Why you want a paramedic in the field and not a doc

[DropkickMurphy]

My organization requires us to be able to master the BVM while holding c-spine, making a seal, AND bagging by yourself.

That's why God gave paramedics knees.....

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[canjosh]

He meant one handed mask seal, the other hand squeezing the bag.

But you supported our argument with your statement about poor technique- why should we give you the privilege to insert an ET tube if you can't master bag-valve-mask ventilation? Especially given that proper ventilation is an important technique both prior to and after intubation.....that same ****ty technique that leads to gastric insufflation is the one that leads to pneumothoraces and pneumomediastinum from barotrauma and volutrauma in intubated patients.

If you master proper technique you can very easily use non-invasive means to maintain an airway and ventilate effectively in all but the most extreme cases. If you have not mastered these techniques then you have no business being in the field (or in any setting for that matter) because we must be at an utmost level of comfort and confidence in our abilities with every procedure in our scope of practice. The reliance upon the next skill in the protocol isn't suitable for any situation....if you can't intubate and a surgical airway is contraindicated due to an expanding anterior neck hematoma (which I have seen in the field by the way), and the patient is too short for the Combitube....what do you do? You go back to trying to use a BVM to ventilate as best you can- lets hope for the patient's sake you've mastered that skill.

I have mastered that skill...it can be harder to do it CORRECTLY than people make it out to be. That's my point. Same point that was made about the dummy-proof tag surrounding the Combitube. If you think to yourself 'this is a basic skill which can't be screwed up' you'll screw it up. You said that if you've mastered proper technique you can effectively Bag-mask nearly all patients. That's true, but how many providers have actually mastered proper technique? Honestly, most physicians aren't expert BVM operators, almost zero nurses are, EMTs and medics on average are probably just slightly better. Most people just throw the mask on and bag away--somewhat effectively. Now, tell me what percentage of medics out there you believe have achieved mastery of BVM. Salt your response with some humility please...

 

[911medicine]

Okay, first off, I will be the very first one to admit, those with a MD or DO or even PA behind their name, know a heck of alot more than me about medicine! Their in depth understanding blows me away at times. I am challenged by it. That being said, there are areas where docs excell and medics excell. Our domain is in the PREHOSPITAL field. That is we are trained to take care of the patient, keep them alive best we can until we get to more definitive care. It seems several of you have forgotten this. We do not fix our patients ! DOCS DO THAT !!!! They also maintain the continuing care and everything which goes with it, including the risk of a lawsuit and huge malpractice bills. To me, they can have them.

I work for a very progressive service part time, and full time in a primary care role within industrial health. I am not an md, premed student or any of the above. I do have a degree in emergency medical care , but I work EMS and that is it, so this solely comes from my perspective. I took the job I have now to extend my learning, as a challenge. And challenge me it has. I realized exactly how little I knew despite five years on the street with one of the most progressive services in the state. I am constantly working to increase my knowledge, but sometimes it seems no matter how much I learn it is never enough. Despite my background, I have a feeling occasionally of the first day I was cut loose on a truck of "oh my God, why did I think I could do this?" I enjoy my job, but I will admit, it is better suited to a PA rather than a medic. They have the knowledge of how the body works much better than I do to understand the pathology behind the worker's injuries. I simply for lack of a better term treat and street.

As far as missed intubations, yes it is a fairly easy skill to acquire, but extremely difficult to master. Even anesthesia people will admit this. That is why there are such things as back up airway devices like the combitube, king, LMA, etc. If intubation were as simple as you state, these would be useless and worthless items. Our service does require us to do intubation clinicals each year, and have 20 successful ones PER YEAR ! This is to keep our skills sharp. We utilize small rural hospitals to help us achieve this as well as the larger facilities. We are a small but busy service, so it is easier to achieve with us. Because we are small and primarily BLS based (one or two medics per shift- usually OIC ) much of the call volume is BLS treated, with long transport time. We have extemely good basics and I would not trade them for anything. They call for a medic when needed, but truthfully those are few and far between despite our call volume. Our medics are taught BLS before ALS, as so many forget. I never cease to be amazed at the great job our basics do at handling things which most services would have called a medic for with great patient outcomes.

As far as misplaced tubes, there is no excuse for it. There are enough devices out there to ensure placement, that if you are doing your job properly, you should not arrive at the ER with a misplaced tube ! There is no excuse for that ! End tidal CO 2 detectors, esophageal bulb detectors, breath sounds. Come on guys, check every time you move a patient- or did you forget that part of class?

The only one up a medic truly has on a basic is the ability to administer drugs. I agree that I would either like to see basics allowed to administer first round cardiacs, D-50, start lines of NS or LR in addition to what they already do, perhaps throwing neb treatments into the mix. Intermediates should be much more utilized in the areas where medics are needed, with just a few medics to deal with the truly critical cases - and those should be critical care equivilant. It is true that a doc on his first time out probably couldn't start an IV in a moving buggy, but probably neither did you. It is an acquired skill. I think increased continuing education with medical directors actually requiring signing off from people doing the different areas would be appropriate rather than training officers saying, yep you can do it. My question is when is the last time you did it? How many do you do a year? And how many is enough? Better training and continuing ed guys, not more medics will improve medicine. Remember some countries do ride docs on the ambulances rather than medics- don't forget we COULD be replaced !

 

[DropkickMurphy]

I have mastered that skill...it can be harder to do it CORRECTLY than people make it out to be. That's my point. Same point that was made about the dummy-proof tag surrounding the Combitube. If you think to yourself 'this is a basic skill which can't be screwed up' you'll screw it up. You said that if you've mastered proper technique you can effectively Bag-mask nearly all patients. That's true, but how many providers have actually mastered proper technique? Honestly, most physicians aren't expert BVM operators, almost zero nurses are, EMTs and medics on average are probably just slightly better. Most people just throw the mask on and bag away--somewhat effectively. Now, tell me what percentage of medics out there you believe have achieved mastery of BVM. Salt your response with some humility please...

Well, given that I'm also a respiratory therapist does mean that I don't have to salt my responses with anything, especially when I'm talking to someone who has a lower level of education compared to me when it comes to airway management and ventilation. Just as you need to remember that when you are trying to tell a doc you are the expert when it comes to emergency medicine- regardless of the setting- perhaps you should salt your responses with some humility.

 

[DropkickMurphy]

Okay, first off, I will be the very first one to admit, those with a MD or DO or even PA behind their name, know a heck of alot more than me about medicine! Their in depth understanding blows me away at times. I am challenged by it. That being said, there are areas where docs excell and medics excell. Our domain is in the PREHOSPITAL field. That is we are trained to take care of the patient, keep them alive best we can until we get to more definitive care. It seems several of you have forgotten this. We do not fix our patients ! DOCS DO THAT !!!! They also maintain the continuing care and everything which goes with it, including the risk of a lawsuit and huge malpractice bills. To me, they can have them.

I work for a very progressive service part time, and full time in a primary care role within industrial health. I am not an md, premed student or any of the above. I do have a degree in emergency medical care , but I work EMS and that is it, so this solely comes from my perspective. I took the job I have now to extend my learning, as a challenge. And challenge me it has. I realized exactly how little I knew despite five years on the street with one of the most progressive services in the state. I am constantly working to increase my knowledge, but sometimes it seems no matter how much I learn it is never enough. Despite my background, I have a feeling occasionally of the first day I was cut loose on a truck of "oh my God, why did I think I could do this?" I enjoy my job, but I will admit, it is better suited to a PA rather than a medic. They have the knowledge of how the body works much better than I do to understand the pathology behind the worker's injuries. I simply for lack of a better term treat and street.

As far as missed intubations, yes it is a fairly easy skill to acquire, but extremely difficult to master. Even anesthesia people will admit this. That is why there are such things as back up airway devices like the combitube, king, LMA, etc. If intubation were as simple as you state, these would be useless and worthless items. Our service does require us to do intubation clinicals each year, and have 20 successful ones PER YEAR ! This is to keep our skills sharp. We utilize small rural hospitals to help us achieve this as well as the larger facilities. We are a small but busy service, so it is easier to achieve with us. Because we are small and primarily BLS based (one or two medics per shift- usually OIC ) much of the call volume is BLS treated, with long transport time. We have extemely good basics and I would not trade them for anything. They call for a medic when needed, but truthfully those are few and far between despite our call volume. Our medics are taught BLS before ALS, as so many forget. I never cease to be amazed at the great job our basics do at handling things which most services would have called a medic for with great patient outcomes.

As far as misplaced tubes, there is no excuse for it. There are enough devices out there to ensure placement, that if you are doing your job properly, you should not arrive at the ER with a misplaced tube ! There is no excuse for that ! End tidal CO 2 detectors, esophageal bulb detectors, breath sounds. Come on guys, check every time you move a patient- or did you forget that part of class?

The only one up a medic truly has on a basic is the ability to administer drugs. I agree that I would either like to see basics allowed to administer first round cardiacs, D-50, start lines of NS or LR in addition to what they already do, perhaps throwing neb treatments into the mix. Intermediates should be much more utilized in the areas where medics are needed, with just a few medics to deal with the truly critical cases - and those should be critical care equivilant. It is true that a doc on his first time out probably couldn't start an IV in a moving buggy, but probably neither did you. It is an acquired skill. I think increased continuing education with medical directors actually requiring signing off from people doing the different areas would be appropriate rather than training officers saying, yep you can do it. My question is when is the last time you did it? How many do you do a year? And how many is enough? Better training and continuing ed guys, not more medics will improve medicine. Remember some countries do ride docs on the ambulances rather than medics- don't forget we COULD be replaced !

I'll let one of the docs field this one.....I'm tired of playing slap and tickle with the lower end of the EMS food chain.

 

[911medicine]

Lower end of the EMS food chain? I am speaking from a different perspective than you may think...I am advocating better education and training not more privledges....if you had truly read my post rather than mouthing off and attempting to sound more intelligent than you are, you would have realized that. Instead, you have chosen to make yourself look ignorant.

 

[DropkickMurphy]

Lower end of the EMS food chain? I am speaking from a different perspective than you may think...I am advocating better education and training not more privledges....if you had truly read my post rather than mouthing off and attempting to sound more intelligent than you are, you would have realized that. Instead, you have chosen to make yourself look ignorant.

Oh, I see you're more observant that I figured.....

Actually, you're strongly advocating more skills for basic EMT's- skills which have not been proven (in the case of ACLS drugs in particular) to do squat for survival rates.

Although I do agree with additional education, I don't believe handing the entry level people a drug bag, a few more hours of training and an ACLS card and going "Have at it" is a good idea. That's not an ignorant perspective at all. It's very realistic and based on the principles of evidence based practice.

 

[NYMDinMI]

Let's face it, with the way our current EMS system is set up, EMTs are trained, not educated. It is the good EMTs/Medics that go on to educate themselves. Maybe EMT should be a college level thing, might help weed out those who shouldn't be there (to some degree). We also need to have a national standard that all states go by, something a little more comprehensive than national registry. Should we go as far as to say there should be a specialty board similar to ABEM, or maybe ABEM should take on yet another role (and get rid of LLSA). How about putting PAs on ambulances?

 

[911medicine]

Drop Kick,

Are you proposing that we eliminate cardiac drugs in codes? If you are so against them as it sounds, and they do no good, then why are we still using them? Yes, some are better than others, and also the survival rate even with immediate CPR is terrible, something hopefully that will improve, but I'd rather have the drugs to go with than nothing at all. What would you propose be used as the alternative to drugs? I am interested in hearing, and no there is no sarcasm inflected in that statement.

I was not promoting just giving our current basics drugs and saying have fun. I believe they should know the reasoning why they are giving what they are and what it will do. I think medics should have a better understanding. I am thinking more of an entry level similar to intermediates, but with an additional cardiology, pharmacology, and anatomy physiology class required as I had to go through in addition to the traditional medic program. I feel I got an excellent education, and feel competent under most circumstances. As I mentioned, my current job is requiring different things than I am used to, so I have to rely strongly on anatomy/physiology. I intend to take an additional class to brush up this fall. As I said previously, more education is the key. No offense involved to your previous statements, simply a lack of understanding where you were directing you thoughts. I am not advocating releasing people to do skills without the understanding, if that means longer education then go for it. I don't agree with degrees neccessarily due to the useless classes (ie british lit, etc), but a concentrated degree which would include the classes beneficial for medics across the board.

 

[Sinnman]

Drop Kick,

Are you proposing that we eliminate cardiac drugs in codes? If you are so against them as it sounds, and they do no good, then why are we still using them? Yes, some are better than others, and also the survival rate even with immediate CPR is terrible, something hopefully that will improve, but I'd rather have the drugs to go with than nothing at all. What would you propose be used as the alternative to drugs? I am interested in hearing, and no there is no sarcasm inflected in that statement.

I was not promoting just giving our current basics drugs and saying have fun. I believe they should know the reasoning why they are giving what they are and what it will do. I think medics should have a better understanding. I am thinking more of an entry level similar to intermediates, but with an additional cardiology, pharmacology, and anatomy physiology class required as I had to go through in addition to the traditional medic program. I feel I got an excellent education, and feel competent under most circumstances. As I mentioned, my current job is requiring different things than I am used to, so I have to rely strongly on anatomy/physiology. I intend to take an additional class to brush up this fall. As I said previously, more education is the key. No offense involved to your previous statements, simply a lack of understanding where you were directing you thoughts. I am not advocating releasing people to do skills without the understanding, if that means longer education then go for it. I don't agree with degrees neccessarily due to the useless classes (ie british lit, etc), but a concentrated degree which would include the classes beneficial for medics across the board.

911, I'm tired so I'll try to make this brief.

I'm not really sold on more education. You can read my previous post.

In general, I think education is great. I'm finishing medical school now and this is my fifth degree with over 400 hours of college credits to date (it is a sickness). I have reversed my thoughts on EMS education over the years. There really is no convincing data that increased education leads to better outcomes. In fact, the data point to quite the opposite.

The thing with medicine is that there is a terminal degree, MD or DO, and ultimately all patients should be managed by a physician. For a variety of reasons people in health-related jobs always seem to want more education generally without solid evidence that it really helps anybody other than there own professional self-interest. I mean, do nurses really need a doctorate? Do you even need a BSN to push meds or give an enema? There is a significant push for this by their ivory tower leadership. Look at the PTs, the audiologists, speech pathologist and many others. I think that in general all this really does is increase the cost of healthcare for everyone.

Back to EMS. If you make EMT-B a true college course think of the unintended ramifications. You will decrease the number of trainees. I personally like training a bunch of EMTs because to me more EMTs = better access. I know if I arrest I'd rather have a couple of EMT-Basics with a volunteer fire fighters EMT class and an AED that are 5 minutes away than a University trained EMT-B with a more advance anatomy course that is 20 minutes away.

I personally saw these unintended effects with the adoption of the newest NTSA Paramedic curriculum. More requirements and more education = less graduates.

We don't need docs, PAs, nurses or anyone else on the trucks. We also don't need a bunch of medics with bachelor’s degrees. We NEED EMTs and Paramedics that can effectively perform the basic and initial care of critical patients and a system that ensures performance and continued validation of these skills.

So much for brief.

 

[deleted6669]

Let's face it, with the way our current EMS system is set up, EMTs are trained, not educated. It is the good EMTs/Medics that go on to educate themselves. Maybe EMT should be a college level thing, might help weed out those who shouldn't be there (to some degree). We also need to have a national standard that all states go by, something a little more comprehensive than national registry. Should we go as far as to say there should be a specialty board similar to ABEM, or maybe ABEM should take on yet another role (and get rid of LLSA). How about putting PAs on ambulances?

you are not the 1st to think of this idea....at present pa's are only used on critical care transports but in the future....?
from one of the pa journals last yr....

Fast track in the field: Another option to ease ED overcrowding

Emergency department (ED) overcrowding is becoming a serious problem in the nation’s hospitals. Many are forced to go on ambulance diversion status because of a shortage of bed space, clinicians, or resources needed to take care of patients. Patients who seek care in the ED often require ED evaluation and are there appropriately. There is, however, a subset of patients who use the ED for conditions that are neither emergent nor, at times, even urgent. Many of these patients do not have access to a primary care provider, or they live in communities lacking adequate free medical resources for the uninsured or underinsured, so the ED becomes their only choice. One option that meets the needs of patients, hospitals, and emergency medical services (EMS) providers is to create a system by which these patients are seen outside of the ED yet receive the same high-quality care from the same providers that they would in an ED setting.

Fast track in the field
The EMS community is advocating for advanced training for paramedics to perform these functions. But, why not use PAs in emergency medicine to fill this void? They already have the requisite skills and experience, and they could rotate between working in the field and in their home EDs.

Many PAs in emergency medicine started their careers in medicine as paramedics and would welcome the opportunity to use their new skills outside the ED setting. I have spoken about this concept with a number of my PA colleagues who previously worked in EMS. The consensus was that they would enjoy the opportunity to return to the field and be able to concentrate on a single patient at a time instead of the six to eight patients that are followed at one time in the typical ED setting. Some unpleasant aspects of being a paramedic would be absent from this system, such as carrying heavy patients down multiple flights of stairs and being awakened in the middle of the night for low acuity cases. These are among the chief reasons many PAs leave EMS to go to PA school.

This system would also benefit EMS because they would no longer have to transport patients with minor complaints to the ED. The large number of nonemergent 911 calls has been a significant cause of burnout and frustration among EMS personnel. The system I am proposing would allow paramedics to focus on what they do best—treating truly emergent patients in the field setting.

How would it work?
The concept would initially utilize a trial ambulance team of one PA and one basic EMT/driver and would be staffed only during the busiest hours of the day. The team would not respond directly to 911 calls but would be summoned after an initial decision by paramedics that the patient was nonemergent and met criteria for field treatment and release. The criteria might involve such complaints as minor lacerations, upper respiratory infections in otherwise healthy persons, prescription refills for noncontrolled medications, ingrown toenails, and so forth. EMS and members of the field group would agree on these criteria in advance. The ambulance company could still bill for a home response and any supplies used, while the hospital ED could bill for the PA’s time and any hospital supplies (such as suture sets) used in treatment.

If a single unit saw a patient every 30 minutes for 8 hours, 16 fewer patients would arrive at the ED and 16 more emergent ambulance calls could be made. Some patients might initially be thought to be appropriate for field treatment and later be found by the PA to need further evaluation. These patients could then be transported nonemergently to the local ED by the PA unit and checked in there in the same fashion as a typical walk-in patient. A busy area could use more than one unit or staff it for more hours daily.

This system would be practical only in a busy metropolitan area where ED overcrowding and a strained 911-response system are daily issues. While using PAs in the field in other settings is an option, there would be no clear benefit to local hospitals or emergency services through such utilization.

Patients would also benefit from such a system. Currently, patients with low-acuity complaints face long waits in EDs, sometimes as long as 4 to 6 hours or more. Field treatment would allow rapid evaluation and treatment of their minor injuries and illnesses, greatly increasing patient satisfaction. Follow-up visits would be done by the same “city call” physicians who see unassigned ED patients after their discharge from the hospital. The patients could also be given a list of local resources, such as primary care providers in the community and social workers who can arrange for federal or state health coverage.

Benefits on many levels
In this system, there would be no decrease in revenue to either the hospital or the EMS company. Members of the team would be paid by their normal employers at their normal rate of pay. No changes would need to be made to the configuration of the ambulances used. The PA could simply carry a tackle box with supplies and a few noncontrolled medications, such as antibiotics. All the pieces are in place for this to work, with very little preparation time involved. The staffing already exists. Oversight would continue per current practices. The supervising physicians of the ED PAs would review the PAs’ field documentation in addition to their regular ED charts. The PAs’ malpractice policy from the hospital would be amended to include work in the field. Hospital EDs would be able to allocate their resources more appropriately to evaluate sicker patients in a shorter amount of time.

This is only the outline of a concept. I hope that this model can be tested in busy urban areas to determine its effectiveness at decreasing ED wait times and improving service to those in need of medical care.

 

[DropkickMurphy]

I've always said that PA's are what paramedics were envisioned as- physician extenders. The idea of a "prehospital physician assistant", a "PHPA" if you will would be a good step forward. Now is it ever going to happen? I doubt it.

 

[deleted6669]

I've always said that PA's are what paramedics were envisioned as- physician extenders. The idea of a "prehospital physician's assistant", a "PHPA" if you will would be a good step forward. Now is it ever going to happen? I doubt it.

remember...no 's in PHYSICIAN ASSISTANT.....

 

[DropkickMurphy]

Oops....sorry.

 

[Happy613]

Before I went to med school I was a firefighter; I worked with some truly awesome medics and that experience had a huge affect on me.

To me, what makes ems and medics unique is there ability to improvise in the field and perform life saving manuveurs in harsh conditions.

Most doctors just don't realize the conditions the medic is working in. I have seen a medic intubate a poly trauma victim at night in a snowstorm, next to a burning car, wearing bunker gear and an SCBA on his back. Thats not something we see in medical school.

As trauma evolves as a science, it is becoming clear that a patient's best chances at survival stem on the ability of the ems team to get the patient to a trauma center a soon as possible. A doctor in the field I don't really think adds anything, it is however important for them to see how medics work on the side of a highway without the advantage of a safe, well lit, sterile trauma bay.

I think trauma doctors in the field may be beneficial in the rare sitations in which extracation is lengthy and hemodynamic stability can only be obtained with invasive procedures.

I think that this argument over who is better, really takes away from the unique role medics play. Its not about medical knowledge or critical thinking in the field, its about speed, and technical skill, ensuring that the patient has a chance once they get to the truama bay.

 

[rn29306]

Before I went to med school I was a firefighter; I worked with some truly awesome medics and that experience had a huge affect on me.

To me, what makes ems and medics unique is there ability to improvise in the field and perform life saving manuveurs in harsh conditions.

Most doctors just don't realize the conditions the medic is working in. I have seen a medic intubate a poly trauma victim at night in a snowstorm, next to a burning car, wearing bunker gear and an oxygen tank on his back. Thats not something we see in medical school.

As trauma evolves as a science, it is becoming clear that a patient's best chances at survival stem on the ability of the ems team to get the patient to a trauma center a soon as possible. A doctor in the field I don't really think adds anything, it is however important for them to see how medics work on the side of a highway without the advantage of a safe, well lit, sterile trauma bay.

I think trauma doctors in the field may be beneficial in the rare sitations in which extracation is lengthy and hemodynamic stability can only be obtained with invasive procedures.

I think that this argument over who is better, really takes away from the unique role medics play. Its not about medical knowledge or critical thinking in the field, its about speed, and technical skill, ensuring that the patient has a chance once they get to the truama bay.

A most excellent post.

 

[canjosh]

Well, given that I'm also a respiratory therapist does mean that I don't have to salt my responses with anything, especially when I'm talking to someone who has a lower level of education compared to me when it comes to airway management and ventilation. Just as you need to remember that when you are trying to tell a doc you are the expert when it comes to emergency medicine- regardless of the setting- perhaps you should salt your responses with some humility.

Dropkick-
Uh, I think you've got me confused for someone else dude. I don't care whether you're an RT, I asked you to humbly tell me how many providers [physicians, nurses, medics, RTs, etc.] you believe are MASTERS at bag-mask ventilation. My feeling is that the number is relatively low. I was looking for an honest answer, not a pride inflated one--hence my humility comment.

I've never said anything about telling a doc that 'I'm the expert when it comes to emergency medicine'. Somebody else might have--not me. Re-read the posts and get it straight before getting personal.

Lastly, why do you assume I have a lower level of education than you? I've never mentioned my level of education to you. I could be a doctorate prepared supraglottic anatomy professor for all you know.

BTW, I never thought being a respiratory therapist makes a person so qualified as to not have any humility regarding airway management. Especially when you don't even know me...

 

[Krazed_Medic]

Hello, I've been following this thread a tad. I noticed someone mention that PA's should be on the ambulance. A few years ago, wasn't there a proposal of some sort for what they called, Paramedic Practitioners? I've done a quick google search on it, and it looks like they are doing it on a trial basis in the U.K. with some success.

With that being said, I myself am a Paramedic for 6 years now. I'll never claim to master anything, but I do know that I feel that the EMT-Basic skills are a MUST KNOW, and the need to be comfy with these skills is extremely important. I would take a guess and say about 90% of the transports that I have done in my career, did not require any paramedic, or even advanced level of care for the transport. Well, that's about all that I have to say about that.... for now.

 

[DropkickMurphy]

I would say in the ten years, I've been in EMS, probably 95% of the patients I've treated were BLS level cases. Out of the patients I feel my coworkers and I have "saved", I would bet that 95% of those were saved by our BLS skills.

 

[igcgnerd]

I feel my coworkers and I have "saved", I would bet that 95% of those were saved by our BLS skills.

Speak the Truth! It had to be said.

 

[Taaki]

Wow. Lots of hostility in a feild where team work is essential.
I agree with most Doc's and seasoned Medics, we as ems personnel do not receive enough training or backround information as to why we treat the patient in the fashion that we do. I have been an EMT-B for 10+ years and within the last two years upped the ante to EMT-Intermediate. How long did it take me to aquire the I behind the EMT? 72 hours. Yep, 72. 72 hours to learn how to start IV's, administer life saving/threatening drugs. I personally do not feel that this was an adequate amount of time to learn all that was thrown at us. I am currently in the Paramedic program, not to be able to "play with new toys" or drugs, but to get a better understanding of how and why I treat my patient. I agree, even on the Paramedic level it is only a dip in the knowledge pool vs. an MD. However, the bulk of our calls require only BLS, thankfully. My job is to attempt to keep the patient alive with no further harm until I can get them to someone with the proper training and tools. Prehospital EMS is invaluable even if it is lacking. We dig patients out of the snow, contort our bodies in ways never thought possible in order to perform our BLS skills. We shoo dogs away, enter environments that should be condemned, to retrieve the patient and deliver them to the ED. I think we are all a valuable part of the team, regardless of our initials or degrees, as long as we utilize the skills we have been taught properly.
It takes time in the field (whether it literally be a field or the ED) to be good at what we do. It also valuable to remember that we do not know everything and never will, this includes the MD's. We are humble servants to the human race in a world where disease and tragedy is forever growing, so quit chewing on each other, link hands and sing........KumBaYa. LOL, K, little over the top there, but you get my point.

 

[deleted6669]

Wow. Lots of hostility in a feild where team work is essential.
I agree with most Doc's and seasoned Medics, we as ems personnel do not receive enough training or backround information as to why we treat the patient in the fashion that we do. I have been an EMT-B for 10+ years and within the last two years upped the ante to EMT-Intermediate. How long did it take me to aquire the I behind the EMT? 72 hours. Yep, 72. 72 hours to learn how to start IV's, administer life saving/threatening drugs. I personally do not feel that this was an adequate amount of time to learn all that was thrown at us. I am currently in the Paramedic program, not to be able to "play with new toys" or drugs, but to get a better understanding of how and why I treat my patient. I agree, even on the Paramedic level it is only a dip in the knowledge pool vs. an MD. However, the bulk of our calls require only BLS, thankfully. My job is to attempt to keep the patient alive with no further harm until I can get them to someone with the proper training and tools. Prehospital EMS is invaluable even if it is lacking. We dig patients out of the snow, contort our bodies in ways never thought possible in order to perform our BLS skills. We shoo dogs away, enter environments that should be condemned, to retrieve the patient and deliver them to the ED. I think we are all a valuable part of the team, regardless of our initials or degrees, as long as we utilize the skills we have been taught properly.
It takes time in the field (whether it literally be a field or the ED) to be good at what we do. It also valuable to remember that we do not know everything and never will, this includes the MD's. We are humble servants to the human race in a world where disease and tragedy is forever growing, so quit chewing on each other, link hands and sing........KumBaYa. LOL, K, little over the top there, but you get my point.

nice post.
just curious, where can you get an emt-I in 72 hrs?
around here it takes around 250+ hrs including lots of er and field time.
http://www.pcc.edu/academics/index.cfm/46,896,30,html
to get the emt-i.v. cert( 1 step up from emt-b, no drugs/adv airway) around here requires 50 documented iv sticks in the er and a bunch( ? 10-25 ) in the field and it takes most folks 5+ er shifts(over 50 hrs) plus a bunch of field shifts to get this.and that is just an IV cert......
emedpa, pa-c, emt-p

 

[Taaki]

nice post.
just curious, where can you get an emt-I in 72 hrs?
around here it takes around 250+ hrs including lots of er and field time.
http://www.pcc.edu/academics/index.cfm/46,896,30,html
to get the emt-i.v. cert( 1 step up from emt-b, no drugs/adv airway) around here requires 50 documented iv sticks in the er and a bunch( ? 10-25 ) in the field and it takes most folks 5+ er shifts(over 50 hrs) plus a bunch of field shifts to get this.and that is just an IV cert......
emedpa, pa-c, emt-p

Sorry, the 72 hours was just the classroom time. We also had to have 50 in class sticks, and a so many sticks in the field. I am in WI. A basic can administer nitro (with online orders from med control), glucagon, albuterol, aspirin, epinephrine, use the combitube, do EKG's (although they can't read them, and it doesn't alter their treatment). As an Intermediate you can administer all those plus narcan, D-50, Atrovent, and start IV's with NS (most of the rigs around here do not carry Lactated Ringers).

 

[DropkickMurphy]

I miss my old protocols as an Intermediate:
-Intubations (nasal and oral)
-CPAP
-Manual defib and pacing (couldn't convince the medical director to let us cardiovert though )
-Needle decompressions (although I only did it a couple of times in several years)
-IV's/IO's with NS, D5W, and LR
-12 leads
-Epi, atropine, naloxone, lidocaine, glucagon, D50, thiamine, albuterol, ipratroprium, aspirin, nitrous oxide and nitroglyerin

This was after an extra 5 or so months of training.

 

[Taaki]

I am curious, what do other states allow Basics to do?

 

[DropkickMurphy]

Most states it is pretty close to the National Standard Curriculum- no intubation (non-visualized airways only), no IV's, "assist" with prescribed medications only etc....

 

[canjosh]

I am curious, what do other states allow Basics to do?

You may need to clarify...you said basics could give NTG, ASA, epipen, albuterol, etc. In your state is that only for meds prescribed for the pt? In other words, you're assisting the pt with his/her established meds, correct?

 

[DropkickMurphy]

Personally I think EMT-Basics should be allowed to use Epi-Pens and NTG on pts who need them that don't have prescriptions for them, even if it requires online medical control OK for it. Just my opinion, but I have heard of a couple of states allowing this.

 

[Medic_9]

Time for me to step in I think. I work in Ontario, Canada as a Primary Care Paramedic (PCP). We work with different levels than the states. My level falls between an EMT-B and EMT-I.

I can give 6 meds with standing orders (no need to get Dr's permission first) these include Nitroglycerin, ASA, Salbutamol, Glucagon, Glucogel, and Epi. Our standing orders are for chest pain, difficulty breathing, anaphylaxsis, croup, hypoglycemia, and pulmonary edema. In some services we can also be certified to do IV's and give D50 and Lasix. This is going to be province wide soon. If you are a PCP on an air ambulance you are also certified to give gravol (best med ever).

I can't imagine not being able to do the skills that I can.

Our other levels are Advanced Care Paramedic and Critical Care Paramedic. Except for Toronto, Critical Care Paramedic's are only on the air ambulances.

 

[leviathan]

In some services we can also be certified to do IV's and give D50 and Lasix.

Hey Medic,

They can do IVs and give D50 in BC. I'm not sure about lasix, though...that sounds more along the lines of ACP protocol.

 

[OSUdoc08]

Personally I think EMT-Basics should be allowed to use Epi-Pens and NTG on pts who need them that don't have prescriptions for them, even if it requires online medical control OK for it. Just my opinion, but I have heard of a couple of states allowing this.

They do in Texas. No med control needed.

 

[Medic_9]

Hey Medic,

They can do IVs and give D50 in BC. I'm not sure about lasix, though...that sounds more along the lines of ACP protocol.

Yeah BC follows the EMT level system. I was referring to the services in Ontario excluding Toronto.

 

[leviathan]

Yeah BC follows the EMT level system. I was referring to the services in Ontario excluding Toronto.

No, we are EMR, PCP, ACP, and CCP trained just like Ontario.

 

[Taaki]

You may need to clarify...you said basics could give NTG, ASA, epipen, albuterol, etc. In your state is that only for meds prescribed for the pt? In other words, you're assisting the pt with his/her established meds, correct?

Nope. The basics can "assist" with the patient's prescribed nitro, but they can administer albuterol, aspirin, epipen, glucagon, all without med control. As an intermediate I can give nitro once I have established an IV, if no IV established than I have to call med control and get permission. I can administer up to 2mg of narcan before contacting med control. I can give aspirin, glucagon, atrovent, epi (we draw it up on our rig), all without med control. I do need med controls permission to administer D-50 though. It is up to the individual medical director as to what his "staff" can do before contacting medical control. Some services out here have to call med control before they give albuterol. The services I work for have an excellent med director who is very involved.

 

[DropkickMurphy]

The service I used to run with....our medical director would ream our asses if we called in for anything that would be blatantly obvious....now if there was a good reason- weird presentation or whatnot- then he gave us a little leeway, but otherwise he expected us to think for ourselves. Of course he also mandated that we effectively knock out two years worth (according to state regs) of CE every six months in order to stay up to speed and attend monthly audit and review sessions in order to still run as providers......