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

This issue between medics and basics seems to be a fairly global problem .... from the posts I've read.
To Redrick Jim - it sounds as the medic you've been dealing with is an a**. Like a physician in the hospital, I feel it's the medic's responsibility to have control but not necessarily be the one with hands on .... delegate and lead, and teach. Most every call has a learning potential for a crew or maybe to its newest crew member.
Maybe it's a confidence issue with the medic. Maybe this medic got burned by a basic that couldn't do what he/she said.
Typically, Im the only ALS provider on my unit or on the scene. I enjoy working with the basics that I ride with. And yes, it takes time to build a trusting relationship with new crew members. But no matter what kind of Pt I have, I let the basic do as much as possible while I do the ALS that is needed. It's a team. It may be my responsibility, but I view it as our Pt.
With that said ... I feel it's best practice to get/hear Pt info 1st hand, and do assessments or re-assessments for yourself.
 
everyone's going to have a different perspective and not really knowing about your system specifically, people are going to relate it to their own experiences and personality.
maybe its the paragod attitude maybe it isnt, but that seems to be the most common cop out. certain things, like handsome robb and stx medic were saying (letting the EMT draw up meds, and setting up invasive equipment) isnt personal. its just the fact that ALL the responsibility and liability ultimately falls on the medic.
no way in hedes id let someone else draw up meds for me, and me actually give them. NO WAY.
it definitely will take a while for the medic and EMT to become a team and trust each other.
just seems like this was a quick change and not everyone is adjusting.

give it time. but also respect that medics don't always and wont always need your help. just sit back and watch, listen and ask questions when appropriate.
 
The only time I've worked in a tiered system was in a rural county that when teh volunteers bothered to show up to a call, they were usually good and knew what they were doing. But sometimes those that showed up did it cause they wanted to look cool and work the 'fun calls'
To a basic I come across on scene (not often here, other than one deputy who is an EMT-B in a neighboring county's service when he's off shift at my SD), I'm usually polite and professional. But unless I know you and are familiar with your work and trust you, I'm probably going to repeat most things that have been done and I'm NOT going to ask you to help me set up my gear. That's what my partner on the bus is for. No offense to you, but as it was stated one post above, I'm ultimately responsible for any and all care and procedures done to my patient.
 
Having worked in a 100% tiered system (NJ), part of the issue will always be specific medics who don't play too well with others that they don't know (and even people they do know, including their partners). In that case it's them not you that is the problem. Then there are some medics who are always pleasant or at least always willing to teach and involve others. Be that as it may, there are also BLS level issues. In NJ, for example, I could interact with 8 different BLS services in a day. In a given tour, you may not see the same crew more than 2-3 times... or you could see them multiple times each shift (if it's a paid service). And when you have high concentration of volunteer organization who scramble to calls, even if you have the same BLS service, you may not have the same crews. So it can be hard to get to know who's good and who's not. BLS services will have reputation of being generally good or generally bad. One of my more experienced partners told me "expect nothing more than an ambulance and someone to drive it; anything more is a bonus". Kind of crude, but it saved me from much frustration.

Want to get on the good side? Dress professionally, even if you're responding from home. Take a decent H&P and give a good succinct report to ALS. Age, PMHx, meds, and allergies should be ready to go. Specific demographics such as DOB, social security, insurance info, etc. can all wait. Those things are pretty simple but could go a long way because, believe it or not, a lot of EMTs are not good at even doing the above.

Anyhow, keep on keeping on. If you're consistent and decent, medics will notice and you'll find your interactions changing to be more positive among the grumps (and even better with others).
 
I must work with some awesome medics or something.. The way our system is set up is that on ALS calls medics administer the meds, and the EMTs have the variances through the MD to do pretty much everything else.

They want vitals immediately, they want a BGL before we get a pt off the floor. My medics want a 12 lead printout in their hands within 6 minutes on arrival of a possible heart call. On a CA, they do meds, I get a Lucas on without assistance. After the Lucas I'm expected to get an airway and have at least an OPA in within 30 seconds, and drop King if we're going to work it for a while. And I had better have my g-tube, RPod and end tidal on properly because they don't have time to fuss with my airway equipment. On trauma calls, they want me to stop the bleeding and get packaging . And I better have 4x4s in my cargo pockets for when they ask for some. Some CA calls, or drownings, I'll grab a couple extra epi and NaHCO because I know I might get asked for it.

The big complaint the medics have around my place is the high turnover of EMTs. They say that as soon as they find one that can take orders, and get one trained in to run the way they want, the good EMTs go on to (supposedly?) bigger and better things.

My medics are more than happy to say "BLS call. This one is yours." and then hop in the driver's seat. I think they're pleased to pass on the paperwork. It's nice to be appreciated, and it's nice to have my skills valued.
 
I have little respect for medics who seem to forget that they were once EMTs (or the occasional Nurse or Doctor who seem to forget that they were once a Paramedic).
 
Household, for what it's worth our agency standard is 2 minutes from PT contact to initiation of a 12-lead in suspected ACS patients. Obviously if you've got an atypical presentation and catch one they'll generally ignore the time and give you a "good catch son" and a slap on the *** and send you on your way.
 
The attitude would seem to be ubiquitous. "Stand there silently, eyes averted and hands folded in humility, wait for me to tell you what end of the gurney to pick up, then when I tell you, drive the bus in the manner I say." In short, if there is a multi tier system the EMT does not do much more than a Basic Responder would. Occasionally you get a service too broke to afford a Para on each run. then the senior EMT adopts a somewhat mitigated version of the attitude noted.
 
drl said:
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).
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Yes, in an ideal world this would happen, it is the way doctoral students are brought into teaching in a university setting. Maybe one day it will happen in an EMS setting...it will be Friday, July 4th, the sun will be shining, 80 degrees and heavy snow.

I had more and did more teaching as a basic responder.
 
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greenmountains said:
The attitude would seem to be ubiquitous. "Stand there silently, eyes averted and hands folded in humility, wait for me to tell you what end of the gurney to pick up, then when I tell you, drive the bus in the manner I say." In short, if there is a multi tier system the EMT does not do much more than a Basic Responder would. Occasionally you get a service too broke to afford a Para on each run. then the senior EMT adopts a somewhat mitigated version of the attitude noted.
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PS I could not edit the previous...
Before next spring I will advance from EMT-B to EMT-Advanced (which you probably know is taking over or has taken over for the former EMT-Intermediate...it has in MA , soon in VT). Once a EMT-A, I will become the go-to ALS person on most runs, with EMT-P taking over for the most grave issues en route. I wonder...with the paras catch a new attitude? What will their view be toward someone not a para who can do just about everything they can with the exception of anal and ossious administration, Hmm...
How about me? Will I become arrogent and condescending?
Well, I taught university for many years and I like to think that my background as a teacher has not left me. Certainly the passion for it has not. If a university surrounding did not make me arrogent and condescending to students, I have to wonder why a two year course of study for EMT-P is sufficient to condescend to brother-providers in the field.
If eight years of advanced training did not make me an arrogent axx, I wonder why a two year degree...or even none...is sufficient in many eyes to become God-like in their attitude to their fellows.
 
drl said:
I think it's important for medics to delegate tasks to EMTs in mixed medic/EMT systems.
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In the system I just left, we ran county paramedics with a mix of volly/paid BLS crews on FD ambulances. Some were great, some sucked. I always gave the EMT the benefit of the doubt. It was easy to see who wanted to help and learn. If they wanted to get involved, I delegated. If they just wanted to be a stretcher fetcher... well, I'd let them do that. I'm more than capable of taking care of the patient by myself.

Do i think BLS should be running 911? Sure. they need experience. Should they be running calls solo? No way.
 
DEmedic said:
Do i think BLS should be running 911? Sure. they need experience. Should they be running calls solo? No way.
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Question: before you became a Paramedic, were you an EMT? Did you run calls solo as an EMT?

Or even better, do you think a MD, someone with 4 years of post bachelors education, would trust a person with maybe a 2 year associates degree, to operate on their own and exercise good clinical judgment, without a lot of clinical oversight?

If a paramedic treats me like a stretcher fetcher, than that is what I will be. I will even carry my bags and put a NRB on the patient. If a paramedic is respectful, and doesn't treat me like an idiot, I can be a lot more helpful. You'd be surprised how many paramedics totally blow off a good assessment from an EMT, or won't even ask what an EMT thinks they should do to treat a patient (gets even worse with FT EMTs & paramedics vs volunteer EMTs and paramedics)... I have found the better ones actually listen to what their EMTs say, and tend to be better providers with fewer complaints filed against them.
 
Yep. I became an EMT IN 1988, made lots of mistakes and learned a lot.

The most important thing I learned was that as a paramedic I was woefully undereducated. As am EMT I knew barely enough to keep from stepping on my ****. Kind of where you are right now.

And as I mentioned, there are two kinds of EMTs, those that want to learn and help me with patient care and then there are those who are colossally bored with the entire endeavor.

And I appreciate an assessment and history from an EMT that I trust, but it's a pretty safe bet that I'm going to do it all again, because after all, it's my name on the report. And if I have to ask the EMT what I should do to treat the patient, well... We've got bigger issues.

If that's not okay with you, please...sit in the front and drive me to the hospital.
 
MrJones said:
I have little respect for medics who seem to forget that they were once EMTs (or the occasional Nurse or Doctor who seem to forget that they were once a Paramedic).
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You are right on!
 
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