EMT Bs and a 12 lead

[firemoose0827]

Thanks for replying. Since it is limited to a 3 lead only, I have no further comment as I thought you were implying you perform 12 leads prior to medic arrival. I was going to get into placement, positioning of patient, etc, because there are a lot of medics that do not even know that stuff and do it incorrectly every time.

Understood. I was once an EMT-CC and know of this too. But we just learn the basics of getting a picture to the ALS provider of what things looked like before they got there, which helps them get a bigger timeline. Thanks.

My only issue with the way you do it, is someone already mentioned it. The thought of having equipment on scene, knowledge of a problem, but no licensure or true education to fix the problem.

I guess this is the same as any other EMT arriving on scene of a code, knowing what is needed but cant help because they don't have a little piece of paper that says they can...Especially for those of us who were ALS providers once and than let it drop and became BLS providers...we know what is needed, and how to go about doing it, but without that tiny piece of paper...:sad: we cant do anything but what our BLS protocols tell us to do, which is use the AED, CPR, O2 and hope ALS gets there or you can get to a decent level ED quick. In my view, BLS providers trained in applying the heart monitor and printing a strip is just another diagnostic tool to aid in the overall treatment and care of the prehospital patient. Good discussion, thanks!

It is like 2 basics arriving in an ambulance that says Advanced Life Support or MICU or whatever language your area uses...it is false representation.

I think it is potentially bad juju and there will be fallout somewhere, sometime, eventually.

Well, our rigs simply say "Cobleskill Fire & Rescue" on the side. We do not feel the need to label them with ALS signs or Paramedic symbols. We keep track of resources in our county at the dispatch level, they know where the ALS is located, and the EMS Captains know it as well, so we do not need to plaster the bus with the decals. That helps some.

Stay Safe

 

[VentMedic]

Well, our rigs simply say "Cobleskill Fire & Rescue" on the side. We do not feel the need to label them with ALS signs or Paramedic symbols.

So the public has no idea what or who they are getting? You could be running all EMTs who just happen to carry some equipment that people believe to be standard on a Paramedic truck?

Especially for those of us who were ALS providers once and than let it drop and became BLS providers...we know what is needed, and how to go about doing it, but without that tiny piece of paper...:sad: we cant do anything but what our BLS protocols tell us to do, which is use the AED, CPR, O2 and hope ALS gets there or you can get to a decent level ED quick.

The EMS providers let their ALS certs drop but still want to be like one? If one did not have the ambition to maintain their advanced cert, what is to say they can maintain proficiency at the very basic skills of an EMT?

I do know this is a practice with some of our FDs once you achieve a certain number of years but those FFs are also now running where there will be little patient care contact. They don't pretend to be something they no longer hold a license for but do maintain EMT proficiencies.

 

[firemoose0827]

So the public has no idea what or who they are getting? You could be running all EMTs who just happen to carry some equipment that people believe to be standard on a Paramedic truck?



The EMS providers let their ALS certs drop but still want to be like one? If one did not have the ambition to maintain their advanced cert, what is to say they can maintain proficiency at the very basic skills of an EMT?

I do know this is a practice with some of our FDs once you achieve a certain number of years but those FFs are also now running where there will be little patient care contact. They don't pretend to be something they no longer hold a license for but do maintain EMT proficiencies.

Wow...Ouch. Thanks for the insult.
I let my ALS drop because I was a FT EMT-CC and had no issues getting my CME's. When I left my FT Job for better pay, I could not continue to get my CME's, work 2 jobs and support a family, so I went to a Basic EMT again to help my volunteer squad. Some people are not as fortunate as others I guess to have all the free time in the world to keep up their certs and still come on these web sites and belittle others. Where I come from we work as a team and support each other, and thats the way I like it.

 

[VentMedic]

Wow...Ouch. Thanks for the insult.
I let my ALS drop because I was a FT EMT-CC and had no issues getting my CME's. When I left my FT Job for better pay, I could not continue to get my CME's, work 2 jobs and support a family, so I went to a Basic EMT again to help my volunteer squad. Some people are not as fortunate as others I guess to have all the free time in the world to keep up their certs and still come on these web sites and belittle others. Where I come from we work as a team and support each other, and thats the way I like it.

You believe that lowering the stanards serves your community better? Maybe if they had someone who promoted higher standards they would see a way to accomplish that for the community. If you real the EMS newswires, you will find that many small communities are now developing ways to get ALS service.

BTW, many of us have families also when we were getting our education. You are not the only one. I just saw how my education could benefit my family even if I had to make a few adjustments for a couple of years.

 

[Level1pedstech]

What was the logic behind such a plan?


You're an ALS provider, with ALS gear, but can't do anything until you have more ALS personnel?

My former department was a combination department with ALS engines. If we did not have a medic in the company we ran BLS. All meds were kept in a lock box with access only available to those authorized to use them.

 

[firemoose0827]

You believe that lowering the stanards serves your community better? Maybe if they had someone who promoted higher standards they would see a way to accomplish that for the community. If you real the EMS newswires, you will find that many small communities are now developing ways to get ALS service.

BTW, many of us have families also when we were getting our education. You are not the only one. I just saw how my education could benefit my family even if I had to make a few adjustments for a couple of years.

I am glad for you and your desire to remain in EMS. And obviously your pay scale is better than mine. Can you raise your family on $14/hour as a medic?? As a basic I started with $7.50/hour...sorry, but that is not enough to raise a family. I did make adjustments to suit my family. I got a better paying job and I still help my community as an EMT, nothing wrong with that sir.

But you digress from the original content of the post, so can we get back on track? You have your opinions and values and I have mine, thats what makes us different people, and there is nothing wrong with that. So we should stop the highjacking of this thread and get it back on track.
Sorry everyone! lol

Back to the BLS members armed with monitors...

 

[VentMedic]

I am glad for you and your desire to remain in EMS. And obviously your pay scale is better than mine. Can you raise your family on $14/hour as a medic?? As a basic I started with $7.50/hour...sorry, but that is not enough to raise a family. I did make adjustments to suit my family. I got a better paying job and I still help my community as an EMT, nothing wrong with that sir.

We all make choices. However, it is when you use your own personal choices at arguments for what is best for your community it becomes an issue. If you read the arguments pro volunteer, you will also hear these same ones at the town meetings when it is debated. Too often people can not differentiate whether they are arguing for the good of the community or they are wanting to hang on to the way things are for their own selfish reasons.

Imagine how much better a community would be with a paid employee who put their career in EMS first and not their "other" job.

As far as $14/hr, it all depends on where you live and the lifestyle you have chosen. Many do survive much less and still have a quality life.

Back to the topic:
Handing out extra skills just to keep EMTs satisfied and to give them more reason not to advance their education should not be condoned nor should it be used as an excuse for a service to remain BLS and hire cheap labor. EMS has ended up with 50+ different certs by trying to keep the lowest level provider happy. BLS truck employers are happy because they can offer a nickel more for a "skill" and the EMTs will keep applying because they can do 1 more "skill".

 

[firecoins]

So the public has no idea what or who they are getting?

what makes you think they know what they are getting either way? Most members of the public have no idea the difference between BLS and ALS. If someone shows up and takes them to the hospital, they be none the wiser.

Handing out extra skills just to keep EMTs satisfied and to give them more reason not to advance their education should not be condoned nor should it be used as an excuse for a service to remain BLS and hire cheap labor. EMS has ended up with 50+ different certs by trying to keep the lowest level provider happy. BLS truck employers are happy because they can offer a nickel more for a "skill" and the EMTs will keep applying because they can do 1 more "skill".

That is correct.

 

[VentMedic]

what makes you think they know what they are getting either way? Most members of the public have no idea the difference between BLS and ALS. If someone shows up and takes them to the hospital, they be none the wiser.

That is correct.

That depends on where you live. In Florida, they know they are getting Paramedics.

Of course, in services as described in some of these posts, it is to the advantage of that EMS system if the public doesn't know what is really going on.

Can you imagine in a hospital if they didn't have enough RNs so they had CNAs appear to be doing what an RN would normally do?

While CNAs do put on monitor electrodes, they know it is only for assistance and do not give any pretense otherwise.

 

[firecoins]

That depends on where you live. In Florida, they know they are getting Paramedics.

Do they know that really means?

 

[VentMedic]

Do they know that really means?

Yes the majority of them do. Many attend meetings in their city halls or condo associations, read newspapers, subscribe to AARP which does a great job of explaining EMS, read what they are paying taxes for especially at election time and attend local health fairs to get more information. As well, the FDs (yes, Fire Based EMS) make their rounds doing public safety inspections and distributing useful information at various locations. The FDs do a great PR job with informing people what "ALS" and Paramedics are. It is also hard to walk more than a 100 yards in Florida without meeting a Paramedic either working for the FD or working at Burger King waiting to get on at the FD. So there is always someone around to tell you what a Paramedic is.

One more little thing to add, many of our tourists and citizens are from other countries where EMS is advanced. Many probably wouldn't be familar with or would be shocked at our "BLS" or EMT-B level.

 

[firemoose0827]

We all make choices. However, it is when you use your own personal choices at arguments for what is best for your community it becomes an issue. If you read the arguments pro volunteer, you will also hear these same ones at the town meetings when it is debated. Too often people can not differentiate whether they are arguing for the good of the community or they are wanting to hang on to the way things are for their own selfish reasons.

Imagine how much better a community would be with a paid employee who put their career in EMS first and not their "other" job.

As far as $14/hr, it all depends on where you live and the lifestyle you have chosen. Many do survive much less and still have a quality life.

Back to the topic:
Handing out extra skills just to keep EMTs satisfied and to give them more reason not to advance their education should not be condoned nor should it be used as an excuse for a service to remain BLS and hire cheap labor. EMS has ended up with 50+ different certs by trying to keep the lowest level provider happy. BLS truck employers are happy because they can offer a nickel more for a "skill" and the EMTs will keep applying because they can do 1 more "skill".

Well, we agree on one thing. I believe that a paid system needs to be started in every community. The service to the patient is what is priority, and the timely delivery of this service is key. Most volunteer based services, especially rural areas, have extremely high response times. This is not acceptable any more. We all need to think about the patient first, everything else second. If I had a decent paying job as an EMT I would still be there, but my family comes first. Does this mean I do not want to help anymore? No. Does this make me a bad person? No. I still want to be able to use any free time I may have to help my community as a Firefighter/EMT. Back to my idea in my original post, I believe that EMT's having the knowledge to attach a monitor to a patient and get a strip for the medic is a way to help both the medic and the patient. Im here to help others any way I can. If that means going to a paid EMS system supplemented with volunteer staff, I would be the first to vote yes.
For now, in my community, what we have been practicing is working fine for us as EMT's and the service we provide to our residents. I work for the local private EMS agency PT and I am the one in front at the volunteer meeting telling everyone to turn our calls over to the paid service for weekday calls, and have them be primary mutual aid nights and weekends.

Look at that...lots of different people with different opinions able to share them in an open forum.

 

[emtjack02]

Ether or. Doesn't matter. My post was to demonstrate the stupidity of EMTs carrying around a machine that they cannot use, where there will be people pressuring them to use it.

Well I believe it does matter to an extent because if they BLS service is using a LP12 or another unit that has an AED function they would be able to use it. I will not argue the point of a BLS having a monitor like the LP12 because I am sure each service has their reasons...plus I guess if you have the money..wow.

I do enjoy the help I can get from a basic. If they put electrodes on wrong then fix it, educate, and move on. I think there have been many good points about not giving basics things to do just because they want to do more w/o an advance cert but I think we should be evaluating this on a case by case basis. I would love to have one uniform thing but I dont know if that will be happening anytime soon.

 

[firespec35]

why can't basics just do basix stuff. you wanna do als go to medic school

 

[Shishkabob]

why can't basics just do basix stuff. you wanna do als go to medic school

I suggest actually reading this thread before you make a comment.

 

[MrBrown]

One more little thing to add, many of our tourists and citizens are from other countries where EMS is advanced. Many probably wouldn't be familar with or would be shocked at our "BLS" or EMT-B level.

I would have to agree. Our "basic" providers (called an Ambulance Officer or "AO") are able to administer GTN, aspirin, acetaminophen, glucagon PO/IM, methoxyflurane and entonox (although nox is being withdrawn) and nebulize salbutamol. They are also able to insert NPAs, OPAs and the LMA (laryngeal mask airway) as well as obtain (but not interpret) a 3 lead ECG and soon, a 12 lead ECG.

Now I was going to make the argument in support of EMT-Basic's being allowed to obtain a 12 lead ECG for the reason that it provides basis for serial ECG comparison by hospital/ALS and that it could potentially assist ALS if they do an intercept by having a 12 lead already done for the Advanced Paramedic.

Having reviewed the DOT/NHTSA EMT-Basic national standard cirricula it does not mention anything about rhythm monitoring or ECG acqiusition (which honestly suprises me, even our most basic volunteer officers (analouge to Fire Responders) are taught to acqurie a 3 lead ECG) ... so on that basis I would have to be against it.

Before I respond, and hopefully some of the other ALS providers will follow my lead...would you please take the time to explain how and what you teach the BLS providers i n order for them to do a 12 lead?

Please go into detail regarding everything you cover or give a very thorough outline with the important highlights noted.

Before being able to acquire a 3 lead we are taught the following at the BLS level:

- cardiac anatomy (position, chambers, layers, valves and vascularization)
- cardiac physiology (systole, diastole, systemic/pulmonary circulation)
- cardiac electrical structure/function (origins and path of electrical circut)
- placement of LA/LL/RA/RL leads
- ECG waveforms and intervals (PQRST, PR and QT)
- interpretation of NSR, VT, VF, asystole

Once 12 leads become a BLS skill they will be included into the cardiac education; I don't know exactly WHAT will be taught but for interest here is what our Paramedics (ILS) are taught before they can obtain one (granted this will also allow use of manual defibrillator and cardioversion):

- advanced cardiac anatomy and electrophysiology (cellular anatomy, electrolytes/action potential physiology etc)
- to identify who should/should not have a 12 lead performed
- to be able to competently acquire one
- to link the 12 lead back to rationale of treatment (published evidence)
- interpretation of atrial, ventricular, supraventricular, junctional and sinus rhythms (MAT, WAP, VT, VF, SVT, blocks, IVR etc)
- manual defibrillation and cardioversion

Hope this provides an international perspective; we are also trialling thrombolytics prehospitally at the moment with, from what I have seen, some very pleasing results.

 

[Melclin]

Welcome to the forum MrBrown,

What are the educational requirements for AO and Paramedics?

 

[MrBrown]

Welcome to the forum MrBrown,

What are the educational requirements for AO and Paramedics?

Well, it depeneds which track you take. Like Australia we are transitioning away from the in-service "on the job" trade school type education model towards a pre-employment university degree system. I don't know how much of your transition was supported by MAS but St John has been OK but somewhat less than accepting of the graduates.

There are currently three education streams being offered in New Zealand; Bachelors, paid in-service and volunteer in-service.

Bachelors degree is three years and graduates are employed autonomusly as an AO but can practice up to the skill level of thier partner (AO, Paramedic, Upskilled Paramedic or Advanced Paramedic) while they go through the 18 month internship.

If you are a volunteer or a new paid member of staff (employment of ab-initio zero qualifications paid staff is declining as the service begins to recognize the value of the Bachelors degree students) you have to complete the National Diploma in Ambulance Practice (NDAP) to become an AO. This is a new qualification introduced last year. It's a very broad qualification that has had some fundamental changes from the old National Certificate in Ambulance (NCA). the NCA had more book based theory in anatomy and physiology (e.g. cells and tissues), laws, ethics and mushy grief handling. These have been removed from the new Diploma and everything is now specifically geared towards "...an ambulance context" so for A&P it shifts the focus towards system level "form and function" rather than "can you describe the cellular membrane and selective permiability?" which I personally take an issue with.

Besides the "form and function" based A&P you have to do basic pharmacology, cardiology (which I must say the ECG components I was quite impressed with), a core skills module (scoop stretcher, vital signs, scene management etc), medical module and a trauma module. This part of the course is done over 12 weeks online and with 12 days in the classroom doing practical skills.

You then have to document 20 calls (assessment, treatment, rationale, evidence based practice etc) and pass an end-of-course assessment with your mentor and somebody from Clinical Standards. If they are happy, you can become an AO.

To become a Paramedic (ILS) which adds 3 lead interpretation, 12 lead acquisition, manual defibrillation, cardioversion, IV cannulation and IV fluids (NS and D10) to your scope you need to complete 6 written assignments, 6 days in class, a logbook of at least 50 (preferably 100) IV cannulations and 20 rhythm strips in ED and a shift with your mentor on road. The written assignments are 4 cardiac and 2 shock/fluids/trauma but also include some pharmacology and awareness/knowledge of hospital based treatment/continuim of care; they are fairly comprehensive with about 30 rhythms strips you have to identify and questions such as ...

- Explain why fluid tends to shift from the interstitial to intravascular space in the early stages of shock.
- Explain the difference between the injuries (and thier MOI) commonly encountered in and the management of shock caused by both blunt trauma and penetrating trauma.
-List 15 causes of chest pain other than an MI and 10 symptoms of an MI other than chest pain
- Describe the difference between an interpolated PVC and a PVC with a compensatory pause.

Upskilled Paramedic is a wishy-washy level mostly introduced to remove demand on ALS for adrenaline /pain relief and give rural patients access to treatment they would not otherwise have avaliable. It requires the completion of 4 written assignments (I haven't seen them), a viva with a medical director and some more days in class. You can then administer adrenaline IM/IV, naloxon IM/IV/IN, metaclopramide IV and naloxone IM/IN/IV.

From there the final step is Advanced Paramedic (ALS) which requires completion of the Bachelors Degree.

 

[TomB]

There are some areas in the country where BLS providers can capture a 12 lead ECG and transmit it for physician interpretation. In some cases, this allows the BLS provider to bypass a non-PCI hospital, which is a good thing!

Tom

 

[VentMedic]

There are some areas in the country where BLS providers can capture a 12 lead ECG and transmit it for physician interpretation. In some cases, this allows the BLS provider to bypass a non-PCI hospital, which is a good thing!

Tom

That could be a good thing provided the other hospital is within a very reasonable distance. I would hate to think of the bad outcomes if this is a BLS truck that can only rely on speed when the BP is dropping or the rhythm changes to VT/VF while bypassing another hospital and is at the point of no return. It is one thing to bypass hospitals if you are ALS and have similar capabilities as to what would be initially done in an ED but it is a whole other pandora's box to tell a crew with nothing more than first-aid training and an 12 - lead EKG skill to bypass and keep going just by a transmitted piece of paper and a BLS assessment. Would they also be trained to recognize rhythm changes that might require immediate attention? They would also be speeding into the further ED with no IV access (not that they should be taking more time at scene to do that either at a BLS level) and probably a very sick patient if nothing else from a very scary ride.