Should EMT-B be split

[vc85]

I was just wondering if anyone thinks that what is currently EMT-B should be split into two positions.

One which would be continued to be called EMT and would have a scope of practice similar to:
CPR
AED
Oxygen
BVM
Pulse Oximetry
Glucometry
Oral Glucose Administration
Epi-Pen
Albuterol
Asprin
Atropine auto injector (Organophosphate poisoining and WMD)
Assisted Nitro
OPA
NPA
Clotting Sponges
1 attempt to reduce a fx if distal pulse is missing
Plus all of the splinting, backboarding, bandaging, etc
Nasal Narcan
CPAP
Expanded Nitro protocol (Systolic of 100)
Epi-pen for asthmatics not responsive to albuterol with med-control
Venturi masks
Automatic Transport vents
ETCO2 readings (numbers, not waveform)
King/rescue airways
Tourniquets
Activated Charcoal
Ice/Heat Packs

The new position that would be created would be called AMT (Ambulance Medical Technician, note the lack of the word "emergency") or something like that, and would be devoted more towards IFT/Dialysis Txp work.

It just seams unusual to me that one title, EMT, covers everything from people working/volunteering in completely 911 systems who rarely if ever do IFT and deal with the long term care population, and also people who deal exclusively with such population, and as others have said "never used the backboard since EMT school".

I have seen what this can lead to. One day we had two EMTs sign up for an extreme sports event standby detail, both were new EMTs and had done exclusively IFT work prior. As you can probably guess, one of the participants suffered a major trauma. Let's just say I've seen pre-teens display more poise and calm under pressure.

 

[Aprz]

This is due to lack of experience instead of lack of knowledge or training. The training ironically already focus too much on emergencies and ignored IFT.

I don't think it should be separated. I would like to see ambulance do a combo of both 911 and IFT, not be exclusive to one. IFT patients don't deserve less.

 

[RebelAngel]

Someone correct me if I'm wrong, but they're moving away from EMT-B and instead EMT-B has become EMT, next would be Advanced Emergency Medical Technician, and then Paramedic. I know NYS also recognizes Critical Care right below Paramedic. The lowest level of EMS is now called Emergency Medical Responder. I'm not sure if it's just NYS or federally, but EMRs can not transfer patients, that starts at the EMT level.

As far as splitting, no. I don't think that is a good idea. I think, based on what you stated in your post, continued training exercises and education would be the most effective and efficient way to handle the lack of experience and knowledge.

 

[mycrofft]

This is due to lack of experience instead of lack of knowledge or training. The training ironically already focus too much on emergencies and ignored IFT.

I don't think it should be separated. I would like to see ambulance do a combo of both 911 and IFT, not be exclusive to one. IFT patients don't deserve less.

Paragraph 2, agreed. Para 1, not so much.

EMTs were created for emergencies (hence the "E"), and if you are being used for IFT's etc you can feel underutilized. However, if something goes awry enroute, or you stop to pick up the pt and the pt is crashing, you need the training to recognize that and act on it

 

[mycrofft]

Someone correct me if I'm wrong, but they're moving away from EMT-B and instead EMT-B has become EMT, next would be Advanced Emergency Medical Technician, and then Paramedic. I know NYS also recognizes Critical Care right below Paramedic. The lowest level of EMS is now called Emergency Medical Responder. I'm not sure if it's just NYS or federally, but EMRs can not transfer patients, that starts at the EMT level.

As far as splitting, no. I don't think that is a good idea. I think, based on what you stated in your post, continued training exercises and education would be the most effective and efficient way to handle the lack of experience and knowledge.

I've read here that's happening, but someone can get the citation, I'm busy.
As this old codger remembers time and again, originally it was "EMT-A" (ambulance) and EMT-P (paramedic). States instantly began coining new varieties like EMT-Advanced, EMT-I.V., etc. to use as cheaper labor.

 

[Handsome Robb]

Nevada doesn't even call paramedics paramedics technically. It's EMT-Basic, EMT-Intermediate and EMT-Advanced.

That is supposed to be changing.

I think the levels are already broken down too much. If I were to have it my way EMT would turn into an IFT class with training to recognize and treat acute emergencies but primarily focus on transfers. Then the AEMT level would be the minimum level for staffing an ambulance but just call them EMTs then you have associates degree paramedics with a bachelors for Critical Care. Eventually moving to AAS for EMT, BS for Paramedic and MS/Post graduate certificate for Critical Care but that's an entire topic all together.

 

[Aprz]

Paragraph 2, agreed. Para 1, not so much.

EMTs were created for emergencies (hence the "E"), and if you are being used for IFT's etc you can feel underutilized. However, if something goes awry enroute, or you stop to pick up the pt and the pt is crashing, you need the training to recognize that and act on it

I think I worded that poorly cause you said exactly what I think. What I meant is that they should have additional training on IFT like type of calls they'll run, why the patient needs an ambulance, narratives, be familiar with paperwork like 5150, DNR/POLST, and be introduced to things like EMTALA. I feel like current EMTS are trained for emergency only, and IFT is kinda shock and they are lost initially. Scenarios in class could be IFT calls that go wrong. Thankfully IFT is easy, they could get away with 1-2 classes on this and just include it in scenarios in the future. As of now, IFT isn't even mentioned in EMT classes in my area.

 

[unleashedfury]

I was just wondering if anyone thinks that what is currently EMT-B should be split into two positions.

One which would be continued to be called EMT and would have a scope of practice similar to:
CPR
AED
Oxygen
BVM
Pulse Oximetry
Glucometry
Oral Glucose Administration
Epi-Pen
Albuterol
Asprin
Atropine auto injector (Organophosphate poisoining and WMD)
Assisted Nitro
OPA
NPA
Clotting Sponges
1 attempt to reduce a fx if distal pulse is missing
Plus all of the splinting, backboarding, bandaging, etc
Nasal Narcan
CPAP
Expanded Nitro protocol (Systolic of 100)
Epi-pen for asthmatics not responsive to albuterol with med-control
Venturi masks
Automatic Transport vents
ETCO2 readings (numbers, not waveform)
King/rescue airways
Tourniquets
Activated Charcoal
Ice/Heat Packs

The new position that would be created would be called AMT (Ambulance Medical Technician, note the lack of the word "emergency") or something like that, and would be devoted more towards IFT/Dialysis Txp work.

It just seams unusual to me that one title, EMT, covers everything from people working/volunteering in completely 911 systems who rarely if ever do IFT and deal with the long term care population, and also people who deal exclusively with such population, and as others have said "never used the backboard since EMT school".

I have seen what this can lead to. One day we had two EMTs sign up for an extreme sports event standby detail, both were new EMTs and had done exclusively IFT work prior. As you can probably guess, one of the participants suffered a major trauma. Let's just say I've seen pre-teens display more poise and calm under pressure.

The skills you stated and add on a solid A&P course, and IFT skills to EMT school. truth be told the EMT title is pretty much a misnomer even as a 911 EMT the amount of True emergencies you actually treat are probably 10% of the total calls you receive. This is generally true for all levels of certification in EMS.

The scenario give where you had two NEW EMT's sign up for a extreme sports event with the potential for traumatic injuries that seems more like a operations level error. If I had to I would have had at least one solid experienced EMT with one New EMT to allow for mentoring. But not my organization to make that call.

 

[Ridryder911]

There are too many levels already!

Actually, in the beginning, for NREMT there was the EMT -A (ambulance) and EMT ( non-ambullance) One had to work on a EMS unit for 6 months provisional before they obtain the ambulance rocker for the patch or call themselves an EMT-A.

IFT should be added to the curriculum. More and more EMT's roles are no longer emergencies. Sorry, it's the fact and will not change. We need a sniff of good reality and change the whole curriculum. This could place IFT as part and emphasize some basic emergency care.

The national committees have attempted to reduce titles as much as possible:

The newer National recognized levels are :
EMT
Advanced EMT (AEMT)
Paramedic

As we see the medical community change, we also see the roles change. The E will be less and less. How many emergencies do you think an ER Doc really gets to see? Their primary focus is emergencies but; realistically majority of treatments are routine general medical/ clinic treatments.

R/r 911

 

[jerrys]

Emt

I agree the EMT levels need to stay as is unless we are looking at changing the entire industry and non-emergency transports are now going to be just a taxi serivces and not require an ambulance.

 

[46Young]

We need to keep EMT's. Medics need someone to unload non-acute patients, so that they can remain available for patients that are actually in need of ALS. Otherwise, the medics never learn anything or gain much useful experience running BLS most of the time.

Really, since most of our calls are non-acute, and would turn out the same with or without ALS, I feel that the most effective model would be a two person crew, EMT-B/EMT-E, and have medics in chase cars to ride for the very occasional true ALS call.

 

[Handsome Robb]

We need to keep EMT's. Medics need someone to unload non-acute patients, so that they can remain available for patients that are actually in need of ALS. Otherwise, the medics never learn anything or gain much useful experience running BLS most of the time.



Really, since most of our calls are non-acute, and would turn out the same with or without ALS, I feel that the most effective model would be a two person crew, EMT-B/EMT-E, and have medics in chase cars to ride for the very occasional true ALS call.

That's what I've been saying here for a long while.

ILS ambulances with ALS fly cars.

Sign me up.

 

[46Young]

That's what I've been saying here for a long while.

ILS ambulances with ALS fly cars.

Sign me up.

One major problem that I have with fire based EMS is that the ILS bus/ALS fly car concept will never happen, because instead of having a medic on every ambulance, it will be a firefighter. Firefighters generally don't like spending the majority of their time on an ambulance. In an engine/medic house that has the EMT-B/EMT-E crew on the bus, and paramedic and EMT riding the two engine bucket spots, you'll have three firefighters sharing one riding position on the engine.

No one here will present that as an option. Instead, our entire txp fleet is either medic/medic or medic/EMT. It's made me largely indifferent towards EMS txp, since we rarely use ALS interventions on a patient, running mostly BLS. I like medicine, but what we see and do 90% of the time could be done by a trained monkey taught to get vitals and properly place a 12 lead.