Value of B's

Differences abound

There are so many different levels of treatment in EMS that it is difficult to state an opinion on this issue. A basic EMT in my area can give nitro and aspirin for chest pain, give albuterol for a respiratory emergency, give an epi-pen for anaphylaxis, and use an AED in cardiac arrest. Some areas of Michigan even allow basic EMTs to start IVs with proper training, of course.

I know there are those that would like to see all these things standardized so that everywhere a basic EMT, as well as other levels, would only be allowed to do certain things. This "Standard of Care" is probably a good idea, but I'm against making the this absolute because different situations require different treatments. Here is an example.

We provide EMS on an 85 square mile Island in Lake Michigan that is 32 miles from mainland Michigan. Our longest treatment and transport time was a little over 12 hours in the most recent past. How we practice EMS should be allowed to be different than how the agency with transport time of 20 minutes or less practices EMS. If you're interested in reading a couple of stories about this, you can go to http://ruralemsisdifferent.com for this an other stories. I'll gladly post some of your stories there as well. Send them to me at medic5740@yahoo.com.

When you simply cannot transport a patient due to weather (no airplanes can fly, no helicopters can fly, and no boats can run) and you are surrounded by water, there needs to be a different system in place with different education and training to prepare the EMS personnel for this situation. Do basic EMTs make a difference in every EMS system in this nation? I can't answer that question, but for this isolated island, we could not exist without them. My hat is off to all basics. Thank you for what you are allowed to do, but mainly, thank you for what you are willing to do.
 
Has anyone on this island ever considered building one of those big boxes full of doctors and nurses....what do they call those things? Oh yeah, hospitals.

Seriously, at least build a clinic with emergency capabilities and a helipad for the Coasties to fly them out for you. Isolation is nice for a vacation, but in a medical emergency it will cost you your life. Doctors are definitive care, ems is for transport to doctors.

And I thought I worked in a rural setting, farmers and deer hunters in the woods have nothing on twelve hours from civilization.
 
Good points, if you are going to be that isolated either obtain a medic or have some form of medical provider that can provide "general medicine" such as a P.A. or NP. Just because one isolated area there should not be an exemption, medicine is medicine be it in rural, remote, or large metro areas, AMI's, burns, etc. does not change due to the area.

R/r 911
 
Ridryder911 said:
Good points, if you are going to be that isolated either obtain a medic or have some form of medical provider that can provide "general medicine" such as a P.A. or NP. Just because one isolated area there should not be an exemption, medicine is medicine be it in rural, remote, or large metro areas, AMI's, burns, etc. does not change due to the area.

R/r 911
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Under the current system of healthcare those options are just not financially viable. I've lived in rural areas for most of the past 20 years or more. I've seen medical practices close, clinics come and go and bottom line, it's the bottom line that determines the sucess or failure.
 
Volunteerism keeps us going

We do have a rural health center on our Island, we have Nurse Practitioners, and we do have ALS here. The only way we continue to have paramedics is to get them to volunteer. Other than me, I have been volunteering in EMS here for twenty years, we get our paramedics by training them for free. We invest our time and our money in them with a promise that they will provide us two years of service. We first train them to the level of Basic EMT for free, then move them on to the paramedic level after some experience and demonstration of willingness to participate.

Sometimes these paramedics stay and sometimes they leave. There was a period of five years where I was the only paramedic here for nine months of those five years. We got visiting paramedics to help out during the summer tourist season.

No one volunteers completely during our busy tourist season--we pay a whopping $100 per 24 hour day for on-call paramedics and EMTs during the summer, but these new paramedics and EMTs need to help share the other nine months of the year as volunteers. We require them to do that for no less than two years. They get the paramedic program including books and materials for free. We even pay the cost of the liability insurance,flights to the mainland of Michigan, and motel costs for them to do clinical rotations.

The idea is that we may actually get someone to stay and continue to volunteer for a longer period of time. We figure that IF we invest in the human resources available to us, THEN we will get a return on that investment.

I am interested in hearing from others about how they creatively staff rural EMS areas. Please email me at info@ruralemsisdifferent.com
 
In my hometown, not the one I work in, the ems system uses bls trucks only for scheduled transfers, and a emt/paramedic rig for all 911 calls, and it seems to wrok pretty well. if it is a non emerg response, the emt can tend if pm is ok with it, and emerg response requires a paramedic to tend. it works out ok, except for the fact that an emt is stuck on a bls rig for at least 9 months before ever answering a emergent call.

in the county where I work bls rigs can run a priority 2 or 3, and als rigs get the priority 1 and 2. But both sides help the other out, if we a backlogged on dialysis pt's the als rigs will take the close ones in town, and if we emergent calls and no als, of course the bls trucks get them no matter what. The emt can also tend on any als call that both crew members are comfortable letting him take (ie- the 230 priority 1 call for shortness of breath that ends up being someone who stubbed there tow on the kitchen sink getting a drink of water) it lets us practices assesment on a non critical pt, and helps alot when we go on to medic school
 
when i went through EMT-B classes we were told over and over again by the paramedics that you can not have good ALS without good BLS....perhaps the system that i live in is WAY different from yours...being that every call automatically has an ALS unit dispatched along with BLS units...but i still think the same phrase applies. I cant even begin to count the times that the paramedics have praised the EMTS-B's because of the workload that they take off of them.

I also am a driver for the local transport agency, and there are sometimes where the paramedic will drive to the hospital and let me take care of the patient because they are a BLS level pt....so, it also allows for the paramedic to do things they dont do very often, like brush up on their driving...

so yes i believe that paramedics find EMT-B's tremendously helpful
 
I just read this from another posting and thought it would be great to post here also:

Hi, my name is Jamie, I'm a paramedic in SC and was recently hired as a flight medic. I've been writing blogs on myspace (www.myspace.com/jamie83002)that are ems related and have had such a huge response from my latest one I wanted to post it here as well. I hope you enjoy and I'd love to hear your responses to it.




The definition of SYSTEM

I was inspired by some recent events to vent again…imagine that, right? Well here I go on my soapbox again!

First, I utilized freedictionary.com to get you all the definition of system:

sys•tem .. n.
1. A group of interacting, interrelated, or interdependent elements forming a complex whole.
2. A functionally related group of elements, especially:
a. The human body regarded as a functional physiological unit.
b. An organism as a whole, especially with regard to its vital processes or functions.
c. A group of physiologically or anatomically complementary organs or parts: the nervous system; the skeletal system.
d. A group of interacting mechanical or electrical components.
e. A network of structures and channels, as for communication, travel, or distribution.
f. A network of related computer software, hardware, and data transmission devices.
3. An organized set of interrelated ideas or principles.
4. A social, economic, or political organizational form.
5. A naturally occurring group of objects or phenomena: the solar system.
6. A set of objects or phenomena grouped together for classification or analysis.
7. A condition of harmonious, orderly interaction.
8. An organized and coordinated method; a procedure. See Synonyms at method.
9. The prevailing social order; the establishment. Used with the: You can't beat the system.


Now with that clarified, healthcare, as a whole is a system. We have all talked about EMS systems, Trauma systems, hospital systems, etc… After some recent events and some further inspiration from an awesome group of professionals at 4Medics (check out their myspace page at http://www.myspace.com/4medicsllc) I really think that a lot of people that work in healthcare don't have a full understanding of what a system is. We tend to value the importance of ones job by the role that they play in the system as a whole. We judge importance by certification levels and assume one role is more important than the other. The fact of the matter is NO ONE ROLE WORKS EFFICIENTLY WITHOUT THE OTHER. No matter if you're a physician, a nurse, a street medic, a flight medic, an EMT, or a dispatcher; and no matter if you work for a hospital, an emergency service, or a convalescent transport service, one role is just as important as another to make the SYSTEM work. If you think about it logically, it makes perfect sense.

Could I do my job as a paramedic without an EMT? Realistically, I could probably treat a critical patient, transport, and get a patient to an ER all by myself, but would I be able to do my job efficiently and provide good patient care? Absolutely not! The EMT, EMT-I, Paramedics, Supervisors, and Administration all have equal roles in the system. They all have different roles to play but no one is more important than the other. I cannot stand to hear someone say, "I'm just a basic EMT." There is nothing easy or simple about what they do! They get the title basic because the skills we are taught in EMT school are the most important; they are the foundation for what we do! Without the basics no one would live and the advanced care, x-rays, CT scans, lab work, and surgeries would be useless. We have to stop judging the importance of a persons role in the system by their job title…it is simply ridiculous.

I have learned over time that the nurses and physicians in the ER, the surgeons in the OR, or the medics that have been doing this longer than I have and know a lot more than I do are no more important than I am. With that being said, I am no better than the brand new, green paramedic, the EMT or EMT-I, the dispatcher, or the person that does the billing for the service in which I work. We have all chosen different roles in the system, but we are all equals. It takes us all to make it work. We all have different levels of experience and different reasons for doing what we do. No matter what the reason, financial, emotional, or age the role you have chosen to play is an important one!

My biggest pet peeve in this career field is a paramedic that expects to be seen as having a more important role in the system than his co-workers…and that goes for system wide, not just service wide. They are usually the ones that complain about running calls that they feel are "beneath them". The calls that they decide were not a true emergency and did not require their level of expertise. You know when you wake up in the morning and put your uniform on what role you will be playing in the system that day. Don't complain about it and don't insult your co-workers by belittling them when it is a true emergency Don't treat them as if their role in the emergency isn't just as important as yours because it is. Remember where you came from, you were in their shoes at some point. Many of them look forward to playing the role of paramedic in the future and should be able to look at you as a positive role model that is there to guide them through their journey. Many of them are fresh out of school and have not yet had the opportunity to experience the things that you have. You should be an educator, not necessarily in a class room, but you have already experienced playing the role of "basic" or "green paramedic". You have made your mistakes and learned from them and have the knowledge and experience to guide others into a successful career, if you go about it the right way. Lead by example, be an educator, and be a positive role model.


Finally, for everyone out there that has felt belittled by another person in the healthcare system, keep this in mind:

The true professionals in this business will not judge you by your position, certification, or job title; and not by your level of experience, mistakes you have made, or how old you are.
A true professional will make their impression of you based on your level of professionalism, your willingness to learn, your willingness to educate and guide others in the right direction by serving as a positive role model, and most of all your passion for the job and understanding of the system as a whole.
Always keep in mind that the way your carry yourself as a professional represents the system as a whole, that's right, those of you that think you are "just a basic" represent all of the physicians, nurses, medics, other EMT's, administrators, dispatchers, billing clerks, etc…. in the health care system nationwide!



James Compton EMT-P
 
medic5740 said:
The only way we continue to have paramedics is to get them to volunteer.
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I think herein lies your problem............

medic5740 said:
I am interested in hearing from others about how they creatively staff rural EMS areas.
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We pay them!

medic5740 said:
No one volunteers completely during our busy tourist season--we pay a whopping $100 per 24 hour day for on-call paramedics and EMTs during the summer, but these new paramedics and EMTs need to help share the other nine months of the year as volunteers. We require them to do that for no less than two years.

We invest our time and our money in them with a promise that they will provide us two years of service. We first train them to the level of Basic EMT for free, then move them on to the paramedic level after some experience and demonstration of willingness to participate.

They get the paramedic program including books and materials for free. We even pay the cost of the liability insurance,flights to the mainland of Michigan, and motel costs for them to do clinical rotations.

The idea is that we may actually get someone to stay and continue to volunteer for a longer period of time. We figure that IF we invest in the human resources available to us, THEN we will get a return on that investment.
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With all due respect, honestly I can't blame them. I really believe your incentive of education is inadequate. Many ALS services offer free medic schooling in addition to a paid position on their staff. My service offers the Paramedic class for free and PAYS the students their regular 48 hour work week while doing their clinicals. Plus our service obligation is only one year and very loosely enforced at that. Only offering $100 per shift as a Medic and expecting someone to volunteer their time on a remote island for free while attempting to maintain their other financial obligations is impractical. Liability insurance should be covered by any EMS agency so thats not really an incentive. If you paid medic's fulltime, the motel and travel items wouldn't be an issue. Heck those items alone could probably save you a significant portion of a medics salary.

Based on your description, I am going to assume you are speaking of Beaver Island, which as you know has a very strong tourist economy in addition to fishing and logging. There is money there, you just have to convince the powers that be to utilize it. Also consider utilizing fixed wing aviation instead of just helicopters. A fixed wing aircraft only needs 1 mile visability and 300 feet of ceiling to take-off, 600 feet and 1 mile to land. Beaver Island airport has a published instrument approach, utilize an air service that will use it. What you need can be done, it may just take some perseverance and time! Good luck to you................
 
Value of the basics

A knowledgable and experienced instructor (paramedic for years) said he knows many paramedics who are great at the ALS, but are poor at the BLS, and therefore perform poorly on calls. BLS definitely HAS value. Thats my two cents.
 
They can't be "great Paramedics" without having great so called basic skills and knowledge, that would be an oxymoron. They are then horrible paramedics if they cannot perform those so called basic skills.

Patient treatment should be one continuum from start to finish. There is no such things as BLS when one can perform all levels. If you can't perform all levels, then .. you suck at your job.

R/r 911
 
Unfortunately, there's no clear-cut answer as to what's "best." So much depends on the service area, available facilities and personnel, and even the time of year. Come vacation time and an influx of tourists, for example, paramedic level of service available to all is not terribly cost-effective as, not knowing where else to turn, visitors often will dial (Sorry, nobody dials anymore!) 9-1-1. And, as has been mentioned, the bottom line is the bottom line.

As rid says, you better keep every ounce of your basic training available to you. And I say, a paramedic's bag of tricks can run out very fast, and all you're left with is the basics of the basics.

I don't care what level of service is available, as long as someone with training gets to the scene of the emergency soon. In an ideal world, my preference would be a paramedic-level trained person be first response, in a rig capable of transport, and then he or she would make the call to transport basic or advanced, if at all.
 
ffemt8978 said:
...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...
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Our B's give Albuterol, Aspirin, Epi-Pen, Narcan (nasal), Glucagon(nasal), nitro, Mark-I, and Combi-tube. I's add Adenosine, Atropine, D-50, Epi 1:1000 and 1:10,000, Lasix, Lidocaine, Narcan, Morphine and Valium (maybe it's the non narcotic kind :)), and manual defibrillation, needle thoracotomy, and synchronyzed cardioversion.
 
Anomalous said:
Our B's give Albuterol, Aspirin, Epi-Pen, Narcan (nasal), Glucagon(nasal), nitro, Mark-I, and Combi-tube. I's add Adenosine, Atropine, D-50, Epi 1:1000 and 1:10,000, Lasix, Lidocaine, Narcan, Morphine and Valium (maybe it's the non narcotic kind :)), and manual defibrillation, needle thoracotomy, and synchronyzed cardioversion.
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So really basically, your administrator gets Paramedic care at an Intermediate pay rate!... While getting reimbursed an ALS rate.. smart on their part.. Who needs Paramedics when you can get an imitation and bill the same?

R/r 911
 
Ridryder911 said:
So really basically, your administrator gets Paramedic care at an Intermediate pay rate!... While getting reimbursed an ALS rate.. smart on their part.. Who needs Paramedics when you can get an imitation and bill the same?

R/r 911
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Unfortunately that's the current state of pretty much every industry in the US. Maybe you missed Chimp's post a year or so ago about trying to train Chimps to the EMT-B level.

I hate to say it, but much of being an EMT is recognizing a sign/symptom and stabilizing it. Every so often you'll have to put 2+ variables together to recognize a condition, but it doesn't happen often at the Basic level.

I see being a Paramedic as having a more profound understanding of what's happening, why it's happening, and how to treat it. If you can pay an EMT-Basic to simply look at what's happening, and push a drug or two, some systems will let it happen.
 
I totally agree. This is why I am so misinterpreted and misunderstood from other levels. Patient care should always be based upon individual treatment findings. Rather than "blanket" protocols that I have seen patients been placed into instead of their illness into the protocol.

Treating according to strictly sign and symptoms, one is shooting in the dark. Without understanding the pathological disease process, the body responses, immune system, and the physiological response one cannot fully appreciate or treat accordingly.

We need to remove ourselves from the mentality that signs and symptoms is adequate enough to know about medicine. As well, that multiple Paramedic impersonators (EMT-A-XYZ) is Paramedic care, when really it is just substitute care. Remember, no matter what letters or "what I can do" is always compared to the highest level.

Can communities afford ALS care.. rather, the question should be; can they afford not to?

R/r 911
 
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Ridryder911 said:
So really basically, your administrator gets Paramedic care at an Intermediate pay rate!... While getting reimbursed an ALS rate.. smart on their part.. Who needs Paramedics when you can get an imitation and bill the same?

R/r 911
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We're supposed to get paid for this?
 
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