Those who persevere

[Jay114]

Just sitting in class the other night and wondered how many of the 36 folks in my class will end up having a career in EMS for say, 3 years. Or 5 years, 10, 20?
Anyone have any knowledge or ideas on statistically what percentage of those who take an -B course stay in the field...thanks in advance

 

[Guardian]

I don't know but would guess the % is very small. IMO, Emt-basic is like a really great first aid class. Many people take the class who aren't really sure whether they want to do ems or just want the training. I think that's great and love that there are so many "sleepers" around to help before our arrival.

 

[Raf]

There are plenty of people who stay as basics for their terminal career. Most bascis I have met however, plan or want to go to medic school. A small percentage actually set aside the money and/or take the time commitment for it though.

 

[firecoins]

going through A&P I right now in prep for medic class. But I have thoughts of other careers in medicine that pay more. If I am going to go through the trouble of becoming a medic, I could easily become a nurse or PA and make a ton of more money.

I am still going to be a medic. But I have the options and backround now.

 

[Ridryder911]

A few years ago American Ambulance Association and NAEMT, did an informal study and the general length of time for Paramedics in the field after completion of Paramedic school was about 5-7 years, and Basics was about 8-10 yrs.

R/r 911

 

[Jay114]

Thanks for the responses!

 

[rdnkmom]

i am currently and LVN taking the EMT B class. I finish in a couple of weeks. I plan on being in the field for a while. I eventually want to become a flight nurse, but IMO, every nurse should be and EMT first. I have learned so much more through this class that they don't teach you in nursing school.

 

[Ridryder911]

Why should a nurse take a first aid class? Sorry, until you have finished your LVN course do not make assumptions. As well, just curious why choose an LVN course if you are considering being a flight nurse? Considering, that to be a flight nurse one usually needs > 5 yrs critical care and emergency department experience as a RN.

 

[rgnoon]

We were told tonight in class that the average "life-span" of an EMT-B in NJ was Three years. Now I have no idea of how this figure is affected by EMT-Bs going on through further training, but this figure seemed a bit low to me. Just some food for thought.

 

[oldschoolmedic]

Rid if you look closer I believe rdnkmom IS an lvn currently. A simple typo she made is misleading.

She typed, " i am currently and LVN taking the EMT B class" when I believe she meant," I am currently an LVN taking the EMT B class"

This topic has once again devolved into the "emts are dirt, and all other healthcare workers mock us because we are big stoopidheads" versus the "we are so smart doctors should thank us for treating their patients, and nurses are really big stoopidheads." Can't we all just agree to disagree?

True, we need a better educational system as far as EMS goes, but not every emt or medic out there is without an education. I hold two college degrees, big whoop. They are helpful when I watch Jeopardy. My boss is always after me to go and finish my nursing degree. Don't want it, simple as that, plus I can't afford a paycut to become a new nurse.

Change is coming slowly. Remember EMS as a career is only about 200 years younger than the fire service and even younger than law enforcement. We will get there we just have to be patient.

I see the next progression being licensure for medics, intermediate becoming the first tier of service, then paramedics becoming public health officers doing sutures for minor lacs, treating minor injury and releasing, etc...

Oh and before anyone starts on how hard suturing is, trust me if I can learn to sew someone up in the field, anyone can. Thank you Uncle Sam.

 

[Alexakat]

Rid if you look closer I believe rdnkmom IS an lvn currently. A simple typo she made is misleading.

She typed, " i am currently and LVN taking the EMT B class" when I believe she meant," I am currently an LVN taking the EMT B class"

This topic has once again devolved into the "emts are dirt, and all other healthcare workers mock us because we are big stoopidheads" versus the "we are so smart doctors should thank us for treating their patients, and nurses are really big stoopidheads." Can't we all just agree to disagree?

True, we need a better educational system as far as EMS goes, but not every emt or medic out there is without an education. I hold two college degrees, big whoop. They are helpful when I watch Jeopardy. My boss is always after me to go and finish my nursing degree. Don't want it, simple as that, plus I can't afford a paycut to become a new nurse.

Change is coming slowly. Remember EMS as a career is only about 200 years younger than the fire service and even younger than law enforcement. We will get there we just have to be patient.

I see the next progression being licensure for medics, intermediate becoming the first tier of service, then paramedics becoming public health officers doing sutures for minor lacs, treating minor injury and releasing, etc...

Oh and before anyone starts on how hard suturing is, trust me if I can learn to sew someone up in the field, anyone can. Thank you Uncle Sam.

Well said Oldschoolmedic! BRAVO! My opinion on why a nurse would want to take a "first aid class" (& I do not like this term because I feel as though I am more valuable on the truck than a yahoo who puts on band-aids) if they want to pursue a career as a flight medic? Because the average hospital-based clinician does not understand the rigors (& hazards) of working in the field.

I'd venture to say that many nurses have no clue what to do in an emergency. I've seen it...our Rapid Response Team is called to a deteriorating patient (or code) in the hospital & the RNs are standing around with a deer-in-the-headlights gaze while the team (usually consisting of prior EMS people) works the patient.

And Oldschoolmedic, you are right...just because we're EMT-Bs, doesn't mean we're out there w/o an education. I will finish my masters degree next year (yes, even though I'm an EMT-B)...I know I have the brains, perseverance & commitment to continue on with my EMS education. I just don't want to be one of those medics who goes straight through B to P without any field time b/c those individuals don't seem as comfortable out on the streets as someone who went through the program more gradually (ie. a year or 2 as a B, then the next level, etc.)

Sorry...I've been kind of quiet since I've been a member of this forum watching these posts go up & I just had to say something here.

Again, BRAVO, Oldschoolmedic...

 

[Ridryder911]

I don't care if you have a PhD, graduate or an GED. The basic EMT course is only based upon an 120 hour course. This is just a few hours above the American Red Cross Advanced First Aid course. Sorry, but really what treatment does the Basic EMT really perform? This is not an insult, rather facts.

Now, before all get ruffled up, (as those that do not understand medical versus first responses classes) understand it is the role of the EMT that needs to be changed. Since the removal of majority of anatomy and physiology has now been removed from the curriculum, as well as majority of medical science, the role needs to fit the current curriculum. This is where the EMT role should be strictly as the first responder.

Review the current and even the proposed curriculum's. Patient assessment is usually one chapter in length. This is less than one hundred pages in length. Now, realistically how much information can be given and then understood from that, then this was written at junior high level.

Sorry, EMS has now been around nearly fifty years. Unfortunately, we are now retrograding backwards. At least, we all have agreed in the curriculum committee, the EMT level is very lacking

Now in response to the original post, as a LVN suggesting obtaining an EMT would be a personal choice. Not practical for in hospital use, and as well the anatomy portion, medication(s), professional standards in the LVN course is about four times more in depth than the Basic level. Remember, LVN is a one full year calendar course, not 120 hours.

You are probably right, most nurses do not know what to do in codes and emergencies. Just as majority of EMT's know nothing of psychiatric, social, medical surgical drainage, and procedures... apples versus oranges. Remember, majority of nurses do not want or plan to ever work in critical care or emergency environment. Really, there is more than emergency and critical care in medicine. Ironically, believe it or not, ER and ICU is not considered the "hot" place to work in, rather kinda looked down upon.

It is ironic we have so many so called experts in EMS that attempts to make comparisons in the medical field, when they have yet never been exposed to the work environment past the ER doors. This would be like me making comparisons of a CPA and bookkeepers. Not really understanding the profession.

In regards to flightnurse/paramedic, as a former one and instructor for a very large corporation that taught that profession, I can assure you I am quite aware of what is required and not. The competition is very high. Less than 1% ever make the transition and then very few can make the adjustments afterwards, because it is not the "glorious" job they assumed. This includes medics as well.

If one really wants to enter that profession, I would suggest to review the general requirements ASAP and work upon those and definitely not waste time on the "non-required". RN's are required to have ICU, ER and even neonatal experience. Remember, they want the one's with most experience and certifications. The same as Paramedics. They don't care how long you were a basic. The requirement is a Paramedic, and then preferred Critical Care Paramedic experience, with experience in transporting critical care and of course experience in a active progressive EMS. Again, those with the most "CCP" experience.


R/r 911

 

[BossyCow]

Well said Rid. I do understand your point of view and there's a lot in there I agree with. But here's my perspective:

I don't need to be considered more proficient at a task than someone else in order to see value in what I do, or to take pride in my skills. We've all seen the off duty floor nurse who freaks out on an emergency scene, that doesn't mean I know more than he/she does about emergencies in the field, just means I have more experience in dealing with them.

I think one distinction that needs to be made between our professions is the level of control in the environment. ER staff works in a clean (comparatively), well lit, and well ordered (generally speaking) environment. We do what we do, often on the side of the road, in the middle of the night, often with chaos surrounding us. We can be dealing with hazards and challenges of a small, filthy residence with 7 tiny dogs yapping at our heels.

Personally I find great value in what we do. I am proud of my role as an EMT-B (soon to be EMT-I if my schedule works out) Because of where I live and the economic realities of the rural community that is my home, I am not going to see 24/7 ALS available for many years to come. I am going to have to deal with a minimum 20 minute transport time to my local ED. I am going to work with the barely trained, breaking in new EMT's as fast as the older ones burn out or leave for a system that has more 'excitement'.

The establishment of a heirarchy in EMS is already there as near as I can tell. There is a very clear level of education, certification and licensure that documents who knows more than who else. I have found in most cases, those with a higher level of experience or education have always been willing to explain calls, treatments, outcomes, diagnoses and protocols to me. I have been able to expand my knowledge as deeply as I am willing to invest time and effort. I have taken A&P, Medical Terminology, Pharmacology (okay, that one I had to audit and only got in because the Instructor's kids were in swimming lessons with mine).

My point is, our education can be self directed and motivated. Just because there is a minimum educational requirement for becoming an EMT-B doesn't mean we stop learning when the ink is on the credential. I agree that it would be wonderful, in a perfect world if we all had R.N.'s with additional training in PHTLS and ACLS. It would be lovely to have the training for in field experience equal that of the ED staff.

But, in the meantime, when two log trucks do a head on at 50MPH on a lonely country road, when the ATV flips someone a$$-over-teakettle, 2 miles into the backcountry, under the powerlines and in deeply forested hillside, when my neighbor has an MI, when the kid down the road goes into anaphylactic shock, I'm not going to expect the government to be responsible to make everything okay. I'm going to roll up my sleeves, put on my gloves, and stand shoulder to shoulder with my neighbors at the scene of the emergency and we're going to do our level best to minimize the danger and to get the patient(s) to those who can help them.

This is valuable. This is a skill. This is a role to be proud of and not just a temporary fix until something better comes along.

 

[Ridryder911]

Definitely agree. That is why I am in the field setting instead of the ED as a full time, it by my choice and yes, I can say I have been called crazy more than once for returning back to the field setting.

The way I look at it is that health care is like a jig saw puzzle. Each division is piece or part of that puzzle. Some pieces may be larger than others, but still without that single piece it is not a whole picture.

That is why I laugh, when EMT's, medics, describe themselves as being the EMS. In reality, we are only a part of EMS, albeit an important part, just a part. Surgery, trauma and ICU services, even rehab is just as an important part.

Again, it is not the EMT that is the problem rather the role that is expected with the current training/education or lack of. Medicine has increased and with it expectations and understanding of general medical care. Unfortunately, the EMT curriculum did not follow the same path and upkeep and progression. I am not being critical on the Basic alone, the Paramedic level as well is far behind the same expectation level. The difference is though, the Paramedic is required to obtain additional educational courses such as ACLS, PHTLS/ITLS to at least expose and upkeep current trends.

As I noted after reviewing the new curriculum, I was one of the first to criticize the Paramedic's portion as well. Yes, additional notations was made, but still lacking. The old philosophy of .."you don't need to know that"... has always been stated by those that did not know "that". I have as of yet, seen any thing and describing, .. Wow! I wish I was more ignorant on this or I wasted my time learning that!... Field medicine, really should be considered a speciality. Instead of making excuses of "not knowing", in reality, we need to know prehospital and in-hospital as well. Since medical patients are now routinely premature discharged, and more in-home treatments are now being routinely performed, the old adage of "field medicine only" is no longer valid. EMS personnel has to be abreast not only in out of hospital but in-hospital treatments as well.( i.e chemotherapy treatments, at home vents, IV antibiotic therapy infused through central lines.) We are the only health care professional that perform broad care that do not have a "general medical knowledge" before specializing. That is why, others in medical care do not understand EMS role. Yes, you might be able to run a code, but cannot read a thermometer or describe the importance of BUN, which is basic medicine.

I agree the ED maybe more a controlled environment, (although that can be debatable at times ) one needs to remember, There are stressors everywhere. True, in different forms, but still stressors. Instead of the "yapping dog, the ill lit room, or possible assailant; one may have a surgeon that is yelling and screaming about .... "lab's being late!"..or the "wrong size trochanter or wrong scalpel blade!".. and at teh same time the three other patients that want to go to the bathroom, t.v. channel needs to be changed or the IV pump is going off. Now, you are still stuck with that critical patient (after EMS has left) and there are no ICU beeds to receive that patient. Each person that provides care, has some level of stressors in their work environment.

Personally, I rather enjoy the stressors of the field. Maybe, because it is like home to me, but the more the better. This is what I was educated to do and perform, as well the challenge of the job.

Again, most of the time I have read my interpretation as "slamming EMT's": rather quite the opposite is true. I much rather see the role be defined for the current level of training that they receive. That is as a first responder role; to initially stabilize and assess the patient. Then after arriving EMS (ALS) unit arrives, to assist as directed.

It is foolish to expect someone to be comfortable or perform transport on a patient on ventilator with a trach tube, with a triple lumen at home, that is septic has now developed pericarditis and having chest pain. It is not fair for the patient nor the EMT.

Many may claim, that it would be too "radical" to change. I ask those from Canada to describe how it changed within their system and did so in a very short time. So yes, it can be done and be done successfully.

Something to think about...

R/r 911

 

[Jay114]

Again, most of the time I have read my interpretation as "slamming EMT's": rather quite the opposite is true. I much rather see the role be defined for the current level of training that they receive. That is as a first responder role; to initially stabilize and assess the patient. Then after arriving EMS (ALS) unit arrives, to assist as directed.

R/r 911

As a student, my opinions are obviously based on a limited amount of knowledge, but I agree on that definition of my role as an EMT-B. I find it noble for what it is, important for what it is, but I don't have any illusions of being more than that.

 

[Ridryder911]

Oh, I don't disagree it is however; the role we must consider has to change with the times. Similar to LPN and other allied health care professionals that cannot no longer function at that level in critical care areas.

Ignoring it will not cause it to go away. I much rather for the EMT's to be involved in the change than for someone else not involved in EMS to be responsible for it. Yes, the role will change it has to. More and more communities expect ALS as the norm as well as insurance and payers for EMS. Payers want the best bargain for their bucks... as well as the citizens.

Yes, EMT's are definitely needed and never will be replaced, however; their position and their role needs to be redefined now. With it becoming harder and harder for Basics to even get work exposures to emergencies, it is to be expected. We will see this increasing more and more. Look at the want ads and see what is needed. When was the last time you seen an ad for a Basic EMT. I know in my state alone (which is rural) we have over 5,000 Basics and only 180 EMS, (which the largest only use EMT's as drivers or do not employ them) thus we have an excess of EMT's that expire before they get any experience, thus leave the profession.

Majority of you may believe this is non-sense, but remember this statement in about 5-7 years.

R/r 911

 

[VentMedic]

I'd venture to say that many nurses have no clue what to do in an emergency. I've seen it...our Rapid Response Team is called to a deteriorating patient (or code) in the hospital & the RNs are standing around with a deer-in-the-headlights gaze while the team (usually consisting of prior EMS people) works the patient.

First, I believe the EMT-B has a place in our still evolving EMS system.

Now for the hospital stuff; Rapid Response Team (RRT) usually consist of an ICU RN and Respiratory Therapist(RT) not EMS people. Some of us (like myself) may have been Paramedics or EMTs at one time. But, my RT license and training supercedes that in the hospital - different playing field and rules. The EMT-P may have taught me some skills but the next 3 years in RT school taught me the whys and refined my skills/knowledge to an advanced level.

The RRT is called prior to the patient coding. The med-surg nurses recognize the patient needs a higher level of intervention before the "code" happens. For that, they should be commended not criticized. They could have watched as the patient coded because they couldn't get definitive help from the primary MD.

This is very much like a good EMT-B who recognizes the need for ALS to meet up with them if they have a long distance to the hospital.

The RRT is part of a nationwide "100,000 Lives Campaign" to save lives. It now includes both children and adults. The same organization is setting forth to improve care in hospitals. Just an added tidbit because it is a news maker in healthcare as the system strives to provide better care.
http://www.ihi.org/IHI/Topics/Criti...ies/ChildrenCountinthe100000LivesCampaign.htm

In the ED, the patient to nurse ratio is usually 4 (or 5):1 and no PCTs. This consists of all of the beligerent patients that EMS has brought in who are demanding "service" and a few unstable patients, possibly a ventilator patient or two. No ICU or med-surg beds available yet and EMS crews wanting to know why it's taking so long to get a stretcher to unload makes for no picnic in the ED either.

Yes, EMT-Ps transport many different types of patients. Many times they have no idea what they are transporting. Many times only certain things are given in the RN to EMT-P report prior to transport to another facility. "Need to know only" and the EMT-P may not be ICU savvy enough to ask for more information. A few lab values and the EMT-P may also have the deer in headlights gaze.

Now, as far as nurses taking EMT-B; in Florida, an RN can still challenge the EMT-P if he/she has EMT-B. This will remain this way until the EMT-P sacks the certificate program and makes the 2 year degree a standard.

Both EMT-B and EMT-P, as it stands now in the US, teach only a few skills and a limited knowledge about disease process, anatomy and physiology. Lengthening the overall education standards for both could raise the level of care in EMS systems for the patient's benefits.

For those who want to split hairs about paramedic skills; NOT all ALS systems have the same protocols or skill capabilities. Some are more special than others.

I think I've lasted 30 years by continuing my education and teaching. As long as you keep learning, even if you don't advance your certification/license level, you will provide something more to yourself and your patient.