The practicality of EMT Basics as an emergecy responder

[mycrofft]

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 EMT part is supposed to follow protocols. The SAR, Tactical, or whatever part is a whole 'nother world. Those issues are not medical ones, although they impact the medical aspects.

I think folks get that point but the hyperbole puts them off.

 

[mycrofft]

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

Of course EMT's make life or limb decisions, but the path to follow to do that is supposed to be covered by a protocol.

And theoretically when you get enough protocols every possible situation is covered.:rofl:

The decision to stay and treat versus treat enroute is one such decision, the decision to open an airway with OPA or by patient positioning can be another. The big one is deciding when the protocol doesn't make sense, and alternative "diagnoses" must be entertained or the protocols bypassed for cause.

 

[hogwiley]

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.

I dont really disagree with this statement, however it really isnt the EMTs fault. Most people when they go to school to be an EMT, assume they are taking on a lot of responsibility, that the school will be difficult and have high standards and that their decision making ability is crucial and will be put to the test. Like most people, I didnt even know paramedic and EMT were different things. It isnt until most of the way through EMT school that the student begins to realize that hey, this stuff really isnt that hard, and its the Paramedics who have the real responsibility, but its not like you can blame the EMT for that.

There seems to be this notion that people who dont immediately go to Paramedic school are somehow stupid, or lazy, or just want the minimum standards, yet MOST paramedics didnt go right from EMT school to Paramedic school. Most worked as EMTs, sometimes for years, and many of them(the honest ones) will say that working as an EMT made Paramedic school less stressful and working as a brand new Paramedic less difficult.

The ones who say EMT experience makes no difference in Paramedic school are simply wrong. The pass rate for students with EMT experience is significantly higher than it is for those with no experience, and Ive personally seen those medics who did pass with no experience struggily mightily as brand new Paramedics, versus the ones with EMT experience who had a far smoother transition.

 

[NYMedic828]

Most people wait to go to medic school because they are set in their lives or simply can't afford it.

$10,000 is a lot to come up with on such low wages. Not to mention the vocational schooling is not covered under any student loan programs. At least not here it isn't. It has to come out of pocket or a regular loan.

Having initial experience helps but only because it increases your comfort level in communicating with patients. Everything else is a waste of time.

 

[triemal04]

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.

Calm down for a minute. This type of knee-jerk hyperbole filled reaction is why conversations along these lines never go anywhere, and why certain people's opinions of EMT's continues to be low/go lower.

It's not that EMT's don't have patient care as a goal, it's that their definition of patient care is very, very, very low. (as is a paramedic's, depending on the situation/location and who you are comparing them to) In all actuallity there is very little that an EMT can do for a patient to change their overall mortality and outcome from their current problem beyond driving them to a hospital; ie "higher medical care." Couple that with how little EMT's are actually taught about disease's, injuries, pathophysiology, anatomy and physiology and you should be able to start to see why their level of care is so low, and why their ultimate goal is to get the patient to someone who understands those things.

Leaving out the hyperbole about a very small subset of EMT's, then yes, there aren't that many decisions that the average EMT will make regarding the care of a patient. While there are still some to be made, as far as medical treatements and care go...not a lot of autonomy.

For the 3 groups that you mentioned...even they don't do much. And the vast majority of services that they do provide have much less to do with their training and education as an EMT than with whatever else they are required to know. Add in that it's not just EMT's that function is those roles and that many, many paramedics have to make decisions outside "their clean rigs" in very austere environments...invalid arguement.

In the grand scheme of medicine, EMT's do almost nothing of vital importance. (wether or not the average paramedic does is also debatable) It isn't a slam on EMT's or an insult...it's just being honest. Most EMT's don't make very critical decisions. Most EMT's don't have to make medically oriented decisions on their own. Most EMT's won't effect a patient's outcome. Sad but true.

If you really have been an EMT for 13 years, don't have a chip on your shoulder, have a decent understanding of what healthcare and medicine are and how they work, and understand what it is that EMS does, then none of this should be news...and it shouldn't be upsetting you.

 

[Veneficus]

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.

Why is this statement shocking to you?

Do you have a license or a certification? Can you practice without the authority of a medical control physician? Is that physician not ultimately responsible for the care you provide? Does that physician not exclusively determine what you can or cannot do? If your protocol dictates you must perform a specific intervention and you follow such, if harm comes to the patient from it are you held accountable or your physician medical director?

(i'll admit somebody might try to make you the scapegoat, but your defense is still going to be "I was following protocol.")

If you actually had patient care as the goal, EMTs and infact all of EMS would be demanding that educational standards meet the demands of today's medicine. As of this moment, the opposite is true.

If you actually had patient care as the goal there would be a demand of the rank and file to abandon harmful and useless practices and institute interventions that are beneficial in today's world.

Let's not pretend we are anywhere near that.

The EMT has 2 endpoints to patient care and both of them revolve around passing that patient off. Either to ALS or to a hospital.

What you tell girls or guys at parties is your business.

But the fact is anyone who can do compressions and follow the instructions on an AED can provide the scientifically proven life saving care EMT-Bs do.

I would expect a professional minded patient centered care provider would know every in and out of the values and limitations of their scope of practice and its interventions, am I wrong?

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

These environments and the specificities of them are not related to the EMT-B curriculum or scope.

The operational aspects and training are seperate from EMT-Bs. That is no different from firefighter/emt-bs, hazmat emt-bs, industrial medicine emt-bs, er techs with an emt-b cert and a list that goes on even outside of the austere environment.

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.

So what?

I don't have figures, but if I was a betting man, I would definately wager there are more paramedics functioning in austere environments specifically for their paramedic cert (aka medical cert) than EMT-Bs specifically for their EMT cert and not another specific knowledge or skill and being an EMT is just a bonus.

I dont really disagree with this statement, however it really isnt the EMTs fault. Most people when they go to school to be an EMT, assume they are taking on a lot of responsibility, that the school will be difficult and have high standards and that their decision making ability is crucial and will be put to the test.

The issue isn't about assigning blame. It doesn't matter who is to blame, it only matters the problem is fixed.

However, we must acknowledge the problem isn't being fixed because of special interests that would lose considerably if the system was changed who constantly fight to keep things the same.

There seems to be this notion that people who dont immediately go to Paramedic school are somehow stupid, or lazy, or just want the minimum standards, yet MOST paramedics didnt go right from EMT school to Paramedic school. Most worked as EMTs, sometimes for years, and many of them(the honest ones) will say that working as an EMT made Paramedic school less stressful and working as a brand new Paramedic less difficult..

I worked as an EMT for years and largely slept through medic school. I never suggested they were lazy, stupid, or otherwise.

I was even forced to become an EMT, were I not forced, I would not have gone to EMT school.

But I would relate that it was a different time. We knew less than we do now and back in the day, paramedics were so rare that an EMT was likely to be the only prehospital medical provider. But the decisions that were made were operational. Every patient got one of the same handful of treatmentswe had no matter what.

It is not that EMTs were never valuable, the world evolves, but EMTs are not evolving with it and they are making themselves obsolete by not demanding their vocation advance. They do not choose this on the individual level, they choose it at the organizational level.

The ones who say EMT experience makes no difference in Paramedic school are simply wrong. The pass rate for students with EMT experience is significantly higher than it is for those with no experience, and Ive personally seen those medics who did pass with no experience struggily mightily as brand new Paramedics, versus the ones with EMT experience who had a far smoother transition.

I am not always right. But I say with the job opportunities available to EMTs today, they may have a chance to gain experience that will be beneficial, but not only is it not guaranteed, they have a far better chance of having experience that actually harms them when in paramedic school.

I refute your assertion EMTs with experience have the highest pass rates in paramedic school. In my nearly 10 years of teaching EMS at multiple organizations, in the 2 organizations that kept records on the demographics of pass/fail, experienced EMTs were the group that failed the most. The group that not only passed but had the best grades were those with prior or concurrent university education.

In my observation, the reason experienced EMTs struggle with medic school is because 1. they think they know things they don't. 2. They have been taught incorrect information in the field. 3. As adult learners they are resistant to changing preconceived notions and most always never reconcile this. I have seen it so much that I can tell you if they are going to pass or fail usually within a couple of weeks with them. Now and again I am wrong about one of them, but not often.

Yes, new people struggle, whether it is a new nurse, new paramedic, or new doctor. However, the ones with more knowledge will often become more proficent providers faster because they gain more insight from every experience.

If you want to see for yourself, observe a new EMT with only EMT training. Compare this to observations of new EMTs with prior basic science or other healthcare education.

 

[JPINFV]

I dont really disagree with this statement, however it really isnt the EMTs fault.

I agree that it isn't the fault of new EMTs. Those with experience that make the choice to not work toward moving EMS from a technical trade to a profession, however, do share fault.

The ones who say EMT experience makes no difference in Paramedic school are simply wrong. The pass rate for students with EMT experience is significantly higher than it is for those with no experience, and Ive personally seen those medics who did pass with no experience struggily mightily as brand new Paramedics, versus the ones with EMT experience who had a far smoother transition.

...which is, at it's base, because of cruddy schools and cruddy instructors who treat the cruddy minimum somehow as a maximum. Minimum experience requirements are a band aid to an arterial bleed that needs to be sutured.

 

[Brandon O]

I was trying to figure out why I find these discussions so vexing, and I think it's this: despite everybody knowing exactly what's wrong with the world, it's still just talk. So we simply do it all again next month. We have these same back-and-forths around the crew room or the ambulance bay.

 

[triemal04]

I was trying to figure out why I find these discussions so vexing, and I think it's this: despite everybody knowing exactly what's wrong with the world, it's still just talk. So we simply do it all again next month. We have these same back-and-forths around the crew room or the ambulance bay.

Talk is cheap. Very, very cheap depending on the setting.

But...the more people that are talking about it and recognizing the problem, the better the odd's are that someone will actually start to act on it and try and improve things. The changes that were/are being adopted by NREMT (and thus some states), though quite small, are still a step in the right direction.

Of course, "better" is still a relative term were EMS is concerned.

 

[Wheel]

This discussion has been very interesting, and as a new medic who went straight through to medic without working as a basic here are my thoughts.

First, it helped that I was in school mode still, unlike my classmates who worked previously as emts. Second, it helped that I had taken a lot of basic science as a chemistry major before starting this. These things put me way ahead of my classmates in understanding physiology, drug reactions, nerve pathways in the heart, hemodynamics, and drug math, among other things. They were better at skills, for the most part, and we helped each other. What I can say, however, is that it was much easier for them to teach me patient packaging and movement than it was for me to teach them hemodynamics or even basic algebra. They just didn't have a good time understanding these things, which are essential in my opinion.

I am in my first job as a medic now, where I'm working double medic until they release me in six months or so to run my own truck (because I have no experience.) I admit that logistical and operational issues are a huge learning curve for me right now, and working as an emt would have made that much easier. I would argue that the science behind what we do is much more important for the future of ems and much harder to teach on the job than monkey skills and ambulance operations, and this is the direction than ems needs to go.

 

[Brandon O]

Talk is cheap. Very, very cheap depending on the setting.

But...the more people that are talking about it and recognizing the problem, the better the odd's are that someone will actually start to act on it and try and improve things. The changes that were/are being adopted by NREMT (and thus some states), though quite small, are still a step in the right direction.

Well, how about this for a step in the right direction? When an EMT comes onto a forum like this asking questions and trying to learn, rather than a dozen replies telling him to get a degree and opining about the state of EMS training (quickly spiraling into Yet Another Thread Like This), we just try to answer the questions?

Can we all commit to that? Or is that not as fun? I can't tell you how many times I was on the other side of that when I was starting out, and was utterly baffled by the contradictory nature of what I was hearing. The internet has massive potential as a tool for learning. How much can someone believe in improving the educational standards if they aren't willing to contribute?

 

[Veneficus]

Talk is cheap. Very, very cheap depending on the setting.

But...the more people that are talking about it and recognizing the problem, the better the odd's are that someone will actually start to act on it and try and improve things. The changes that were/are being adopted by NREMT (and thus some states), though quite small, are still a step in the right direction.

Of course, "better" is still a relative term were EMS is concerned.

Some of us have been trying to change things for a long time.

There have been more setbacks than victories though.

I think it is going to actually take the collapse of the US healthcare system (coming soon) in order to fix it.

When that happens, the fewer of the voacational minded people around the easier it will be.

Additionally, I think telling people to get a degree and then test into EMS will increase the number of people in EMS with a degree faster than hoping the ones already in without a degree will step up.

 

[VFlutter]

Well, how about this for a step in the right direction? When an EMT comes onto a forum like this asking questions and trying to learn, rather than a dozen replies telling him to get a degree and opining about the state of EMS training (quickly spiraling into Yet Another Thread Like This), we just try to answer the questions?

Can we all commit to that? Or is that not as fun? I can't tell you how many times I was on the other side of that when I was starting out, and was utterly baffled by the contradictory nature of what I was hearing. The internet has massive potential as a tool for learning. How much can someone believe in improving the educational standards if they aren't willing to contribute?

While I agree about not letting threads spiral into the reoccurring debates I do not think blindly answering every question posted on the forum will be a step in the right direction. There are constantly questions being asked that could easily be found in a decent patho book or with some research on the Internet. Serving up over simplified explanations to complex issues will not solve the problem. Most will never truly understand a lot of the concepts that are constantly asked about without first having the foundational (Bio,chem,patho,pharm) knowledge that EMS education lacks. So instead of encouraging people to pursue higher education we should just expect them to learn from this forum and apply that knowledge in the real world? Sounds counterproductive and dangerous.


Also, it is not nearly as fun. These debates cure my boredom

 

[triemal04]

Well, how about this for a step in the right direction? When an EMT comes onto a forum like this asking questions and trying to learn, rather than a dozen replies telling him to get a degree and opining about the state of EMS training (quickly spiraling into Yet Another Thread Like This), we just try to answer the questions?

Can we all commit to that? Or is that not as fun? I can't tell you how many times I was on the other side of that when I was starting out, and was utterly baffled by the contradictory nature of what I was hearing. The internet has massive potential as a tool for learning. How much can someone believe in improving the educational standards if they aren't willing to contribute?

I don't know, is that what happened in this thread? I'm not going to bother reading the whole thing so I don't know. In looking at the comment I specifically responded to, if the poster is actually here to ask questions and learn, then why are they immedietly getting defensive when a deficiency is pointed out? Instead of trying to understand why someone said something and figure out if the statement they reacted to is right...they got upset instead. Not very condusive to learning, and leads to the type of situation you're talking about.

 

[triemal04]

Some of us have been trying to change things for a long time.

There have been more setbacks than victories though.

I think it is going to actually take the collapse of the US healthcare system (coming soon) in order to fix it.

When that happens, the fewer of the voacational minded people around the easier it will be.

Additionally, I think telling people to get a degree and then test into EMS will increase the number of people in EMS with a degree faster than hoping the ones already in without a degree will step up.

And if nobody was even talking about it, where do you think things would be at? If nobody even mentioned bucking the status quo what would happen?

Whatever your view of where EMS is at and where it is/should be/could be going, changes have to start somewhere. And getting people aware of problems and solutions is better than nothing.

 

[Brandon O]

I don't know, is that what happened in this thread?

Not so much here, but it is incredibly common.

 

[Jambi]

And if nobody was even talking about it, where do you think things would be at? If nobody even mentioned bucking the status quo what would happen?

Whatever your view of where EMS is at and where it is/should be/could be going, changes have to start somewhere. And getting people aware of problems and solutions is better than nothing.

Change does not occur by consensus with these sorts of things. It's not a democratic process. Look up the Elite model of policy creation. That is what we, and the rest of EMS, are subjected to. Don't let cries of national associations and unions fool you. Once such organizations become large enough, they switch over to the elite model and policy creation, direction, etc., no longer becomes a function of the members except by way of mass-manipulation and pandering for support.

 

[triemal04]

Change does not occur by consensus with these sorts of things. It's not a democratic process. Look up the Elite model of policy creation. That is what we, and the rest of EMS, are subjected to. Don't let cries of national associations and unions fool you. Once such organizations become large enough, they switch over to the elite model and policy creation, direction, etc., no longer becomes a function of the members except by way of mass-manipulation and pandering for support.

Yeah? And? I never said anything about a consensus. It does not, and has not taken a majority of all EMS providers agreeing on something before change occurs.

It just takes a group that is willing to put in the effort and get's the right people to listen.

Is that the best way? There's benefits and drawbacks, but, realistically it's what happens and how the system works.

 

[Veneficus]

Yeah? And? I never said anything about a consensus. It does not, and has not taken a majority of all EMS providers agreeing on something before change occurs.

It just takes a group that is willing to put in the effort and get's the right people to listen.

Is that the best way? There's benefits and drawbacks, but, realistically it's what happens and how the system works.

I think the overall issue is that because of those with financial interest in keeping things in EMS how they are have both the money and political power to block any change or even attempt, the best we can hope to do is instill the better way in the mindset of providers so that when the resources to continue business as usual are gone, the new leadership will believe in a progressive solution.

 

[triemal04]

I think the overall issue is that because of those with financial interest in keeping things in EMS how they are have both the money and political power to block any change or even attempt, the best we can hope to do is instill the better way in the mindset of providers so that when the resources to continue business as usual are gone, the new leadership will believe in a progressive solution.

Maybe. If that was to happen now or in the next couple years, I don't think so. Ever heard "meet the new boss, same as the old boss?" If there was a sudden (by sudden I mean over the course of say 5 years) need to change how EMS was delivered and ran, the people who would be making those decisions and influencing them are the same that are doing so now. Would there be (depending on why change was suddenly needed) more opportunity for other, better informed and educated people to step up? Sure. But there really aren't that many groups or even individuals who are both moving towards the type of system I think you'd want or what I want AND are allready in a position of influence. Even if the national gov't suddenly took an interest in reforming EMS, the initial people they'd be consulting would be the ones making decisions and policy now. While there'd be opportunity, it wouldn't be the easy deal you make it sound like.

Gettting people better informed and maybe active in trying for change or seeking leadership goals is part of why simply talking about an issue can help. It's just can be a slow process. But, like I said above, all it takes is a group getting together and being able to touch the right people...then you start getting people who can influence policy.