If there were no EMT-B certification .....

[JPINFV]

I disagree with you that we are basically giving the community a bad set of skills to give them EMT-B's. While I can only speak for myself, I am glad I am starting from the bottom so to speak and working my way up. We have not failed our communities nor or citizen's by giving them basics, what we have done is failed them if we have not trained them to have strong skills and to know when to call for ALS.

The problem is not necessarily poor training (how much training is really needed to take a blood pressure), but that there isn't enough education (education and traing are two vastly different concepts) to understand what their assessment is telling them and what their treatments are doing. Assuming no change in scope, a strong background education is still needed to be able to handle patients that don't necessarily fall into the premade boxes that training gives us.

I have heard of more ALS providers failing their hands on skills when being tested because they forgot their basic set of skills. I think each level is well needed, none should be forgotten and all should work as a team. We can advance further if we wish, but we have to do it with the citizen's in mind and with our community and believe me, I have also seem more crappy ALS providers who get the big eye and don't see the whole picture or get attitudes and egos because they are the ALS provider. Doesn't make you any more valuable than I, as I worked just as hard and put in just as much time and effort as you did, mayhaps not as much class hours but learning and sharpening my skills and volunteering to be on that rig at any time of the day or night or asking questions and going to extra classes when offered.

As I've said before, show me a medic who is failing at basic patient care and I'll show you a medic who needs remedial education and training (to be fair to the medics, insert nurse, physician, or basic in place of "medic" as you see fit). Furthermore, yes, a medic is much more valuable than a basic. A boy scout could do most of the "skills" that a basic does (I was a boy scout and am basic). Yes, the extra class hours does matter and does make a difference that no "sharpening of skills" or "volunteering" or "taking CMEs" will ever change. That would be like an associate degree register nurse complaining that they are just as important as a physician because they do extra things that don't even come close to the differene between 2-3 years of education to 8+ years.

So please, don't discount the EMT-B. We are needed, some just don't want to see it or care to acknowledge us.

By writing a sentence in first person you are indicating that you are taking this personally and you shouldn't. Any system that fails communities by thinking that 110 hours (per NHTSA) of first aid training is sufficient enough for a primary 911 response is failing their providers as well.

 

[JPINFV]

I'm fine with having Basics to send out on the 90% of calls that are BS and don't require ALS.

However, to make the suggestion that Basics can run advanced calls effectively is simply wrong.

Ahh, but here's the rub. Who gets to decide which calls are "BS" and which require a medic? Can a level that lacks the background education and assessment knowledge to provide (or justify providing) the needed care adequately determine which level is needed for the patient?

 

[BossyCow]

There is no point to the "I've seen medics fail" comments. Who hasn't? Medics fail, stumble, make mistakes.. hey.. even neurosurgeons have bad days! Just happens when you put human beings into jobs. A bad or inadequate Medic isn't proof that BLS is or isn't needed on as an adjunct to Pre Hospital care. Using that in your post merely shows a lack of professionalism, maturity and critical thinking skills.

I've seen medics blow IV starts, gut-tube, and misread vitals..... still, if I have an unstable pt I want whoever's on duty that shift! The point of the post as I understand it is to determine if .. given the option of EMT-P or nothing.. would you enter EMS?

If the educational requirements for doing what you do, regardless of your status of career or volly, were the same as for paramedic.. would you jump in, or pass on it. Personally, I'd probably go for EMT-P. If it were the only route, and my district would pay for it, as they did my EMT-B, I would do it.

I think the point is to prove or disprove whether or not, those happy with being 'just EMT-Bs' make that decision based on a lack of desire to further themselves academically or for other reasons. I am reading this thread carefully, I would love to see it discussed without the acrimony and emotional outbursts that other threads on the topic have taken. So, EMT-Bs... and I am one of you... speak up on this.... If you had to take more education than the crash course you were initially given.. would you have signed up or sat out?

 

[MedicAngel]

My apologize for speaking in first person. To the original question, if I had the chance, I would work toward a paramedic license.

I don't see why there has to be, do we need basics. Okay, some don't think were needed, but others do. And your right, when do we know when it is a "bs" call or one that you truly need an ALS provider? You can't until you get on the scene and assess the situation. I know when I need an ALS provider and I will call for one while doing what I can in my scope of practice to ensure the patient is comfortable and hopefully, calm enough till help arrives.

Some instructors I have talked to say that it is better for someone to start from being a basic and work your way up from there to intermediate to paramedic. Give yourself some time in each step to assess and see if you truly like what you do and can handle the stress that comes with emergency medicine. There is some validity in that. Some people aren't prepared to take on all that is required to be a paramedic.

My husband hates sometimes that I am a basic, that I run calls and that I am gone a few nights a month. Unfortunately my first fire/rescue squad had a lot of internal problems and were pretty hard on the EMS side of the house.

 

[Hastings]

Ahh, but here's the rub. Who gets to decide which calls are "BS" and which require a medic? Can a level that lacks the background education and assessment knowledge to provide (or justify providing) the needed care adequately determine which level is needed for the patient?

Actually, it'd be dispatch. God knows that the information given over the radio is rarely accurate, but it would at least ensure Basics never got sent to Priority 1 or 2 calls. They should be restricted to 3 and 4, and be trained to recognize and call ALS the SECOND the patient starts deteriorating.

Dispatch Information / Call Priority Basics should never be sent for except as first responders in locations where ALS is an EXTENDED amount of time away:

1 - DIB
1 - CP
1 - Altered LOC
1 - MVA
1 - Cardiac Arrest
1 - Respiratory Arrest
1 - CVA
1 - Diabetic
1 - Uncontrolled Bleeding
1 - GSW / Stabbing
1 - Seizure
1 - Drowning
1 - Burn
1 - Cold Injury
2 - Overdose
2 - ETOH
2 - Abdominal Pain
2 - Syncopal Episode
3 - Unknown Medical

And most Assault, especially of a sexual nature, with a special victim, or with the involvement of weapons.



But that being said, and the list being made (I know I'm still missing plenty), and the unreliability of dispatch information, is it worth sending EMTs out at all? What isn't in that list?

4 - Transfer



The solution is to train more medics and phase out Basics. THAT is the highest level of care.

 

[Hastings]

Add:

1 - Electrocution
1 - Poisoning
1 - Machine Trama
1 - Pinned Victim / Extrication Required
2 - Significant Fall
2 - Bloody N/V
2 - Bloody Stools
2 - Uncontrolled Vomiting

 

[MedicAngel]

Actually, it'd be dispatch. God knows that the information given over the radio is rarely accurate, but it would at least ensure Basics never got sent to Priority 1 or 2 calls. They should be restricted to 3 and 4, and be trained to recognize and call ALS the SECOND the patient starts deteriorating.

Dispatch Information / Call Priority Basics should never be sent for except as first responders in locations where ALS is an EXTENDED amount of time away:

1 - DIB
1 - CP
1 - Altered LOC
1 - MVA
1 - Cardiac Arrest
1 - Respiratory Arrest
1 - CVA
1 - Diabetic
1 - Uncontrolled Bleeding
1 - GSW / Stabbing
1 - Seizure
1 - Drowning
1 - Burn
1 - Cold Injury
2 - Overdose
2 - ETOH
2 - Abdominal Pain
2 - Syncopal Episode
3 - Unknown Medical

And most Assault, especially of a sexual nature, with a special victim, or with the involvement of weapons.



But that being said, and the list being made (I know I'm still missing plenty), and the unreliability of dispatch information, is it worth sending EMTs out at all? What isn't in that list?

4 - Transfer



The solution is to train more medics and phase out Basics. THAT is the highest level of care.

WOW Hastings...lets just give all the basics the crap calls...and I mean literally. I live in a rural area, sometimes all the caller or patient has IS a basic and their driver, so were trained to call for an ALS, load and go and meet en route. I have been on an MVA, cardiac, entrapment, stroke, heart attack, suicide, ETOH, and diabetic to name a few and some of them I have transported with just myself in back and my driver, got that patient to the hospital and none worse for wear.

I am amazed that all the ALS providers are so dead set on phasing us out and if not that, giving us the crap calls. Why ARE we trained in basic life support if all you think we should do is wipe noses and hold hands?

 

[Hastings]

WOW Hastings...lets just give all the basics the crap calls...and I mean literally. I live in a rural area, sometimes all the caller or patient has IS a basic and their driver, so were trained to call for an ALS, load and go and meet en route. I have been on an MVA, cardiac, entrapment, stroke, heart attack, suicide, ETOH, and diabetic to name a few and some of them I have transported with just myself in back and my driver, got that patient to the hospital and none worse for wear.

I am amazed that all the ALS providers are so dead set on phasing us out and if not that, giving us the crap calls. Why ARE we trained in basic life support if all you think we should do is wipe noses and hold hands?

That's the point. If all Basics were replaced with medics, everything is solved. Higher level of care, better for the community. And it's not an unrealistic goal either. Why are some Basics so set on not advancing?

As for your question, because wiping noses and holding hands is basic. Cadiac problems, diabetic emergencies, CVAs, and anything else in that list is far from basic. As in, not for an EMT-Basic.

 

[JPINFV]

WOW Hastings...lets just give all the basics the crap calls...and I mean literally. I live in a rural area, sometimes all the caller or patient has IS a basic and their driver, so were trained to call for an ALS, load and go and meet en route. I have been on an MVA, cardiac, entrapment, stroke, heart attack, suicide, ETOH, and diabetic to name a few and some of them I have transported with just myself in back and my driver, got that patient to the hospital and none worse for wear.

I am amazed that all the ALS providers are so dead set on phasing us out and if not that, giving us the crap calls. Why ARE we trained in basic life support if all you think we should do is wipe noses and hold hands?

No worse for the wear? So being nothing better than a taxi should be good enough? So what about the "crap calls?" Do you think that emergency PAs and NPs complain because the physicians get all the "good patients?" The PATIENT CENTERED ideal is to get the highest level of care to all patients. Yes, a paramedic might not be able to treat all conditions, but there are several conditions that can mimic each other that does require a paramedic to differentiate between (stroke/hypoglycemia). Any one suggesting otherwise ("giving crap calls to basics") does not have their priorities straight. Yes, lower acuity calls might not be as fun as playing with the pretty lights, but I thought that the primary thing from a treatment and patient care standpoint was the patient, not the providers enjoyment or ego.

Furthermore, no one is impressed with a laundry list of calls. I've been on all of those calls as well as other types of calls, both serious, specialty, minor, event, routine, and regular first aid (water park). Just because all of my patients make it to the hospital in one piece doesn't mean that I've just justified a basic attending to a diabetic patient. In fact, no one should be justifying having a basic handle a call that would be better suited for a paramedic. That's like arriving at a hospital to find a CNA with a phone number to call a doctor.

Finally, yes, most of what basics can do is wipe butts and noses. Sorry, but BLS is, for the most part, first aid. A very large portion of the EMT-Basic course is covered in the Boy Scout first aid merit badge and even the life guards at the water park I worked at were trained in administering oxygen (as well as AHA CPR and first aid). It's good as a support and/or first responder role.

Now to be clear, am I calling all basics stupid or ignorant? No. There are a lot of smart and intelligent ones out there. Unfortunately, this is more often due to the individual than anything relating to their EMT-B class. You simply can't provide enough of a background or education in 110 hours (NHTSA standard, no one cares that your (generic "your") course was an exception).

 

[BossyCow]

Why are some Basics so set on not advancing?

I'm sorry, I missed this part. Who said that Basics are 'so set on not advancing'. There are a number of reasons why someone chooses to certify or license to a particular level. Please show me what evidence you have that supports your assumption.

Saying that Basic Life Support has a place in EMS is not saying.. "I don't want to advance and wouldn't even if I could"

 

[Hastings]

I'm sorry, I missed this part. Who said that Basics are 'so set on not advancing'. There are a number of reasons why someone chooses to certify or license to a particular level. Please show me what evidence you have that supports your assumption.

Saying that Basic Life Support has a place in EMS is not saying.. "I don't want to advance and wouldn't even if I could"

They have a place. First aid. Wiping noses and holding hands, as was suggested.

But medical emergencies in the list above are not basic. And while Basics are great for simple hospital transfers, they have no place in that list. It's that simple.

 

[VentMedic]

Why are some Basics so set on not advancing?

Let me toss out some numbers:
source: http://www.emsresponder.com/survey/

Florida:

EMT-Basic 25,063
Paramedic 14,910


New York:

CFRs 13,136 (all are trained in defibrillation)
EMTs (below Intermediate level) 37,945 (all EMTs in New York state are trained in defibrillation)
Intermediate EMTs 2,033;
EMT-Critical Care technicians 2,773
Paramedics 4,297


California:

Basic EMT 70,000
EMT-I 119
EMT-P 14,500


Washington:

First Responder 1,336
Basic EMT 14,232
Intermediate EMT 862
Paramedic 1,723

What interesting about Washington is its levels:
EMT-Basic
IV Technician
Airway Technician
IV/Airway Technician
IV Intermediate Life Support Technician (ILS)
EMT-Paramedic

Correct me if I am wrong but the EMT-B numbers still reflect the other 3 different inbetween certs until ILS is reached?

 

[JPINFV]

As a note about California, EMT-I (technically EMT-II (2)) is only used in a handful of counties.

 

[VentMedic]

As a note about California, EMT-I (technically EMT-II (2)) is only used in a handful of counties.

One could literally go bonkers keeping track of EMS "certs" for each state.

 

[JPINFV]

http://en.wikipedia.org/wiki/Emergency_medical_responder_levels_by_U.S._state

and a new layout once we finally get it set up:
http://en.wikipedia.org/wiki/Talk:Emergency_medical_responder_levels_by_U.S._state/draft

 

[Guardian]

They have a place. First aid. Wiping noses and holding hands, as was suggested.

But medical emergencies in the list above are not basic. And while Basics are great for simple hospital transfers, they have no place in that list. It's that simple.

I don't agree. I've seen successful systems that use emt-basics extensively. My system for example runs 1 paramedic and 1 basic on an ambulance. They then dispatch supervisor paramedics for complicated calls or MCIs. Therefore, on the "real emergencies" calls, there might be 4 emt/firefighters, 1 emt partner, maybe 1 emt bystander, and 1 or 2 paramedics. I use this, as an example to illustrate there is a huge need for emts on bona fide emergency calls. They can do a lot of stuff on scene. Even on the "real emergencies," 85% of it is BLS. That's 85% that I don't have to worry about doing. 2 paramedics/truck would be better, but not realistic for some places at the current time and I have seen no studies that indicate 2 paramedics is better than 1. My main point is that this issue is not cut and dry. To come on a site that is made up primarily of emt-basics and say that all they’re good for is wiping noses and holding hands is being a little extreme. Oh, I'm sorry, you're only implying it by pointing out that others have suggested it. Where I’m from, we consider people who talk like this to be smarmy. I say we should continue to work and try and get ems back in a progressive state that doesn't rest on its laurels, while at the same time recognizing the gigantic and obvious need for emt-basics. That means that part of our progression should include carving out new places for emts if necessary. To that end, why do we even bother continuing with the emt verses paramedic threads. If I were an emt-basic and were given a chance to run as primary provider on 911 calls, I'd probably do it. The real culprits here are the ems leaders (who are usually ALS) who allow this to continue to cover up their own shortcomings. Let's turn our aggression to these SOBs. I feel like there are enough of us starting to trickle into leadership positions now that we might have a chance at really making a change for the better. So lets focus on overthrowing the current leadership who is keeping our profession stagnate, while backing the progressive ems leaders.

 

[Hastings]

The progressive leaders are those who are trying to replace Basics with Paramedics. Seriously. How can you not see that doing so is the only way to provide the highest level of care to members of the community most efficiently? There is nothing a Basic can do that a Paramedic can not, and as such, having Basics on scene is not in fact necessary. No, there should be no starting point at EMT-B, and no one should be allowed to stop at that level. It should be all or nothing. Instead of one year for Basic, one year for Paramedic (or however individual systems work), it should be two years for Paramedic.

 

[VentMedic]

I The real culprits here are the ems leaders (who are usually ALS) who allow this to continue to cover up their own shortcomings. Let's turn our aggression to these SOBs. I feel like there are enough of us starting to trickle into leadership positions now that we might have a chance at really making a change for the better. So lets focus on overthrowing the current leadership who is keeping our profession stagnate, while backing the progressive ems leaders.

The problem is, as I have mentioned in other threads, lack of support from the providers. When the politicians and EMS leaders who do lobby for us come to a State or National seminar, out of 10,000 conference attendees, only 10 -20 may show up to listen to these people speak or to express an opinion. What interest in change does that show? The other 9,990 will be at the pool or lounge griping about how bad things are.

When Nurses or RRTs show up to a conference where there will be legislators and professional representatives to discuss change, the entire group of conference goers show up which can easily be over 10,000 people per conference also. RT had some of its best conference attendence prior to the 2002 mandate of the 2 year degree as entry. The majority were there to support it.

I also put the numbers of EMTs and Paramedics on my previous post to show how opinion to the legislators could be skewed. The ratios of EMT-B to Paramedic are something like FL 1:2, NY 1:9 , CA 1:5 and WA 1:7. Now based on some of the opinions expressed on this and other forums, if the legislators and EMS leaders took a poll on if higher education should be instituted, what would the numbers look like? Quite possibly the same ratios would show up as for these states. There might even be a bigger gap for those at the Paramedic level to contribute a NO vote that don't want to advance to a two year degree.

 

[MedicAngel]

This is from my state that I live in:

Numbers of EMS personnel. (state certified). First Responders, 1,503; Basic EMT, 23,677; Shock Trauma, 470; EMT-Enhanced, 1,251; Cardiac Technicians, 1,232; EMT-Intermediates, 1,791; EMT-Paramedic, 3,348; EMS instructors, 548; ALS coordinators, 418.

Numbers of EMS services. Volunteer, 491; commercial, 76; governmental, 89; industrial, 32; nonprofit, 13; other, 18.

 

[Ridryder911]

Personally, I have never stated that there was not a place for EMT Basics. In my "perfect EMS world" there would be three places.

1) MFR level. What they are trained and designed to do. Be the first on the scene, prepare for treatment and quickly initiate first line tx.
2) Very remote areas, where medical care will never be feasible, but will not be considered the "end all". Continuous action with documentation of that those areas are attempting to improve care & services.
3) While in Paramedic school, to assist Paramedic in care. Obtain experience on those so called .."B.S." calls. After a Paramedic has made the determination that the patient does not or will not need more interventional therapy. The EMT will be held accountable to detect such treatment or changes occur. This will allow those EMT's to come in contact with patients and clinical exposure. Certifications and license would be only good for two years.

As one becomes more educated in medicine, one finally is able to determine that there is not B.S. call! Stating such is demonstrating ignorance of the medical system. Is it frustrating and will cause one to be jaded.. yes. Abuse, and misuse .. Yes! Again, granny calling at 0200 for inability to get up, or "panic attacks"; one learns that it maybe a form of loneliness, chemical imbalances, stress, or even psychological problems... It could be said even the abuser, has a psychological problem to attract attention. Yes, probably not treatable or treated by us except our presence but still a real problem.

Is the role of the EMT way out of proportion .. A definite yes. We are placing to much emphasis on substitute provider and placing way too much responsibility on those that lack the education and training. Too many place emphasis on "basic skills". Not that they are not important, but the reason many do is that is all that they know. Again, nothing to compare to.

I am sure that many probably critique my BLS skills when I am a preceptor. That I do not always obtain a auscultated blood pressure before I move a patient, or that I do not always take a full minute respiration count or place oxygen on every chest pain and supposedly trauma patient, or raise the feet in trendelenburg for that "shocky patient".

Although, they are able to critique such actions, they do not understand my level of assessment and history as well. They do not understand that I was able to detect perfusion level by grades of pulse, location of perfusion will give me an estimate of a blood pressure, that not all chest pains are an AMI and in the need of oxygen therapy, or know that Trendelenburg position is a myth. Yet, they maybe the first to write on here, what a lousy provider I am for "missing my basics"..

On the other hand, they do not realize the in-depth's of assessment I have obtained by extensive education and decades of clinical practice, as well as literally thousands of patients.

We have made erroneous teaching errors by teaching step by step process. Unfortunately, we continue to do so because the normal aptitude of EMT students do not have the broad background or education level to understand differently. Yes, that has been proven..over & over. The same reason we still teach out of a 6'th grade reading level single textbook.

Yes, one has to have a methodological way but medicine is an art.. it is unique and to the individual. Something that comes with higher education and formal education.

Is there too many EMT's .. Yes! For the wrong reason. If they were to be in a role as I described, then there would not be, but I doubt that many would stay in EMS or participate if the roles changed.

We still keep repeating ourselves..
R/r 911