Why does EMT level of care exist?

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uglyjon

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I am nearly finished with class and after going on several ride alongs and talking with a number of EMT's,I have to wonder... why does this level of care even exist? In my area EMT's are regulated to stretcher fetchers and ambo drivers. It seems to me that doesn't require 4-6 months of training. In my area EMT's can't even do NPA or OPA, Pt contact is literally moving pt's on and off the truck. Why not have a person trained as an "Ambulance technician" drive the truck so medically trained personal can work on the pt in the back? Doesn't make sense to me. Also it seems to me that first responders can perform the same exact things that an EMT (at least in my area) can do, so why would someone bother to get the extra 3-5 months of training?
 
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New Jersey is very different in that aspect. Our ALS do not respond with the ambulance, they respond as chase cars. We actively respond and treat patients as EMTs. Many of our patient are transported without ALS.

Why have the training? Even if all that you do is be a stretcher fetcher, you need to know how to do that. Also, many EMTs can assist a medic and/or nurse. There actually are states that do not even require an two EMTs or a medic and EMT, where a MFR takes that role and simply drives.
 
EMT certs are also good for IFT transports on the BLS level. Provide comfort care, lift/moving, oxygen as needed, etc.
 
We usually do not have a medic with us and get one upon request of the EMT. You can't do opa or NPA? Well luckily you can assist medics in much needed care.

Here, an EMT can do those airways, KING airways, bgl, a few medication assists, 12 leads, cpap, o2, pulse ox, etc. . A bit more than a stretcher fetcher.
 
Why do PEMS techs exist?

1. Historic: DOT originated prehospital emergency care standards and two levels of tech: EMT-Ambulance, and EMT-Paramedic. The ghoul was to disseminate to as many places as possible and as cheaply as possible people trained not to pull people out of burning car by their hair. (Well, literally, to use spinal immobilization for extrication from auto wrecks in cars built before 1969. EMT's and spine boards were born together, so to speak).

Also, most EMS was constructed on the framework of existent emergency services; since most places didn't have a government ambulance service, they used fire and police departments (New York City's original rescue and first aid was police department) as their infrastructure by receiving notice of events, sleeping quarters, vehicle maintenance and quartering.

2. Functional: Sometimes you NEED two trained people at once. What if you have two or three victims at a car wreck? (See #1 above). For IFT's requiring a tech to monitor in the back, you could hire drivers to drive the techs around in the back, but you can pay techs as low as drivers and get both, plus have staffing flexibility. And if you are fire service employees, that allows the brass to justify having that many more employees, providing needed depth of staffing in case of disaster or multiple emergencies, or epidemic cutting your effective staff.

This is an urban, suburban and small town model. The further you get out from under the streetlights, the more disseminated you want the knowledge but the fewer people who are willing or able to get it.
 
ZombieEMT said:
New Jersey is very different in that aspect. Our ALS do not respond with the ambulance, they respond as chase cars. We actively respond and treat patients as EMTs. Many of our patient are transported without ALS.

Why have the training? Even if all that you do is be a stretcher fetcher, you need to know how to do that. Also, many EMTs can assist a medic and/or nurse. There actually are states that do not even require an two EMTs or a medic and EMT, where a MFR takes that role and simply drives.
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When I worked in Lincoln NE (1980-81) we had BLS ambulance provided by contract from Eastern Ambulance (the Dodge brothers and Marty) plus the "Heart TEam" in a Suburban furnished by contract from Bryan Hospital and staffed with a driver/paramedic or nurse, a lead nurse and a paramedic. Fire was not in it, but in 19890 they forced every firefighter to get their EMT-A (basic); some good men quit. But it worked pretty well overall.
 
Quite frankly, because there are not enough paramedics to put two on every truck. In progressive states I think there is a role for the EMT-I but I think EMT-B is a dying breed. For practical purposes EMT basics don't (can't) do anything that I can't talk a calm lay person through doing correctly.


Practically - They drive a truck
Legally - They fulfill requirements to staff ambulances at several dollars an hour cheaper than paramedics
 
And frankly, sometimes you just need someone to drive a person to the hospital on a stretcher.

I have said for years that CNAs with additional ambulance training would be a better fit for BLS IFT. We need to teach our entry level providers less of the "life saving hero" pap that's the main thrust of today's curriculum and more about safe patient movement, interpersonal communication and defensive driving.

I'd much rather have an EMT that knows how to move a bed bound patient, can change an adult diaper without gagging and drives the truck like a responsible adult.
 
DEmedic said:
And frankly, sometimes you just need someone to drive a person to the hospital on a stretcher.

I have said for years that CNAs with additional ambulance training would be a better fit for BLS IFT. We need to teach our entry level providers less of the "life saving hero" pap that's the main thrust of today's curriculum and more about safe patient movement, interpersonal communication and defensive driving.

I'd much rather have an EMT that knows how to move a bed bound patient, can change an adult diaper without gagging and drives the truck like a responsible adult.
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This..

There are many patients who need no interventions other than a Ride. Why tie up a ALS truck for a bed bound patient who needs ambulance/ambulette services or has something that cannot be treated in the field.
 
Rialaigh said:
Quite frankly, because there are not enough paramedics to put two on every truck. In progressive states I think there is a role for the EMT-I but I think EMT-B is a dying breed. For practical purposes EMT basics don't (can't) do anything that I can't talk a calm lay person through doing correctly.


Practically - They drive a truck
Legally - They fulfill requirements to staff ambulances at several dollars an hour cheaper than paramedics
Click to expand...
In some places, 2 certified EMTs are required to be on the ambulance to legally place it in service. This includes CCT ambulances where the RN has many years providing high level care. Here's where things get interesting: if the RN is also certified as an EMT, that counts as one of the EMT staff.
 
In all reality it just matters where you work and who you work with. Most of my partners (who are Paramedics) just have me run the calls because that is what we have become comfortable with. If he wants to start an IV or something so be it, but I'm doing the questioning, assessments, etc to determine the plan of care. Hell I'm usually the one looking at the EKGs too. And of course anything from King Airway, Airway stuff in general (ie Bagging etc), Drawing up drugs, I will do too, or I instruct someone from the fire department (who show up to help us if needed) to do so while I assess the situation like on a Cardiac Arrest or something requiring more people. If my partners needs me to do something, I help him out. It works both ways.

If you want to be a good EMT (and maybe one day Paramedic) work for a service that lets you be a MEDIC. EMTs are medics too.
 
BasicBek said:
In all reality it just matters where you work and who you work with. Most of my partners (who are Paramedics) just have me run the calls because that is what we have become comfortable with. If he wants to start an IV or something so be it, but I'm doing the questioning, assessments, etc to determine the plan of care. Hell I'm usually the one looking at the EKGs too. And of course anything from King Airway, Airway stuff in general (ie Bagging etc), Drawing up drugs, I will do too, or I instruct someone from the fire department (who show up to help us if needed) to do so while I assess the situation like on a Cardiac Arrest or something requiring more people. If my partners needs me to do something, I help him out. It works both ways.

If you want to be a good EMT (and maybe one day Paramedic) work for a service that lets you be a MEDIC. EMTs are medics too.
Click to expand...


I got a good laugh out of this. Thanks. I needed that this morning.
 
DEmedic said:
I got a good laugh out of this. Thanks. I needed that this morning.
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I'm glad you laughed. It just made my head hurt...
 
If EMTs are Medics than are Medics...Doctors? :rolleyes:
 
I know there's some interesting White Patch/Gold Patch interplay at EMSA, at least from reading a page on Facebook.

Not for nothing, but an EMT shouldn't be the one to develop a "plan of care" when there is a paramedic there, especially when it's an ALS-centric call like a code. I've worked with some great EMTs and some that were not so great, and I'll allow them to perform tasks if I'm comfortable with their past performance. But, the minute the EMT starts to believe that they run the show, it's time for a come to Jesus meeting.
 
DEmedic said:
I know there's some interesting White Patch/Gold Patch interplay at EMSA, at least from reading a page on Facebook.

Not for nothing, but an EMT shouldn't be the one to develop a "plan of care" when there is a paramedic there, especially when it's an ALS-centric call like a code. I've worked with some great EMTs and some that were not so great, and I'll allow them to perform tasks if I'm comfortable with their past performance. But, the minute the EMT starts to believe that they run the show, it's time for a come to Jesus meeting.
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I am mainly referring to BLS calls because we run both BLS/ALS calls. I've worked with a lot of partners but my regular partner over a year and half and he knows what I feel comfortable with and don't and what he feels comfortable with me doing. A lot of the Paras here seem to show great faith in a lot of the EMTs which has helped them excel and learn. I have also worked with Paramedics who prefer do EVERYTHING literally and that's fine too but it's not something I'd like to do every shift other wise I'd never learn. There are some that initiate the assessments and some that don't. I've had a lot say thank you, I didn't even have to say anything in there. That's awesome.

With that being said we literally just did a new shift bid and my regular partner left for school, my new partner seems to work a long the same plane. If it becomes something absolutely ALS then he does what he wants to do and I'll do what he needs me to do. But the majority of calls are in fact BLS, at least here. It's always been a complete partnership with my partners here and I feel like that's how it should be. When talking about an arrest or something it also depends on the partner, again, my ex partner and I could go a whole code without speaking and all movements were silent and near robotic, any talk was to the fire department because the station is different at every call.
 
I am not saying that EMT's should do more. I am complaining that what we can do is too little for the pt. EMT's literally do the exact same things as certified first responders in my area. Why train someone for months to do the exact same thing that someone with a few weeks of training does? Why waste the time? Why not do away with EMT level of care completely and let first responders have that position? EMR is a much simpler cert to get and can do anything an EMT can (at least where I am). I also feel that the minimum care a pt should receive should be intermediate level of care. At least they can do things like start IV's and drop some drugs down.

I completely agree that if an EMT wants to do more they need more education. Here is what I propose, an EMR gets certified as EMR then undergoes special ambulance driving training. Then if they want to have pt interaction they go to school for 8-9 months and graduate at the intermediate level. I don't think EMT (again, where I am) is a viable position of use.
 
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