How do ALS feel doing BLS calls?

I think the point you are trying to make, Medic38572, is that a "newly minted" EMT needs to be "broken in some" before they get thrown the "oh crap" calls. I really agree with you.

I recently helped out with the city Airport's "Holy Crap" drill.... transported 2 "red" patients to a trauma/burn center across town.

I'm driving... my partner has been an EMT for a year, but ONLY worked transport. I'm driving, trying to coach her in what she would need to do to treat a 3rd degree burn to the leg, and what she would need to do to treat a patient with a respiratory rate of 8, and burns to the face.....

We didn't actually "use" supplies, but documented as if we did...


My partner admitted afterwords that she was a little worried, because class was a long time ago, and she's not really used many of her skills since class... and was afraid she might have to actually deal with a "sick" patient someday.

Jon
 
Originally posted by Medic38572@Nov 7 2005, 05:13 PM
My feelings are this as a Paramedic I dont mind to make an a call. Thats why I schooled for two years. But I like many feel that bls calls should be made by the EMTs. The reason is this I feel that when you get out of EMT school you are just certified or licenced. And you have to agree just that. You have no experience except what you did on clinical rotation's. The place for you to get this experience is in the field in the back of the truck. Im not saying that all EMT's cant do there jobs, I have seen several new Paramedic's spaz on the first true emergency they have run. And they have been doing hundreds of hrs of clinicals. But when you are in control for the first time its differant and everyone here can relate to that. By putting EMT's in the back running granny back and forth you not only give then the extra clinical experience on a non - emergent patient but you also instill confidence in them. Giving them a chance in a controlled enviroment to properly assess there patient's with out all the stress of having to deal with a very sick patient.


Just my thought's.......................... ;)
Click to expand...
Do all EMS systems not require "precepts" before an EMT of any provider level is allowed to be the tech on a run. Our EMS system requires that you have 7 transporting runs before they clear you. Baqsically that blue card you get only allows you to practice under another EMT-B or higher until the precepting EMT(s), the department EMS officer, the hospital EMS director, and the MD say you are really an EMT.

The requirement is 7 transporting runs, no SOR's count, only 3 can be ALS assist, and 1 can be a DOA. This is only under an approved preceptor, so on our department you could theoretically make 15 transports to get 7 precepts since only 4 EMT's are allowed to precept.

I assumed that all EMS systems were similar, but apparantly I am wrong.
 
Each place has their own requirements. What it comes down to at my FD is this: if there are no other EMTs on a call, and you are brand new, you run the call. The closest department take 1/2 hr to get to our scenes, so even if you just get started in the direction of the hospital and have the other department meet you with more experience, it's better than standing there doing the stare of life.

At the Corps the official policy is three months of ALS ride alongs with a provider chosen by the Chiefs... or approval by the Chiefs. I rode one call with the Chief and he blessed me and sent me on my way.

We do all of our precepting during our classes.
 
My FD has a policy that, if there is no primary EMT availible, and there is a secondary (un-blessed) EMT availible, AND THEY FEEL COMFORTABLE TAKING THE CALL, they are allowed to take the call.

The FD requires each preceptee to complete at least 10 BLS and 10 ALS calls with a senior EMT before the officer staff discuss the canidate and decide whether or not to "bless" them, or throw them back for more training.

My ambulance Co. has a new program, and they require 5 ALS calls, 5 BLS medical, and 5 BLS trauma calls. Refusals count, so long as there was an assessment done. Our problem is that at least 50% of our calls are ALS, and the medics respond from the hospital across the street from our sqaud. On an ALS call, you often have little patient contact. You must precept with at least 3 preceptors (not sure of the number) A secondary is "blessed" after completing their 15 calls and a final "Check-ride" with a senior preceptor or supervisor. The final check ride is with someone you haven't precepted with before.

Jon
 
We have to do precepts during our class as well (8 patient contacts, minimum of 3 in an ambulance) just to pass the class so that gets us our blue card, but to transport without another EMT-B or higher you have to have permission from the affiliating MD. That is what requires the 7 precepts. There are no exceptions with our affiliating hospital, no amount of non-precepted, non-transporting runs mean anything.

So rescuecpt, you were OK'd after one run? That would be a little scary for me, our driver does not have to be a tech or even a FR. AHA BCLS is all that is required to ride the bus. I wouldnt want to get out there without the experience and have a hairy call with no other EMS trained personnel to fill in those gaps that we all have (dumba$$ attacks).

Did that ever cause any problems?
 
Not to toot my own horn, but I'm pretty smart, very calm, and I don't freak out. Never have in 5 years. It's not like I'd NEVER been on an ambulance before - I had been in the department 10 months before I got my card and was going on calls with the rest of the crew throughout my training (I was in the department for 4 months before I started my EMT class).

To get your basic in NYS you need 10 hours of hospital clinical time or 10 hours of ambulance calls (from leaving the pad to arrival at the hospital). The majority of people around here are riding as "probies" before they ever start class, and that truly helps a lot.

For my ALS time, I had been an EMT for 3 years by the time I finished my ALS training and had been riding with a preceptor for 9 months during my training. If I pass the state exams, pass the practicals, pass the protocols exams, in theory, as an experienced BLS provider and graduate of ALS training you should be able to handle ALS calls on your own. Granted some are more challenging than others, but don't we even encounter that after 5, 10, 20 years of experience?
 
Wow I continously am surprised at vaiable levels of clinical hours and orientation level. In my state the basic has to do at least 40 hrs of EMS and 24 ER. This is still not considered enough. As the EMS educator in my service , I require the basic EMT level to have at least 3 months of field time before releasing as well as documented various calls. These calls have to include at least 3 cardiac arrest, 3 major trauma patients, and various other responses including O.B. The Paramedic level is of-course higher, in experience and much more exposure.

16 hrs is not even a full shift, and we expect these people to have a general knowledge ?

Be sfe,
Ridryder 911
 
Originally posted by ridryder 911@Nov 10 2005, 09:31 AM
Wow I continously am surprised at vaiable levels of clinical hours and orientation level. In my state the basic has to do at least 40 hrs of EMS and 24 ER. This is still not considered enough. As the EMS educator in my service , I require the basic EMT level to have at least 3 months of field time before releasing as well as documented various calls. These calls have to include at least 3 cardiac arrest, 3 major trauma patients, and various other responses including O.B. The Paramedic level is of-course higher, in experience and much more exposure.

16 hrs is not even a full shift, and we expect these people to have a general knowledge ?

Be sfe,
Ridryder 911
Click to expand...
I am too...we had to do 30 hours in the ER, 72 on the rig, and I don't think it was enough.
 
Originally posted by ridryder 911@Nov 10 2005, 08:31 AM
Wow I continously am surprised at vaiable levels of clinical hours and orientation level. In my state the basic has to do at least 40 hrs of EMS and 24 ER. This is still not considered enough. As the EMS educator in my service , I require the basic EMT level to have at least 3 months of field time before releasing as well as documented various calls. These calls have to include at least 3 cardiac arrest, 3 major trauma patients, and various other responses including O.B. The Paramedic level is of-course higher, in experience and much more exposure.

16 hrs is not even a full shift, and we expect these people to have a general knowledge ?

Be sfe,
Ridryder 911
Click to expand...
The one thing that is true about EMS is that no amount of time will ever prepare you for dealing with every situation. Hopefully we all have enough brains to use our training and education to make the best choice possible.

I know EMT's who want to treat every problem, try and diagnose the patient or just generally try to remember every detail in their text books and training manuals. That is not the approach I take.

My approach is that depending on the call, I am either there to take baseline vitals and comfort the patient and get them to the hospital, or I ensure a patent airway and keep them from getting worse while I take them to the hospital. I constnatly re-read my text, take as much training as possible, and am not afraid to ask questions. But at the end of the day, I keep them alive, take them to the hospital, and give the nurse a report on my observations and findings.

We are not doctors (that includes EMT-P's), we are there to assess, comfort, and transport, and sometimes on the hairy calls we have to work our a$$es off to present the hospital with a viable patient. No amount of clinical time will prepare a person for those hairy calls when you are the only tech or medic- you revert to the basic desire to help people at this point. You know if a patient is pulseless and apneic that you are going to have to get in there, you know if there is a bleeding laceration that you are going to have to apply pressure. That preceptor is not going to be their to catch us when we get the one situation that never presented itself in training or clinicals (anal discomfort= MI)

Know your scope of practice, do what is best for that patient and throw deisel on it.
 
I too was shocked to see that we had to do so little in ER and on the rigs. Our instructor req. 24 in ER (I did 36) and 12 calls on the ambulance, I barely met this req due to work schedule and and other things.

Our course was 5 mos long (about an avg. semester) but only met 2x/week.

Id like to see a full 5 mos course meeting 4 nights a week for 4 hrs at a time. And requiring weekends to be spent in the ER or on the ambulance (160 hrs in ER, 160 hrs on the ambulance). Have the students write an depth report paper due at the end of the course. Also have a skills night once a week where the students do nothing but skills, critique each others pt. assessments. And each student must throughly document all pt contacts in ER as well as ambulance. And as Rid does it require a minimum amt of certain types of calls, but if for some *legitimate* reason that they werent able to get those calls take into consideration class participation, grades, and skills assessment, time spent at clinicals, also maybe even require a letter of recommendation from the ER supervisor and preceptors before completing the course. Each call report should be reviewed 2 two weeks before finals, if the calls and student are satisfactory, the student may sit for class finals, if the student passes class final then student may test for NR/state certification.

But thats just coming from a students perspective. :unsure:

-CP
 
At least your school requries precept time.

In PA, it is OPTIONAL. I didn't ride an ambulance until a month into the program, when I was told I needed to be riding an ambulance, or I was going to look like an idiot later. This was a month into the course.

Jon
 
Originally posted by CaptainPanic@Nov 10 2005, 12:20 PM
I too was shocked to see that we had to do so little in ER and on the rigs. Our instructor req. 24 in ER (I did 36) and 12 calls on the ambulance, I barely met this req due to work schedule and and other things.

Our course was 5 mos long (about an avg. semester) but only met 2x/week.

Id like to see a full 5 mos course meeting 4 nights a week for 4 hrs at a time. And requiring weekends to be spent in the ER or on the ambulance (160 hrs in ER, 160 hrs on the ambulance). Have the students write an depth report paper due at the end of the course. Also have a skills night once a week where the students do nothing but skills, critique each others pt. assessments. And each student must throughly document all pt contacts in ER as well as ambulance. And as Rid does it require a minimum amt of certain types of calls, but if for some *legitimate* reason that they werent able to get those calls take into consideration class participation, grades, and skills assessment, time spent at clinicals, also maybe even require a letter of recommendation from the ER supervisor and preceptors before completing the course. Each call report should be reviewed 2 two weeks before finals, if the calls and student are satisfactory, the student may sit for class finals, if the student passes class final then student may test for NR/state certification.

But thats just coming from a students perspective. :unsure:

-CP
Click to expand...
Wow, then there would be no vollies. When would people who have 40hr a week jobs (or even two jobs) find time?

I think if I spent 4 nights a week in class for 4 hours a) I would have time to read the entire Brady book 4 times and B) I wouldn't have done it.

Maybe I'm just burned out, jaded, or snotty - but it's not sooooo difficult to be BLS that we need to spend 320 hours in basic class plus 320 on rotations.... but then again I could be a crappy provider for all you all know.
 
Originally posted by rescuecpt@Nov 10 2005, 03:06 PM

Maybe I'm just burned out, jaded, or snotty - but it's not sooooo difficult to be BLS that we need to spend 320 hours in basic class plus 320 on rotations.... but then again I could be a crappy provider for all you all know.
Click to expand...
Lets see- Airway, airway, airway, breathing, circulation, stop the bleeding, immobilize the patient, drive to the hospital, write down what you did. 640 hours of training for that? You are right there would be no volunteers. And you would have to pay the B's alot more.
 
Now just think the person that cuts and styles your hair went to school 4 X's longer than the average Basic EMT..... and about 200 hour longer in clinical setting.

Now which one do you think .. should have the most education & training ? .. & should we really care if it decreases the vollie number rate or improve & provide competent patient care ?


Be safe,
Ridryder 911
 
Originally posted by ridryder 911@Nov 11 2005, 09:49 AM
Now just think the person that cuts and styles your hair went to school 4 X's longer than the average Basic EMT..... and about 200 hour longer in clinical setting.

Now which one do you think .. should have the most education & training ? .. & should we really care if it decreases the vollie number rate or improve & provide competent patient care ?


Be safe,
Ridryder 911
Click to expand...
Well, seeing as on long island we really only have vollies, and we're hurting for members as is, yeah, we should care if it decreases the vollie rate.

Under current basic protocols, there is only so much you are allowed to do. If you can't learn that in the amount of time currently being taught, you shouldn't be an emt - volly or paid.

PS - it is much harder to feather someone's hair than to apply a pressure dressing. :P
 
Originally posted by ridryder 911@Nov 11 2005, 09:49 AM
Now just think the person that cuts and styles your hair went to school 4 X's longer than the average Basic EMT..... and about 200 hour longer in clinical setting.

Now which one do you think .. should have the most education & training ? .. & should we really care if it decreases the vollie number rate or improve & provide competent patient care ?


Be safe,
Ridryder 911
Click to expand...
Rural and small town areas simply cannot afford to pay full time firefighter/EMT's (see my response to you in the "ranks of volunteers plummeting" portion in ems related news). So those areas that have coverage by volunteers get put out of business by unattainable standards (and yes it is hard to have time for even a B when you have a family, 50 hour a week job, other schooling, and are active on the FD). Then what happens? Private ambulance services wont cover our area because they can't commit a unit to our area due to such a small run load. Wait on the next closest entity?- which could be 20 minutes away depending on where the run is and that is if they are not already busy with other stuff.

The amount of training that EMT-B's receive is adequate for what they need to do, If not there is this thing called a Paramedic that does have to do long clinical hours and have a minimum of 1 years training on top of the EMT-B certification.

If there is immediate transport required and/or defibrillation is required, then having an ambulance with an EMT-B 5 minutes away becomes critical. You seem to have this impression that throwing money at the problem will fix it. That is simply not the case. Volunteers have been and will continue to be a very effective response to emergencies. The people who are doing this have been held to ever increasing standards and that has cut into the ranks greatly, but most of the standards are necessary. But taking what is effectively 200 hours of training (in Indiana w/ 160 hour class, clinicals, precepts, a+r prior to being affiliated) and doubling that or more, you would make the time commitment beyond what the members could give.

Ridryder, I am guessing you have never served on a full volly dept. Or if you have, it must be a municipality that overfunds the equipment and training budget since they do not have to pay career FF's. There are a few dept.'s like that, they have don't have to wonder where they are going to get their next big purchase from, they are very visible, etc. but they are still having trouble getting new personnel due to increased time commitments.
 
I can say that where I work, some (not all) of the ALS providers feel it is beneath them to do BLS transfers. And they let the dispatcher know it too. But at the same time, some of the Basics feel it is beneath them to do wheelchair van transfers. For some reason they all forget that we are one team, and a call is a call. No matter if its "below your licensure" or not.
 
Medic38572 said:
My feelings are this as a Paramedic I dont mind to make an a call. Thats why I schooled for two years. But I like many feel that bls calls should be made by the EMTs.
Click to expand...

As in EMT-P??

There are Basics in my co. whos medic will absolutely not run on a BLS call. The agreement I have with my partner is I take the first three and then she fills in every other one after. We do this as a mutual respect for each other. If we get a day of nothing but ALS calls, I will run a day of BLS. I will also on an ALS day jump in and take a borderline call just to give her a break. It is all about careing for each and every patient, as well as careing for your partner. If you are willing to let your partner get 3-4 sheets down simply because it is a BLS day, then not only do you not have my respect as a person, but I feel you should re-think why you are on a rig in the first place.
 
Last edited by a moderator:
Have we forgotten our training

One of the systems I work for is a 911 ALS service, the company run ALS and BLS buses. Shucks are the norm and all jobs are in rotation/next available. It is a norm with most paid service and a Medic accepts that going into the job, if they don't want to do the shucks and ED transport they find a service to meet their needs. But as experience will prove, not every 911 call is an ALS call. But unless we all have forgotten our training, it was drilled into our heads "BLS before ALS". It all starts with the ABC's, not IV ABC. Most of the Medics I know and have worked with had no problems working an BLS job, especially at re cert time. It is the best way to keep all your skills in check, and yea after working a code was refreshing shucking grandma back to the home. :rolleyes:
 
You must log in or register to reply here.
Back
Top