Paramedics in the tier 2 system, what do you think of EMT-B's.

[RedrickJim]

I run in a tier 2 system. Recently in the last few months, I've come across paramedics who for lack of a better sentence: Would just rather not have me on board. They have this poor attitude when I whole-hardheartedly ask in the back of the ambulance "Do you need anything man, I'm here to help". and I get "Nope, sit there." in this passive aggressive tone of voice that makes me feel like my training is useless, when I know it's not.

I've run into paramedics that went right from EMT school to paramedic school, and have no field experience as an EMT, and have found themselves get flustered because they beat us to the call and have no idea what to do because we are typically already there with a report, and are getting them packaged and doing the necessaries.

I may not want to become a paramedic, but as an EMT, I think it works best when you show me things that I can do to help you (Let's not beat around the bush here, anyone involved in a tier-2 system knows that we basically help and do a number of what the paramedics do short of actually sticking the Pt and pushing the drugs.) Teach me, you can see I'm a young'n, show me things, show me what this rhythm means, or why you are doing this. (Obviously I would never ask this during a trauma code or something, I have my own priorities which I know, trauma naked, control the obvious bleeding, keep looking for hidden injuries, assess the Pt and immobilize, exc...)

Other medics, are great. There's this one crew I get that I love having on board, they know their ****, they teach me, and treat me as an equal. It's ****ing incredible and even on the harsh calls we operate like clockwork.

I'm more or less asking this: In a tier 2 system, do you, paramedics, find EMT's to be more or less a nuisance that shouldn't even be a thing in the 911 system that should be sticking with transport only?

I mean no sarcasm at all, I've only been doing this a year and a half, and am trying to get a gauge on the reality of this system.

 

[DrParasite]

In NJ, most paramedics have at least 1 year of experience as EMTs before they get hired as paramedics. I am pretty sure there are still no zero to hero paramedic programs in NJ.

I've only been doing this about a year and a half. I was incredibly fortunate that I went directly into 911 EMS right out of EMT school, so I'm still getting a feel for it, but yeah, I got thinking about the above.

you've been doing this for only a year an a half..... maybe you don't know as much as you think you do, maybe you aren't as good as you think you are, and maybe you should try transport for a bit, so you can check your attitude and ego at the door?

When I worked BLS in NJ, It was very rare for me to be told to just sit there and do nothing, even on ALS calls. sick patients, not sick patients, I knew what my job was, and usually did it without having to be told what to do. I knew my paramedics, and they knew me. And if they needed something done, they would ask me, and they actually listened to both my assessment and when I said "something isn't right, I disagree with your partner that this is BS, this is serious." But that takes time, and trust must be earned, and with the amount of turnover in EMS, it doesn't happen overnight

Maybe there is something about you, or your agency's reputation, that is making the paramedics not want you to do anything, or even touch the patient?

And yes there are some paramedics who just want to do everything themselves. I got paid by the hour, so if they wanted to do all the work themselves, I wasn't going to get all worked up over it.

 

[teedubbyaw]

What I've heard from medics in a newly switched tiered system is that they would rather not have a basic. Throughout medic school you always have an ALS team, and when you graduate, most of the time you work for a system that runs ALS only (aside from fire) in this area. So, to go from someone always being able to back you in a bad situation, to a partner with a limited scope isn't something that many are ready for.

Just my observations.

 

[DesertMedic66]

What I've heard from medics in a newly switched tiered system is that they would rather not have a basic. Throughout medic school you always have an ALS team, and when you graduate, most of the time you work for a system that runs ALS only (aside from fire) in this area. So, to go from someone always being able to back you in a bad situation, to a partner with a limited scope isn't something that many are ready for.

Just my observations.

Are you meaning in the classroom portion (skills, Megacode, etc) or are you meaning in the field?

 

[RedrickJim]

In NJ, most paramedics have at least 1 year of experience as EMTs before they get hired as paramedics. I am pretty sure there are still no zero to hero paramedic programs in NJ.you've been doing this for only a year an a half..... maybe you don't know as much as you think you do, maybe you aren't as good as you think you are, and maybe you should try transport for a bit, so you can check your attitude and ego at the door?

When I worked BLS in NJ, It was very rare for me to be told to just sit there and do nothing, even on ALS calls. sick patients, not sick patients, I knew what my job was, and usually did it without having to be told what to do. I knew my paramedics, and they knew me. Maybe there is something about you, or your agency's reputation, that is making the paramedics not want you to do anything, or even touch the patient?

And yes there are some paramedics who just want to do everything themselves. I got paid by the hour, so if they wanted to do all the work themselves, I wasn't going to get all worked up over it.

I think you mis understood my post as being some cocky jerkoff. I know I don't know much, as I said I've only been doing it for a bit over a year. I ask, because like you said, some want you to just sit there. It's only polite, and the last thing I want to do is step on someones toes in the rig. I don't get cocky and say "Want me to do X for you?" because that implies I know their job, and that could be mis-interpreted as me saying that they forgot something. I merely ask "Hey sir, I'm here, I'm an extra set of hands, if you need anything, please feel free to ask." This is on the standard chest pain call where it's more or less, hooking them up to the EKG and giving them nitro with a bit of saline (at leas that's what I've seen them do for these calls if the Pt is aware, oriented, and alert.

It's also just some medics. I want to say it's split down the middle of ones that want me to actively engage in helping them when I ask if they'd like it, and others who just say to sit back and **** off.

 

[STXmedic]

I was actually just talking about this with my partner the other day...

The system I work in will typically have Fire first respond (can either be all basics, or basics and medic(s) ) and get things started for EMS. I started off on the Fire side as a medic and used to get beyond frustrated with EMS mostly blowing us off.

Now that I'm on the EMS side, I find myself doing exactly what I so despised. I didn't start out that way, but I see why I ended up becoming like that. We don't respond with the same fire crew every time. We may not see the same crew twice in one shift. Each crew has skill levels that vary tremendously. Unfortunately, unless you are very familiar with a certain group, you likely won't know what that skill level is. I've seen vitals clearly wrong or blatantly made up, assessments that missed something major, unnecessary treatments, or most commonly absolutely nothing being done. Now I've also seen the inverse, but again, it's not always immediately apparent what kind of crew you're dealing with. While I don't know if I can trust the assessments of the responding crew, I do know that I can trust my own assessments and judgement. I trust myself and my partner to not miss things, to get accurate vitals, to perform appropriate treatments, etc. While I will hear what you have to say, it will likely only be used to lead me in a general direction. If you ask me if I need help, I will say "no" 99 times out of 100 (the caveat being a critical patient where I truly do need hands). However, I love teaching. If you ask me why something is being done, or why something is the way it is, or how to do something, I will help you learn all day long. Do I need your help, not typically. I will be more than willing to help you, though.

 

[RedrickJim]

I was actually just talking about this with my partner the other day...

The system I work in will typically have Fire first respond (can either be all basics, or basics and medic(s) ) and get things started for EMS. I started off on the Fire side as a medic and used to get beyond frustrated with EMS mostly blowing us off.

Now that I'm on the EMS side, I find myself doing exactly what I so despised. I didn't start out that way, but I see why I ended up becoming like that. We don't respond with the same fire crew every time. We may not see the same crew twice in one shift. Each crew has skill levels that vary tremendously. Unfortunately, unless you are very familiar with a certain group, you likely won't know what that skill level is. I've seen vitals clearly wrong or blatantly made up, assessments that missed something major, unnecessary treatments, or most commonly absolutely nothing being done. Now I've also seen the inverse, but again, it's not always immediately apparent what kind of crew you're dealing with. While I don't know if I can trust the assessments of the responding crew, I do know that I can trust my own assessments and judgement. I trust myself and my partner to not miss things, to get accurate vitals, to perform appropriate treatments, etc. While I will hear what you have to say, it will likely only be used to lead me in a general direction. If you ask me if I need help, I will say "no" 99 times out of 100 (the caveat being a critical patient where I truly do need hands). However, I love teaching. If you ask me why something is being done, or why something is the way it is, or how to do something, I will help you learn all day long. Do I need your help, not typically. I will be more than willing to help you, though.

I suppose it's different all around the states, because even when I'm driving us to the hospital and my partner is in the back with the medic, I'll see ask them, then depending on the answer will do a number of different things: hooking up the EKG bits, BP cuffs, hanging the bags of saline or whatever, restraining the Pt if he's violent, exc...

 

[STXmedic]

I suppose it's different all around the states, because even when I'm driving us to the hospital and my partner is in the back with the medic, I'll see ask them, then depending on the answer will do a number of different things: hooking up the EKG bits, BP cuffs, hanging the bags of saline or whatever, restraining the Pt if he's violent, exc...

I'm not quite sure where you're going with this or what you're relating to my post...

 

[OnceAnEMT]

What I've heard from medics in a newly switched tiered system is that they would rather not have a basic. Throughout medic school you always have an ALS team, and when you graduate, most of the time you work for a system that runs ALS only (aside from fire) in this area. So, to go from someone always being able to back you in a bad situation, to a partner with a limited scope isn't something that many are ready for.

Just my observations.

I haven't heard the "I'd rather not have a Basic with me" argument, but here's why I disagree with your post. It sounds like the issue with folks that have that mentality is more so the fact that they are not working smoothly as partners. Medic orders meds, Basic draws them, Medic pushes. Basic sticks electrodes and hooks up 12 lead, Medic interprets. Basic prepares intubation and cric equipment, Medic sends it. Just because Basic's aren't allowed to intubate, cric, insert IVs, send IOs, and all the other fun jazz, doesn't mean we don't know what is going on and can hand the medic the supplies and equipment needed for the ALS activity. Only one person can intubate at a time, only one can IO at a time (unless you have 2 drills or an old fashioned needle, you fancy systems)... many skills can only be done one person at a time. Why not increase the productivity percentage and hire a Basic 2nd man to pay less, instead of hiring a Medic 2nd man to not "actually" do the skills? Its a money thing, sure, but that just gives us Basics more to do.

 

[RedrickJim]

I'm not quite sure where you're going with this or what you're relating to my post...

I'm saying that every state appears to have a different program for the 911 service is all. I understand your post fine.

 

[Rin]

I find I dislike having others gather history for me. I always feel like things get left out or filtered. I'd rather hear it directly from the patient.

When I'm running a call, I prefer my partner to hang back and act as an extra set of hands and only back up eyes & ears.

 

[OnceAnEMT]

I find I dislike having others gather history for me. I always feel like things get left out or filtered. I'd rather hear it directly from the patient.

When I'm running a call, I prefer my partner to hang back and act as an extra set of hands and only back up eyes & ears.

This mentality is reflected in the ED I am at. Hell, it is that way with every transfer from dispatch to fire to EMS to ED to floors. Information given is taken anecdotally. Keep it in the back of your mind, but it doesn't necessarily create your course of action.

 

[teedubbyaw]

I haven't heard the "I'd rather not have a Basic with me" argument, but here's why I disagree with your post. It sounds like the issue with folks that have that mentality is more so the fact that they are not working smoothly as partners. Medic orders meds, Basic draws them, Medic pushes. Basic sticks electrodes and hooks up 12 lead, Medic interprets. Basic prepares intubation and cric equipment, Medic sends it. Just because Basic's aren't allowed to intubate, cric, insert IVs, send IOs, and all the other fun jazz, doesn't mean we don't know what is going on and can hand the medic the supplies and equipment needed for the ALS activity. Only one person can intubate at a time, only one can IO at a time (unless you have 2 drills or an old fashioned needle, you fancy systems)... many skills can only be done one person at a time. Why not increase the productivity percentage and hire a Basic 2nd man to pay less, instead of hiring a Medic 2nd man to not "actually" do the skills? Its a money thing, sure, but that just gives us Basics more to do.

Not sure what you're disagreeing with. These are my observations and what I've heard from the medics I work with.

The issue here is that this is an incredibly busy system that made the switch. The influx of basics weren't experienced, and if anything, can be a liability at times. There are few basics that do what you're talking about, in part because it takes years of experience working with medics to be a step ahead of them.

This is certainly something that varies from system to system and 911 vs IFC.

 

[OnceAnEMT]

Not sure what you're disagreeing with. These are my observations and what I've heard from the medics I work with.

The issue here is that this is an incredibly busy system that made the switch. The influx of basics weren't experienced, and if anything, can be a liability at times. There are few basics that do what you're talking about, in part because it takes years of experience working with medics to be a step ahead of them.

This is certainly something that varies from system to system and 911 vs IFC.

I'm saying its not a good habit to ignore the Basic in the back of the truck, more specifically if that Basic is your partner. Not arguing you, just the mentality of those you observed working that way.

 

[teedubbyaw]

I completely agree. A lot of burnt out medics dealing with a constantly evolving system seems to equate to a piss poor attitude. Not an excuse, though.

 

[OnceAnEMT]

I completely agree. A lot of burnt out medics dealing with a constantly evolving system seems to equate to a piss poor attitude. Not an excuse, though.

I wasn't aware that the change was recent. How long ago was it? And did they change every crew overnight? Seems like that is something that should be done truck by truck.

 

[Rin]

I completely agree. A lot of burnt out medics dealing with a constantly evolving system seems to equate to a piss poor attitude. Not an excuse, though.

The problem is the system keeps evolving based on politics and money, with no input from the folks on the ground.

 

[Handsome Robb]

I don't push drugs I didn't draw myself. Also I setup my own advanced invasive equipment.

Just an observation from a medic.

STX pretty much hit it on the head. It's not personal but not everyone is a good teacher and if we don't know you often it's easier to do it yourself rather than potentially having to fix something that was done incorrectly.

Some medics like to teach, some don't.

 

[avdrummerboy]

Ah the old paragod attitude. I don't buy into it and I'll let medics know that homie don't play that game. Every good medic knows the value of a good EMT- sort of the BLS before ALS montra. If they want to do everything themselves, sure I'll stand back and let them, I get paid the same either way. But if they give me a hard time about it and condemn me for being an EMT, well, act like an a**hole and I'll treat you like one. Also look at all the studies that show that dual ALS units- i.e. calls that have a lot of medics running around- and see that patient care decreases, and the few studies that don't show it also don't show that care goes up.

I've told many a student/ trainee who gets crap from an RN, medic, whomever that BLS saves just as much life as ALS. Give me two EMT's and an AED and other necessary BLS gear and send them on a full code and they will have just as many saves as an ALS crew. Sure ALS interventions are something that should be obtained ASAP, but regardless, the life was saved.

So, to the poster, if they don't want your help or you know that the medic you're working with is an a**hole, let them do their thing all alone! They want to act that way, treat them that way- don't let pt. care dwindle though, do what you know is necessary even if the medic cries about it. It'll come back to them eventually.

 

[drl]

I think it's important for medics to delegate tasks to EMTs in mixed medic/EMT systems. It's the same way in teaching hospitals, where even when an attending surgeon can easily do a procedure, he has the resident do much of the actual work: it's critical training, and gets the resident used to doing these tasks without supervision.

A bit different in the prehospital setting where time is often critical and there's less opportunity to teach, but even during my ride-alongs I appreciated the FF medics who let me check out their gear and assist them with some basic stuff (hooking up a 12-lead, going through the steps of spiking an IV bag).