Value of B's

Alexakat

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I'm just curious...& I hope this question doesn't come off the wrong way to anyone...I'm really hoping to get some genuine input...this kind of goes along with Guardian's "video" thread, which got me thinking...

On our very active, volunteer 911 EMS service, every shift we have at least 1 ambulance (driver & AIC <most often a BLS person> & sometimes a trainee), 1 ALS provider (either an Intermediate or Paramedic that drives his/her own zone car) & a supervisor (that drives his/her own car as well).

I see a lot of discussion on these forums about EMT-B's & references to B's as being "first aiders" & "if you were the patient, who would you rather have...an EMT-B or paramedic responding to you?"

I completely agree that if I or any member of my family was having a serious, life-threatening condition, I would want the responding individuals to have the highest level of pre-hospital certification. However, what about those calls (& we get them all the time), & I stress, in the middle of the night, we get for minor lacerations, ground-level falls, sinus pain/congestion, etc. I run in an area where there is a large indigent population & we get quite a few calls for people who literally just need a ride to the hospital & use the ED as their PCP.

I'm not saying that calls that seem to be benign can't be serious, because we all know that something seemingly simple can be more than it appears.

My question is: don't ALS providers find some value in EMT-B's who can respond to these minor, Priority 3 calls at 3 a.m. rather than utilizing someone with higher skills for these types of calls? On my service, our ALS providers seem find value in the EMT-B & that they don't have to respond to every single call right off the bat---that there is a BLS unit who can respond to a "patient dropped picture frame on their foot" at 3 a.m. (I kid you not!). Of course, if I get to a call & my general impression is bad or something is troubling, etc., I do not hesitate to call for ALS.

And don't paramedics find value in a good EMT-B who can anticipate their needs? Have an IV set up & ready to go, hook 'em up to the monitor, get a good, solid set of vitals right away, etc.?

My service seems to really appreciate all of the above...what do you guys think?
 

Guardian

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EMT-Basics are tremendously valuable and ems could not exist without them. For the most part, I'm happy with emt-basic education and the role they play. My problem is with ALS or more specifically all the half *** ALS out there today and the fact we aren't being truthful to the public about the services we provide.

I would venture to guess that emt-basics have actually saved more lives than ALS providers simply because of their numbers and quicker response times.
 
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Canoeman

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Alexakat,

I am certainly unaware of how your EMS system or service is set up for policy, but rest assured, just as Guardian states, that the foundation for ALL calls comes from the "basic building blocks" as I call them. In our service BLS calls are screened appropriately and if it is deemed a BLS call by all means the BLS ambulance does the call. Should the call be changed they can call upon the Paramedics to assist.
When I am on duty my partner is an experienced Basic EMT or an experienced "first-aider". They are experienced because I teach them to be my wingman and they will have my respect if they want to learn and are a patient care advocate. Soooooo yes Basic EMT's come on board.
That's where I started and I am proud of it as well.

Canoeman
 

MMiz

I put the M in EMTLife
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In Michigan I worked for a private EMS service that initially was totally ALS. Paramedic rigs would respond do all BLS/ALS transports and respond to all calls. I was one of the first EMT-Basics they hired. In fact my unit was the only BLS unit available that would respond to the entire county during the night hours. From 7PM - 7AM my partner and I would do all the transfers and BLS calls. We'd do all the early morning dialysis patients and the psych transfers. We'd also respond to ALS calls if we weren't busy to help assist. The system worked very well.

The system then tried transitioning to an all ALS system. All EMTs were sent to Paramedic school, and they only scheduled ALS rigs during the day and night. Now ALS was doing our dozen daily dialysis patients, psych transfers, and all the other calls that were normally being handled by five BLS units. It only lasted for a few months before low morale set in, Paramedics became tired, and the whole system collapsed.

We went back to an ALS/BLS system and I can't see that changing any time soon. Where I currently live, in a more rural area, the local ALS agency does both ALS/BLS calls, but their call volume is significantly less. ALS/BLS systems work well when everyone is on board and working together. ALS seems to appreciate our assistance on scene, and we like knowing that they're available should we need a higher standard of care.
 

StrokedOut

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I am taking a provincial registration exam this weekend which WHEN I pass, will 'morph' me from an EMR into an EMT-A. Those are Alberta's equivalent of the EMT-B and EMT-I respectively. We are all invaluable at all levels.

What is that phrase ... paramedics save lives and EMT's save paramedics! One hand washes the other ...
 
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ffemt8978

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What is that phrase ... paramedics save lives and EMT's save paramedics! One hand washes the other ...

<<<Looks around for Rid and ducks for cover

signrun6.gif



Seriously, I believe that BLS, ALS, and yes, even ILS all have their place in our current system of healthcare. I'm not saying it's the best system, because there are some things that need to be fixed.

What I am saying is that everything is a compromise. Let's see: we have what our patients want, what our patients need, what our patients deserve, and what our patients are willing to pay for.

BLS, ILS, and ALS are all various levels of compromise when compared to the hospital setting. Since the beginning, EMS has been a field of triage and stabilization/transport. We're continuing along those lines even as we expand (or reduce) what we do in the field.
 

Airwaygoddess

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BLS and ALS work together hand and hand and we still must strive to educate ourselves and others to deliver the best patient care. BLS is the strong foundation for ALS. :)
 

Ridryder911

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There is no harm for basic as first responders (as they should be). It is after that, I have a problem. EMS units should be composed of medics for monitoring and transport. We should be using the EMT level at the most warranted. If medics become disgruntled or "burned out" it is because of unrealistic expectations or misuse of the system.

No one is above treating minor injuries, it is part of the business. Even trauma centers has B.S. wounds, toe pain, etc.

R/r 911
 

Summit

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There is no harm for basic as first responders (as they should be). It is after that, I have a problem. EMS units should be composed of medics for monitoring and transport.

What is the point of this silly statement?

You certainly aren't arguing that EMTs shouldn't be in the back of a rig under the current system. We all know that there isn't enough budget or ALS personel.

You can't be arguing that for an ideal system either. Once you start imagining you have extra budget or personel, you might as well fix the system and, instead of relegating BLS to first responding drivers and loaders as implied above, you could actually bring BLS (and ALS) education up to where it should be.
 
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MMiz

I put the M in EMTLife
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Rid,

We tried ALS-only rigs for quite a while. Do dialysis patients really need ALS? What about psych transfers? What about those BS calls for stubbed toes and broken fingers. Do they really need ALS transport?
 
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Alexakat

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Rid,

We tried ALS-only rigs for quite a while. Do dialysis patients really need ALS? What about psych transfers? What about those BS calls for stubbed toes and broken fingers. Do they really need ALS transport?


That's my point...

Personally, I enjoy being the "assistant" on heart-pumping calls - GSWs, MVCs with lots of trauma, codes, etc. (& we get a lot of them where I run)...I like being part of the team involved in that. We get a lot of "real 911calls" quite a bit. The exciting stuff people sign on to be an EMT for! And I strive to be a really great "assistant" on these calls.

But I also don't mind the other calls that are not as emergent b/c I get to run them...I get to do all the patient history, vitals, call in the report to the hospital, turnover to the ED, write the report afterward...& my ALS provider is usually happy that they don't have to get out of bed (even though it's part of the business) on those calls b/c of how our agency is staffed.

A nearby agency does not utilize their B's. As an EMT-B for a year, I've had way more experience than a 5+ years EMT-B in a neighboring city.

I guess what I'm saying is, I'm glad I'm not volunteering for a strictly "transport" agency (I don't think I'd enjoy that)---that I get the opportunity to work ALS calls with my ALS provider AND get the opportunity to run some of my own calls too.
 

StrokedOut

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BLS and ALS work together hand and hand and we still must strive to educate ourselves and others to deliver the best patient care. BLS is the strong foundation for ALS. :)

You're 271.44% correct!
After all, one cannot be a good paramedic unless they've been a good EMT right?
 

Ridryder911

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You're 271.44% correct!
After all, one cannot be a good paramedic unless they've been a good EMT right?

One cannot be a good Paramedic without knowing the treatment within their scope of care. You area exactly right, they must be able to perform and understand "BLS" skills without a second thought.

In medicine, there is really no basic or advanced. Only in EMS we attempt to divide and emphasize the difference, because of our multiple EMT levels. If one was to read surgical or about any other texts, it would describe .. " make sure BLS or reemphasize BLS .. thus meaning, perfusion and oxygenation, as well as hemodynamic is covered.

I know of many excellent Paramedics, that have never worked as EMT's, but have an understanding of their treatment regime. That is why there are many attempting to remove EMT from the Paramedic title, with reason. Becoming and practicing as an EMT prior is nice, but not essential as many would believe.

With the decreasing number of EMT positions, and many EMS services not even having a EMT position, where are basics to get experience? This would be similar stating one would have to be a nurse aide, or LPN before becoming an RN. Again, it is not deformation to the EMT, rather their role needs to redefined.

R/r 911
 

StrokedOut

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Things are quite a bit different here. One MUST be an EMT before they can be a paramedic, there is no way around that as it is provincial law. There is a tremendous shortage of EMT's and paramedics for actual 911 services. This is in part due to the fact that a lot might only get their EMR which is a $1000 course (not including registration exam costs). They can make that back in half a week sitting on their soon-to-be fat butts doing nothing as industrial "EMS" personnel.

I guess we all get into the industry for different reasons. Money is of course important, however I would rather be using my skills on a constant basis rather than getting rusty doing nothing.

The industry seems to vary considerably in terms of each level between countries. I would love a private message from someone explaining in further detail exactly what (in the USA) each level is responsible for. Or a website perhaps? I don't wanna come across as being a #*$&, I just want to understand is all.
 

Guardian

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Things are quite a bit different here. One MUST be an EMT before they can be a paramedic, there is no way around that as it is provincial law. There is a tremendous shortage of EMT's and paramedics for actual 911 services. This is in part due to the fact that a lot might only get their EMR which is a $1000 course (not including registration exam costs). They can make that back in half a week sitting on their soon-to-be fat butts doing nothing as industrial "EMS" personnel.

I guess we all get into the industry for different reasons. Money is of course important, however I would rather be using my skills on a constant basis rather than getting rusty doing nothing.

The industry seems to vary considerably in terms of each level between countries. I would love a private message from someone explaining in further detail exactly what (in the USA) each level is responsible for. Or a website perhaps? I don't wanna come across as being a #*$&, I just want to understand is all.


Good luck with that. I still have trouble with it. An emt-intermediate in Florida is a paramedic in Texas is a emt-st in Virginia, etc, etc, etc. When you figure it out, let me know.
 

ffemt8978

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It varies by state, but here is a very generalized breakdown of what the 4 generic levels are and what they can do:

MFR - First Responder - very basic level, similar to EMT-B but generally can not transport a patient without an EMT present. Trained in basic treatments and adjuncts.

EMT-B - EMT Basic - As the name implies, it is the basic level of being an EMT. Trained in basic treatments and adjuncts. Also trained in some advanced adjuncts like Combitube or other multi-lumen airways. Can generally assist patient with meds but can only administer very limited meds PO.

EMT-I - EMT Intermediate - A *******ized cross between the basic and paramedic levels. Generally can start IV's, administer a very limited set of drugs (non narcotics), and may be trained in advanced adjuncts. May also be trained in EKG interpretation and other ALS skills.

EMT-P - Paramedics - The highest level of prehospital care.
 

mfrjason

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Believe it or not yes,even though that they dont seem to recognize,especially when it comes to minor calls. Ive heard that some depts always have 1 ALS rig and 1 BLS rig on duty and dispatch the one that is most suited for the type of call.
 
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Alexakat

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With the decreasing number of EMT positions, and many EMS services not even having a EMT position, where are basics to get experience?
R/r 911

I know it's different everywhere, but EMT-Bs get A LOT of experience running with my agency. We get a lot of calls where the B's are the only providers on the call & we get a lot of calls where the B's act as an assistant. We get lots of calls & people come out to run with us b/c they get lots of experience period. I guess I'm lucky in this regard.
 
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