The practicality of EMT Basics as an emergecy responder

[mycrofft]

A true H&P, not the stripped down version, is not taught to BLS personnel. That is the root of so many incidents, one does not know what one does not know unless someone else tells you, or you drive a patient right over the cliff then have to figure out why things went west, maybe at a coroner's inquest or a Grand Jury.

 

[EpiEMS]

Wouldn't teaching a complete version of H&P to BLS providers require a background in biology and chemistry?

 

[mycrofft]

No, although it wouldn't hurt. Anatomy and Physiology and Physical Exam are needed, plus some special work in recognition of common and uncommon complaints...such as a year working in a primary care or family practice clinic with a bunch of shifts in an ED. A week or two in Ortho, Cardio, Pulmo, etc would not be amiss either.

 

[Brandon O]

A true H&P, not the stripped down version, is not taught to BLS personnel.

I agree that it is often not taught. But strictly speaking, that doesn't mean it's not BLS. To me, BLS involves the fundamentals of assessment, diagnosis, decision-making, and life support. They're essential at all levels of care and we should all strive to master them. With that attitude, ALS becomes BLS plus more interventions and some additional diagnostics. I think these can be useful for palliation (if they're actually used), useful or even essential for patient management in rare to very rare cases, and in certain situations (i.e. early STEMI detection and diversion/activation) beneficial to course of care. But just as often they stand in the way of the BLS that ought to be happening.

In most emergencies that I can imagine myself dialing three digits for, I'd want someone to show up who will do extremely good BLS, perhaps with some pain management or other palliative care on top. I don't care what their initialism is.

 

[Brandon O]

Wouldn't teaching a complete version of H&P to BLS providers require a background in biology and chemistry?

Well, I'm not sure what "complete" would be; most docs spend a lifetime learning it. I suppose my point is just that, although I recognize the practicalities, I'm saddened when I see that we need to invoke ALS units just to get competent clinical assessment. That's BLS, and should be bread and butter for all of us; we should all be drinking the same water and reading from the same graven stones. Then some of us should go away and learn additional useful psychomotor skills to be paramedics.

But that's just me.

 

[mycrofft]

"I agree that it is often not taught."
I'd say it is never taught to BLS. I spent a semester each in A,P and PEx, and none concurrent.

 

[Undaedalus]

If the topic is whether the buck EMTB as it exists today is still a relevant provider, my response would have to be in the negative. There is just not enough of a rigorous didactic component to Basic education to allow much clinical evaluation beyond: not breathing equals bad. This issue, in my opinion, can be ameliorated by a more comprehensive and fundamental education with an accordantly increased scope to these providers.

If the question is whether there is a need for providers certified below the paramedic level, then I would have to argue in the affirmative, though I'm not sure anyone here is arguing this point.. There absolutely exist arguments against skill dilution, and the cost-efficacy of high level care in remote areas that necessitate a lower level of certification below that of the paramedic. Personally, I think a more skilled Basic provider would make mixed rigs more effective and increase the usefulness of BLS ambulances beyond the status they hold today.

Not to beat a dead horse here, but, the reason the Basic is going the way of the dodo is that even though it's BLS skills that form the foundations of ALS care, the education needed to properly and prudently apply them is lacking. Educating the first tier beyond near-mandatory O2 administration, and fear-based long spine boarding, as examples, is the first step towards more relevant and efficient EMS systems in the US. Furthermore, (in my opinion!) the bare bones EMTB is the biggest drag on EMS salaries out there. As long as there are undereducated and underskilled Basics hiding under every rock, whose primary role in the field is to determine whether or not they need to summon someone else, pay will remain low.

 

[Veneficus]

I find it peculiar that you'd say, Vene: "As our knowledge and technology advanced, the 'basic' levels of assessment and intervention have largely become obsolete" -- given your belief in and advocacy for the traditional clinical H&P.

Which, strictly speaking, is within the BLS scope of practice.

Within scope, yes.

Commonly taught or practiced?

No.

How many basics really listen to heart tones?

How many actually perform superficial and deep palpation of the abd.?

How about take a temperature?

Yes, I advocate history and physical, but if has to actually be done to be useful.

Look at the amount of posts in this thread referring to "in my protocol."

 

[Brandon O]

If the topic is whether the buck EMTB as it exists today is still a relevant provider, my response would have to be in the negative. There is just not enough of a rigorous didactic component to Basic education to allow much clinical evaluation beyond: not breathing equals bad. This issue, in my opinion, can be ameliorated by a more comprehensive and fundamental education with an accordantly increased scope to these providers.

If the question is whether there is a need for providers certified below the paramedic level, then I would have to argue in the affirmative, though I'm not sure anyone here is arguing this point.. There absolutely exist arguments against skill dilution, and the cost-efficacy of high level care in remote areas that necessitate a lower level of certification below that of the paramedic. Personally, I think a more skilled Basic provider would make mixed rigs more effective and increase the usefulness of BLS ambulances beyond the status they hold today.

Not to beat a dead horse here, but, the reason the Basic is going the way of the dodo is that even though it's BLS skills that form the foundations of ALS care, the education needed to properly and prudently apply them is lacking. Educating the first tier beyond near-mandatory O2 administration, and fear-based long spine boarding, as examples, is the first step towards more relevant and efficient EMS systems in the US. Furthermore, (in my opinion!) the bare bones EMTB is the biggest drag on EMS salaries out there. As long as there are undereducated and underskilled Basics hiding under every rock, whose primary role in the field is to determine whether or not they need to summon someone else, pay will remain low.

Very well said.

 

[EpiEMS]

Within scope, yes.

Commonly taught or practiced?

No.

How many basics really listen to heart tones?

How many actually perform superficial and deep palpation of the abd.?

How about take a temperature?

Yes, I advocate history and physical, but if has to actually be done to be useful.

Look at the amount of posts in this thread referring to "in my protocol."

Maybe the protocol-type arrangement is the problem. If everybody in EMS operated under independent licenses like in progressive systems (Canada, Australia, UK, etc.), we could avoid this -- the "College of Paramedics of the United States," say, would be able to come up with scope and such.

 

[emtevan]

ive had many discussions about this and i dont care what people say emt-b's are very helpful and DO save lives.ive saved many and helped many people.Most calls are BLS anyways and it only becomes ALS because they put ekg's on people and give iv's.it's all how u use it and how good u are.Basics are just as good.

 

[VFlutter]

ive had many discussions about this and i dont care what people say emt-b's are very helpful and DO save lives.ive saved many and helped many people.Most calls are BLS anyways and it only becomes ALS because they put ekg's on people and give iv's.it's all how u use it and how good u are.Basics are just as good.

:rofl::rofl::rofl:

 

[RocketMedic]

ive had many discussions about this and i dont care what people say emt-b's are very helpful and DO save lives.ive saved many and helped many people.Most calls are BLS anyways and it only becomes ALS because they put ekg's on people and give iv's.it's all how u use it and how good u are.Basics are just as good.

What is the BLS fix for anaphylaxis? What about something like a near-total airway obstruction resistant to the Heimlich? What about seizures? What about pain relief or nausea?

Still, attitudes like this are (I think) the product of a UK-like system where the scopes of practice between paramedics and EMTs are narrowed.

 

[abckidsmom]

What is the BLS fix for anaphylaxis? What about something like a near-total airway obstruction resistant to the Heimlich? What about seizures? What about pain relief or nausea?

Still, attitudes like this are (I think) the product of a UK-like system where the scopes of practice between paramedics and EMTs are narrowed.

In my experience, attitudes like this are results of EMT instructors with unreasonable views of BLS care who spend the whole entire 100 hours telling the people what lifesavers they are about to become instead of telling them that they are firmly and officially at the jumping off point.

 

[RocketMedic]

Maybe the protocol-type arrangement is the problem. If everybody in EMS operated under independent licenses like in progressive systems (Canada, Australia, UK, etc.), we could avoid this -- the "College of Paramedics of the United States," say, would be able to come up with scope and such.

Then again, look at the differences in a UK paramedic to a US paramedic to a Canadian or AUS/NZ medic. Everything I've ever heard about UK medics is that they are closer in scope of practice to American EMT-I/85 or a military medic with less emphasis on cardiology and pain palliation than American medics.

AUS/CAN/NZ medics are, in my opinion, where American paramedics should push our education base and scope of practice to.

In my opinion, a 2-year associate's degree with EMT-Advanced should replace EMT-Basics entirely (yes, even in rural areas), with a 4-year Bachelor's equivalent for Paramedics.

This, of course, would predicate a significant wage increase for EMS in general and Paramedics in particular.

 

[RocketMedic]

In my experience, attitudes like this are results of EMT instructors with unreasonable views of BLS care who spend the whole entire 100 hours telling the people what lifesavers they are about to become instead of telling them that they are firmly and officially at the jumping off point.

Many of those are medic mills who are financially vested in delusions and "education", not real education. See the watered-down card courses, OSHA/JHACO-mandated "everyone certifies" and EMT-B as textbook results.

 

[Bullets]

What is the BLS fix for anaphylaxis? What about something like a near-total airway obstruction resistant to the Heimlich? What about seizures? What about pain relief or nausea?

Still, attitudes like this are (I think) the product of a UK-like system where the scopes of practice between paramedics and EMTs are narrowed.

Whats the ALS fix for Stroke? Cadiac Arrest? Bleeding?

 

[RocketMedic]

Whats the ALS fix for Stroke? Cadiac Arrest? Bleeding?

Rapid transport to a facility with true definitive care, not "community hospital X".

Definitive care for cardiac arrest is changing every day, but I'd bet it ends up being ALS and BLS combined with insane amounts of luck.

 

[abckidsmom]

Whats the ALS fix for Stroke? Cadiac Arrest? Bleeding?

• ACLS, airway management, treatment of hypoglycemia if indicated
• ACLS, post-resuscitation care as needed
• control bleeding, monitoring for complications, tourniquet placement if needed

There are no fixes, but there are plenty of things on the to-do list. Also, I find that the hospital takes informed pre-alerts more seriously. How many BLS providers do you know who've transported an MI straight to the cath lab, or a CVA right to the CT scanner?

 

[VFlutter]

Whats the ALS fix for Stroke? Cadiac Arrest? Bleeding?

Stroke is really the only one of the three that you can argue there is no prehospital treatment (let's just say bleeds not clots). But the presence of situations in which there is no meaningful treatment is not an argument for the value of EMT Basics. There are a lot more common situations in which basics are worthless than there are situations in which paramedics can do nothing. I don't really see your arguememt?