What do you guys expect out of your EMTs? Seems like every medic is different and it depends on which way the wind blows that day. Do you want your EMT to jump in and handle the assessment or do you feel you should be the one doing it? Do you want your EMT taking initiative and setting up a 12 lead or grabbing a blood sugar without you asking, or just wait until you ask them? This would be for guys that run with different people all the time so you are not too familiar with the EMT. Wondering if there is some kind of general consensus.
Question for the medics: What do you expect from EMT's?
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Shishkabob
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It totally varies from call, and from partner. My last EMT partner and I had a working relationship so good that we never really spoke on scene to get my wants across as we were always on the same page. Working with a new medic every day is going to be much harder than having one consistent partner.
I like to tell my partners that they have their own certification, therefor they do what they think needs to be done, within their scope, with the exception of giving medications as I may be going down a different path than they are. I want them to have some form of autonomy so I don't have to voice every single wish.
My one rule, that I'm sure all here share, is if it's my call, I do the question asking and make the decisions on what gets done. Don't call out my decisions unless what I want done is dangerous to the patient.
I like to tell my partners that they have their own certification, therefor they do what they think needs to be done, within their scope, with the exception of giving medications as I may be going down a different path than they are. I want them to have some form of autonomy so I don't have to voice every single wish.
My one rule, that I'm sure all here share, is if it's my call, I do the question asking and make the decisions on what gets done. Don't call out my decisions unless what I want done is dangerous to the patient.
NYMedic828
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Here in NYC we run dual medic/dual EMT so my experience is not the same as most folks here.
That said, if I had an EMT partner who I don't know, work with once or twice tops then id expect everything within their scope to be done by them. Anything beyond and within mine done by me. If I had an EMT partner who I work with regularly and knew to be a competent provider, there would be no problem with them spiking bags, checking glucose levels and drawing up meds if I was doing something else or starting an IV etc etc.
It would have to be a person I was pretty confident in though considering if we had a needle stick incident there would be some splaining to do.
That said, if I had an EMT partner who I don't know, work with once or twice tops then id expect everything within their scope to be done by them. Anything beyond and within mine done by me. If I had an EMT partner who I work with regularly and knew to be a competent provider, there would be no problem with them spiking bags, checking glucose levels and drawing up meds if I was doing something else or starting an IV etc etc.
It would have to be a person I was pretty confident in though considering if we had a needle stick incident there would be some splaining to do.
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If it's a partner that I work regularly with and they've proven their competence to me, I'll let them do as much of the assessment they want.
If you're new to me, jump in and get vitals, let me do the talking. Know how to spike bags, put on 3-leads and 12-leads, D-sticks, etc. Also, be willing to learn with an open mind. Especially if you can't do the aforementioned skills.
*Unless an intervention, or lack thereof, is posing an immediate life threat to the patient
If you're new to me, jump in and get vitals, let me do the talking. Know how to spike bags, put on 3-leads and 12-leads, D-sticks, etc. Also, be willing to learn with an open mind. Especially if you can't do the aforementioned skills.
Yes. My call, my ultimate decision. Do not argue with me about the patient needing oxygen because that's what you were taught. If I have or have not done something, there's a reason for it*
*Unless an intervention, or lack thereof, is posing an immediate life threat to the patient
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Pretty much the same as above. When I work as an intermediate I do all the assessments and my medic stands back and will step in once he seems the call ALS or I ask for help. We have a great working relationship and good trust between the two of us. Now if we walk in and it's an obvious ALS call that needs intervention now I go straight to getting the appropriate stuff in place so he can do his job.
Personally it's easier for a medic to step in during the assessment to take over rather than them doing the assessment the dishing it to me when we get to the truck.
As an intern I do all the assessments then give the EMT a quick run down if I deem it BLS/ILS because that's the way my preceptor and program director want it done. The EMT on my internship shifts is newer so I try and let him do all the skills and attend ILS or BLS patients to help him learn as well.
Personally it's easier for a medic to step in during the assessment to take over rather than them doing the assessment the dishing it to me when we get to the truck.
As an intern I do all the assessments then give the EMT a quick run down if I deem it BLS/ILS because that's the way my preceptor and program director want it done. The EMT on my internship shifts is newer so I try and let him do all the skills and attend ILS or BLS patients to help him learn as well.
fast65
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Eh, depends on my partner, a couple partners I've had, I hardly trusted them to get a BP.
However, my current partner, I pretty much let him handle anything within his scope. I handle the assessment, and in the end, it's my call and I make the final decision. That being said, I'm open to suggestions from my partner based on how much I trust them, and most of the basics here are phenomenal, so it works out pretty well.
However, my current partner, I pretty much let him handle anything within his scope. I handle the assessment, and in the end, it's my call and I make the final decision. That being said, I'm open to suggestions from my partner based on how much I trust them, and most of the basics here are phenomenal, so it works out pretty well.
Christopher
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As I tell any EMT riding with me:
The only difference between an EMT and a Paramedic is education, and I've met plenty of EMT's who have closed that gap.
You're operating as a team and happen to represent the only part of the team who has a job to do on every call. I expect EMTs to develop a plan of care with me, often times in parallel to my actions. We're both clinicians, but with a different scope of practice.
When the EMT/Paramedic team is working properly, the EMT shouldn't have to wait on the go-ahead from their Paramedic partner to apply oxygen or setup a nebulizer or acquire a BGL or a 12-Lead or vitals or administer aspirin, etc.
When you decide who is lead on the call, they take the history while the other "performs skills".
Patient assessment and history taking is not a Paramedic skill.
However, on an ALS call it is usually best to let the Paramedic handle the talking so they can gather a plan of care in their head. I don't personally care if an EMT takes the lead with questioning, just be prepared to keep asking the questions
I think a lot of EMTs are worried about being corrected, but being corrected is Ok. We may disagree on a treatment plan and likely the Paramedic has a reason for their plan. Sometimes you may be the one who is correct! There is a right way to handle differences in a treatment plan, and usually it is best to offer your plan as a question a Paramedic can answer.
What is a bad thing is when a partner is not willing to admit they don't know something. A lot of EMS ends up being On the Job Training, so admit when you need instruction early.
Hopefully you get a like-minded paramedic partner so that you can practice to your fullest and learn to operate as much as an individual but as a team.
Every patient needs BLS care, only a very few need ALS care in addition.
The only difference between an EMT and a Paramedic is education, and I've met plenty of EMT's who have closed that gap.
You're operating as a team and happen to represent the only part of the team who has a job to do on every call. I expect EMTs to develop a plan of care with me, often times in parallel to my actions. We're both clinicians, but with a different scope of practice.
When the EMT/Paramedic team is working properly, the EMT shouldn't have to wait on the go-ahead from their Paramedic partner to apply oxygen or setup a nebulizer or acquire a BGL or a 12-Lead or vitals or administer aspirin, etc.
When you decide who is lead on the call, they take the history while the other "performs skills".
Patient assessment and history taking is not a Paramedic skill.
However, on an ALS call it is usually best to let the Paramedic handle the talking so they can gather a plan of care in their head. I don't personally care if an EMT takes the lead with questioning, just be prepared to keep asking the questions
I think a lot of EMTs are worried about being corrected, but being corrected is Ok. We may disagree on a treatment plan and likely the Paramedic has a reason for their plan. Sometimes you may be the one who is correct! There is a right way to handle differences in a treatment plan, and usually it is best to offer your plan as a question a Paramedic can answer.
What is a bad thing is when a partner is not willing to admit they don't know something. A lot of EMS ends up being On the Job Training, so admit when you need instruction early.
Hopefully you get a like-minded paramedic partner so that you can practice to your fullest and learn to operate as much as an individual but as a team.
Some differences of opinions as I expected. My partner and I are both EMT-B, but we run with fire/medics on every call. Some will say things like "okay load him up and continue with paramedic level assessment (being facetious and implying that we should have been doing the assessment). and others feel you are stepping on their toes if you try and handle the assessment.
So far my very limited experience has been every city and truck guys do things differently, some are cool and willing to teach and others think your just a taxi service/water boy.
appreciate the responses!
So far my very limited experience has been every city and truck guys do things differently, some are cool and willing to teach and others think your just a taxi service/water boy.
appreciate the responses!
I always told my EMT-B partners that the basics I wanted done was:
O2; whatever they thought was right, remembering that it doesn't matter what school said not everyone gets Hi flow via NRB.
on a monitor: 3 or 4 lead and/or 12 lead. depending on how they presented.
Vital signs:
Set up an IV.
I told them to see what I was doing and do one of the others, and then the next, etc. That way if I was setting up a neb treatment they wouldn't waste time by putting the pt on a NC.
While working IFT: After working with the same partner longer I would teach them how to assess a patient, and when I went to find the nurse and get a report, they would go and assess the patient. When I came into the room either we would decide together if they needed to be ALS (their assessment and what the report from the nurse stated) or BLS. or if I walked into the room and the patient was on a monitor, IV set up VS given to me etc I would take them. (I would complain that my partner wanted me to work way too much for given shift LOL).
O2; whatever they thought was right, remembering that it doesn't matter what school said not everyone gets Hi flow via NRB.
on a monitor: 3 or 4 lead and/or 12 lead. depending on how they presented.
Vital signs:
Set up an IV.
I told them to see what I was doing and do one of the others, and then the next, etc. That way if I was setting up a neb treatment they wouldn't waste time by putting the pt on a NC.
While working IFT: After working with the same partner longer I would teach them how to assess a patient, and when I went to find the nurse and get a report, they would go and assess the patient. When I came into the room either we would decide together if they needed to be ALS (their assessment and what the report from the nurse stated) or BLS. or if I walked into the room and the patient was on a monitor, IV set up VS given to me etc I would take them. (I would complain that my partner wanted me to work way too much for given shift LOL).
And I tried very hard not to do things that made my partners feel like idiots: if they put them on hi flow O2 and I didn't feel like the patient needed it, I would lower it or change them to NC during transport or if it was BLS I would comment that the vitals looked better, lets drop O2 and see if the patient tolerated it well.
If my partner put a BLS patient on a monitor, I would document a note in the run report about it. Sometimes we caught something that made the pt ALS; when up to that point it was going to go BLS
If my partner put a BLS patient on a monitor, I would document a note in the run report about it. Sometimes we caught something that made the pt ALS; when up to that point it was going to go BLS
abckidsmom
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I try really hard to always teach, and always include my partner in decision making, but I work with a different person nearly every day. There are only a couple of partners I have worked with enough to have them run the show.
We run Paramedic/EMT medic units, with a long transport time, and I like to get the show on the road as soon as possible every call, especially at night. I hate wasting time on scene, so this is what I expect out of my partners on scenes:
When we get off the truck, I really prefer for them to be responsible for all radio traffic after that, so I don't have to have my ears torn between the radio and the scene. Our dispatch checks us after 5 minutes of being on scene and if we don't say we're ok, they send a "no contact mayday" response, so we really don't want to be paying attention to the ramblings of a little old lady and miss that. I prefer to do the talking until we make a decision about who's riding in with the patient, and only about 20% end up for my partner, if that, so it starts as me.
I like to get the bag and set it on the stretcher and pull that to the door, every time. I firmly believe that getting complacent and not bringing what you need for the sickest people, just because "this is just BS" brings on evil spirits and you WILL get caught with your pants down, and it will be awkward for one of us while the other goes out to get some stuff, unnecessary steps in their day.
When we get deep enough into the interview that it's time to get vitals (cause it's not time until after you have a little bit of a clue of what's going on), I say something like, "My partner is going to check your blood pressure and listen to your lungs, let me write down that list of meds." Even when I am working with someone I've never met before, I've never done that and had it look anything other than seamless like we have worked together forever and had a plan for this.
In the truck, if it's ALS, one of us is going to get the IV stuff set up, one of us is going to get the patient on the monitor. I want the monitor person to get the patient out of his shirt and into a gown as a part of that process. Makes things easier for lots of people down the road to start that now. I don't care which is which.
If I don't need anything from my partner, or I'm in a hurry to get moving, when we are loading the patient, I go around to the side door and get in on that side, and before he's closed the back doors, I tell him we're good to go. I really expect that he believe me when I say that and go drive. I hate when a partner tries to get in and do stuff after I deliver the "OK lets drive away now" message.
What a ramble. I'll stop now.
We run Paramedic/EMT medic units, with a long transport time, and I like to get the show on the road as soon as possible every call, especially at night. I hate wasting time on scene, so this is what I expect out of my partners on scenes:
When we get off the truck, I really prefer for them to be responsible for all radio traffic after that, so I don't have to have my ears torn between the radio and the scene. Our dispatch checks us after 5 minutes of being on scene and if we don't say we're ok, they send a "no contact mayday" response, so we really don't want to be paying attention to the ramblings of a little old lady and miss that. I prefer to do the talking until we make a decision about who's riding in with the patient, and only about 20% end up for my partner, if that, so it starts as me.
I like to get the bag and set it on the stretcher and pull that to the door, every time. I firmly believe that getting complacent and not bringing what you need for the sickest people, just because "this is just BS" brings on evil spirits and you WILL get caught with your pants down, and it will be awkward for one of us while the other goes out to get some stuff, unnecessary steps in their day.
When we get deep enough into the interview that it's time to get vitals (cause it's not time until after you have a little bit of a clue of what's going on), I say something like, "My partner is going to check your blood pressure and listen to your lungs, let me write down that list of meds." Even when I am working with someone I've never met before, I've never done that and had it look anything other than seamless like we have worked together forever and had a plan for this.
In the truck, if it's ALS, one of us is going to get the IV stuff set up, one of us is going to get the patient on the monitor. I want the monitor person to get the patient out of his shirt and into a gown as a part of that process. Makes things easier for lots of people down the road to start that now. I don't care which is which.
If I don't need anything from my partner, or I'm in a hurry to get moving, when we are loading the patient, I go around to the side door and get in on that side, and before he's closed the back doors, I tell him we're good to go. I really expect that he believe me when I say that and go drive. I hate when a partner tries to get in and do stuff after I deliver the "OK lets drive away now" message.
What a ramble. I'll stop now.
While there is some level of truth to this statement, generally, the more education you have, the more experience you have, and the more adjunctive findings you can add to your exam and history, the more useful a physical and history is.
A paramedic who is doing the same quality of exam as a basic has failed somewhere.
Not to take away from a motivated basic, but as a medic if you do not advance your knowledge, then you are coasting(read going backwards) while everyone else is advancing.
Christopher
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Perhaps the intent of my post was lost, being on the ALS board. That was meant to let the EMT-Basic know that there is no difference in an assessment for EMT, EMT-I, and EMT-P beyond the education and experience.
A Paramedic assessment has the same components as an EMT assessment (at least in NC, besides the interpretation of a 12-Lead or 3-Lead). An EMT should not need a Paramedic to make an assessment.
I don't think the intent was lost, but since knowledge is what guides and helps one interpret physical findings, as well as ask more directed history questions, under the current educational curriculums, a basic probably (exception for extenuating circumstances such as non EMS health education) does not have the same physical exam abilities as a paramedic.
I agree the basic has a similar skill check off sheet, but the ability to perform a physical exam extends well beyond a few check off boxes that need to be accomplished.
abckidsmom
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I just want to put a triple what he said under Vene's post.
I don't know how many times over my career that I had presented all of my findings to a physician, who immediately knew exactly what the problem was. I love when that happens because I learn so much.
Same with BLS providers I encounter. I went to a lady the other day, BLS providers thought she had a big CVA: down on one side, pupils big and slow, unresponsive with cold, clammy skin. She was really sick...with hypoglycemia.
You can assess people all day but if you don't have something to do with your findings, you've wasted your time and the patient's.
I don't know how many times over my career that I had presented all of my findings to a physician, who immediately knew exactly what the problem was. I love when that happens because I learn so much.
Same with BLS providers I encounter. I went to a lady the other day, BLS providers thought she had a big CVA: down on one side, pupils big and slow, unresponsive with cold, clammy skin. She was really sick...with hypoglycemia.
You can assess people all day but if you don't have something to do with your findings, you've wasted your time and the patient's.
Christopher
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Are you in an area where BLS providers are not allowed to assess BGL? Acquiring a BGL in a suspected CVA patient is the standard of care. The only difference in assessment for this case will be...nothing. I'll concede that 3-Lead and 12-Lead interpretation is decidedly not an EMT assessment in the US.
I stand by my assertion that the standard of care for patient assessment does not differ as you go from an EMT to a Paramedic. Instead, the standard of care for your treatment differs. You're no less responsible for identifying life threats as an EMT than as a Paramedic. If you miss a hypoglycemia case because you thought it was a CVA, you've fallen beneath the standard of care no matter what certification is in your wallet.
I guess if our advice to EMTs is, "you're a technician, ALS will handle the tough stuff," then sure there is a difference in patient assessment. But that's simply not the case, or if it is, it surely is not the way it should be.
I stand by my assertion that the standard of care for patient assessment does not differ as you go from an EMT to a Paramedic. Instead, the standard of care for your treatment differs. You're no less responsible for identifying life threats as an EMT than as a Paramedic. If you miss a hypoglycemia case because you thought it was a CVA, you've fallen beneath the standard of care no matter what certification is in your wallet.
I guess if our advice to EMTs is, "you're a technician, ALS will handle the tough stuff," then sure there is a difference in patient assessment. But that's simply not the case, or if it is, it surely is not the way it should be.
abckidsmom
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"should" and "is" are very different. Especially when dealing with people who got there initial 140 hour certification and then 6 hours a week of staffing an ambulance in a super rural area. They maybe do 30 calls a year.
My FT gig is double ALS with the same partner every day and we work well together, but my volly service is everything from ALS/ALS to ALS/BLS down to a "driver" and if I'm coming from home it's a crap shoot to see what I'm gonna get.
In my opinion the best BLS partner knows the way around the truck, CAN do things automatically and is calm like me.
Try to look at things from your perspective and add what you can at your level.
"What do you want me to do?"
VS
"Do you want a BGL/Limb Lead/12 Lead."
A good basic knows what needs to be done, but ask first. I hate hate HATE when a partner spikes a bag without asking, ESP before a line is established.
In my opinion the best BLS partner knows the way around the truck, CAN do things automatically and is calm like me.
Try to look at things from your perspective and add what you can at your level.
"What do you want me to do?"
VS
"Do you want a BGL/Limb Lead/12 Lead."
A good basic knows what needs to be done, but ask first. I hate hate HATE when a partner spikes a bag without asking, ESP before a line is established.
very helpful, thank you for the post.
Brandon O
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