ER Tech vs Rig Work

[Tigger]

re: #34 and #35.

I can see your point, you think 120 hours is not enough for the best prehospital care, and it isnt. Here in NY we have two kinds only. BLS and ALS. one is the EMT-B and the other is EMT-P. nothing in between.

the EMTB is allowed to only do what is allowed for EMTB, and the P is allowed to do what the P is allowed.

I can honestly say, I wish every bus out there was a moving ED complete with diagnosis machines and surgery compartments, Portable X-Ray and MRI, Full Lab and pharmacy, yada yada and with 2 MDs and a surgeon per bus. But we cant have everything we want...

So we have the EMTB, and the EMTP.. anything else goes to the hospital.

The current EMT-B Class, if done correctly, and the student learns all of it, then that 120 hours worth of training is plenty enough to do the job of the EMT-B.

If you add more hours to the class, then these people would end up being a higher level and not a Basic anymore. which is not my agrument.

I know you might think that they should get rid of the EMTB rank, and start letting people on the street starting at AEMT or maybe even a all paramedic force, but that is not reality, the goverment decided that emtB is good for the street. I think the current class is more than adequate for the skills an EMT B must peform, and only perform, and if he performs more than that he gets fired.

When you have a job as an EMT, the deficiencies in your training will come to light, as they have for everyone else. Every job is going to have a certain degree of "on the job" learning, but there is to much of it going on in EMS, especially with basics.

You could certainly add hours to the EMT-B class without adding any skills or interventions. Much more time should be spent learning anatomy and physiology beyond "this is the femur, it hurts when you break it." More time could be spent on proper lifting techniques (bed to bed, chair to stretcher, etc). Documentation is very important in EMS yet how long do we spend learning to write narratives? I could go on but I hope you get the point, even with the current basic scope 120 hours is still not enough.

And despite working on a BLS ambulance, I am wholly in favor of their elimination from American EMS.

it must be a NY thing, here, the Basic dont include any phlebotomy training / certs at all.

Many times in the hospital you will find that techs have an expanded scope of practice authorized by the ER's medical director.

 

[Vetitas86]

I've heard stirrings of a push to redo the education requirements from EMT-B on up. Anyone heard anything about this?

 

[Miscusi]

Re: 41, Oh yes, I know that alot of people can improve on what they learned that 120 hours. I know a few females in our class werent able lift her end of the stretcher. they could really use a year of bodybuilding and protein eating training.

I can see how if the Director at the hospital directs the EMT-B to do an IO, then I guess the B is then authorized to do it. Perhaps there would have been some kind of expansive training period in-house for the newly hired ER TECHS... I just could just imagine that then the EMTB is no longer working as one, but working as an ER TECH which then might fall into a different legal catagory.... somehow....

 

[Handsome Robb]

The triage nurse brings back a patient and gives you the reason your patient is here today. Your going to get about the same amount of information you would receive with a field dispatch,basically the patients chief complaint.

I'd be willing to be that information is more accurate than dispatch info especially in a 911 system but I do agree with the rest of your post.

but for those not in school, with no intention of taking more classes, knowing more than what the EMTB should know holds no real job value as the emt b is prohibited from doing more than what the standard of care is anyway. these emtbs are better off in the truck, perfecting the art of the perfect stair chair grip, and etc..

we are all given a place in life, a role to play, if it is to be an EMTB, then I rather learn to do the best and fastest AED application rather than to take the time to learn the EKG which I will never use anyway.

Just because you can't perform advanced skills doesn't mean you can't use the knowledge you gain to perform a more thorough assessment to help the ED in their treatment path...Sure everyone will argue that the ED doesn't listen to EMS and does their own assessment which is true to a point but at least in my system the nurses definitely listen to the EMS report and take advantage of the information we have for them. It's not uncommon for nurses to ask field crews for help with a critical patient once we get to the ED, especially if they are busy or shorthanded.

Example, we had a heroine OD that desatted while we were waiting for a nurse and an MD in the room with a "Trauma Tech 1" <- intermediates who were grandfathered in after they switched to all Paramedic techs. He couldn't do anything about it besides bag the patient and wait for orders and while we were waiting i gave him another .4 of narcan and improved the patient's respiratory drive to only require a nasal cannula at 4 lpm rather than sitting there bagging him and inflating his stomach which could cause further problems for the hospital down the line.

 

[Vetitas86]

Something that would be interesting is specialized training for ER techs, leaving prehospital to the extant EMTs.

Pharm already does it with compounding and such certs for techs. Why not EMT-Emergency Dept? You'd get less exposure to nonsituational patients. Yes, there'd be loss of flexibility, but each would be able to function independently.

Then again, that kind of scope really has been the domain of nursing, so why not let EMTs focus solely on prehospital?

Thinking out loud, but imagine an ED staffed with EMTs under a charge nurse or similar. They'd have the duties of CNAs and RNs, but within the limited scope of the ED. This would make cross training and ease of information easier from EMT to midlevel to doc.

Again. Just thinking out loud.

 

[Miscusi]

Example, we had a heroine OD that desatted while we were waiting for a nurse and an MD in the room with a "Trauma Tech 1" <- intermediates who were grandfathered in after they switched to all Paramedic techs. He couldn't do anything about it besides bag the patient and wait for orders and while we were waiting i gave him another .4 of narcan and improved the patient's respiratory drive to only require a nasal cannula at 4 lpm rather than sitting there bagging him and inflating his stomach which could cause further problems for the hospital down the line.

well ok. I am all for people to learn everything their job entails.

If they switched to all Paramedic Techs, and dude was grandfathered in as an EMT-I, shouldnt he be required to do more training to achieve the new job's requirements ?

Then this is the fault of the system. they should have taken the man off the floor if he did not meet the new requirements. grandfather or not.

things change everyday, as the demands of medicine gets greater, the ER Techs must meet the challenge.

this is a case of the person not knowing all that he should know...

but I am saying that there is not much of a need to know MORE than what you should know...

I think every position has a purpose. I think the EMTB are more transport, and less medicine, so they should work greatly on the specific skills of driving, map reading, staying strong and working out for the lifting and moving, and knowing all they should know for the job of the EMT B... I think IMHO that knowing your OWN JOB is the most important thing, Knowing the job of a paramedic when you arent one just do not help because you cannot know everything the medic knows, and he went to a thousand hour class to know, whats worse, is that if you think you know, but then you are mistaken because you werent formally trained and taught, leads to distaster and dead patients.. just imho..

 

[Level1pedstech]

I'd be willing to be that information is more accurate than dispatch info especially in a 911 system but I do agree with the rest of your post.



Just because you can't perform advanced skills doesn't mean you can't use the knowledge you gain to perform a more thorough assessment to help the ED in their treatment path...Sure everyone will argue that the ED doesn't listen to EMS and does their own assessment which is true to a point but at least in my system the nurses definitely listen to the EMS report and take advantage of the information we have for them. It's not uncommon for nurses to ask field crews for help with a critical patient once we get to the ED, especially if they are busy or shorthanded.

Example, we had a heroine OD that desatted while we were waiting for a nurse and an MD in the room with a "Trauma Tech 1" <- intermediates who were grandfathered in after they switched to all Paramedic techs. He couldn't do anything about it besides bag the patient and wait for orders and while we were waiting i gave him another .4 of narcan and improved the patient's respiratory drive to only require a nasal cannula at 4 lpm rather than sitting there bagging him and inflating his stomach which could cause further problems for the hospital down the line.

You have the right attitude and I imagine you dont suffer from the problems that those with "issues" do when it comes to dealing with the ER staff. Honestly it took me a few years to figure out that we are all working towards the same goal and it never hurts to show your appreciation and say thank you.

Your probably right about being given more information from the triage nurse than you would usually get from the 911 folks. Of course a good call taker on the 911 end might mean having a good idea what to look forward to,or not. When we had 15 or so kids in the waiting room you would be suprised how little informtion I would get out of the triage booth. When it got crazy the "urgent care" kids would get thier triage in back leaving the triage nurse free for the more complex patients. This was the same on the adult side which made for great practice especially for those that needed to brush up on thier triage skills this included techs and nurses.

 

[Handsome Robb]

Example, we had a heroine OD that desatted while we were waiting for a nurse and an MD in the room with a "Trauma Tech 1" <- intermediates who were grandfathered in after they switched to all Paramedic techs. He couldn't do anything about it besides bag the patient and wait for orders and while we were waiting i gave him another .4 of narcan and improved the patient's respiratory drive to only require a nasal cannula at 4 lpm rather than sitting there bagging him and inflating his stomach which could cause further problems for the hospital down the line.

well ok. I am all for people to learn everything their job entails.

If they switched to all Paramedic Techs, and dude was grandfathered in as an EMT-I, shouldnt he be required to do more training to achieve the new job's requirements ?

Then this is the fault of the system. they should have taken the man off the floor if he did not meet the new requirements. grandfather or not.

things change everyday, as the demands of medicine gets greater, the ER Techs must meet the challenge.

this is a case of the person not knowing all that he should know...

but I am saying that there is not much of a need to know MORE than what you should know...

I think every position has a purpose. I think the EMTB are more transport, and less medicine, so they should work greatly on the specific skills of driving, map reading, staying strong and working out for the lifting and moving, and knowing all they should know for the job of the EMT B... I think IMHO that knowing your OWN JOB is the most important thing, Knowing the job of a paramedic when you arent one just do not help because you cannot know everything the medic knows, and he went to a thousand hour class to know, whats worse, is that if you think you know, but then you are mistaken because you werent formally trained and taught, leads to distaster and dead patients.. just imho..

No he knew what needed to happen he just couldn't do it. The "Trauma Tech 2s" which requires paramedic + street experience couldn't do anything about it either. They can't push meds thanks to the nursing union.

That was more an example of how prehospital and ED staff work together, that tech asked us if we could give the narcan so he didn't have to bag the patient. Sorry I should have done a better job of specifying that in the original post.

 

[Miscusi]

wait a minute, how were you able to give the .4 if you werent the nurse ?, your avatar says you are a medic student ?

 

[DrankTheKoolaid]

He hadnt turned care over i would assume.

 

[Miscusi]

well, IIRC, here in NY, EMTb and Aemts dont have any narcan.... I think the medics do, but I guess thats vegas..

 

[Ackmaui]

you as an EMT in the ER is allowed to go IO ? There must be something I am missing about scopes of practice, or maybe its a NY thing...

I'm not allowed to do IOs, what I said was that I got the nurses thinking about IOs. There are things that's techs cannot do, due to liability reasons. It's also up to the medical director and what they are comfortable with having the ER techs do. By the way there were 6 males in my EMTB class that couldn't lift their end of the stretchers.. The 9 females in my class?... Well, none of us had a problem lifting the stretcher. Just sayin

 

[dmc2007]

Example, we had a heroine OD that desatted while we were waiting for a nurse and an MD in the room with a "Trauma Tech 1" <- intermediates who were grandfathered in after they switched to all Paramedic techs. He couldn't do anything about it besides bag the patient and wait for orders and while we were waiting i gave him another .4 of narcan and improved the patient's respiratory drive to only require a nasal cannula at 4 lpm rather than sitting there bagging him and inflating his stomach which could cause further problems for the hospital down the line.

well ok. I am all for people to learn everything their job entails.

If they switched to all Paramedic Techs, and dude was grandfathered in as an EMT-I, shouldnt he be required to do more training to achieve the new job's requirements ?

Then this is the fault of the system. they should have taken the man off the floor if he did not meet the new requirements. grandfather or not.

things change everyday, as the demands of medicine gets greater, the ER Techs must meet the challenge.

this is a case of the person not knowing all that he should know...

but I am saying that there is not much of a need to know MORE than what you should know...

I think every position has a purpose. I think the EMTB are more transport, and less medicine, so they should work greatly on the specific skills of driving, map reading, staying strong and working out for the lifting and moving, and knowing all they should know for the job of the EMT B... I think IMHO that knowing your OWN JOB is the most important thing, Knowing the job of a paramedic when you arent one just do not help because you cannot know everything the medic knows, and he went to a thousand hour class to know, whats worse, is that if you think you know, but then you are mistaken because you werent formally trained and taught, leads to distaster and dead patients.. just imho..

So you're basically saying we should go back to being Ambulance drivers...

(not saying that we aren't, but EMS in this country will never gain respect if we keep this attitude up).

 

[usalsfyre]

So you're basically saying we should go back to being Ambulance drivers...

(not saying that we aren't, but EMS in this country will never gain respect if we keep this attitude up).

As long as we insist the level of care of EMTs provide is acceptable we won't gain any respect...

 

[Miscusi]

Re : 9 hulking super chicks: i gotta meet them lol...

Re : respect... To gain respect is to do your job well. EmtB is necessary in the world. Who else is gonna care and transport the sick and injured? I will respect any emtb who do their job well. Knows their job limits and takes the job seriously. Every role in ems is vital and commands respect already. It is the individual behavior of some that makes people lose respect for those peeps, and as far as self respect, if you cant understand that emtb is a good thing, then stop the chip on shoulder thing and go school urself till u r the surgeon general.

 

[Vetitas86]

So you're basically saying we should go back to being Ambulance drivers...

(not saying that we aren't, but EMS in this country will never gain respect if we keep this attitude up).

I agree 100%. EMS needs to push for more respect. It's part of the Public Safety establishment along with Fire and LE. Why not be respectable and able to operate in multiple environments?

I think EMS needs an overhaul to its education system and a definite across the board scope of practice to ever be taken seriously. That's why everyone from EMT-B on up needs to push for it. Change will never happen if no one acts on it.

As far as EMT-Bs having their place, I doubt anyone will dispute that. But as far as career advancement, etc there are relatively few options compared to Fire and LE except for going back to school.

And just because there is a demand and a job done well, it doesn't mean that the profession will be more respectable. I think that's the issue rather than the individual EMT being respected or not.

 

[Ackmaui]

Re : 9 hulking super chicks: i gotta meet them lol...

Re : respect... To gain respect is to do your job well. EmtB is necessary in the world. Who else is gonna care and transport the sick and injured? I will respect any emtb who do their job well. Knows their job limits and takes the job seriously. Every role in ems is vital and commands respect already. It is the individual behavior of some that makes people lose respect for those peeps, and as far as self respect, if you cant understand that emtb is a good thing, then stop the chip on shoulder thing and go school urself till u r the surgeon general.

Lol..we aren't hulking chicks..just strong!! I agree with your comment about respect...I think anyone, regardless of their title, who does a great job will earn respect.

 

[Shishkabob]

I agree 100%. EMS needs to push for more respect. ...Why not be respectable and able to operate in multiple environments?

Because we're fighting an uphill battle with the IAFF and the nursing unions, both who have very lengthy and powerful unions that benefit greatly by keeping Paramedics down at the current level.

 

[Vetitas86]

I do agree its an uphill battle. That's why I think the best thing to do is redo education and procedure across the board. Set concrete standards that are transferrable from state to state, moreso than they are now.

I don't see it happening soon. EMS is the youngun in healthcare, but its shown it has a place. I'm not advocating expanding into nursing or related fields, just making the standards of care on par with the existing organizations, but still functionally different.

 

[dmc2007]

As long as we insist the level of care of EMTs provide is acceptable we won't gain any respect...

^This is what I was trying to get at, if I wasn't clear.