Role of an EMT on scene?

[Paramedic91]

So I am a new paramedic and I started working with a new emt. We are having issues because we have two very different ideas of an Emts role on scene of 911 call. She thinks that the emt does everything from patient care interview to deciding if someone needs medication and my job as the paramedic is to sit back and watch until a medication needs to be pushed and that's how she ran calls with her previous partner . I was an emt for four years before I went to medic school and that's never how it was, I considered my role as an emt was more of an assistent and always being one step head for example getting vitals, doing a twelve lead, starting an IV, getting the stretcher ready when the patient was leaving. We have had numerous discussions about what I expect out of her on scene and she says she understands and than whines to co-workers about how I don't let her do anything, which frustrates me because I tried to get her involved like making calls a bls attend and letting her start Ivs and be involved in critical patients.

(Moderator merge of two threads into one)

So I am a new paramedic and I started working with a new emt. We are having issues because we have two very different ideas of an Emts role on scene of 911 call. She thinks that the emt does everything from patient care interview to deciding if someone needs medication and my job as the paramedic is to sit back and watch until a medication needs to be pushed(why did i got to school to sit back and watch) and that's how she ran calls with her previous partner . I was an emt for four years before I went to medic school and that's never how it was, I considered my role as an emt was more of an assistent and always being one step head for example getting vitals, doing a twelve lead, starting an IV, getting the stretcher ready when the patient was leaving. We have had numerous discussions about what I expect out of her on scene and she says she understands and than whines to co-workers about how I don't let her do anything, which frustrates me because I try to get her involved like making calls a bls attend and letting her start Ivs and being involved in critical patients. My personal Opinion is that at the end of the day I am in charge and that includes running calls and deciding if a call is AlS or bls and she as an emt do what I deligate to her on scene and with time and trust she can run calls. So I guess my question is what is an Emts role on scene? And is my opinion not right?

 

[Achilles]

Aren't they there just to hold the IV bags

 

[DesertMedic66]

As the medic on scene you are in charge. If your EMT has an issue with you running the scene well then too bad.

The EMTs role on scene (assuming there is a medic) is doing anything the medic wants them to (within scope).

I am not a hard person to work with but partners who whine that like get on my nerves. That would cause me to have them do nothing until they stop whining. But I wouldn't take my advice haha

 

[Amberlamps916]

Wait, just wait a minute....please tell me this is not an EMT-B pulling this nonsense.

 

[DrParasite]

It depends on your state, your agency, and your comfort level with what you let them do.

In my state, EMTs do everything. They are expected to be able to operate on their own, without a medic looking over their shoulder or telling them what to do (whether or not that happens, well, that's another story).

I do know many states that run B/P crews where the EMT's sole purpose is to drive the ambulance, and carry bags. These EMTs are usually paid minimum wage, can't think for themselves, never take initiative, and are pretty much useless without the paramedic there to hold their hand.

I happen to consider myself a pretty decent EMT. I'd put my assessment skills on par with almost any paramedic with a similar experience level. Are there there paramedics who can assess better than me? sure. are there ones who are worse? absolutely. But I also know when I am in over my head, and when it's time to pass the patient to a higher medical authority, and most of the paramedics who I have worked with knew that about me.

If you work with a regular partner who trusts you, and you trust, than what she suggests absolutely can work. Let her do her assessment, let her decide if you need to do something. You are still over seeing her, and if you agree, great. If not, you intervene. Let her apply the stickies, and you interpret what the monitor shows. If she thinks a medication should be administered, she can suggest it, but it's your call as to whether the patient gets it or not. But all that stuff takes time, and as a new medic, with a new partner (especially a new EMT), I wouldn't expect you to do that for 3 to 6 months of full time working with this person. You need to get comfortable with what your new partner knows, and what you will allow her to do.

one last thing. when you show up to a bad MVA, 2 vehicles involved, with at least 1 serious person in each vehicle, no FD on scene (they are tied up at a fire), and your 2nd due ambulance still 15 minutes away, what are you going to have your EMT doing? Wouldn't you want them to know how to operate without you looking over your shoulder before they have to do it in the real world on a real major call?

 

[RocketMedic]

Why are you letting an EMT-B put both of your jobs on the line by letting her work outside of her scope of practice?

The most my basic gets to do on an IV is generalized site prep and assistance with hub stabilization when you need three hands on the old folks. Yes, he knows how to start an IV, but he doesn't. Not with my patients. Because we both need our jobs.

As for the scene role, I personally like them to have some autonomy, but I am an expert in their job. We check eachother- I check his straps, bandages, etc, he checks that my cables are still plugged in, etc. If we get a Spanish-speaking patient, he's my inquisitor.

A good partnership isn't based on certification levels, but all good partnerships need a leader, and that leader is the lead medic. At the end of the day, who gets fired if they mess up? You're mistaken if you think "they looked BLS, so I let my partner tech it" is going to keep you employed in that situation.

 

[mcdonl]

So I am a new paramedic and I started working with a new emt. We are having issues because we have two very different ideas of an Emts role on scene of 911 call. She thinks that the emt does everything from patient care interview to deciding if someone needs medication and my job as the paramedic is to sit back and watch until a medication needs to be pushed(why did i got to school to sit back and watch) and that's how she ran calls with her previous partner.

My approach as a measley intermediate was a learned approach from good medics I have worked with. I let the EMT-B do functions within their license level as long as a) there is a learning potential and b) the calls merits the basic doing vitals, o2, etc... you know... THINGS WITHIN THEIR LICENSE LEVEL!!!

I was an emt for four years before I went to medic school and that's never how it was, I considered my role as an emt was more of an assistent and always being one step head for example getting vitals, doing a twelve lead, starting an IV, getting the stretcher ready when the patient was leaving.

Your protocols must be VASTLY different because I for one was written up as an EMT-B for putting a 12 lead on while in my I95 class. I was even ASKED to do it, but that is NOT in the EMT-B protocols.

Starting an IV? Were you also an IV-Tech?

We have had numerous discussions about what I expect out of her on scene and she says she understands and than whines to co-workers about how I don't let her do anything, which frustrates me because I try to get her involved like making calls a bls attend and letting her start Ivs and being involved in critical patients.

My personal Opinion is that at the end of the day I am in charge and that includes running calls and deciding if a call is AlS or bls and she as an emt do what I deligate to her on scene and with time and trust she can run calls. So I guess my question is what is an Emts role on scene? And is my opinion not right?

So... my answer... The EMT-B is there to do whatever you need them to do. It is your patient. Your job, as a health care provider should be #1 care for the patient and #2 educate those below your license level any time you can.

 

[Christopher]

So I am a new paramedic and I started working with a new emt. We are having issues because we have two very different ideas of an Emts role on scene of 911 call. She thinks that the emt does everything from patient care interview to deciding if someone needs medication and my job as the paramedic is to sit back and watch until a medication needs to be pushed(why did i got to school to sit back and watch) and that's how she ran calls with her previous partner . I was an emt for four years before I went to medic school and that's never how it was, I considered my role as an emt was more of an assistent and always being one step head for example getting vitals, doing a twelve lead, starting an IV, getting the stretcher ready when the patient was leaving. We have had numerous discussions about what I expect out of her on scene and she says she understands and than whines to co-workers about how I don't let her do anything, which frustrates me because I try to get her involved like making calls a bls attend and letting her start Ivs and being involved in critical patients. My personal Opinion is that at the end of the day I am in charge and that includes running calls and deciding if a call is AlS or bls and she as an emt do what I deligate to her on scene and with time and trust she can run calls. So I guess my question is what is an Emts role on scene? And is my opinion not right?

Finally, an EMT who understands their role on the scene. Unfortunately we do not provide enough education to our EMT's for them to appropriately fill this role.

Every patient needs an EMT, very few need a Paramedic.

 

[medicdan]

As others have said, it boils down to the relationship and understanding you come to with your partner. You are I charge. I can see a situation with a more senior medic and experienced EMT where you would sit back and let your partner do the assessment on scene while you watch/listen, to give them experience, but you remain aware of everything and in control.
Don't let your partner walk all over you. At this point in both of your experiences, you need to take every opportunity to develop your own clinical skills and groove... until you grow more comfortable. I'm wondering why you're working PB as such a new medic, but that's a different question.

Bottom line, you need to have a conversation with your partner at the start of next shift laying out your expectations of your partner, (i.e vitals while you're interviewing, laying out Iv supplies, capturing 12 lead, driving, fetching equipment, etc.)

Good luck!

 

[Bullets]

Since every call in NJ gets 2 EMTs we are expected to be able to manage a patient until we can get them to advanced levels of care, either a medic or a hospital

However when we do have ALS on scene, its not uncommon for the EMTs to hook up the monitor, set up the locks and flushes, bags, tubes, blades, take a BGL, get meds like NTG and DuoNeb set up the other one helps the medic get info, demos, ect. So we have 1 medic and an EMT working the patient and a medic and an EMT doing the documentation

Now on a big scene with multiple patients, while the physical patient care falls ultimately upon the medic, who has more experience running major scenes? Ive been the IC on many incidents that required multiple units and ALS. there is more to being the IC then the medicine part, which can be difficult to push the natural instinct to treat asside and grab and extra radio and a clipboard and start documenting

 

[NomadicMedic]

Finally, an EMT who understands their role on the scene. Unfortunately we do not provide enough education to our EMT's for them to appropriately fill this role.

Every patient needs an EMT, very few need a Paramedic.

I beg to differ.

Every patient deserves a paramedic, just not evey patient needs one.

An EMT that works with me is expected to be able to perform "medic assist skills" and as part of the FTO process, new hires are expected to delegate those skills to the EMT. If the EMT steps outside of the boundaries, performs a skill incorrectly or mars any type of error it's up to the medic to correct and assume responsibility.

There are several EMTs that don't touch patients when I am ridding because they can't demonstrate competency in the skills I need them to perform.

 

[Christopher]

I beg to differ.

Every patient deserves a paramedic, just not evey patient needs one.

An EMT that works with me is expected to be able to perform "medic assist skills" and as part of the FTO process, new hires are expected to delegate those skills to the EMT. If the EMT steps outside of the boundaries, performs a skill incorrectly or mars any type of error it's up to the medic to correct and assume responsibility.

There are several EMTs that don't touch patients when I am ridding because they can't demonstrate competency in the skills I need them to perform.

It is a highfalutin myth that you need a paramedic to evaluate every patient.

I also don't agree that they deserve one either.

What you meant to say is that the patient deserves to receive a thorough examination and evaluation.

If your EMT's can't do this, blame those EMT's. Don't use it as a crutch to perpetuate the tired myth that ALS is always necessary (it rarely is).

(in reality our EMT levels need to expand their standards to the paramedic didactic curriculum as the minimum, with their same or similar skills scope; then we can finally do away with this ridiculousness that "everybody deserves a paramedic")

 

[wanderingmedic]

There is a time and place for EMT's, Medics, LPN's, RN's, PA's, NP's, and MD's. Everyone has a job to do that's important - patient's need a team of providers. If you don't like what someone who holds a higher license than you is asking you to do either a) go get more education or b) shutup and do as you are told.

EMTs are important, and without them Medics cannot operate efficiently. With that being said, it is not the EMT's job to direct patient care, just like a Paramedic would not try to direct patient care in the ED. Higher education = more responsibility to provide a higher level of care.

If I were in your shoes I would go straight to a supervisor and request a new partner for the reasons you stated. Heck, if the partner did not cooperate after a discussion about roles on your truck, I would start writing them up for every time they did not do as they were asked/told (your partner is compromising patient care).

Also, it sounds like your partner might just be immature and insecure. If you are going to be stuck with them for a while I would try to root out their insecurity by building up their confidence in THEIR SCOPE, while maintaining control and ensuring quality care is rendered.

 

[mcdonl]

If your EMT's can't do this, blame those EMT's. Don't use it as a crutch to perpetuate the tired myth that ALS is always necessary (it rarely is)

In my experience it is like a gun. When you NEED one, you need it FAST.

 

[Christopher]

In my experience it is like a gun. When you NEED one, you need it FAST.

You likely work in an area where EMT's cannot do BLS, which unfortunately seems to be common. In areas where EMT's have an actual BLS scope, all of the immediate life threats (which "cannot wait" for ALS or the hospital) are covered.

In this instance the particular EMT is not following the chain of command, it is not that they are operating as more than an EMT. In my opinion they're exercising their scope appropriately but had a really lazy prior partner and their new partner has different expectations.

So be it.

 

[RocketMedic]

You likely work in an area where EMT's cannot do BLS, which unfortunately seems to be common. In areas where EMT's have an actual BLS scope, all of the immediate life threats (which "cannot wait" for ALS or the hospital) are covered.

In this instance the particular EMT is not following the chain of command, it is not that they are operating as more than an EMT. In my opinion they're exercising their scope appropriately but had a really lazy prior partner and their new partner has different expectations.

So be it.

There's some middle ground. My partner is more than welcome to handle BLS calls. Real calls = me, and we both know it.

 

[Christopher]

There's some middle ground. My partner is more than welcome to handle BLS calls. Real calls = me, and we both know it.

I guess teamwork goes by the wayside once you get your EMT-P or something. EMS has specialization of labor and you should make full usage of these. EMT's handle EMT stuff, EMT-I's handle EMT-I stuff, and paramedics handle the rare paramedic things. Which just gets you back to what I said before, every patient requires an EMT. If your EMT's aren't willing to step up into that role, that is a personnel problem rather than a problem between "knowing your role".

Yes, I as the paramedic may be asked to "run the 'real' calls", but that typically means a few directed questions, my own exam (typically rehashing what BLS providers have already done), and an intervention here or there plus the paperwork. (perhaps I just work with better providers in general, a few I may have to "boss around" to get them to do what's expected, but otherwise they're no different than I am outside of skills, and some extra night classes)

 

[Trashtruck]

I'll let the EMT do whatever they want, but they know I'm watching and am not going to let them hurt somebody.

Also, I wonder this: How are people getting written up or in trouble for placing a 12-lead or starting an IV or doing whatever 'out of scope'?
Ya'll working with a bunch of George Washingtons or something?

 

[VFlutter]

I'll let the EMT do whatever they want, but they know I'm watching and am not going to let them hurt somebody.

Also, I wonder this: How are people getting written up or in trouble for placing a 12-lead or starting an IV or doing whatever 'out of scope'?
Ya'll working with a bunch of George Washingtons or something?

It is your decision but also your license to lose. Personally I would never let anyone exceed their scope of practice under my license.

Letting someone do a 12 lead? Sure. Start an IV? Absolutely not

 

[Tigger]

Finally, an EMT who understands their role on the scene. Unfortunately we do not provide enough education to our EMT's for them to appropriately fill this role.

Every patient needs an EMT, very few need a Paramedic.

If EMTs do not have an adequate education, then they are not providing proper patient care. It seems so backwards to me have the lesser educated provider try and figure who needs a higher level than vice versa. There are plenty of subtle clinical signs that many basics are just not going to recognize and even if they do they likely lack the ability to rule many conditions out.

I'm new at the P/B thing but so far the calls have gone one of two ways. 1) We walk in and the patient is obviously in need of care I cannot provide. 2) I start an assessment with the medic right next to me and within 30 seconds it becomes very apparent as to who's call it is. My job is not to say "the patient needs this medication, a 12-lead, and transport downtown to a trauma center." Those are the medic's responsibility, as I frankly do not always possess the assessment skills needed to determine these treatments.

Also everyone is blowing up at the OP for having his EMT partner start IVs. OP does give us his location, but any EMT in a 911 system in Colorado is expected to start lines for the medic. Obviously it is also in our scope.