medics with attitudes

[46Young]

It seems to me that the Medics are saying two medics on a team are better than a medic and an emt. Meanwhile the Basics's are saying a medic and an emt is better than just a medic.

Both are correct.

Are we done now?

An extra set of hands can only help a lone medic. That's obvious. If that person is also a medic, then they are more useful. If you have two medics and a couple of basics, it works even better still. Everyone is a valued resource.

 

[CAOX3]

I think it may have something to do with the design of your system, in a PB system I would imagine some EMTs are looking for acceptance and approval from their medic partner, the medic takes on more of a preceptor role and at times the medic is going to have to put his foot down, the EMT never has to make treatment or transport decision they have a safety net. In a tiered system the EMT is soley responsible for all decisions, he works autonomously 85 percent of the time, on most occasions they will never see a medic. Its easier for me to turn over all responsibility to the medics when they arrive because I understand the complaint is beyond my reach.

I'm not looking for approval, acceptance, friend or anything I'm looking for whats in the best interest of the patient, the medic provides that when he arrives

I have no problem carrying bags or cleaning up a mess, while the medics tend to the patient its called professionalism, I don't have an ego problem nor do most of the ALS providers I work with, if the call dictates I carry the bags, clean the mess or stand on one foot and recite a nursery rhyme (LONG STORY) that's fine.

We are all part of a team, the duties we perform change from call to call my goal which is whats in the best interest of the patient never does and if ego or attitude ever gets in the way of that its time for a career change.

 

[usalsfyre]

I think it may have something to do with the design of your system, in a PB system I would imagine some EMTs are looking for acceptance and approval from their medic partner, the medic takes on more of a preceptor role and at times the medic is going to have to put his foot down, the EMT never has to make treatment or transport decision they have a safety net. In a tiered system the EMT is soley responsible for all decisions, he works autonomously 85 percent of the time, on most occasions they will never see a medic. Its easier for me to turn over all responsibility to the medics when they arrive because I understand the complaint is beyond my reach.

I'm not looking for approval, acceptance, friend or anything I'm looking for whats in the best interest of the patient, the medic provides that when he arrives

I have no problem carrying bags or cleaning up a mess, while the medics tend to the patient its called professionalism, I don't have an ego problem nor do most of the ALS providers I work with, if the call dictates I carry the bags, clean the mess or stand on one foot and recite a nursery rhyme (LONG STORY) that's fine.

We are all part of a team, the duties we perform change from call to call my goal which is whats in the best interest of the patient never does and if ego or attitude ever gets in the way of that its time for a career change.

Important distinction, I work in a P/B crew configuration. MOST of the time when I have an issue with an EMT it's over second guessing treatment in an inappropriate manner, such as "do we really need one" in response to a 12 lead, or "why can't we just no ride/take them to doc in the box local ED/call HEMS" when I want to transport to a tertiary center. Another favorite is "my regular partner doesn't do that" when their regular partner is often a lazy mouth-breathing, window-licking excuse of a paramedic. It's VERY easy to second guess and armchair quarterback when you have very little responsibility and often times are clueless as to the intricacies of what's going on.

In a tiered system where Basics actually do have a fair bit of responsibility I would imagine there's fewer issues.

 

[Veneficus]

In a tiered system where Basics actually do have a fair bit of responsibility I would imagine there's fewer issues.

It has been my experience that this is the case. However, because the basics have far more direct patient care and some time being in charge of patient care, they have considerably more employer provided training as well as command skills that basics who always have and work with a medic lack.

From my perspective, a great basic is like a great NCO, they are not the Captain, they know they are not and don't pretend to be. But they are great at performing the tasks that make the whole operation run smoothly.

 

[usalsfyre]

From my perspective, a great basic is like a great NCO, they are not the Captain, they know they are not and don't pretend to be. But they are great at performing the tasks that make the whole operation run smoothly.

Great way of putting it into words.

 

[DrParasite]

you know what's amazing? all you paramedics are stupid. Just ask MrBrown or Veneficus or anyone in medical school, you really don't know anything, your education is laughable, and you can't do anything without a doctor holding your hand (at least that is what they always say). Hell, there are other US paramedics (on this board!!!) who say the same thing.

and the secret truth of EMS is that prehospital ALS has minimal impact on patient mortality rates (and no, I don't have the study in front of me, but I am sure someone has read it and will stomp their feet that the research doesn't apply to them). Helicopter EMS is in the same boat.

The other secret truth is outside of a cardiac or respiratory most medics can't do much. In a major trauma, they have no beneficial effect http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522139/ and the bulk of EMS calls aren't cardiac or respiratory in nature.

Now EMTs? 120 hours is pretty pitiful. of course you can combine all the con ed training (pepp, phtls, ics, START, GEMS, and every other course you can name) and you can get it to between 250 and 500 hours. college level courses can help (A&P I & 2 can be useful if you have a decent prof, and I enjoyed Bio 1 & 2, but Organic Chem did make my brain hurt), but the biggest advantage Paramedics have is their clinical time, where they can screw up as a student under the supervision of a senior paramedic instructor, while an EMT is given her or her card and cut free (sans the clinical experience under an experienced provider).

Do some medic's have attitudes? you betcha. are some EMTs retarded? you betcha. are some medic's retarded? you betcha. do some EMTs have attitudes? you betcha. And just like some medic's don't respect EMTs, some EMTs don't respect medics. an ignorant *** is still an *** whether it be an EMT or paramedic.

There are some medics that don't respect me. There are some that don't respect any BLS provider. There are some paramedics I don't respect. there are some paid BLS providers that don't respect volunteer providers. I do my job and go home, I have enough confidence in myself and my abilities to not give a F*ck if someone respects me or likes me. and I refuse to kiss *** to be more liked by certain providers.

I know what I can manage on my own, based on my training, and when I need to call for help. and I have no problems calling for ALS if they can benefit the patient, or cancelling ALS if the patient needs definitive care in an ER, not a paramedic who can only do so much. I have activated BAT teams on my own, trauma teams, and just once I even notified the ER I had a patient who was having an MI, despite not having a paramedic on my truck, and he was treated by the ER staff based on my dumb EMT's report. Would a paramedic have helped? well, considering I was arguing with a paramedic with 10 years experience who didn't want to call a brain attack on a patient as we were transporting to the hospital, I don't know. BTW I finally convinced her partner to call it, and the follow up on the patient showed she was having a massive bleed in her head, and the ER had orders to intubate and send her to the Neuro ICU.

and while I'm sure I pissed off the paramedics here, a) I don't care and b) paramedics are a valuable resource that should be used correctly. Sick patients who need them should get them; but if for some reason they can't get them, than BLS should know what do do. EMTs should NOT need a paramedic in order to operate they should have enough knowledge of the situation to know what is going on, and what they need to do. and even paramedics miss things and do make mistakes (I know this might shock some people)

geez, we all have EMT in front of our cert/license (although EMT-Paramedics seem to forget that, and that they were once dumb (sometimes even volunteer) EMTs ones). working together is often a lot more effective than fighting each other. and lets also try to remember, it's supposed to be all about patient care, not the egos of individual providers.

 

[Shishkabob]

geez, we all have EMT in front of our cert/license (although EMT-Paramedics seem to forget that,).

In, what, a year, we won't have EMT infront of Paramedic anymore. And heck, some places already don't have EMT infront of Paramedic.

The other secret truth is outside of a cardiac or respiratory most medics can't do much. In a major trauma, they have no beneficial effect http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522139/ and the bulk of EMS calls aren't cardiac or respiratory in nature.

According to that study, doctors are even worse than Paramedics... with a much bigger difference between Physician and medic (11%) than medic and EMT(6%).

The overall mortality rates by type of on-site personnel were physicians 35%, paramedics 24%, and EMTs 18%

 

[JPINFV]

you know what's amazing? all you paramedics are stupid. Just ask MrBrown or Veneficus or anyone in medical school, you really don't know anything, your education is laughable, and you can't do anything without a doctor holding your hand (at least that is what they always say). Hell, there are other US paramedics (on this board!!!) who say the same thing.

Are you arguing that the education currently required for EMTs and paramedics in the US is appropriate? If not, why complain about people arguing that the current requirements are not enough?

Additionally, where has anyone said that hand holding must occur?

and the secret truth of EMS is that prehospital ALS has minimal impact on patient mortality rates (and no, I don't have the study in front of me, but I am sure someone has read it and will stomp their feet that the research doesn't apply to them). Helicopter EMS is in the same boat.

The other secret truth is outside of a cardiac or respiratory most medics can't do much. In a major trauma, they have no beneficial effect http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522139/ and the bulk of EMS calls aren't cardiac or respiratory in nature.

Minus transport, which doesn't even need EMTs, is there any evidence that "BLS" has benefits in the sense of life saved?

Additionally, the vast majority of studies are relatively flawed in the sense that they only look at survived/died. How about instances where hospital stay is decreased? How much is the relief of suffering worth? Sure, the patient with reactive airway disease will most likely survive just fine in urban and suburban areas for that 10 minute ride to the hospital sans beta agonists. How much is relieving the shortness of breath sooner worth? Same with pain management. Prehospital pain management doesn't save lives, but it's a service worth having if providers are already properly educated to provide it.

Now EMTs? 120 hours is pretty pitiful. of course you can combine all the con ed training (pepp, phtls, ics, START, GEMS, and every other course you can name) and you can get it to between 250 and 500 hours. college level courses can help (A&P I & 2 can be useful if you have a decent prof, and I enjoyed Bio 1 & 2, but Organic Chem did make my brain hurt), but the biggest advantage Paramedics have is their clinical time, where they can screw up as a student under the supervision of a senior paramedic instructor, while an EMT is given her or her card and cut free (sans the clinical experience under an experienced provider).

What about people who don't have those merit badge CMEs?

Should patients suffer because their EMTs are fresh out of class and the course work relies, in part, on providers taking a few years to get appropriate CMEs to cover pertinent education not covered in class?

geez, we all have EMT in front of our cert/license (although EMT-Paramedics seem to forget that, and that they were once dumb (sometimes even volunteer) EMTs ones). working together is often a lot more effective than fighting each other. and lets also try to remember, it's supposed to be all about patient care, not the egos of individual providers.

Actually, the national standards have changed and it's no longer EMT-paramedic. NREMT just hasn't implemented it yet.

 

[DrParasite]

In, what, a year, we won't have EMT infront of Paramedic anymore. And heck, some places already don't have EMT infront of Paramedic.

I'll believe it when I see it. There is always talk. I am also curious if the EMT certification will be removed as a prereq to becoming a paramedic.

According to that study, doctors are even worse than Paramedics... with a much bigger difference between Physician and medic (11%) than medic and EMT(6%).

you are absolutely right. a trauma patient needs bright lights and cold steel, not prehospital ALS interventions; the exception being if there is an ABC problem,and even then if an OPA and BVM are doing the job, don't mess around intubating.

 

[JPINFV]

I'll believe it when I see it. There is always talk.

Ask and ye shall receive.

http://ems.gov/pdf/811077a.pdf

and

http://www.nhtsa.gov/people/injury/ems/EMSScope.pdf

and

http://www.nremt.org/nremt/downloads/Newsletter_2009.pdf

 

[samiam]

Going back to the license and certification thing, didn't they change the EMT "certification" to a license now? I mean I don't want to start anything because believe me I won't be staying an EMT for long, paramedic school starts in August and I will be in that class. It just seems like there is a lot of bickering lately, and it shouldn't be like that.

In michigan MFR, EMT-P and EMT-B are all "licenses" for legal purposes.

 

[DrParasite]

Ask and ye shall receive.

http://ems.gov/pdf/811077a.pdf

and

http://www.nhtsa.gov/people/injury/ems/EMSScope.pdf

and

http://www.nremt.org/nremt/downloads/Newsletter_2009.pdf

ummmm, yeah, those are the proposals..... they have been kicked around for a while, and discussed, but never actually implemented by a national EMS governing body, or each 50 state's EMS regulatory agencies.

even the national scope of practice, while is good, isn't adopted by all 50 states..

 

[JPINFV]

Yea... and the old National Standard Curriculum wasn't adopted by all 50 states, but it is now the standard for the NHTSA (which is as close as you're going to get to a national EMS governing body). These are the closest you'll find to national standards. Many states are adjusting their standards to meet them, including the more often than not behind the times State of California.

Oh, and the last one from the NREMT isn't being proposed, it's currently being implemented.


So, what's your source that there's a national governing body still using EMT-P" or that all 50 states use the designation "EMT-P" now that the old National Standard Curriculum is no longer the guiding document from the federal level?

 

[MrBrown]

you are absolutely right. a trauma patient needs bright lights and cold steel, not prehospital ALS interventions

Ask any surgical registrar, they will tell you trauma is increasingly a non surgical disease.

Does that mean stay on scene and wongle your dongle? No but it doesn't mean every trauma patient is going to get surgery.

 

[CAOX3]

you know what's amazing? all you paramedics are stupid. Just ask MrBrown or Veneficus or anyone in medical school, you really don't know anything, your education is laughable, and you can't do anything without a doctor holding your hand (at least that is what they always say). Hell, there are other US paramedics (on this board!!!) who say the same thing.

and the secret truth of EMS is that prehospital ALS has minimal impact on patient mortality rates (and no, I don't have the study in front of me, but I am sure someone has read it and will stomp their feet that the research doesn't apply to them). Helicopter EMS is in the same boat.

The other secret truth is outside of a cardiac or respiratory most medics can't do much. In a major trauma, they have no beneficial effect http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1522139/ and the bulk of EMS calls aren't cardiac or respiratory in nature.

Most of this post is laughablle at best.

Maybe you should have prefaced this with "your medics."

I havent ssen a paramedic call for orders in fifteen years.

If your system still bases treatment on who survives then you should run, it hasnt been about survival rates in decades.

If you havent witnessed the benefits an educated and experienced medic brings the table your either not looking or dont care to know.

I love the trauma refrences also, ever witness a decompression, surgical cric, the list goes on. There is plenty that can be done by an ALS provider to change the mortality rates of traumatic injuries, but the medics have to be on their game and from your tone Im guessing yours are not.

 

[DrParasite]

Most of this post is laughablle at best.

the first paragraph was intended to be laughable

Maybe you should have prefaced this with "your medics."

actually, I am basing that based solely on what I read on this forum. Many of the medics I know are pretty good, many are extremely knowledgeable, and the experienced ones are good at what they do. I guess it helps that every NJ medic has a degree behind them.

I havent ssen a paramedic call for orders in fifteen years.

cool. Neither here nor there, but cool. Sidenote: I know some EMTs who haven't called for paramedics in 10 years. Doesn't mean they were right just that they chose not to do it.

If your system still bases treatment on who survives then you should run, it hasnt been about survival rates in decades.

really? so all these studies by doctors and research specialists are wrong? and here I was thinking medicine was about not killing people. imagine my shock to learn that all the evidence is, well, not evidence at all, and there is no proof. Anecdotal (which is "I think is the best thing to do because I say it is") is the way to go!!!!! I can't wait for the research community to pick that up.

If you havent witnessed the benefits an educated and experienced medic brings the table your either not looking or dont care to know.

I didn't say that. In fact, the entire first paragraph was sarcasm based on what others say.

I love the trauma refrences also, ever witness a decompression, surgical cric, the list goes on. There is plenty that can be done by an ALS provider to change the mortality rates of traumatic injuries, but the medics have to be on their game and from your tone Im guessing yours are not.

Actually a surgical cric and chest decompression are two amazing procedures that paramedics can do. you truly are saving someone's life with your intervention, and yes, I have seen it done. my medics are on their game, and typically only treat sick patients, so their skills aren't diluted by BS. and what other items are on your "list that goes on" that a paramedic can do for a trauma patient that will save his or her life?

But lets be honest, how many chest decompressions and crics does your typical medic do a year? maybe 12? once a month? maybe 6 a year? 1 year, if that? So if do you something maybe once a year, is it really good support for your argument?

Some in EMS are trying to move toward evidence based medicine. Using research to show was works and what doesn't. And yet, you want to ignore the evidence using skills that are used on maybe 1% of patients to support your position?

well done good sir, you have convinced me.

 

[usalsfyre]

Focusing solely on mortality is only half the picture, although it greatly suits basics who argue to keep the status quo. Tell me DrParasite, how much can a basic due to reduce morbidity and ease pain and suffering?

 

[CAOX3]

Focusing solely on mortality is only half the picture, although it greatly suits basics who argue to keep the status quo. Tell me DrParasite, how much can a basic due to reduce morbidity and ease pain and suffering?

Apparently in New Jersy its the whole picture.

 

[Handsome Robb]

If you are so anti-EMS Dr. Parasite, why do you stick around this site? If EMS was not useful, you'd think that they would have done away with it years ago. We must make a difference, otherwise why pay us to do this job?

 

[46Young]

Focusing solely on mortality is only half the picture, although it greatly suits basics who argue to keep the status quo. Tell me DrParasite, how much can a basic due to reduce morbidity and ease pain and suffering?

Wasn't he the one that was arguing againt the necessity of an ALS evaluation of an injured pt, to decide whether or not pain management needs to be implemented? The bottom line for a basic, is that you don't know what you don't know. Like others said earlier in the thread, if the EMT sees the medics react a certain way to certain pt presentations, they begin to think they know as much as the medic.

BTW DrParasite, if every medic in NJ is degreed, then explain why I had four NJ guys in my class at NY Methodist, from 8/2004-9/2005? What about the NJ guys at the classes after that, both in Brooklyn and the Bronx? I have a hard time believing that your state has only degreed medics. We have a few NJ guys on my dept. OR is the only state I know that can make that claim.