The practicality of EMT Basics as an emergecy responder

[NYMedic828]

I would just like to point out that there are places in rural US that are still entirely bls volunteer ambulance services. I would like to use covelo, ca as an example: it is an hour and a half drive to the nearest town from there let alone to the nearest hospital and als ambulance. The folks up there are mostly dope growers and natives. Handfuls of ambulance companies have looked at staffing that town but no one will touch it because its so secluded. They usually rely on air transport if the weather is nice other than that hour plus als rendezvous. Now, doing away with the emt-b cert entirely would mean the FD would have to figure out a way to motivate their volunteers into taking expensive classes that are hours away and all for something that they get no financial reimbersment for in the first place. Covelo is lucky to even have the service they have right now and forcing bls out of the picure would just elimate healthcare there entirely. Just saying something to think about.

Or as Vene stated, just have two untrained regular joes drive them to the hospital. They can still be volunteer fireman they don't need EMS training.

For an hour and a half ride what is an EMT going to do other than take vitals 100 times and give O2 which probably isn't even indicated for the condition let alone the length of time it would be on the patient for. Even if the patient degraded enroute an EMT can still only provide CPR and ventilate which is a futile effort that far from a hospital and CPR training is widespread and far less costly than EMT b.

 

[TransportJockey]

I would just like to point out that there are places in rural US that are still entirely bls volunteer ambulance services. I would like to use covelo, ca as an example: it is an hour and a half drive to the nearest town from there let alone to the nearest hospital and als ambulance. The folks up there are mostly dope growers and natives. Handfuls of ambulance companies have looked at staffing that town but no one will touch it because its so secluded. They usually rely on air transport if the weather is nice other than that hour plus als rendezvous. Now, doing away with the emt-b cert entirely would mean the FD would have to figure out a way to motivate their volunteers into taking expensive classes that are hours away and all for something that they get no financial reimbersment for in the first place. Covelo is lucky to even have the service they have right now and forcing bls out of the picure would just elimate healthcare there entirely. Just saying something to think about.

There are areas here in NM that manage coverage for areas like that at the ALS level. Texas had areas like that with ALS coverage too. So I'm not seeing the problem. It's just an issue with looking at it as a county wide thing rather than one podunk town seperate from the county

 

[Jambi]

Now, doing away with the emt-b cert entirely would mean the FD would have to figure out a way to motivate their volunteers into taking expensive classes that are hours away and all for something that they get no financial reimbersment for in the first place. Covelo is lucky to even have the service they have right now and forcing bls out of the picure would just elimate healthcare there entirely. Just saying something to think about.

This notion discounts distance education with periodic travel for in-class instruction and skill competency practice. Delivering AEMT would be trivial with this method and the associated cost would be far lower than that fancy piece of apparatus that gets washed, waxed, and polished far more often than it goes on medical aids.

 

[Veneficus]

I would just like to point out that there are places in rural US that are still entirely bls volunteer ambulance services.

I think there is an important discussion here so I will spin it off as another thread.

 

[Brandon O]

The only part of EMt-B training applicable is the ability to take a set of vitals.

I would give up the ability to take vital signs (i.e. the numbers -- not the overall physical exam) before I'd give up many other portions of my assessment.

 

[hogwiley]

Or as Vene stated, just have two untrained regular joes drive them to the hospital. They can still be volunteer fireman they don't need EMS training.

For an hour and a half ride what is an EMT going to do other than take vitals 100 times and give O2 which probably isn't even indicated for the condition let alone the length of time it would be on the patient for. Even if the patient degraded enroute an EMT can still only provide CPR and ventilate which is a futile effort that far from a hospital and CPR training is widespread and far less costly than EMT b.

Ok, so now the argument has gone from EMTs dont have enough training, to EMTs have too much expensive time consuming training? Well which is it.

You basically made the same friggin argument that I did, that it doesnt take a PHD to drive an ambulance, so whats the point in having 2 medics on every 911 call, or delaying transport substantially because you insist on every responder and ambulance driver being a Paramedic.

 

[Veneficus]

I would give up the ability to take vital signs (i.e. the numbers -- not the overall physical exam) before I'd give up many other portions of my assessment.

Have you taken an actual pathophys class yet?

 

[Veneficus]

Ok, so now the argument has gone from EMTs dont have enough training, to EMTs have too much expensive time consuming training? Well which is it.

You basically made the same friggin argument that I did, that it doesnt take a PHD to drive an ambulance, so whats the point in having 2 medics on every 911 call, or delaying transport substantially because you insist on every responder and ambulance driver being a Paramedic.

A bit of both I think.

They don't have enough training to really be effective, they have too much for what they are actually doing.

 

[NYMedic828]

Ok, so now the argument has gone from EMTs dont have enough training, to EMTs have too much expensive time consuming training? Well which is it.

You basically made the same friggin argument that I did, that it doesnt take a PHD to drive an ambulance, so whats the point in having 2 medics on every 911 call, or delaying transport substantially because you insist on every responder and ambulance driver being a Paramedic.

Because you should either do things properly and have a capable provider on the ambulance to provide actual emergency care or you should have an untrained taxi driver at minimum wage.

This in-between thing is getting old, costly, and pointless.

And for the record, you aren't delaying transport if the initial ambulance is already ALS... don't have to wait for anyone...

 

[mycrofft]

So we need the ability to have paramedics or higher available in case, but EMT-B's are more efficient and prevalent.
Welcome to the crux of the issue in emergency preparedness; how can you balance preparing for the maximum foreseeable need versus the everyday?
I still think the paradigm of a federal or state service providing this makes more sense. People would be rotated in and out of backwaters where some of their skills would atrophy and in and out of inner city areas where their skills could be challenged more in other aspects. Maybe four years service like that, then earning higher rank/education get a more-permanent assignment...sort of like the military used to be. Heck, give them a GI Bill of sorts. And employ veterans preferentially.

 

[mycrofft]

So we need the ability to have paramedics or higher available in case, but EMT-B's are more efficient and prevalent.

Welcome to the crux of the issue in emergency preparedness; how can you balance preparing for the maximum foreseeable need versus the everyday?

I still think the paradigm of a federal or state service providing this makes more sense. People would be rotated in and out of backwaters where some of their skills would atrophy and in and out of inner city areas where their skills could be challenged more in other aspects. Maybe four years service like that, then earning higher rank/education get a more-permanent assignment...sort of like the military used to be. Heck, give them a GI Bill of sorts. And employ veterans preferentially.

 

[Brandon O]

Have you taken an actual pathophys class yet?

Have you practiced the bassoon today? Why are we getting personal here?

 

[Veneficus]

So we need the ability to have paramedics or higher available in case, but EMT-B's are more efficient and prevalent.

Welcome to the crux of the issue in emergency preparedness; how can you balance preparing for the maximum foreseeable need versus the everyday?

I still think the paradigm of a federal or state service providing this makes more sense. People would be rotated in and out of backwaters where some of their skills would atrophy and in and out of inner city areas where their skills could be challenged more in other aspects..

This type of system set up is already employed and works well.

Where I have seen it, there is no way to get out of the rotation.

After a while, there would be a bottleneck of senior guys in prefered positions while the younger ones were getting burned out in the less desirable ones.

Everyone rotates, no exceptions, is the best way I think.

 

[18G]

I have thought for a long time that EMT-Basic should not be allowed to be a primary care provider on an ambulance. The skill set and knowledge is too limited for what is needed and expected today.

While I would like to see the current Paramedic level become the minimum required, I know that will likely never happen on a national level. AEMT from what I have seen is many times better than EMT-Basic. The AEMT has the ability to directly intervene and improve a patients condition and symptoms.

 

[TransportJockey]

I have thought for a long time that EMT-Basic should not be allowed to be a primary care provider on an ambulance. The skill set and knowledge is too limited for what is needed and expected today.

While I would like to see the current Paramedic level become the minimum required, I know that will likely never happen on a national level. AEMT from what I have seen is many times better than EMT-Basic. The AEMT has the ability to directly intervene and improve a patients condition and symptoms.

Sorta like how Georgia seems to be... To work on An ambulance most services require minimum of AEMT. Basics have no business being primary on a truck. I fully agree with you. But then again I also think that Oregon has the right idea with a mandatory AAS minimum for medics. Rumor has it NM is going that way soon

 

[mycrofft]

Canada's first aid laws take distance to/from urban settings as a factor. DO their EMS laws also do that?

 

[hogwiley]

I have thought for a long time that EMT-Basic should not be allowed to be a primary care provider on an ambulance. The skill set and knowledge is too limited for what is needed and expected today.

While I would like to see the current Paramedic level become the minimum required, I know that will likely never happen on a national level. AEMT from what I have seen is many times better than EMT-Basic. The AEMT has the ability to directly intervene and improve a patients condition and symptoms.

This seems reasonable to me, but it seems like EMT specialists are a dying breed. Not sure why, but very few(if any) schools offer this type of training any more.

EMT-I's are kind of the LPNs of EMS. Hospitals prefer to just have RNs aided by CNAs, just as most EMS agencies have Paramedics partnered with Basics. I dont see CNAs being done away with any time soon, and I dont see EMT Basics disappearing. If anything is going to disappear itll be the LPNs and the EMT-I/AEMT because they cant do all the things RNs/Paramedics do, but their training is still fairly time consuming and expensive, making them cost prohibitive as just assistants or ambulance drivers.

 

[Rialaigh]

This seems reasonable to me, but it seems like EMT specialists are a dying breed. Not sure why, but very few(if any) schools offer this type of training any more.

EMT-I's are kind of the LPNs of EMS. Hospitals prefer to just have RNs aided by CNAs, just as most EMS agencies have Paramedics partnered with Basics. I dont see CNAs being done away with any time soon, and I dont see EMT Basics disappearing. If anything is going to disappear itll be the LPNs and the EMT-I/AEMT because they cant do all the things RNs/Paramedics do, but their training is still fairly time consuming and expensive, making them cost prohibitive as just assistants or ambulance drivers.

This. I see no need to have an EMT-I or an AEMT. Frankly if I code or one of my family members crashes I want someone who is trained to at least a medic level showing up.....no need to dumb down an undertrained (in general) even more.

It basically boils down to...if a person doesn't want to give up 18 months to go to class do we really want them to be the highest common pre-hospital care you will be receiving....it's kind of a joke..

I see a place for EMT-B and frankly wish they would make IV access a basic skill so that while the medic is trying to get a feel for the patients injuries the basic can start towards the single most important thing on critical calls which most of the time is going to be IV access...if basics stayed exactly the same but could gain IV access they would be so much more useful.

 

[Veneficus]

This. I see no need to have an EMT-I or an AEMT. Frankly if I code or one of my family members crashes I want someone who is trained to at least a medic level showing up.....no need to dumb down an undertrained (in general) even more.

I'd rather have a bystander with an AED who will perform cpr.

I see a place for EMT-B and frankly wish they would make IV access a basic skill so that while the medic is trying to get a feel for the patients injuries the basic can start towards the single most important thing on critical calls which most of the time is going to be IV access...if basics stayed exactly the same but could gain IV access they would be so much more useful.

I am very proud of my IV skills, but to call it the single most important thing I would say is severely overstating it's value.

 

[Rialaigh]

I'd rather have a bystander with an AED who will perform cpr.



I am very proud of my IV skills, but to call it the single most important thing I would say is severely overstating it's value.

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


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

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). 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.


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.