was doing dialysis transports we were lucky to get anything more than a face sheet unless lab values were going to or from the clinic. A patient history was completely dependent on if such a history was provided on the face sheet. That varied from SNF to SNF. Yes, they might be sicker, but if they're going to dialysis probably dialysis is what they need.

They do require assessing which EMT-Bs are capable of doing. But if an EMT or Paramedic insists on categorizing these patients as "crap" runs, it sends a bad message to younger EMTs or Paramedics and these patients may not get the proper assessment or attitude in the back of a truck. There are definitely reasons why some dialysis patients go by ambulance and some go by a community transfer truck.

Where I worked, non-ambulance, gurney vans were virtually non-existent. I think I can count on one hand the amount of times I had seen one, and that was always near the outskirts of the county. Furthermore, it's my understanding that medi-care doesn't reimburse such transports, hence why one of the necessity criteria is to not be able to transfer to/from a wheelchair under ones own power. So, the sickest of the sick as well as the most stable all went via ambulance if they were not in a wheel chair.

It is unfortunate that too many EMTs and Paramedic blow this patients off as "crap" and never look at the medical history or assessment of these patients to understand that reason. And no, it is not just a "fraud thing" cooked up by the doctors and ambulance companies. If an ambulance service did all the dialysis transfers in a community, there wouldn't be time for anyone else and there probably are not enough ALS and BLS ambulances in a city to do the job. A smaller moderate sized dialysis center can see well over 100 patients in a day.

And that's why there's 8 major ambulance companies in Orange County, CA alone with at least one company running 80k calls a year with over half being non-emergent transports. Mind you, that included hospital discharges, of which, a high number of BLS discharges also really don't need a BLS crew. Some do, but definitely not all.

I can definitely see a need for more education for both EMT and EMT-P in A&P and Disease Processes/Pathology. Maybe there should be a clinical rotation through a dialysis center so EMS students can get a chance to read very complex medical histories, learn to take BPs, avoid damaging the shunt, and see many different vascular access ports that could be useful in ALS as well. You could get the opportunity to see many complex disease processes in just one patient.

I can get behind this idea.

As far as radiation, have you ever known a woman who had to go through that for breast cancer 2 treatments per day? And then, after the second treatment they must call a cab for the ride home because they are just drained physically and emotionally. Unfortunately, they do not qualify for an ambulance because they are usually younger and not as many body systems are affected...yet. For an older pt or someone who is in an advanced stage of the disease can not and should not have to "call a cab". Are you qualified to "stage cancer"?

No, that's the job of the health care providers who sign the "certificate of necessity" job (MD/DO, PA, NP, RN, discharge planner). If the patient doesn't meet an established criteria, there is a place for a narrative to justify the transport. As an ambulance provider, my job is to go where I'm dispatcher, transport to where I'm dispatched to transport too [provider the patient is stable. I have no qualms about rerouting to the nearest hospital], evaluate the patient, and provider competent care both medically and customer service [to both the facilities and the patient] wise. There are plenty of providers who fail at one or both of those points though.

While there should be a system in place to not use the 911 ambulances, these patients deserve at the very least someone who can assess, initiate treatment and know where to divert to if the patient warrants it. There should be an EMT-B or someone with the equivalent even on the community transfer vans.

I do believe that a different title should be selected then because the EMT-B program is currently geared towards acute diseases and not chronic diseases. It shouldn't be a stop for a basic looking to get their year in prior to medic school though. As far as "initiating treatment," what sort of treatment are you looking at basics starting outside of oxygen, PPV, simple airway adjuncts, CPR, and driving?

 

[VentMedic]

JPINFV, I'm not posting this to be disrespectful to you or argumentative. But, you have presented a opening for me to respond as I think labeling patients as "crap" or "BS" is something that can get any provider into difficulty as it will skew you assessment before you even see the patient. I would hope that these labels are not being taught in EMT class. These terms should not be part of any type of medical student's vocabulary. Even a physician in training would be severely reprimanded in front of his/her peers if they referred to any patient with those terms.

I think you misread the purpose of the post. I don't believe that the person driving a patient to the dialysis clinic needs to know all too terribly enough about medicine to accomplish that. This is similar to a transport tech in a hospital. They need to know where the patient needs to go and that the patient is stable for a non-monitored transport. Anything else is gravy. My entire post was about getting providers who look at providing transport as their job and not as something they have to put up with because they're on an ambulance.

You don't honestly mean dialysis patients are something that you have to put up with because you are "on an ambulance".

The example of the foley cath was used for a varying degree of "emergency" calls. Is it important? No doubt, but the crew transporting such a patient to the hospital isn't going to exactly be doing much either during a transport. That was contrasted with a call that should have been a 911 call, yet nursing homes constantly decide to wait 20-30 minutes by calling the local friendly interfacility transport company.

So these patients are not worthy of at least a quick assessment?

Nurses at NHs are caught in the middle. If they call for a routine BLS somebody complains it should have been 911. If they call 911, somebody complains it is just a "crap" or "BS" call. There are also several other variables like the physician may have called ahead for a direct admit with a known diagnosis. This is a gray area for all providers and again the RN and EMT are caught in the middle. There is also the issue with limited resuscitation and DNR orders. Some BLS and ALS trucks will waste time about what to treat or not to treat while more time is wasted. The patient has to lay there and listen to this argument wondering if they are going to get any treatment for that broken hip or if they are just a burden to the system and should be left to die. Yes, that's dramatic but realistic and happens on a daily basis in any given city.

When I was doing dialysis transports we were lucky to get anything more than a face sheet unless lab values were going to or from the clinic. A patient history was completely dependent on if such a history was provided on the face sheet. That varied from SNF to SNF. Yes, they might be sicker, but if they're going to dialysis probably dialysis is what they need.

Do you rely on a face sheet on your 911 calls for a history? Ever try physically assessing and talking to the patient?

Yes they need dialysis but they can also be diabetics, CAD, serious electrolyte imbalances, CHF, acid-base nightmares etc. Do you wait until they crash before you know anything about them. Unfortunately many do wait. They then rush into the nearest ER and the only thing the EMTs or Paramedics can offer is "dialysis patient" and "I think they have kidney failure" as a history.

Where I worked, non-ambulance, gurney vans were virtually non-existent. I think I can count on one hand the amount of times I had seen one, and that was always near the outskirts of the county. Furthermore, it's my understanding that medi-care doesn't reimburse such transports, hence why one of the necessity criteria is to not be able to transfer to/from a wheelchair under ones own power. So, the sickest of the sick as well as the most stable all went via ambulance if they were not in a wheel chair.

And that's why there's 8 major ambulance companies in Orange County, CA alone with at least one company running 80k calls a year with over half being non-emergent transports. Mind you, that included hospital discharges, of which, a high number of BLS discharges also really don't need a BLS crew. Some do, but definitely not all.

And still, I don't believe you actually know how many patients are admitted or discharged from any one hospital either as inpatient or outpatient in one day. In a large city there are definitely well over a 1000 patients needing dialysis 3x/week. That doesn't include all the other therapies including rehab for the quads and paras. Many hospital systems have their own transport vans as courtesy. Ambulances only transport a very small percentage of these patients.

No, that's the job of the health care providers who sign the "certificate of necessity" job (MD/DO, PA, NP, RN, discharge planner). If the patient doesn't meet an established criteria, there is a place for a narrative to justify the transport. As an ambulance provider, my job is to go where I'm dispatcher, transport to where I'm dispatched to transport too [provider the patient is stable. I have no qualms about rerouting to the nearest hospital], evaluate the patient, and provider competent care both medically and customer service [to both the facilities and the patient] wise. There are plenty of providers who fail at one or both of those points though.

So why do EMTs and Paramedics still insist on using the terms "crap" and "BS" when referring to a transfer patient. If somebody with more than 120 or even 1000 hours of training has signed the certificate of necessity, do you not think there might exist a reason? They are accountable for their actions. You posted that you only know what is on the transfer sheet which may be only one general diagnosis.

I do believe that a different title should be selected then because the EMT-B program is currently geared towards acute diseases and not chronic diseases. It shouldn't be a stop for a basic looking to get their year in prior to medic school though. As far as "initiating treatment," what sort of treatment are you looking at basics starting outside of oxygen, PPV, simple airway adjuncts, CPR, and driving?

Chronic does not mean they don't have acute problems. That is the problem with labels. It gives one a misconception about potential problems that are occurring and skews an assessment. Maybe the EMT-B should also complete the CNA cert to have a more rounded view of various patients and not just the "exciting" stuff. At least 80 hours in a SNF or Subacute in addition to the EMT-B clinicals might give one a different perspective on patient care and the system.

As far as "initiating treatment," what sort of treatment are you looking at basics starting outside of oxygen, PPV, simple airway adjuncts, CPR,

I consider that initiating treatment. Assessment of vitals should also be included but is often forgotten on these "so called by many negative terms" routine transports.

I can also tell you that when an RN, RRT or Hospitalist(MD) hears about a dialysis patient coming into the ED or being admitted, they may also say "crap" but not because the patient is "routine". These professionals know how fragile these patients are, how closely they must be monitored, how easy they can go bad, how extensive their histories are and how many meds they must try to regulate.

These are patients with individual needs. They should not be viewed by an "insurance status" or labeled by disease or type of disease. Even though your patch says "Emergency" on it, patient care of all aspects must be respected. When did they stop teaching that in EMT or Paramedic school?

 

[JPINFV]

JPINFV, I'm not posting this to be disrespectful to you or argumentative. But, you have presented a opening for me to respond as I think labeling patients as "crap" or "BS" is something that can get any provider into difficulty as it will skew you assessment before you even see the patient. I would hope that these labels are not being taught in EMT class. These terms should not be part of any type of medical student's vocabulary. Even a physician in training would be severely reprimanded in front of his/her peers if they referred to any patient with those terms.

I don't think that you're trying to be argumentative or disrespectful. I hope you don't think that I'm doing the same. It's a discussion and things go back and forth.

The labels themselves aren't being taught, but I would place money that anyone who has worked in the field has been exposed to people who carried that attitude. There are, unfortunately, plenty of providers who treat non-emergent transports as the bane of their existence and do treat non-emergent patients like crap. It's not right, but given the current situation regarding EMS and ambulance company operations, unfortunately, doesn't seem like it's going to change any time soon.

You don't honestly mean dialysis patients are something that you have to put up with because you are "on an ambulance".

Me, personally? No. I can't say that that didn't apply to some of my coworkers though. I honestly can't say that I was overjoyed when the 5th interfacility dispatch came over the pager in less than 4 hours into a shift, but that is a part of the job and if I didn't like it enough that it affected my patient care, then I know where the door is. Again, that doesn't go to say that there aren't ambulance personal who let these things affect how they act towards a patient.

So these patients are not worthy of at least a quick assessment?

Do patients going to dialysis clincs via wheel chair van receive a quick examination past a look over?

Nurses at NHs are caught in the middle. If they call for a routine BLS somebody complains it should have been 911. If they call 911, somebody complains it is just a "crap" or "BS" call. There are also several other variables like the physician may have called ahead for a direct admit with a known diagnosis. This is a gray area for all providers and again the RN and EMT are caught in the middle. There is also the issue with limited resuscitation and DNR orders. Some BLS and ALS trucks will waste time about what to treat or not to treat while more time is wasted. The patient has to lay there and listen to this argument wondering if they are going to get any treatment for that broken hip or if they are just a burden to the system and should be left to die. Yes, that's dramatic but realistic and happens on a daily basis in any given city.

I won't argue that it's unrealistic. Personally, if I'm on a call that should have been a 911 call then I don't believe that I have enough time to hash out who to call and when on scene. The only exception [which I've never experienced, but have heard first hand stories of it happening] is if I do need paramedics and the nursing home staff is preventing me from making a 911 call for paramedics. Of course Orange County has the insanity of only having paramedics with the fire department, so it's either call for a BLS transport or call 911. There is, litterally, no other option short of arranging a CCT with an RN. Of course even in that case, it takes 1 person to call 911. The other person on the ambulance should be caring for the patient anyways.

As far as being caught in the middle, there are obvious times when 911 should be contacted. I'm not talking about getting my panties in a bunch because a patient with hx of a-fib is being sent BLS and has an irregular pulse rate. The patient that's breathing 40 times a minute with accessory muscle use and is now unresponsive without a DNR, though, is a completely different story.

As far as the interplay between the nursing home staff and the patient's PMD, I've had a chance to witness that first hand, but even then, when push came to shove [the patient was very hypertensive [210/70], as well as running a pretty decent temperature], the RN released the patient for transport [the facility was trying to contact the PMD when we arrived with a discharge. We offered to wait around for a few minutes since we were already on scene. The discharge was completed, though, before we offered to help].

Do you rely on a face sheet on your 911 calls for a history? Ever try physically assessing and talking to the patient?


Yes they need dialysis but they can also be diabetics, CAD, serious electrolyte imbalances, CHF, acid-base nightmares etc. Do you wait until they crash before you know anything about them. Unfortunately many do wait. They then rush into the nearest ER and the only thing the EMTs or Paramedics can offer is "dialysis patient" and "I think they have kidney failure" as a history.

Yes, if the patient can talk. Even then, there are plenty of patient's in SNFs that do not know their full medical history. The patient, face sheet, and any accompanying H/P are all sources for a patient's medical history.

And still, I don't believe you actually know how many patients are admitted or discharged from any one hospital either as inpatient or outpatient in one day. In a large city there are definitely well over a 1000 patients needing dialysis 3x/week. That doesn't include all the other therapies including rehab for the quads and paras. Many hospital systems have their own transport vans as courtesy. Ambulances only transport a very small percentage of these patients.

I guess the area I worked in is pretty screwed up though [not meant tongue in cheek]. I'm trying to think if I can remember any hospital that ran their own transportation. Just because I don't know if they did doesn't mean that it didn't happen. Again, my area had a very healthy non-emergent ambulance transport environment utilizing both wheel chair vans and ambulances. There was no middle ground between those, though. If a patient couldn't sit in a wheel chair, then they, by default, went by ambulance. Of course, not every patient going to dialysis arrived via ambulance, or even ambulance and wheel chair van. You still had, though, ambulances showing up at private residences , board and cares [assisted living out of a private residence], and assisted living places 3 times a week to transport a patient to dialysis.

So why do EMTs and Paramedics still insist on using the terms "crap" and "BS" when referring to a transfer patient. If somebody with more than 120 or even 1000 hours of training has signed the certificate of necessity, do you not think there might exist a reason? They are accountable for their actions. You posted that you only know what is on the transfer sheet which may be only one general diagnosis.

First, I don't think that all of the reasons on a certificate of necessity reflect a need for an ambulance over a gurney van. Gurney vans, though, aren't a covered means of transportation.

Second, even the federal government is saying that up to 25% of non-emergent transports [from 2002, but the report was released last year] do not actually meet the definition of medical necessity.
http://www.emsresponder.com/print/Emergency--Medical-Services/Multimillion-Mistakes/1$5006

Third, is a crew transporting a patient with dementia or other chronic disease that makes a patient confused supposed to argue with the nursing staff for a history and physical? I've had a hard enough time getting a report from staff for an emergency call and, god forbid, if I actually ask for a copy of the MAR instead of a med list [which we have been requested to do by RNs at the receiving hospitals]. Now that crew is delaying transport, which, especially if the transports are running behind, is going to have a ripple affect through out all of the dialysis clinics as they find that they can't clear chairs for their next patient thereby pushing everyone's appointment behind.


[split up due to character limit]

 

[JPINFV]

Chronic does not mean they don't have acute problems. That is the problem with labels. It gives one a misconception about potential problems that are occurring and skews an assessment. Maybe the EMT-B should also complete the CNA cert to have a more rounded view of various patients and not just the "exciting" stuff. At least 80 hours in a SNF or Subacute in addition to the EMT-B clinicals might give one a different perspective on patient care and the system.

You're absolutely right, chronic does not equate to not having any acute problems. But chronic problems can also provide cover for acute problems. Who says that a patient with a history of renal problems, diabetes, dementia isn't extra confused today because of a problem with the first two? A BLS crew that isn't acquainted enough with a patient to truly know the patient's baseline is going to have to accept the care giver's word [RN or otherwise] that the patient's current state is normal.

Personally, I'd like to see some time in SNFs just to understand what a nursing home staff has to do to arrange a transport, especially an immediate/emergency transport.

I consider that initiating treatment. Assessment of vitals should also be included but is often forgotten on these "so called by many negative terms" routine transports.

I'll ask the same question again that I asked earlier in this post. Does a wheel chair van driver do vitals? I'm not saying that vitals shouldn't be done on any routine transport, but I don't believe that all routine transports done by ambulance necessarily need an ambulance.

I can also tell you that when an RN, RRT or Hospitalist(MD) hears about a dialysis patient coming into the ED or being admitted, they may also say "crap" but not because the patient is "routine". These professionals know how fragile these patients are, how closely they must be monitored, how easy they can go bad, how extensive their histories are and how many meds they must try to regulate.

Then should we do away with wheel chair vans that transport patients with similar histories, but aren't bed bound?

 

[VentMedic]

Then should we do away with wheel chair vans that transport patients with similar histories, but aren't bed bound?

No, but I do believe the drivers should have some medical training either CNA or EMT. The EMT trained driver would be able to recognize a problem hopefully and divert quickly if needed. The majority of our outpatients do arrive by some type of transport with a non medical person. Many times have been delivered patients that are too unstable for dialysis but are left in the waiting area to code. I consider it a great day if I only work one code or Rapid Response Team call in the dialysis center.

 

[Aileana]

To answer TKO. Yes we have EMR's. But they are called MFR's ( medical first responder not emergency medical responder). Is there another way we can mix up the alphabet to say the same thing so we can become more confused? Our MFR's are volunteer, mostly with fire depts. and may be first on scene to provide initial care. Some depts. operate that they go to all code 1 medical calls and others at paramedics request. For us we only have two codes. Code 1 is with lights and siren and code 2 without. They have about two weeks of training, can start an assessment, give O2, take a bgl and give oral glucose. I'll have to check to see if they can give ASA and nitro. They also extracate backboard and collar. They do NOT transport.
We are getting more ACP's as more medics upgrade but they are still scarce in the rural areas. At our base we have 26 medics. 10 ACP, 9 PCP, 7 ICP. The ICP was a stopgap measure from about 10 years ago to get als when there were few ACP's. They can do IV's, intubate dead people, give morpine and valium, and in an arrest give epi, atropine, and lidocaine.That's about it. The province stopped registering ICP's about 6 years ago. So there are no new ones. The only exception is if an American EMT-P wants to get registered here they will temporally register them as an ICP. They then have one year to write the provincial exam. If they pass, (and they do), they get registered as an ACP.
Now out of curiosity what do various people get paid for their registration level? How many hours in your avg work week?
Here a new PCP gets $17.50 hr, with 5 years exp. $19.90. An ACP starts at $21.50 and with 5 years exp. $24.50. I might be out a few cents as I haven't got my book handy. We work an avg. 42 hour week plus overtime if you want and there is always lots. We do mostly 12 hour shifts in a two day two night four days off rotation. Some of the quieter rural bases work 24 on 72 off. Our contract is up soon and its nice to know whats around.
Nova Scotia will not consider registering EMT-B's.
I believe Rid is right. You started the ball rolling but have let it pass you by. If you want to move ahead you must push for change from within. Look at our and other countries sucesses and our mistakes. Learn from them and make a better system. It won't be easy and it will cost a lot. But it is doable.

In Ontario, we have MFR courses, but they aren't used in EMS as far as I know (minimum for employment is PCP). Our PCPs can give nitro, ASA, glucagon, oral glucose, ventolin, and epi, do and interpret 4-leads (and 12-leads in some regions), S-AED (don't think they can go manual, but I'm not entirely sure), take BGLs, and some other stuff. Our ACP's do all that plus narcotics and about 20 other drugs, intubations, IVs and IOs, crics, and some other stuff. The region I worked out of normally had split trucks (a PCP paired with an ACP).

I didn't realize that the EMT program in the states was only 120 hours. Not sure how all of the essential information can be learned in that sort of time. Its a 2 year college program here. I have just applied for it now, and am hoping to get in (2000 applicants, and 70 seats at my first choice ).

We normally work 12 hour shifts, on a rotating schedule (few nights, few off, few days, few off etc.) where I ride out of, and PCPs start around $20/hour, and go up to about $25/hour. ACPs start around $30/hour as far as I know, but not sure what they get up to.

 

[Outbac1]

Aileana

Our MFRs are volunteer. Mostly with FD.

Our PCPs and ACPs do the same stuff. We just don't get paid the same, but we are working on it.

Yeah I was surprised that their Basics only had 120 hours or so as well. About what our MFRs have. I thought when we (PAC) created the PCP etc we were just catching up to the US. I didn't think we went right on by.

 

[BEorP]

In Ontario, we have MFR courses, but they aren't used in EMS as far as I know (minimum for employment is PCP). Our PCPs can give nitro, ASA, glucagon, oral glucose, ventolin, and epi, do and interpret 4-leads (and 12-leads in some regions), S-AED (don't think they can go manual, but I'm not entirely sure), take BGLs, and some other stuff. Our ACP's do all that plus narcotics and about 20 other drugs, intubations, IVs and IOs, crics, and some other stuff. The region I worked out of normally had split trucks (a PCP paired with an ACP).

I didn't realize that the EMT program in the states was only 120 hours. Not sure how all of the essential information can be learned in that sort of time. Its a 2 year college program here. I have just applied for it now, and am hoping to get in (2000 applicants, and 70 seats at my first choice ).

We normally work 12 hour shifts, on a rotating schedule (few nights, few off, few days, few off etc.) where I ride out of, and PCPs start around $20/hour, and go up to about $25/hour. ACPs start around $30/hour as far as I know, but not sure what they get up to.

Sorry to bring back an old thread, but I wanted to offer some additional information. Additional PCP skills in Ontario, depending on region, may include: IVs, D50, gravol, benadryl, airway devices such as the Combitube or King LT, and manual defibrillation.

I believe that generally in Ontario the PCP wage to start is around $30 an hour or at least in the high $20 range. I do not know of a service that pays only $20 an hour in Ontario in 2008.