Role of an EMT on scene?

[Aidey]

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)

Maybe it is a difference in areas, but the EMTs around here are not really taught assessment skills. The Paramedics educated locally barely have passable assessment skills.

My EMT is dangerous. He thinks he knows/understands significantly more than he truly does. He has minimal understanding of pathophys. He has zero interesting in continuing education. He thinks having a c-spine clearance protocol is useless because we've done without one for the last 20 years without issue. I could keep going. This is the rule in my experience, not the exception.

When EMTs have the same assessment and pathophys knowledge of a good paramedic, then I might be able to agree that paramedics are only needed for skills, but until then I do my own assessments.

 

[Handsome Robb]

I've been very spoiled with partners who have much more education than a standard EMT-I. Current one has a BS in some fancy bio major, an MS in a similar major and is a few credits away from her BSN. Previous partner was nearing completion of dual BSs in engineering and bio.

With that said, I have no problems allowing an EMT to do the assessment while I listen and interject questions that I want answered then if I deem it's an ALS call I will eventually take over. Personally it flows better that way. But that's my opinion and the Intermediates where I work are held to a pretty solid standard.

That's the way I prefer it, but if my partner is leading a patient or performing sub par assessments I will step in and take over then pass back to them if I seem it an B/ILS call.

The only way new EMTs are going to learn and get better at assessments is if you allow them to practice them... That's the same reason why I let the new firefighters from the new county department do nearly everything on scene, skills and assessment and interject/intervene when I need to, because frankly, they suck and need the practice.

Ill let my partner push any med or do any skill within their scope before me unless its something where I know it's my only shot and I need it done now.

I need to add to this, if I haven't made it clear already, that if I have a sick patient that can't afford to have someone "practicing" on them, I step in and it becomes my show immediately. Do not pass go, do not collect $200, go straight to the Robb show.

 

[Christopher]

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.

If we worked together, you'd be doing every assessment until you were comfortable making a treatment and transport plan. It should be a rare patient where you end up just going, "I have no idea what to do except ask a Paramedic.

You may not know what drugs I'd give, or other interventions I would like; but you'd know what the flow of care should be up until the point we transport. If it's mine then I'll hop in the back and we'll be on our way.

I don't see how this is such a crazy idea

 

[Christopher]

Maybe it is a difference in areas, but the EMTs around here are not really taught assessment skills. The Paramedics educated locally barely have passable assessment skills.

My EMT is dangerous. He thinks he knows/understands significantly more than he truly does. He has minimal understanding of pathophys. He has zero interesting in continuing education. He thinks having a c-spine clearance protocol is useless because we've done without one for the last 20 years without issue. I could keep going. This is the rule in my experience, not the exception.

When EMTs have the same assessment and pathophys knowledge of a good paramedic, then I might be able to agree that paramedics are only needed for skills, but until then I do my own assessments.

If you don't (or your organization does not) set the expectation for the performance of your partner, they'll perform in whatever way they see fit.

Raise the standards (better phrased, make them actually adhere to the minimums). If they're incorrect, correct them. If they have zero interest in continuing education, educate them all day. Some folks groan when they ride with me, because they know we're going to be training all day.

 

[DrParasite]

The only way new EMTs are going to learn and get better at assessments is if you allow them to practice them...

and if you never let them do an assessment, they won't know what to do.

If you never let them do anything other than carry the bags, that's all they will know how to do.

If you never let them do anything on their own, and make them go through you for everything, that makes you a horrible micromanager, which results in a subparr employee who can't think think for themself. Sounds good to start ("well, if I don't let them do anything, they can't hurt anyone or screw up), but if you empower and educate your EMT, let them do their own thing and correct them when needed, if will make your job (as a paramedic) easier since you don't have to do everything yourself, and they will become a better provider and be useful to you than if they were just a driver and equipment carrier.