Medic working BLS only.

Lola99

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I asked this question within a thread once directly, but that person didn't respond, so I guess I'll ask a broader audience.
Back home (I'm in college hours away) I work for a private BLS service doing emergent and non-emergent transport. We also have a mutual-aid contract with the county, so we pick up a good number of their transports as well. My company's entire staff is made up of basics and drivers -and one medic.
The company I work for is contracted (for several years now) to work at a local dirt track. When cars flip, we go out. When people in the stands get too drunk, we go out. We have 2 of our trucks out there and a local volunteer fd brings a truck, too. If there isn't at least one truck on standby, races don't happen. When called down, one rig goes out and the other hangs back unless it is obviously more than one truck should handle or the first truck calls back for assistance.
That medic is one of those guys that only wants to go out on "good" calls. Usually we go, check someone out, and get a refusal, but on those times that we do transport, out medic likes to prod. Obviously if it's more than a BLS call, we're calling for intercept, but he steps on toes and knows it.

So here's my question: If we do have to transport, and the medic begins to poke, should we let him take over just because he's a medic, even if it is a BLS service and he can only use the same skills we can?
 

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So here's my question: If we do have to transport, and the medic begins to poke, should we let him take over just because he's a medic, even if it is a BLS service and he can only use the same skills we can?

Yes. He is in charge. Even if he can't use ALS skills, he has still been trained to a higher level. He still will be held to that level if the it hits the fan. So what if he "steps on your toes" bite your ego and let him run it. If you were a patient on a BLS truck would you want a Medic with 12 to 18 months of training working on you or an EMT-B with 150 hours of training working on you?
 
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EMT11KDL

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I asked this question within a thread once directly, but that person didn't respond, so I guess I'll ask a broader audience.
Back home (I'm in college hours away) I work for a private BLS service doing emergent and non-emergent transport. We also have a mutual-aid contract with the county, so we pick up a good number of their transports as well. My company's entire staff is made up of basics and drivers -and one medic.
The company I work for is contracted (for several years now) to work at a local dirt track. When cars flip, we go out. When people in the stands get too drunk, we go out. We have 2 of our trucks out there and a local volunteer fd brings a truck, too. If there isn't at least one truck on standby, races don't happen. When called down, one rig goes out and the other hangs back unless it is obviously more than one truck should handle or the first truck calls back for assistance.
That medic is one of those guys that only wants to go out on "good" calls. Usually we go, check someone out, and get a refusal, but on those times that we do transport, out medic likes to prod. Obviously if it's more than a BLS call, we're calling for intercept, but he steps on toes and knows it.

So here's my question: If we do have to transport, and the medic begins to poke, should we let him take over just because he's a medic, even if it is a BLS service and he can only use the same skills we can?

I am not sure about your state laws for EMS. But in the State of Idaho, If Said person is a Paramedic, but they are working on a BLS rig, there scope of practice is BLS. So If he is working on the BLS rig, than NO he should not be doing anything more than the scope allowed for that agency/rig.

Personally, what ever he does, DOCUMENT IT! and I am not saying document to get him in trouble, document to keep yourself out of trouble. Document EVERYTHING!!!!!
 

firecoins

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I am not sure about your state laws for EMS. But in the State of Idaho, If Said person is a Paramedic, but they are working on a BLS rig, there scope of practice is BLS. So If he is working on the BLS rig, than NO he should not be doing anything more than the scope allowed for that agency/rig.

Personally, what ever he does, DOCUMENT IT! and I am not saying document to get him in trouble, document to keep yourself out of trouble. Document EVERYTHING!!!!!

He isn't saying the medic is working out of his scope.
 
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Lola99

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Yes. He is in charge. Even if he can't use ALS skills, he has still been trained to a higher level. He still will be held to that level if the it hits the fan. So what if he "steps on your toes" bite your ego and let him run it. If you were a patient on a BLS truck would you want a Medic with 12 to 18 months of training working on you or an EMT-B with 150 hours of training working on you?

See, but here's my problem with that... It's BLS and a BLS call. If I'm not completely efficient in my skills as a basic as much as he's efficient in basic skills even though he's a medic, I'm doing something wrong.
 

Shishkabob

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See, but here's my problem with that... It's BLS and a BLS call. If I'm not completely efficient in my skills as a basic as much as he's efficient in basic skills even though he's a medic, I'm doing something wrong.

Who cares if it's a BLS call? Doesn't make the EMT any more qualified at running it. Most of the calls we run in EMS are pretty much BLS.


The medic is in charge of patient care, no questions asked, regardless of what he's working as at the moment. As has been stated, in a court of law you are held to your highest certification. He still carries the patch and the responsibilities that go with it.


I'll admit it, I've stepped on toes. Every medic has. Tends to happen when you put your patients wellbeing above that of another providers feelings.
 

Shishkabob

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See, but here's my problem with that... It's BLS and a BLS call. If I'm not completely efficient in my skills as a basic as much as he's efficient in basic skills even though he's a medic, I'm doing something wrong.

Who cares if it's a BLS call? Doesn't make the EMT any more qualified at running it. The patient should still get the assessment done by the most educated provider, regardless of their initial complaint. The interventions afterward should correlate with what needs to be done.


The medic is in charge of patient care, no questions asked, regardless of what he's working as at the moment. As has been stated, in a court of law you are held to your highest certification. He still carries the patch and the responsibilities that go with it. That is why I absolutely refuse to work on a BLS truck.


I'll admit it, I've stepped on toes. Every medic has. Tends to happen when you put your patients wellbeing above that of another providers feelings. I try to avoid it, but it happens. However we also do not know to what level he's "stepped on toes" as the OP doesn't really explain that part...
 
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Veneficus

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See, but here's my problem with that... It's BLS and a BLS call. If I'm not completely efficient in my skills as a basic as much as he's efficient in basic skills even though he's a medic, I'm doing something wrong.

I don't think that is the case. If I showed up on a BLS ambulance, the assessment I could perform and the decisions I could make from it could easily exceed that of "BLS skills."

A paramedic is not a higher level of care provider because of a handful of psychomotor skills. They are so because of the knowledge base they can call upon to more accurately decide what treatments are indicated.

Having said that though, it doesn't give anyone the right to be a jerk with their coworkers.

I think many EMS people have a slightly skewed view of higher level providers. They often see what they do as not trusting/capable, showing off, or something similar. It is not that personal, really.
 

firecoins

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See, but here's my problem with that... It's BLS and a BLS call. If I'm not completely efficient in my skills as a basic as much as he's efficient in basic skills even though he's a medic, I'm doing something wrong.

he is responsible for your actions whether your doing something wrong or not. He is in charge whether he takes it or not.

as mentioned, your boiling it down to psychomotor skills.
 

EMT11KDL

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He isn't saying the medic is working out of his scope.

i might have misread what was wrote, The op said "poke" so I was assuming poke as in IV.
 
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Lola99

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Let me add an additional tidbit of info.
Management has reprimanded him for acting as he has and says since we're BLS, so is he, and he should only take the calls in order. There is no system of "he's a medic, he's on top" because that's not how management sees it (though I think that's more of a personal issue than an education one).
The way the track is supposed to run with two trucks is that truck 1, which is closest to the gate to get on the track, is supposed to go down when called, goes first and calls truck 2 if they need assistance. On rare occasions, both go down at once because of multiple car pileups.
He will call over radio and ask us to stop and trade places so me, the EMT, stays at the race track so races can still run and he can take pt in. (Hypothetically. I've never had to deal with him for more reasons than I want to explain.
Anyway... back to taking calls in order.. the plan is that if truck 1 transports, truck 2 becomes truck 1 so that races can still run. If truck 2 transports too, which I've never seen, then races are done until a rig gets back or they're just postponed.
There is no hierarchy because of education there as management stands. That's why things are set that way.

Without all the detail before, I'm asking what's right.
Management or .. everything else.

Trust me, I've considered all this before, but opinions are always a good thing as long as they're p o l i t e.
 

Veneficus

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Let me add an additional tidbit of info.
Management has reprimanded him for acting as he has and says since we're BLS, so is he, and he should only take the calls in order. There is no system of "he's a medic, he's on top" because that's not how management sees it (though I think that's more of a personal issue than an education one).
The way the track is supposed to run with two trucks is that truck 1, which is closest to the gate to get on the track, is supposed to go down when called, goes first and calls truck 2 if they need assistance. On rare occasions, both go down at once because of multiple car pileups.
He will call over radio and ask us to stop and trade places so me, the EMT, stays at the race track so races can still run and he can take pt in. (Hypothetically. I've never had to deal with him for more reasons than I want to explain.
Anyway... back to taking calls in order.. the plan is that if truck 1 transports, truck 2 becomes truck 1 so that races can still run. If truck 2 transports too, which I've never seen, then races are done until a rig gets back or they're just postponed.
There is no hierarchy because of education there as management stands. That's why things are set that way.

Without all the detail before, I'm asking what's right.
Management or .. everything else.

Trust me, I've considered all this before, but opinions are always a good thing as long as they're p o l i t e.

I think management in this case is making a mistake and that they are not properly utilizing their resources to the best benefit of all involved.

In order to make best use of resources, this "medic" if the only one at that level should see all patients. He should then disposition them to be transported, sign refusal, whatever. Since he has nothing to function past that of anyone else, he should remain at the track unless he is part of the last unit to transport before none are available.
 

brentoli

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In Indiana where I am a paramedic can only work as a paramedic if he is on an ALS service. On a BLS service a medic can only function at the BLS level and is not allowed to do any ALS interventions. Even if you intercept with an ALS service the medic can still only work to the BLS scope. If a medic did any ALS interventions while working for a BLS service they could be charged for exceeding their scope.
Of course a medic would have greater knowledge, but a restricted skill set.
I've done a lot of research on ALS/BLS in indiana while my service has considered a transition.
I don't know where you're from, my phone won't tell me, but those are the rules in Indiana. You can learn a lot about our system by looking up the rules on the EMS comission website, and reading their meeting minutes. I assume most states are similar.
 
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Lola99

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In Indiana where I am a paramedic can only work as a paramedic if he is on an ALS service. On a BLS service a medic can only function at the BLS level and is not allowed to do any ALS interventions. Even if you intercept with an ALS service the medic can still only work to the BLS scope. If a medic did any ALS interventions while working for a BLS service they could be charged for exceeding their scope.
Of course a medic would have greater knowledge, but a restricted skill set.
I've done a lot of research on ALS/BLS in indiana while my service has considered a transition.
I don't know where you're from, my phone won't tell me, but those are the rules in Indiana. You can learn a lot about our system by looking up the rules on the EMS comission website, and reading their meeting minutes. I assume most states are similar.

Originally Winamac, currently Bloomington (Give ya one guess. Ha)
I understand that completely. That's why I can see either side of this being viable. One one hand, no matter the restriction on their skills, medics have more experience. But on the other, he can only use the same skills as me and if I'm not 100% with those skills as he should be too, then I shouldn't be out their teching as a basic.
 
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Veneficus

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In Indiana where I am a paramedic can only work as a paramedic if he is on an ALS service. On a BLS service a medic can only function at the BLS level and is not allowed to do any ALS interventions. Even if you intercept with an ALS service the medic can still only work to the BLS scope. If a medic did any ALS interventions while working for a BLS service they could be charged for exceeding their scope.
Of course a medic would have greater knowledge, but a restricted skill set.
I've done a lot of research on ALS/BLS in indiana while my service has considered a transition.
I don't know where you're from, my phone won't tell me, but those are the rules in Indiana. You can learn a lot about our system by looking up the rules on the EMS comission website, and reading their meeting minutes. I assume most states are similar.

I am not talking about interventions.

I am saying that the knowledge of a medic makes him better suited to disposition patients no matter what skills he is using. Just like a physician who showed up and had no equipment would be able to make more educated decisions.
 
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STXmedic

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Even if he's not cleared to do ALS interventions, he's still got a much higher knowledge base than an EMT-B. As has been said, a paramedic's assessment skills are one of the major distinctions between an EMT-B. And you need no special clearance to do a patient assessment. He may see a mechanism that raises a high index of suspicion for an internal injury, that may have been looked over by a basic (no fault of the basic, just a lack of training). He may also see a potential for the patient to deteriorate rapidly 2/2 said injury. Also, I don't know how things work where you are, but where I work if you call the hospital and speak to the attending physician, he can clear you for interventions above what you may be cleared through by your service to do (to an extent, they aren't going to recommend a chest tube in the field, especially without proper training). Example; a month before I finished my P, was on B/B IFT, made a call for a diabetic w/BGL of 23. Called the ER, told them my education situation and what I felt the patient needed, and he cleared me for an IV and D50. Once you get his approval, he signs off on your report and you're covered. Does this medic need to jump every transport y'all get? Probably not. Is there a time when having a medic who's not cleared for interventions should jump a call, if not just to monitor the patient? Absolutely.
 
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Lola99

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I am not talking about interventions.

I am saying that the knowledge of a medic makes him better suited to disposition patients no matter what skills he is using. Just like a physician who showed up and had no equipment would be able to make more educated decisions.

But for a patient that's cut his arm reaching over the fan of a motor? That's a lot of what we see. If you think Mr.Medic should oversee all patients, this is one where I think that's wrong.
For a patient that was in a fight (hickheaven + mini-nascar...) and was injured either by getting hit with fists, beer bottles, car parts, or otherwise... was cut with any of those.
Or for a patient that rolled his car, is bruised from the seatbelt, and whose wife is worried and insists he be taken into ER just in case...

If it's something more than what I completely understand and can take care of, I'm calling ALS in the first place. In the meantime, sure, why not grab the medic? But there's nothing he can do that I can't in those rigs regarding patient care, education and experience or not. If it's something I know how to handle, I do as he would. Same skills. If not, he couldn't do anything about it anyway. ....right?

And I know what you're saying... he knows about outside things I may not recognize. Yes, he may, but I know and understand every skill I was taught as a basic. If I'm dealing with anything outside of that, ALS it is.
 
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Lola99

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Even if he's not cleared to do ALS interventions, he's still got a much higher knowledge base than an EMT-B. As has been said, a paramedic's assessment skills are one of the major distinctions between an EMT-B. And you need no special clearance to do a patient assessment. He may see a mechanism that raises a high index of suspicion for an internal injury, that may have been looked over by a basic (no fault of the basic, just a lack of training). He may also see a potential for the patient to deteriorate rapidly 2/2 said injury. Also, I don't know how things work where you are, but where I work if you call the hospital and speak to the attending physician, he can clear you for interventions above what you may be cleared through by your service to do (to an extent, they aren't going to recommend a chest tube in the field, especially without proper training). Example; a month before I finished my P, was on B/B IFT, made a call for a diabetic w/BGL of 23. Called the ER, told them my education situation and what I felt the patient needed, and he cleared me for an IV and D50. Once you get his approval, he signs off on your report and you're covered. Does this medic need to jump every transport y'all get? Probably not. Is there a time when having a medic who's not cleared for interventions should jump a call, if not just to monitor the patient? Absolutely.

He can do NOTHING ALS on our rigs because we're BLS. It's not him; it's the company.

I agree with you that sometimes throwing him in is a good idea, but not every transport, which is his thinking because he's a medic he says and management has battled.

There are a lot of individual and personal issues involved that play into this more than I realized before talking to people here.
 
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