Question for the medics: What do you expect from EMT's?

My father was a paramedic for many years, and when I started he gave me a ton of advice. One of the best things he told me was "For the first few years, just understand that you don't know anything. Tell your partner when you arrive that you are 'new' and want to know how they like to run their calls."

And that is exactly what I did. If I hadn't worked with someone before I'd ask them what they wanted from me and what they expected. That way we'd be on more or less the same page, because many medics like to do things a little differently than everyone else.

I still do this to some extent even now; if I haven't worked with my partner before I let them know how I expect things to flow. I even have a little phrase I use: VOMIT. Vitals, Oxygen, Monitor, IV, Transport. Pretty easy to follow, right?
 
Milla3P said:
I hate hate HATE when a partner spikes a bag without asking, ESP before a line is established.
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May I ask why?

I'm pretty confident in my ability to establish IVs. Plus if it's a smaller line I'd like to run it TKO rather than a saline lock so it doesn't clot off.

Personal preference I guess.

Also I tend to voice my treatment plan as we are loading into the truck. "Mike can you get an IV for me please while I do a 12-lead and do more assessment." Maybe it's just me but I like doing my own 12-leads so I know it's placed correctly plus it's easier for me to talk to someone while I place the leads than it is for me to talk and listen while I start a line. My EMT partner is excellent though. He always nabs a sugar for me when he does the line and I'll usually have a bag spiked and waiting for him to connect and I tell him if I want a bolus or a TKO rate.

I also like to talk so maybe that's what all this planning stems from. I've learned it's easier to develop a plan and lay it all out rather than try to micro-manage everything but I trust my partner a lot.

When I am working as an Intermediate with a medic I have never worked with before I always ask how they like things to be done at the beginning of the shift.
 
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For the relatively well patient, I expect my partner to do nothing, unless I ask for it.

For sicker pts, I expect them simply to do what I ask in a timely manner. Nothing s**ts me more than when you're trying to run a scene and you turn to your partner and say, "Hey can you hang a bag and then get the bed please?", and then you turn around a minute later and they're writing down a med list or something. There is a reason I've asked for the bag and bed. If someone isn't leading and the rest aren't following then things can go pretty pear shaped. Mostly I've worked with some pretty great people and they can predict what I want when I want it and half the time I don't even have to ask. Thats the partner I try to be. I figure out how they like to do things and fit in with it, whether or not its what I would have done had I been running the show. Legs raised? Sure, I'm not ganna start an argument about the literature for and against passive leg raising at a scene. I would expect the same from them if I chose not to raise their legs. The bloke I'm working with right now is great at that. We have a couple of things that we differ on and we have fantastic arguments over piles of text books and articles, but on a scene, whoever is running the show gets what they want, no questions asked.


As far as clinical decision making goes, I expect my partner to keep up with whats going on, so I can bounce a decision off them if needs be. Ultimately, I'm the boss, but I like plenty of input so long as its given in the right way. Ie not deriding my decision in front of a patient, not argumentative etc.
 
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Brandon Oto said:
Jerk! :P
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Sorry bro, it's the only assessment tool not taught at the BLS level! I certainly wish it were (and if you rode with me, I'd expect you to interpret them).

EMS should start with a 2 year degree with an expanded EMT-B scope, including 3-lead and 12-lead interpretation; and we'd just all be known as Paramedics. Paramedic would simply add to that with skills and the additional required education, but fundamentally we'd all have the current paramedic level of education. Anything less would be CPR/First Aid, since that saves just as many lives (and has the literature to back it up, unlike most of what Paramedics do).
 
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Christopher said:
Sorry bro, it's the only assessment tool not taught at the BLS level! I certainly wish it were (and if you rode with me, I'd expect you to interpret them).
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Say what you want, we're not friends anymore.

Seriously though, capnography would also fall in that category. I tend to feel that any non-invasive assessment is up for grabs at all levels, but a realistic addendum to that might be "unless it requires equipment you don't carry and aren't allowed to use."

EMS should start with a 2 year degree with an expanded EMT-B scope, including 3-lead and 12-lead interpretation; and we'd just all be known as Paramedics. Paramedic would simply add to that with skills and the additional required education
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I like it, but good luck covering this big old country with degreed providers.
 
It depends.

I've been burned more than a few times trusting my partners to get me manual vitals and I've walked in to someone doing the needle jump and one who held the meter in one hand, the bulb in the other, and wedged his scope all the way under the cuff.

I've had partners who scream for o2 on a patient whose awake alert and oriented and in no distress with an spo2 in the low 90s with cold fingers and nail polish.

If you've proven to me you're not freaking retarded then I would love you to get my vitals, do a little assessment, set up monitor and set up my lock or spike a bag.

If you fall into the dumb category, just set up the stretcher. It's easier to do everything myself the first time then to have to go behind you and repeat it.

Im also smart and I like to share my information and teach. Medicine and the human body is my passion. If you are open minded I'm far more likely to trust you then if you roll your eyes and tell me they don't pay you enough to know that.
 
Brandon Oto said:
Say what you want, we're not friends anymore.
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:ph34r:

Brandon Oto said:
Seriously though, capnography would also fall in that category. I tend to feel that any non-invasive assessment is up for grabs at all levels, but a realistic addendum to that might be "unless it requires equipment you don't carry and aren't allowed to use."
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But capnography is BLS, at least in NC...

Brandon Oto said:
I like it, but good luck covering this big old country with degreed providers.
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An associates isn't exactly that much more work over a current Paramedic certification. I also don't really care if it's an AA, just that the minimum level of education for the certification is the current Paramedic educational standard.

I would say that an AA may increase pay for providers...but fancy degrees doesn't make GE pay you any more, so in reality it's a mixed bag.
 
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Does "What does a nurse expect from his med techs in the field?" count?

1. Don't start a debate over what's happening unless it has real clinical significance in the more likely situations. (IE, let's talk about your zebras later over MRE's).

2. Know how to multitask and in what precedent order to pursue the needed tasks (Take vitals while you get me woken up, stop emergency bleeding before you take blood pressure, get the heat victim a canteen of water be3fore you start your hundred questions history and physical).

3. Start learning more from day one. I'll teach you, I'll listen to your suggestions and more-recent schooling as you remember it. The point is not only to make you more satisfied with your knowledge, but knowing at least some of what's on the next shelf up makes it easier to interdigitate during a crunch scene (you will know what help I will need, what I will give you, and what we need to hand off with the pt to the next level up).

4. For the first six months, don't try too hard to anticipate help I will need. Just know where stuff is and how to use it. I'll tell you.

3. Never be a filter between me and the patient. Maybe between me and the bystanders and concerned friends and family....;)
 
Our system is different here we wrok Paramedic/Paramedic or Paramedic/Student paramedic

If you are with a newer student their skill set is much like an EMT-B as the progress its more like having a medic partner, so you have to tailor your treatment etc to what level they are at.

For low acuity calls I expect my partner to obtain vitals while I get a hx and formulate a treatment plan. The person doing 'patient care' for the job generally cannulates here so the other person usually sets the gear up for them, spikes a bag, draws up any drugs or does a 12 lead. Once this is done I expect my partner to start organising extrication, setting up the stretcher etc.

I am about to qualify as a paramedic in around 2 months so will have to work with new & student by myself. Not sure how this is going to go initially, whether I can trust people I havent worked with before as if you are with a student, the buck stops with you.
 
I gotta agree on the EMT vs Paramedic assessment. I just graduated from Paramedic school and it is ridiculous how much more in depth an assessment I do if it warrants it. We have AMAZING EMT's in our system and it is very progressive but Paramedic school is what it is and unless you go through it then you are unlikely to have the same quality of physical exam. There are obviously exceptions to this rule on both sides but generally speaking like Vene said....if your assessment/focused physical is on the same level as a lower level provider than your just doing it wrong.
 
Although it is been a while, what I expect from a Basic is a conversation with them at the beginning of the shift, if I have never worked with them before. The reason I want this conversation is to give the Basic an idea of how I expect each call to go. It also gives me a chance to get a feel for the general level of knowledge that the Basic has.

From there, like Sasha, I basically divide my partners into 2 categories: with a clue and without a clue. Those that "have a clue" are the ones that I trust to do a basic patient assessment and report the finding to me and to anticipate what I am going to need. I also expect this kind of partner to keep an ear open, an eye open, and an open mind. In short, I expect to do very little direction of this kind of partner. I tend to do a lot of teaching with this kind of partner. The other kind of partner is nothing more than a task monkey. This particular kind of partner I expect to do a lot of direction, and very little teaching. With this particular kind of partner, I very much enforce the chain of command between EMT and Paramedic. I expect that my directions be followed and done quickly and efficiently. I do not like having this kind of partner at all. They require too much direction and followup.

If I have worked with a certain partner, we already know what each other's role is and can get to work quickly, easily, and with minimal fuss, especially if my partner is the type I prefer to work with.

The other thing is that I generally prefer to be off-scene in less than 10 minutes, if at all possible. The reason I do this is because there's often little that I can do on scene that I can't do in the ambulance, and it gets the patient moving toward the expected destination quickly. I gather what info I need, do an assessment, and get rolling. I'm not hurrying through, just being efficient, no faster nor slower than necessary. I expect my partner to keep up with me though.

As abckidsmom has said before, sometimes reporting the findings w/o understanding what their significance is can lead to a diagnosis. Sometimes, if you know what the diagnosis is, you can also better describe to the next person up the chain, what is going on with the patient. That can lead to a diagnosis. I have had this happened more than a few times.
 
Maybe the bar is just higher in NJ, because there is no way any paid 911 EMT would have a job for longer than a week if they were unable to do an assessment. As screwy as NJ is, I shudder when I hear stories from other posters on EMTlife who have EMTs who can't do assessment without a medic holding their hand, can't do vitals, can't think for themselves and are basicly just muscle who should have been fired a long time ago but weren't because their replacement would be just as bad.

Yes, some of the IFT EMTs who haven't seen a sick patient since they completed EMT class, and some volunteers who only go on one call every week, but if it's your full time job to be on an ambulance answering 911 calls, it's expected that you know what to do.

While I understand that a paramedic is more educated than emts, how is the assessment different? Paramedics can do cardiac monitoring, and can check BGL, so if something requires those two items, yes, an EMT can't definitively "diagnose" a patient's condition that requires it, but that doesn't mean an EMT can't say "hmm, based on multiple factors, i think this patient is having a serious cardiac episode or a diabetic emergency." Yes I have done it, no, I didn't have a paramedic unit available, we just transported to the hospital (less than 15 in transport time), advised the ER of what we had, and they were ready and waiting with a bed assigned when we got there

btw, I've been burned by retarded EMTs, newbie EMTs, 30 year veteran EMTs (including one dinosaur who was the inspiration for my dinosaur thread), and by stupid paramedics that I wouldn't want to assess my worst enemy (or my idiot brother) (in both NY, NJ, and PA). There are retards everywhere.
 
DrParasite said:
Paramedics can do cardiac monitoring, and can check BGL, so if something requires those two items, yes, an EMT can't definitively "diagnose" a patient's condition that requires it...
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Man, the single craziest thing about EMS that I've learned since joining EMTLife is that BGL and pulse oximetry are considered "ALS" in some states. They're considered less than BLS, instead layperson first aid.

North Carolina is pretty backwards (just read the news, we still can't), but at least we're held to a useful standard of care for BLS providers. BGL, SpO2, EtCO2 (qualitative, quantitative, and waveform)...I really take our minimum competence for granted sometimes!
 
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Christopher said:
Man, the single craziest thing about EMS that I've learned since joining EMTLife is that BGL and pulse oximetry are considered "ALS" in some states. They're considered less than BLS, instead layperson first aid.

North Carolina is pretty backwards (just read the news, we still can't), but at least we're held to a useful standard of care for BLS providers. BGL, SpO2, EtCO2 (qualitative, quantitative, and waveform)...I really take our minimum competence for granted sometimes!
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Colorado EMT's are excellent as well with almost all systems requiring IV training to work the streets. BGL's and Pulse oximetry are also basic skills but while i think some, understand the concept and physiology behind EtCO2 I don't think MOST do.
 
btw, i think EMTs should be able to do BGLs, and even pulse ox, but the state disagrees so we aren't educated on it, and as such it isn't expected of us. but what we are educated on, we are expected to know what do do. and cardiac monitoring (3/4 lead and 12 lead, not just a psO2) is still a paramedic assessment tool.

out of curiosity, for those that allow the other stuff, how long is your EMT class?
 
DrParasite said:
btw, i think EMTs should be able to do BGLs, and even pulse ox, but the state disagrees so we aren't educated on it, and as such it isn't expected of us. but what we are educated on, we are expected to know what do do. and cardiac monitoring (3/4 lead and 12 lead, not just a psO2) is still a paramedic assessment tool.

out of curiosity, for those that allow the other stuff, how long is your EMT class?
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EMT School here in Colorado is 1 semester or 2.5 months in the summer and 3.5 in the fall/spring semesters. You aren't taught anything invasive in school but you are taught pulse oximetry. Once you have your state EMT license you can take a 16 hour IV course. This is two days of classroom training specifically on vasculature, obtaining intravenous access, basic drip rate calculations, using a glucometer, pharmacology of NS/LR/D5W/Naloxone/Dextrose which are all EMT-B drugs in the state of Colorado. Once you pass the classroom test and get two live sticks on classmates you have to get 10 live sticks in the ER to get your certification. You are then technically a EMT-B IV in the state of Colorado but it is more of a 'attachment' to your EMT-B license versus a separate level of provider. It should also be mentioned that this certification only allows you to start peripheral lines as other access areas are still a Paramedic or hospital provider skill. In the end when I got my IV cert I pretty much still sucked at starting IV's and it wasn't until many many many IV's later that I felt comfortable and proficient. It is a motor skill that requires 'skill', proper technique, and practice but once you have it down it is just like getting out of bed. Hope this helps!
 
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SmokeMedic said:
EMT School here in Colorado is 1 semester or 2.5 months in the summer and 3.5 in the fall/spring semesters. You aren't taught anything invasive in school but you are taught pulse oximetry. Once you have your state EMT license you can take a 16 hour IV course. This is two days of classroom training specifically on vasculature, obtaining intravenous access, basic drip rate calculations, using a glucometer, pharmacology of NS/LR/D5W/Naloxone/Dextrose which are all EMT-B drugs in the state of Colorado. Once you pass the classroom test and get two live sticks on classmates you have to get 10 live sticks in the ER to get your certification. You are then technically a EMT-B IV in the state of Colorado but it is more of a 'attachment' to your EMT-B license versus a separate level of provider. It should also be mentioned that this certification only allows you to start peripheral lines as other access areas are still a Paramedic or hospital provider skill. In the end when I got my IV cert I pretty much still sucked at starting IV's and it wasn't until many many many IV's later that I felt comfortable and proficient. It is a motor skill that requires 'skill', proper technique, and practice but once you have it down it is just like getting out of bed. Hope this helps!
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BGLs are taught in the EMT-B curriculum now, or at least they were taught in my class and I was allowed to do them before getting my IV "cert." As mentioned it is not really a certification, it's a certificate that you can show your medical director and then he or she decides whether or not to accept it.
 
Usually when I work with a medic that I know, I take the patient assessment and the lead until it is seen to need something that I can not give. Even then since I am precepting for my Paramedic I usually discuss it with my partner and then go ahead with the intervention.

When I am working with an EMT on a ALS truck I expect them to know all their skills and not be scared of them. If its a cardiac and I am starting a line, hook up a 12-lead. The only time anyone gets asked to do something is usually that call where your doing an intervention to see. For example a 12-lead on a non cardiac patient.
 
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