What's the point of dual medic?

[nocoderob]

I think you merely think too highly of your abilities, or anyone's abilities for that matter as a paramedic. Sure, an EMT can do even less but we can't really do all that much either in the grand scheme of things.

For sure. Most is just a "band-aid" to get them to the ED in the best possible condition.

Not sure how you translated my statement into EMTs are more knowledgeable than paramedics. I stated many paramedics aren't as knowledgeable as their god complex makes them think they are. That would usually imply EMTs being less knowledgeable. I said a small amount of EMTs can best a handful of paramedics. Hardly substantial numbers.

Maybe I misunderstood your point. I guess mine is, the smartest EMT can still do less than the dumbest medic, if that makes sense.

 

[JPINFV]

I got his point. Mine is that knowing a lot does not translate to being able to do a lot. My wife is a RN and know's much more than I do but, I can do more than she can. If that make's sense.

Define "do." Procedure wise, medication wise, diagnostic wise, standing orders vs patient specific orders, etc?

 

[JPINFV]

Maybe I misunderstood your point. I guess mine is, the smartest EMT can still do less than the dumbest medic, if that makes sense.

Well... not always.

 

[Aidey]

Definitely not always!!!

 

[NYMedic828]

For sure. Most is just a "band-aid" to get them to the ED in the best possible condition.



Maybe I misunderstood your point. I guess mine is, the smartest EMT can still do less than the dumbest medic, if that makes sense.

This quote gets tossed around a lot on this forum

The delivery of good medical care is to do as much nothing as possible

Many times, the best thing you can do is gather information/clues at the scene that is otherwise unavailable to the receiving facility. Doesn't take any certification to do that...

 

[JPINFV]

This quote gets tossed around a lot on this forum


Many times, the best thing you can do is gather information/clues at the scene that is otherwise unavailable to the receiving facility. Doesn't take any certification to do that...

Ehh, I take that as "Just because you can doesn't mean you should." One of my pet sayings is "Skills without knowledge is dangerous, knowledge without skills is impotent."

 

[NYMedic828]

I am not literally interpreting it as we should do nothing if a true need presents itself.

My means of using it was to imply that just because the dumbest medic can do more than the smartest EMT, on paper, doesn't necessarily mean he truly can or should. I guess the point I am making is not everything is about toys.

Knowledge is power. (preaching to the quire i'm sure)

 

[Jambi]

" One of my pet sayings is "Skills without knowledge is dangerous, knowledge without skills is impotent."

QFT

And I'm using it

 

[Jambi]

I am not literally interpreting it as we should do nothing if a true need presents itself.

My means of using it was to imply that just because the dumbest medic can do more than the smartest EMT, on paper, doesn't necessarily mean he truly can or should. I guess the point I am making is not everything is about toys.

Knowledge is power. (preaching to the quire i'm sure)

I got what you meant. Here in socal I'm a "do as little as necessary" medic surrounded by a sea of "agggressive" medics. I believe it's knowledge that makes the difference. It's easy to just do everything...

 

[DrParasite]

Not to pick on you but, this type of attitude is common among EMT's. You do not have a "little EMT brain" but, come on, are you truly in a place to make a judgement on how many medic's may or may not be needed on a call?

You know, your right. I should just shred by Bachelors Degree. After I finished my degree, I took some more classes. 6 credits of Biology, 6 of Inorganic Chem, 3 of Organic Chem, 6 credits of Anatomy and Physiology. All those college classes were a waste, since i'm just an EMT.

I'm curious, how much organic chem education do you have? how much A&P do you actually have? not the two weeks that some programs have at the beginning of class, and how much of it do you remember? how much do you really know about the lymphatic system? What do you know about the hypothalamus? what about the liver and kidney, are you familiar with the inner structure of both organs? do you even have a degree?

oh and lets not forget, 15 years as an emt, the last 7 as a career provider in an urban 911 system. I've seen strokes (actual Brain Attacks where time is of the essence), major traumas, found more unconcious diabetics than I can count, overdoses, cardiac arrests, MVAs, MIs, and other calls where the patient was actually sick, and many that did require ALS interventions to either reverse their condition or prevent their condition from deteriorating further. Can you say the same? Does experience count for anything? and I've worked side by side with paramedics, usually getting their before they did and intiating treatments and getting information for them to do their job. But again, I'm just an EMT, so I must not know or do anything without a paramedics there to hold me hand, right

An EMT has virtually no responsibility when working with a medic. Maybe it's different where you are. Where I am at, the medic has to perform a full assessment on every pt before he can turn over care. And the pts the EMT can take are very limited. The medic also has to do the initial portion of the run ticket and has to audit said paperwork as well. And if anything detrimental occur's enroute to the pt, the medic is on the hook. The medic is responsible for the rig check out, monitor tests, glucometer testing, and narcotics log.

and people wonder why their EMTs are useless, need their hands held at every step, and can't do anything without a medic. If I worked with you, there is a good chance I wouldn't be able to do anything either.

As far as being useless on a call, you are not. But, to even suggest that an EMT is anything more than a supportive role and extra set of hands is ridiculous. When you get a "P" card you will see thing's in a whole new light.

You know, it's attitudes like yours that make me not want to ever get my P card. Well, one of the reasons.

You're right, you can do a lot more than I can. you can perform more interventions, give me drugs, and both apply and interpret cardiac monitors. But I'm pretty good at knowing if my patients need any of your fancy toys, or if nothing you do will help them, and they really need rapid transport to the hospital where a doctor can fix what's wrong with them.

And I sure as :censored::censored::censored::censored: don't need you to hold my hand to tell me how to do my job, and if I have a sick patient and you aren't anywhere to be found, I can do what's within my scope (which more often than not is give oxygen which most of the time won't do anything) and rapidly transport to the ER, letting the ER know what is going on so once I get in the door, the patient can get the definitive care they will need to actually get better.

oh, and I think you can surmise from this post how much I care about what you think of my attitude.

 

[DrParasite]

I've worked in 2 states. one had was B/B and P/P, and the other was Senior P/P and Senior P/B. A senior P was an experienced P who could help a new P with any job.

I prefer tiered systems 100%. dual medic and dual EMT. this way the lone medic doesn't do all the work, has someone to bounce ideas off of, has someone else to try to start the IV when the first person can't get it. Not only that, but if regulations don't require it, cheap companies won't pay for the 2nd equally trained provider.

The other thing that you need with a dual medic system is for them to only go on high acuity calls that are likely to need ALS. NJ might be screwy, but in theory you don't have two highly trained paramedics being tied up on a minor MVA, or a child with a fever, or a boil on a person's butt. Letting ALS only deal with ALS patients means they deal with sick people only, so they get really good at dealing with sick people. and if you have a tiered system, you have two vehicles, so if you have a really sick patient, you can have the two EMTs driving both trucks, allowing both paramedics to be in the back of the truck treating the patient (I know, crazy idea right?).

in a perfect world, BLS gets there first, does there thing, and when ALS gets there, take over and BLS assists with what is needed. if ALS can't get there, but BLS gets there first, pt is loaded and taken to the ER. is it perfect? absolutely not. is having a BLS truck taking the patient to the ER better than no ALS ambulance at all? I like to think so. Plus your BLS providers get good at performing assessments, identifying sick vs not sick, and the whole "i don't know what do to without a paramedic telling me exactly what to do" mentality goes away. And sometimes all you can do is perform a really good assessment, document it well, go to the hospital, and tell the doc what you found and let them do their thing.

 

[Bullets]

I truly believe that the dual Medic hospital based ALS is the one thing NJ EMS got right.
I transport truly sick patients BLS to hospitals all the time if I am closer then the medics. Usually freaks the nurses out

 

[nocoderob]

DrParasite,
Too much to quote there so let me hit some highlights;
Nope, no degree. I do have some AP, chem, etc from several years ago when I was going to do nursing.
As far as experience and "seeing the same," yea, in 20 years working in two of CA busiest counties, I have seen a few things myself.
Like I stated earlier, maybe you can perform more tasks where you work than can an EMT where I work. Ours can give O2, CPR, AED, basic first aid, and drive code three if needed.
There is no tiered system. Every 911 call gets a minimum of an ALS rig with one or two medics and an engine with one or more medics. Sending a BLS rig to decide whether an ALS rig is needed seems more like a waste of resources to me. But, maybe you do not have a fire dept response in your area like we do.
I doubt attitudes like mine keep you from getting your card. There must be more to it if you have not done so in 15 years.

In summary, this thread is, again, about why should there be dual medic units. I, and others, have already stated why we think it is a better system. I gave reasons as to why I think that way based on my experiences. You on the other hand had to tell me all about your degree, experience, and all the cool calls you have seen over the years.
Then you state, "I prefer tiered systems 100%. Dual medic and dual EMT. This way the lone medic doesn't do all the work, has someone to bounce ideas off of, has someone else to try to start the IV when the first person can't get it." These are a couple of reasons I feel dual is better. So why are you all bent out of shape again?

I don't consider myself an "aggressive" paramedic. But, I do treat the pt as much as necessary. To me, it is far better for pts to recieve an ALS rig and not need ALS than it is to recieve a BLS rig, actually need ALS treatment, and only recieve a fast BLS ride instead.

 

[Aidey]

You know, your right. I should just shred by Bachelors Degree. After I finished my degree, I took some more classes. 6 credits of Biology, 6 of Inorganic Chem, 3 of Organic Chem, 6 credits of Anatomy and Physiology. All those college classes were a waste, since i'm just an EMT.

I'm curious, how much organic chem education do you have? how much A&P do you actually have? not the two weeks that some programs have at the beginning of class, and how much of it do you remember? how much do you really know about the lymphatic system? What do you know about the hypothalamus? what about the liver and kidney, are you familiar with the inner structure of both organs? do you even have a degree?

oh and lets not forget, 15 years as an emt, the last 7 as a career provider in an urban 911 system. I've seen strokes (actual Brain Attacks where time is of the essence), major traumas, found more unconcious diabetics than I can count, overdoses, cardiac arrests, MVAs, MIs, and other calls where the patient was actually sick, and many that did require ALS interventions to either reverse their condition or prevent their condition from deteriorating further. Can you say the same? Does experience count for anything? and I've worked side by side with paramedics, usually getting their before they did and intiating treatments and getting information for them to do their job. But again, I'm just an EMT, so I must not know or do anything without a paramedics there to hold me hand, right
and people wonder why their EMTs are useless, need their hands held at every step, and can't do anything without a medic. If I worked with you, there is a good chance I wouldn't be able to do anything either.

You know, it's attitudes like yours that make me not want to ever get my P card. Well, one of the reasons.

You're right, you can do a lot more than I can. you can perform more interventions, give me drugs, and both apply and interpret cardiac monitors. But I'm pretty good at knowing if my patients need any of your fancy toys, or if nothing you do will help them, and they really need rapid transport to the hospital where a doctor can fix what's wrong with them.

And I sure as :censored::censored::censored::censored: don't need you to hold my hand to tell me how to do my job, and if I have a sick patient and you aren't anywhere to be found, I can do what's within my scope (which more often than not is give oxygen which most of the time won't do anything) and rapidly transport to the ER, letting the ER know what is going on so once I get in the door, the patient can get the definitive care they will need to actually get better.

oh, and I think you can surmise from this post how much I care about what you think of my attitude.

I've worked in 2 states. one had was B/B and P/P, and the other was Senior P/P and Senior P/B. A senior P was an experienced P who could help a new P with any job.

I prefer tiered systems 100%. dual medic and dual EMT. this way the lone medic doesn't do all the work, has someone to bounce ideas off of, has someone else to try to start the IV when the first person can't get it. Not only that, but if regulations don't require it, cheap companies won't pay for the 2nd equally trained provider.

The other thing that you need with a dual medic system is for them to only go on high acuity calls that are likely to need ALS. NJ might be screwy, but in theory you don't have two highly trained paramedics being tied up on a minor MVA, or a child with a fever, or a boil on a person's butt. Letting ALS only deal with ALS patients means they deal with sick people only, so they get really good at dealing with sick people. and if you have a tiered system, you have two vehicles, so if you have a really sick patient, you can have the two EMTs driving both trucks, allowing both paramedics to be in the back of the truck treating the patient (I know, crazy idea right?).

in a perfect world, BLS gets there first, does there thing, and when ALS gets there, take over and BLS assists with what is needed. if ALS can't get there, but BLS gets there first, pt is loaded and taken to the ER. is it perfect? absolutely not. is having a BLS truck taking the patient to the ER better than no ALS ambulance at all? I like to think so. Plus your BLS providers get good at performing assessments, identifying sick vs not sick, and the whole "i don't know what do to without a paramedic telling me exactly what to do" mentality goes away. And sometimes all you can do is perform a really good assessment, document it well, go to the hospital, and tell the doc what you found and let them do their thing.

How interesting since you said this in a thread asking how old you are a few weeks ago.

20, and networking is the most important part of getting a job.

no, wait, I should rephrase that.... networking is the most important part of getting a GOOD job.

You also posted calling yourself uneducated when you asked why we don't just give everyone narcan. Odd question for someone with so much education and experience who claims they are good at knowing when their patients need any of the "fancy toys" ALS carries.

Question from the uneducated....

what would be the medical consequences to giving every patient we treated narcan? Aside from giving an intervention that isn't indicated (hello, every ALS patient gets an IV?), and the obvious cost involved, would there be any negative outcomes to giving narcan to patient's who haven't taken opiates? Yes, you would kill the highs of people who had taken opiates, and they might not be happy, but are there side effects for the people who haven't taken them?

Lots of older practices of giving for the same of giving (coma cocktail, start a line and give fluids for EVERYONE, etc) were done in the past, and have since stopped.

And I'm not advocating we do this, just asking for information.

You know what is worse than a paramedic who underestimates an EMT? A provider who is a god in their own mind who overestimates themselves.

 

[STXmedic]

 

[DrankTheKoolaid]

Wow imagine my surprise when I awoke this morning to this post! Let the day begin

 

[Handsome Robb]

Edit: Dammit i spent too much time looking for the one I wanted and poetic beat me to it.

 

[STXmedic]

Edit: Dammit i spent too much time looking for the one I wanted and poetic beat me to it.

:rofl: :rofl: :rofl:

I'll share my front row seat with you... but NOT my popcorn!

 

[Handsome Robb]

:rofl: :rofl: :rofl:

I'll share my front row seat with you... but NOT my popcorn!

What if I bring beer? Then will you share? :beerchug:

 

[Jambi]

This will do just fine...