Lead EMT best practices

[Speedylifsavr]

Hello all,

Our service is considering implementing BLS units. We currently run 20 ALS units that are either dual medic or Medic/EMT. I was looking for some information on best practices for the credentialing of the EMT to step in to a lead role on a unit. Any insight you can provide from your department or past experience would be greatly appreciated.

 

[DrParasite]

Several different questions come to mind

The first is, what does your department plan to use the BLS units for? 911 response, special events, BLS IFT, etc.

Secondly, how do you currently credential EMTs? It is tailored towards being a great paramedic helper, or an independent functioning EMS provider who doesn't need their hand held?

Thirdly, by lead EMT, do you mean simply an EMT who is in charge of the two person ambulance? I've never had a "lead EMT;" my partner and I, working as a team, usually switched roles after every call (unless I didn't feel like driving, or had a new guy who kept getting lost, etc). As a general rule, whomever is in the back of the ambulance is the "lead" EMT for the call, and make the decision in case there is a disagreement.

Lastly, do you want everyone to be a "lead EMT", or just select people?

 

[EpiEMS]

I've never had a "lead EMT;" my partner and I, working as a team, usually switched roles after every call

I think this is typical, though my service does have a "lead EMT" concept. They often don't do a very good job at leading, though...ends up being a matter of seniority, mostly.

The "lead" should have supervised experience in that role, and should be comfortable with being an FTO, too.

 

[Speedylifsavr]

DrParasite post: 659955

Several different questions come to mind

The first is, what does your department plan to use the BLS units for? 911 response, special events, BLS IFT, etc.

Thank you Dr. for your reply. Our BLS units will be used primarily for 911 response. We will be using a priority dispatch system and they will be sent to low acuity calls.

Secondly, how do you currently credential EMTs? It is tailored towards being a great paramedic helper, or an independent functioning EMS provider who doesn't need their hand held?

Our current credentialing process for EMT-B's is 60hrs of in house training followed by 192 hrs of clinical ride time with an FTO. After that they are cleared to function as second person. They are introduced to all ALS protocols , equipment and are given a lot of the same training as our paramedics so they have a better idea of how to anticipate their needs. So to answer your question , paramedic helper.


Thirdly, by lead EMT, do you mean simply an EMT who is in charge of the two person ambulance? I've never had a "lead EMT;" my partner and I, working as a team, usually switched roles after every call (unless I didn't feel like driving, or had a new guy who kept getting lost, etc). As a general rule, whomever is in the back of the ambulance is the "lead" EMT for the call, and make the decision in case there is a disagreement.

Yes , an EMT who is in charge of a 2 person BLS unit.

Lastly, do you want everyone to be a "lead EMT", or just select people?

Just select people

 

[EpiEMS]

Our current credentialing process for EMT-B's is 60hrs of in house training followed by 192 hrs of clinical ride time with an FTO. After that they are cleared to function as second person.

Our BLS units will be used primarily for 911 response. We will be using a priority dispatch system and they will be sent to low acuity calls.

That's pretty robust training for a BLS provider. After 16 shifts (12 hours), they ought to be plenty comfortable taking charge on low-acuity calls, if they are coming in with some experience.

Seems to me that you could have folks who are ~1 yr. of experience as your leads.

 

[DrParasite]

Allow me to respond to your responses individually

Thank you Dr. for your reply. Our BLS units will be used primarily for 911 response. We will be using a priority dispatch system and they will be sent to low acuity calls.

Ok, but don't forget, even low acuity calls as defined by priority dispatch can result in sick people, and I say that with 5 years in the comm center in addition to being on the ambulance

Our current credentialing process for EMT-B's is 60hrs of in house training followed by 192 hrs of clinical ride time with an FTO. After that they are cleared to function as second person. They are introduced to all ALS protocols , equipment and are given a lot of the same training as our paramedics so they have a better idea of how to anticipate their needs. So to answer your question , paramedic helper.

Which is great; however, credentialing someone to be a great paramedic helper (which you seem to be very good at) and making sure they can think independently without a medic to tell them what to do are a little different. Not telling you to change, just to keep that in mind

Yes , an EMT who is in charge of a 2 person BLS unit.

does someone really need to be in charge? does that mean they write every chart? or they never write a chart? if they are clinically equals, what benefit does being "in charge" bring? Also, do you want to pay them more? what's the incentive for someone to become a "lead" EMT?

Lastly, do you want everyone to be a "lead EMT", or just select people? Just select people

Ok, so I probably didn't phrase this question right..... Do you want everyone to aspire to be a lead EMT? What would your criteria be to not make someone a lead EMT? I am going to assume you want someone who is familiar with your system, would 1 year of experience be a good minimum? Would you want them to be evaluated by an EMT FTO? Why would you not want everyone to be qualified as a lead EMT?

I come from a system where EMTs are the backbone of EMS; ALS are in flycars, and only go on 20% of the overall calls. So I am confident EMTs can perform well in a 911 environment without dead bodies piling up everywhere.

My recommendation: Don't use the term "lead EMT." use the term "FTO EMT" so the EMT has to have some in system experience, and they are already used to being responsible for someone else (assuming your EMTs are the FTOs of new EMTs, instead of paramedics only). the FTO EMT is "in charge," but make it clear that they are still expected to switch roles, as both the driver and provider. They can be partnered with any credentialed EMT, and I would go as far as to say you can't be on a BLS truck until you have been full time in your system for 6 months. This way they get exposure to how you do things, and the FTO can help them in case they need help. And if a decision needs to be made, or the two partners disagree on something, rank can be pulled; but this shouldn't be a routine occurrence.

While I know you only plan on sending BLS crews to low acuity calls, send them to high acuity ones if they are closer. yes, you might tie up two trucks on a sick patient, but it does get EMS interventions to the scene quicker.

I'm a lousy paramedic helper. I admit it. I've never been good at reading the minds of others, or being able to anticipate what various individuals want. and when you stick me with a medic who likes things done her way, so I get used to doing them her way, and then I am transferred to a new medic who wants things done his way, and isn't happy when I do what the former medic wanted, well, it annoys me. but I'm a great lead EMT. I can anticipate what I will need, I can dictate task to my crew, I know how I can going to handle the situation, and I have no problems making a decision. If the ambulance crew needs another set of hands, I have no problems hopping in the back, and can do anything that I am asked to do, but I can't anticipate what the medic will want (again, crystal ball is broken, can't read minds). And there are plenty of EMTs who are great paramedic helpers, but without the paramedic there to hold their hand, they are completely without direction.

Hope this helped a little bit.

 

[Speedylifsavr]

Hope this helped a little bit.

Immensely. Thank You for your reply.

Speedy