The practicality of EMT Basics as an emergecy responder

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Veneficus

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Id rather have a bystander too, but to think that an EMT-I or a AEMT can replace paramedics in a pre hospital setting is just a terrible idea

I agree.

Mostly because it perpetuates skills based providers instead of knowledge based ones.

In the modern world, skill based EMS is simply not effective and not worth paying for.

As far as the IV thing goes. Name one single other skill that you would rather have a Basic learn. Just one skill...

The ability to take a proper history andperform a physical exam that is more than an easily remembered acronym that is so basc it basically gives no info at all.

IV access would seem to be one of the most important things a pre-hospital team can do to provide relief for patients in life threatening situations.

I respectfully disagree.

Code drugs are basically BS.

Fluid therapy for massive hemorrhage has been reduced in favor of permissive hypotension.

In anaphylaxis, IM is the prefered epi route.

In hypoglycemia there is not only IM glucagon, which carries much less risk than extravasiation of d50, but also buccal and sublingual glucose.

In the US for respiratory emergencies requiring B agonists, nebulized is preferred over IV.

Midazolam and diazepam can be given IN and rectally respectively. (much easier than starting a line on a seizing patient.)

Furosimide is being steadily removed for CHF exacerbation around the world in the prehospital environment.

Did you have another life threatening emergency in mind that isn't better helped with a mechanical or electrical device?

It however is probably the single most important thing it can do to provide an easy continuum of care into the hospital setting to allow for the most rapid treatment of the patient once reaching a hospital.

What about in the growing number of institutions that are imediately DCing prehospital lines and starting their own fr fear of not being reimbursed for "treatment relating to preventable complications" in the US?

In a hospital (here at least) when you roll through the door if you don't have a BP in the last 10 minutes they might say why, but the fact is they will retake one before they do anything (therefore you have not delayed PT care). If you have evaluated the patient mentally they will be happy, but they will do it again before they do anything (therefore whether you do it you have not delayed pt care).

Because they are looking for change over time?

But if you have not placed a IV yet and pushed meds per protocol (and more importantly using a good educational background) then you have delayed patient care whether its a slower time to pain relief or a slower time to lowering a high BP.

Does that include IN fent or SL nitro or nitro paste?

Perhaps if you are using lebatalol you need the IV, but I can count on one hand the number of times I have used that in my career. At least one of those times it wasn't really needed, but verbal orders are verbal orders, and ever since discovering esmolol I would choose that over labetalol any day.
(wh is carrying that on the truck?)

I was wrong to say it was the single most important thing in a pre-hospital setting. I may be more right to say it is the most helpful single skill that could be added on to a basics training with ease.

I agree.
 

Rialaigh

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I agree.

Mostly because it perpetuates skills based providers instead of knowledge based ones.

In the modern world, skill based EMS is simply not effective and not worth paying for.



The ability to take a proper history andperform a physical exam that is more than an easily remembered acronym that is so basc it basically gives no info at all.



I respectfully disagree.

Code drugs are basically BS.

Fluid therapy for massive hemorrhage has been reduced in favor of permissive hypotension.

In anaphylaxis, IM is the prefered epi route.

In hypoglycemia there is not only IM glucagon, which carries much less risk than extravasiation of d50, but also buccal and sublingual glucose.

In the US for respiratory emergencies requiring B agonists, nebulized is preferred over IV.

Midazolam and diazepam can be given IN and rectally respectively. (much easier than starting a line on a seizing patient.)

Furosimide is being steadily removed for CHF exacerbation around the world in the prehospital environment.

Did you have another life threatening emergency in mind that isn't better helped with a mechanical or electrical device?



What about in the growing number of institutions that are imediately DCing prehospital lines and starting their own fr fear of not being reimbursed for "treatment relating to preventable complications" in the US?



Because they are looking for change over time?



Does that include IN fent or SL nitro or nitro paste?

Perhaps if you are using lebatalol you need the IV, but I can count on one hand the number of times I have used that in my career. At least one of those times it wasn't really needed, but verbal orders are verbal orders, and ever since discovering esmolol I would choose that over labetalol any day.
(wh is carrying that on the truck?)



I agree.


I have never seen or been in a hospital that dc's pre-hospital lines only to start their own.

My point with it being the most valuable thing a basic could easily learn is that sure a thorough history is great, and will be repeated upon arrival to er. A 12 lead is great, and will be repeated upon arrival to the er. etc..etc..etc..it doesn't matter what you do or what you find out in an ambulance it will be completely repeated upon arrival to the ER.

One of the few things that EMS does that hospitals "continue" with instead of redoing is placing IV lines. It is one of the few things that legitimately saves time for the ER staff and allows for a reduced amount of time between patient arrival to the ER and medication of the patient.
 

TransportJockey

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I have never seen or been in a hospital that dc's pre-hospital lines only to start their own.

My point with it being the most valuable thing a basic could easily learn is that sure a thorough history is great, and will be repeated upon arrival to er. A 12 lead is great, and will be repeated upon arrival to the er. etc..etc..etc..it doesn't matter what you do or what you find out in an ambulance it will be completely repeated upon arrival to the ER.

One of the few things that EMS does that hospitals "continue" with instead of redoing is placing IV lines. It is one of the few things that legitimately saves time for the ER staff and allows for a reduced amount of time between patient arrival to the ER and medication of the patient.
Around here every hospital pulls field lines and since they are drawing their labs they just use an iv cath instead of a butterfly.
 

Aidey

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I have never seen or been in a hospital that dc's pre-hospital lines only to start their own.

My point with it being the most valuable thing a basic could easily learn is that sure a thorough history is great, and will be repeated upon arrival to er. A 12 lead is great, and will be repeated upon arrival to the er. etc..etc..etc..it doesn't matter what you do or what you find out in an ambulance it will be completely repeated upon arrival to the ER.

12 leads are repeated for several reasons, one of them being so that the hospital can compare them and look for changes. Serial 12 leads are practice for a reason.
 

Rialaigh

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12 leads are repeated for several reasons, one of them being so that the hospital can compare them and look for changes. Serial 12 leads are practice for a reason.

I understand the usefulness of them. It is the same as vital sign trends and lab trends. I am not saying these other things cannot be useful. I am saying that starting an IV line would be helpful, time saving, and useful on at least 80% of calls. You really can't say that about most other interventions that Basics don't know right now.
 

Rialaigh

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Around here every hospital pulls field lines and since they are drawing their labs they just use an iv cath instead of a butterfly.

Wow...honestly this sounds like nothing more than a needless increased risk of infection. I see a few positives to doing this with a lot more negatives. If you can't trust an EMS field line than you shouldn't be having medics start lines in the field anyway.
 
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Veneficus

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Which is already a taught basic skill. Now we can debate the quality of education but a patient assessment is supposed to be taught and passed prior to earning EMT-B

Unfortunately, what is taught is only a shadow of a patient assessment.

The important limit to consider is it teaches how to look for life threatening conditions that largely do not exist anymore because of the evolution of the diseases we suffer from.

Anyone who truly understand patient assessment knows it cannot be done without knowledge of physiology and pathophysiology.

Sadly because of this outdated Basic approach, it is easy to overlook very sick people or people who would benefit from medical attention.

I understand the usefulness of them. It is the same as vital sign trends and lab trends. I am not saying these other things cannot be useful. I am saying that starting an IV line would be helpful, time saving, and useful on at least 80% of calls. You really can't say that about most other interventions that Basics don't know right now.

I am not sure 80% of patients EMS sees even need IVs at all.

Wow...honestly this sounds like nothing more than a needless increased risk of infection. I see a few positives to doing this with a lot more negatives. If you can't trust an EMS field line than you shouldn't be having medics start lines in the field anyway.

It is not so simple. The major driving force is the money.

Medicare has mandated that care needed from "preventable" complications will no longer be paid for. Which means in the unlikely chance of a phlebitis, extravasiation, or even a worst case scenario of sepsis, the hospital is going to eat all the costs of that unless they can show they did everything possible to prevent it from the needlestick.

Hospitals do have control over their employees, procedures, and environment. They cannot exercise that control over non-hospital based EMS employees, their procedures, or their environment.

Recall that in the ICU, especially peds and NICU, insertion of an IO needle is a steril procedure. This is specifically to cut down on infection. Which means, if you start an IO in the field, once that patient gets to the unit, it will certainly be pulled.

In the unlikely event they devide to replace it instead of using another more advantageous method of vessel monitoring and access, it will be under sterile conditions.
 

Jambi

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Which is already a taught basic skill. Now we can debate the quality of education but a patient assessment is supposed to be taught and passed prior to earning EMT-B

If you were to read the thread at the end of that link you'd see that while it may be "taught" as a basic skill, it's not really taught as a truly meaningful skill outside of "ABCs and something is wrong."

It's not a dig at EMT's. It is a dig at the state of the profession, at all levels, and as a paramedic, and a long-time EMT educator I feel comfortable in make such statements.
 

escherichiaColi0157

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I have been an EMT-B for 13 years. I work with an 19 year veteran paramedic and she states she would trusts the basics to do the 'basics' better than her fellow medics. The paramedics tend to rely on their technology; treating the ECG display rather than the patient and the like. All that aside, why do we act like EMT's and paramedics are two rival football teams instead of two groups working on the same team toward the same goal-patient care?
 

NYMedic828

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I have been an EMT-B for 13 years. I work with an 19 year veteran paramedic and she states she would trusts the basics to do the 'basics' better than her fellow medics. The paramedics tend to rely on their technology; treating the ECG display rather than the patient and the like. All that aside, why do we act like EMT's and paramedics are two rival football teams instead of two groups working on the same team toward the same goal-patient care?

A basic being better at basics than the medic is the fault of the service employing poor medics.

The reason this discussion constantly presents itself is because one of the two is already obsolete and the other is quickly following. The current EMS system cannot sustain itself much longer in the current economy and state of medicine. It must advance indefinitely or be left for dead.
 

mycrofft

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It OUGHT to evolve or die, but it will not because there is no alternative. The DRAWBACK to civil services is that, since private companies already have no true interest in providing the same or better service, there IS no parallel track of evolution. The fact that it took the NHTSA to create EMS, and not the Dept of Health or AMA, is a rare example of damning the torpedoes and squaring away a problem.

As for paramedics who can't put on bandaids, try surgeons ("to cut is to curve") versus internists ("a pill for every ill"). When you get handed the big hammers, the little ones get neglected, but every job requires a hammer....so many ruined screws that way.
 
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Veneficus

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I have been an EMT-B for 13 years. I work with an 19 year veteran paramedic and she states she would trusts the basics to do the 'basics' better than her fellow medics. The paramedics tend to rely on their technology; treating the ECG display rather than the patient and the like. All that aside, why do we act like EMT's and paramedics are two rival football teams instead of two groups working on the same team toward the same goal-patient care?

Finally, an easy question...

Because EMTs dn't have patient care as the goal. They have ease of entry, minimum qualifications, absense of responsibility and decision making, and not changing what they have done for the last 40 years despite astonishing strides in medicine as the goal.

Modern paramedics (with the exceptin of the old dinosaurs still preaching they don't diagnose and lack clinical decsion making authority despite protocols that actually spell out they do) are attempting to become a recognized healthcare provider of professional status that has clinical decision making capability along with adding value beyond a taxi ride to the ED in order to increase their social status and pay.

The patient is unfortunately caught in the middle. This same game was played in the past when surgeons started being required to go to medical school. Going from the pay and prestige of the local vocational barber to some of the most prestigious and well payed doctors did seem to work out for them in the end.

(Medical trivia, did you know the modern residency of physicians exists because it was part of the compromise when surgeons were first required to go to medical school and were adamante they would not accept medical education in an academic institution could possibly produce a surgeon that was equal to a multi year apprenticeship?)
 

escherichiaColi0157

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I am shocked at your statements that EMT's have, "Absence of responsibility and decision making," AND do not have patient care as a goal. Gee, what IS their goal then? Wow, you have got to be kidding. Ever consider SAR EMT's? Or Wilderness EMT's or lifeguards? maybe you're thinking of your transport only basics but there are basic's providing patient care in backcountry and extreme wilderness making limb and life decisions many paramedics will never be exposed to in their clean rigs. Trust me, I respect the knowledge and additional training of the medic, but not their ego trips.
 

Tigger

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I am shocked at your statements that EMT's have, "Absence of responsibility and decision making," AND do not have patient care as a goal. Gee, what IS their goal then? Wow, you have got to be kidding. Ever consider SAR EMT's? Or Wilderness EMT's or lifeguards? maybe you're thinking of your transport only basics but there are basic's providing patient care in backcountry and extreme wilderness making limb and life decisions many paramedics will never be exposed to in their clean rigs. Trust me, I respect the knowledge and additional training of the medic, but not their ego trips.

The goal would be to get the patient to a hospital where they can receive care. Care as in something more than placing the patient a backboard and holding their hand.
 

Jambi

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Trust me, I respect the knowledge and additional training of the medic, but not their ego trips.

You may respect what you wish, but I offer the following information...do with it what you will.

1. How many hours are needed to qualify to take the State Board examinations?
Cosmetologist = 1600 hours, Barber = 1500 hours, Esthetician = 600 hours, Electrologist = 600 hours, Manicurist = 400 hours.
http://www.barbercosmo.ca.gov/forms_pubs/faqs.shtml#ae1

versus...

To be eligible for a paramedic license in California an individual must:
• successfully complete an approved paramedic training program;

The minimum number of hours required for training is 1,090:
Didactic and skills 450 hours
Hospital and clinical training 160 hours
Field internship 480 hours
(which must include a minimum of 40 advanced life support (ALS) patient contacts)
http://www.emsa.ca.gov/paramedic/files/FrequentlyAskedQuestionsRevAug2012.rtf

and for EMT

• 120 hours total
• ≈ 110 hours
didactic
• ≈ 10 hours clinical
http://www.emsa.ca.gov/pubs/pdf/EMSA131.pdf
 

rescue1

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I am shocked at your statements that EMT's have, "Absence of responsibility and decision making," AND do not have patient care as a goal. Gee, what IS their goal then? Wow, you have got to be kidding. Ever consider SAR EMT's? Or Wilderness EMT's or lifeguards? maybe you're thinking of your transport only basics but there are basic's providing patient care in backcountry and extreme wilderness making limb and life decisions many paramedics will never be exposed to in their clean rigs. Trust me, I respect the knowledge and additional training of the medic, but not their ego trips.

I'm not sure if a "making a life or limb decision" is even within the scope of practice for a basic.
 

NYMedic828

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I am shocked at your statements that EMT's have, "Absence of responsibility and decision making," AND do not have patient care as a goal. Gee, what IS their goal then? Wow, you have got to be kidding. Ever consider SAR EMT's? Or Wilderness EMT's or lifeguards? maybe you're thinking of your transport only basics but there are basic's providing patient care in backcountry and extreme wilderness making limb and life decisions many paramedics will never be exposed to in their clean rigs. Trust me, I respect the knowledge and additional training of the medic, but not their ego trips.

Quite often I find that the "ego trip" opinion arises from one of two factors. 1, the paramedic is incompetent and hides it via harsh attitude. 2, more common, the accuser is incompetent or feels inferior and tries to hide it or justify themselves by raising their own pedestal.

Wilderness EMTs are basically capable of the same thing as anyone else. Transport to a hospital. They still can not perform any actual emergent procedures.

Also, assuming your comment is in relation to Vene's post, realize that Vene has earned the right to preach what he wants whether you agree with it or not. His "training" buries yours by 15+ years of schooling...
 
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