The EMT-Basic

[daedalus]

A few days ago I had to re-read sections of my Emergency Care textbook for an AMR pre-employment test. I used that text as my EMT book for school over two years ago. Looking retrospectively, I am angry I had to re-read the book because it is not real medicine, and it re teaches bad medicine after I have come so far in understanding the real behind the scenes pathology of what we commonly see and treat. I have read medical texts and my paramedic book, and now that I had to re review EMT material I can finally say with utter confidence that the EMT-Basic material sucks. Badly. Heres why;

You are taught signs to look for, but not what they mean or why they are there, only that they are a bad thing. Examples: battles sign, halo on gauze sign, blown pupils, levings sign.

It actually made me laugh, the wording in the text book "this is an ominous sign" but than goes on to a completely different subject without expanding upon anything.

The cardiac section is especially laughable. Everything from potential heart blocks to cariogenic shock is just blanketed as "cardiac compromise" without any real education as to the functions of the CV system.

The oxygen administration indications starts off decently:
AMS, CP of suspected cardiac origin, reps. distress, and shock, cyanosis or suspected hypoxia

and than it is ruined with
"any other medical or traumatic injury"

The indications for non-rebreather at 15 LPM are:
If the patient or someone else for the patient called 911, that in itself is an indication for 15 LPM. If they are in absolutely no distress they are still getting 15 LPM. The only acceptable reason for a NC is not tolerating the mask. If they are actually in distress, dump the NRB mask and get the BVM out.

They say deliver O2 in every situation because they do not educate us properly on when to give it, so its a bandaid.

Now, what to do with the EMT level? Clearly, it is in need of re-vamping. Or is it? It is painfully obvious to me that EMTs are not educated to the level to even understand that they know nothing. The problem is, if we increase the hours and expand on the material, how will it be taught? Most EMT programs are semester long night classes at community colleges, and it would be difficult to change that format. We could make it two semesters long, but than why not just skip EMT and go to paramedic school? EMT classes already fly through the material as it is, and the EMT student is very busy with the four tests every night to cram everything into the 3 month period.

Should we keep EMT the way it is and make them largely assistive to the paramedic? Could we make up for the program's weakness by requiring a comprehensive set of pre-req classes? The problem with that is, a student who has gone through chem, bio, and antomy/phys with be begging for more depth when discussing disease processes. The EMT class may literally dumb them down. Could we double he hour requirement from 120 to 240, and use that time to teach a little pathophys and pharmocology?

What do you think we should do with the EMT level as far as education and utilization?

 

[Ridryder911]

As I contend there is a need for a EMT level, just not the way it is percieved or used. Use it as a medical first responder level only.

I can say the revamption of the new curriculum of the EMT is nice as in pathophysiology will weed out many of the undesirables, if taught properly. Now, I do believe we will see an increase of failures on the NREMT and other similar examinations. Why? Because, old EMT instructors will attempt to teach the "old objective" way and as well majority of the EMT instructors lack the knowledge themselves. Defintelymost lack the education to be able to teach adult education.

As was told to me .."the old EMT is coming back!"... Maybe, we can be able to build uopn them.

R/r 911

 

[daedalus]

during the whopping two hours of A&P i had, my instructor pointed his laser pointer at the cerebellum on a slide of a brain and called it a tumor....

 

[daedalus]

As I contend there is a need for a EMT level, just not the way it is percieved or used. Use it as a medical first responder level only.



R/r 911

I agree!! FR level is really what the EMT is.

 

[exodus]

And this is the reason I want to take A&P and go to medic school before working for 6 months to a year.... I want to understand why this stuff happens, and what is going on.

 

[TransportJockey]

And this is the reason I want to take A&P and go to medic school before working for 6 months to a year.... I want to understand why this stuff happens, and what is going on.

Why should you have to work before going to medic school? I've never understood why some schools require it.

 

[Shishkabob]

The problem isn't what were taught but who teaches it. My instructors would go deep(er) to explain things as to why and not just "because". I've run into basics taught at other places that didn't know a lot of the stuff I assumed was common knowledge for new basics.

No one is saying we're taught enough, but the problem lays more with the "teachers" that don't try to explain things to the students.

Everyone could always use more education, but doubling the required hours doesn't guarantee that.

 

[fma08]

A few days ago I had to re-read sections of my Emergency Care textbook for an AMR pre-employment test. I used that text as my EMT book for school over two years ago. Looking retrospectively, I am angry I had to re-read the book because it is not real medicine, and it re teaches bad medicine after I have come so far in understanding the real behind the scenes pathology of what we commonly see and treat. I have read medical texts and my paramedic book, and now that I had to re review EMT material I can finally say with utter confidence that the EMT-Basic material sucks. Badly. Heres why;

You are taught signs to look for, but not what they mean or why they are there, only that they are a bad thing. Examples: battles sign, halo on gauze sign, blown pupils, levings sign.

It actually made me laugh, the wording in the text book "this is an ominous sign" but than goes on to a completely different subject without expanding upon anything.

The cardiac section is especially laughable. Everything from potential heart blocks to cariogenic shock is just blanketed as "cardiac compromise" without any real education as to the functions of the CV system.

The oxygen administration indications starts off decently:
AMS, CP of suspected cardiac origin, reps. distress, and shock, cyanosis or suspected hypoxia

and than it is ruined with
"any other medical or traumatic injury"

The indications for non-rebreather at 15 LPM are:
If the patient or someone else for the patient called 911, that in itself is an indication for 15 LPM. If they are in absolutely no distress they are still getting 15 LPM. The only acceptable reason for a NC is not tolerating the mask. If they are actually in distress, dump the NRB mask and get the BVM out.

They say deliver O2 in every situation because they do not educate us properly on when to give it, so its a bandaid.

Now, what to do with the EMT level? Clearly, it is in need of re-vamping. Or is it? It is painfully obvious to me that EMTs are not educated to the level to even understand that they know nothing. The problem is, if we increase the hours and expand on the material, how will it be taught? Most EMT programs are semester long night classes at community colleges, and it would be difficult to change that format. We could make it two semesters long, but than why not just skip EMT and go to paramedic school? EMT classes already fly through the material as it is, and the EMT student is very busy with the four tests every night to cram everything into the 3 month period.

Should we keep EMT the way it is and make them largely assistive to the paramedic? Could we make up for the program's weakness by requiring a comprehensive set of pre-req classes? The problem with that is, a student who has gone through chem, bio, and antomy/phys with be begging for more depth when discussing disease processes. The EMT class may literally dumb them down. Could we double he hour requirement from 120 to 240, and use that time to teach a little pathophys and pharmocology?

What do you think we should do with the EMT level as far as education and utilization?

1) It was a requirement here to have the EMT before medic school.

2) Med schools themselves don't even require a comprehensive set of pre-reqs (unless you are getting the AAS degree... and even then, they are not necessarily required to be taken first before the medic portion). Lucky for me I had a few going into school.

 

[JPINFV]

2) Med schools themselves don't even require a comprehensive set of pre-reqs (unless you are getting the AAS degree... and even then, they are not necessarily required to be taken first before the medic portion). Lucky for me I had a few going into school.

There are med schools out there that don't, for 99% of their students, require at least a bachelors degree? Heck, all of the med schools I know of require at least a year of physics, general chem, organic chem, and biology with plenty requiring a year of math and a handful requiring a year of psych.

 

[fma08]

There are med schools out there that don't, for 99% of their students, require at least a bachelors degree? Heck, all of the med schools I know of require at least a year of physics, general chem, organic chem, and biology with plenty requiring a year of math and a handful requiring a year of psych.

That's my bad, I meant to type Medic schools. Med schools is stuck in my head because I'm looking at them ^_^

 

[AJ Hidell]

Good observations, Daedalus. I agree that the EMT-B curriculum has been outdated for a good twenty years now, and is totally inadequate for what it is being used for.

I don't believe that lengthening or otherwise increasing EMT educational requirements is necessary or even advisable. As already indicated, EMT, in its current form, is not adequate for anything but a first responder. And to actually make it truly useful as a first responder level of training, the entire curriculum requires revamping. I think they should actually get less in-depth with physiology than they currently do, and focus more on the simple technical first aid skills necessary to control the ABCDs until EMS arrives. Concentrating the entire 120 hours on more practical, technical training, we would have more competently functioning people on scene, preparing patients for us, not simply attempting to do the same assessment that we are going to repeat after our arrival.

Instead of trying to cram about 500 hours worth of material into 120 hours, as is currently done, we should simply spend that whole 120 hours focusing on those very few skills that a first responder actually needs.

Nothing less than a full paramedic has any business practicing on an EMS ambulance.

 

[Foxbat]

Instead of trying to cram about 500 hours worth of material into 120 hours, as is currently done, we should simply spend that whole 120 hours focusing on those very few skills that a first responder actually needs.

So basically it means no spinal immobilization, no O2, no vitals, no assisting with meds... That sounds more like 4 hour ARC first aid course, not 120 hours.

 

[AJ Hidell]

So basically it means no spinal immobilization, no O2, no vitals, no assisting with meds... That sounds more like 4 hour ARC first aid course, not 120 hours.

Ummm... no. Did you read what I wrote? Those technical skills are exactly what I said we need to focus on, instead of all the stuff about cardiology, Battle Sign, Halo sign, neuro exams, etc...

I'm finally agreeing with the majority of all EMT-Bs. They don't need all that book learnin'.

 

[fma08]

Good observations, Daedalus. I agree that the EMT-B curriculum has been outdated for a good twenty years now, and is totally inadequate for what it is being used for.

I don't believe that lengthening or otherwise increasing EMT educational requirements is necessary or even advisable. As already indicated, EMT, in its current form, is not adequate for anything but a first responder. And to actually make it truly useful as a first responder level of training, the entire curriculum requires revamping. I think they should actually get less in-depth with physiology than they currently do, and focus more on the simple technical first aid skills necessary to control the ABCDs until EMS arrives. Concentrating the entire 120 hours on more practical, technical training, we would have more competently functioning people on scene, preparing patients for us, not simply attempting to do the same assessment that we are going to repeat after our arrival.

Instead of trying to cram about 500 hours worth of material into 120 hours, as is currently done, we should simply spend that whole 120 hours focusing on those very few skills that a first responder actually needs.

Nothing less than a full paramedic has any business practicing on an EMS ambulance.

I gotta disagree with that part. Anybody can learn the skills. But, there has to be a good background knowledge of when and why you are using a particular skill. The way one decides to do something is through an assessment, and a thorough assessment CANNOT be performed without a decent knowledge base. Cutting out what little physiology is in the EMT course already is not a good idea. While maybe they don't need gen bio, cell bio, gen chem, ochem, biochem, pathogenic microbiology, etc. etc. They do need to add to the curriculum a solid college level A&P course, and they need good teachers that understand the material to teach them.

 

[Foxbat]

Ummm... no. Did you read what I wrote? Those technical skills are exactly what I said we need to focus on, instead of all the stuff about cardiology, Battle Sign, Halo sign, neuro exams, etc...

I read what you wrote. I also read numerous discussions here where medics tended to emphasize that BLS interventions (nitro if allowed, O2, immobilization) can be harmful when a provider does not know the rationale behind them and just blindly follows the book.
Just a couple weeks ago you told me that A&P is very valuable for an EMT-B too and that it should be taken before EMT-B course. Now you are saying EMT-Bs don't need book learning. I don't get it.

 

[AJ Hidell]

I gotta disagree with that part. Anybody can learn the skills. But, there has to be a good background knowledge of when and why you are using a particular skill. The way one decides to do something is through an assessment, and a thorough assessment CANNOT be performed without a decent knowledge base.

I gotta disagree with that. Right now, a great many EMTs graduate completely incompetent in their skills. It's not that the skills are that difficult, or that the training is that inadequate. It's that the average person drawn to EMT school is an idiot in the first place. Improving competence would be more dependent upon improving the quality of students more than improving the quality of education.

As long as we are stuck with such a large percentage of nimrods, we really need to dumb it down more for them. Forget knowing why they are doing anything. They shouldn't be doing it for more than a few minutes anyhow. And learning about Battle Sign and Halo Sign contribute nothing to their ability to provide ABC care in the interim. They don't need to do a "thorough assessment". That's for the paramedic that should be arriving after them to do. There is nothing the EMT can do with the information acquired through such an assessment, so let's focus on providing what they are supposed to provide in the first place.

 

[Sasha]

levings sign

THATS IT!!!! THAT'S IT!!! Do you know how long I've been trying to remember the name of that!!?!??!?! AUGH!

 

[AJ Hidell]

I read what you wrote. I also read numerous discussions here where medics tended to emphasize that BLS interventions (nitro if allowed, O2, immobilization) can be harmful when a provider does not know the rationale behind them and just blindly follows the book.

What's any of that got to do with Battle Sign and Halo Sign? I didn't make a sweeping, across the board statement about eliminating all theory. I said eliminate that theory which does not contribute to technical competence.

And no, they should not be giving NTG EVER.

Just a couple weeks ago you told me that A&P is very valuable for an EMT-B too and that it should be taken before EMT-B course. Now you are saying EMT-Bs don't need book learning. I don't get it.

That was a completely different discussion. This discussion is about changing the EMT curriculum into a strictly first responder curriculum. The previous discussion was about EMT as it currently exists.

 

[bstone]

As I contend there is a need for a EMT level, just not the way it is percieved or used. Use it as a medical first responder level only.

I think also for non-critical IFTs and the Renal Roundup.

 

[AJ Hidell]

I think also for non-critical IFTs and the Renal Roundup.

Meh... I'd rather have a CNA on an IFT ambulance than an EMT. There's just not a lot of call for bandaging, splinting, and extrication while making the nursing home circuit all day long. I'd like to see the EMT requirement for non-emergency transfer ambulances eliminated altogether. It's just ridiculous.