being paid as an EMT

[robcho]

hello everyone. i just have a simple question to ask
i will be taking my EMT basic certification class in the summer, so by the end of summer, i'll be an EMT-B and i'll be able to volunteer and things like that.
my question is that when i turn 18, will i automatically be able to work at a hospital or in an ambulance and get paid as an EMT with just my EMT-B certification, or will i have to take more classes or do some other things.
thanks to anyone who answers =D

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[cavalier329]

if you are looking to do 911 response then you will probably need a year + experience. The only case where you would have to take extra courses is if the agency that hires you requires you to have CEVO and/or EVOC to be a driver (Certified Emergency Vehicle Operator/ Emergency Vehicle Operator Course).

As new EMT-B, the jobs that will probably be open to you are routine facility to facility transports. This often consists of moving an invalid from a nursing home to a dialysis center and back again. If you want to do this then thats cool, however in my opinion, it is a waste of time and skill. You will not get much emergency experience as a transport EMT.

In the hospitals...some hospitals hire ER techs who basically take blood pressure and put patients on O2. Again, this is not really a worthy use of your certification as an EMT. But then again, if you need money...whatever pays the bills. Hospitals may require you to take facility specific protocol courses.

I dont see you having to take any additional courses aside from CEVO or EVOC. But then again, depending on how strict the agency is, you may need to take some additional certs like hazmat awareness, WMD awareness, fire scene awareness, etc.

Now another problem you may run into as a young EMT (which is what happened to me when I started) was many agencies may not be able to hire you until you are 20, 21 or older. Their insurance that covers you may not allow 18 year old workers. Also many don't want students. They need more coverage then a student can give.

I hope that answers your question. Good for you for becoming an EMT. I hope you take advantage of it, especially at your vollie corps. This country is very short on volunteer EMT's. Enjoy!

My advice to you is this: Find a busy volunteer corps, put some time in and get experience, make connections and you'll get hired soon enough. You don't know enough to work paid yet. As a paid EMT your agency will NOT back you up if there is a legitimate lawsuit filed against you. They will fire your ass and separate themselves ASAP. Get volunteer 911 experience for about a year--try for 200 calls before you go paid. If thats not reasonable in your area then try to get 100.

 

[pseudoknot]

In the hospitals...some hospitals hire ER techs who basically take blood pressure and put patients on O2. Again, this is not really a worthy use of your certification as an EMT.

This is not consistent with what I've seen. Usually the tech jobs will have you doing everything an EMT does in the field and more. Those are great jobs for both pay and experience, but in some areas are fairly competitive and require field experience or connections.

Not every place has volunteer EMS but if yours does then it is a great way to get started.

It is possible to do paid 911 response right out of school. Not common, but possible sometimes. You should really talk to people in your area, at as many different agencies as you can. SDN's not going to help much with specifics because our EMS system is very different from place to place and a lot of people don't realize their experience doesn't apply elsewhere.

 

[jbar]

One problem with the tech jobs is that you are missing the practice of evaluating and implementing treatment that you decide on. In the ED you are a pair of hands. You get to see a lot and do a lot, but I really enjoyed showing up on scene, figuring out what was going on with the patient, and implementing my plan till we go to the ED.

 

[cavalier329]

This is not consistent with what I've seen. Usually the tech jobs will have you doing everything an EMT does in the field and more. Those are great jobs for both pay and experience, but in some areas are fairly competitive and require field experience or connections.

if you can find me a job description that says this then I will take back my answer. However, what you say doesn't make logical, financial sense. Why would they higher an EMT to do everything a nurse/doctor does and sometimes what the EMT's who brought the patient in has ALREADY done.

The ED techs that I have seen in my 6 years are exactly what the above poster said, an extra set of hands. An EMT-B cert is essentially useless in the ED when the patient is on the bed. Look at it this way: If paramedic brings in a patient, he/she wouldnt be able to release the pt to an EMT-B because it is a lower level of care. Based on what ive seen, it seems to make sense that EMT's in the ED are there to help move patients, take initial vitals, and take care of the O2.

 

[pseudoknot]

if you can find me a job description that says this then I will take back my answer. However, what you say doesn't make logical, financial sense. Why would they higher an EMT to do everything a nurse/doctor does and sometimes what the EMT's who brought the patient in has ALREADY done.

Job descriptions are usually pretty vague and I'm not going to waste time trying to prove to you what I've seen. I have a friend who is currently employed as an ED tech and she does everything in the EMT scope plus starting IVs and helping with whatever else they need. Of course it makes sense to hire EMTs instead of RNs or doctors if they can. EMTs are much cheaper! Also, I didn't say the techs do everything that nurses and doctors do. That would be ridiculous.

If paramedic brings in a patient, he/she wouldnt be able to release the pt to an EMT-B because it is a lower level of care.

They aren't releasing the patient to the EMT. They release the patient to the RN to whom they give the report.

Based on what ive seen, it seems to make sense that EMT's in the ED are there to help move patients, take initial vitals, and take care of the O2.

OK, that's what you've seen. You haven't seen every ED in the country. I'm not saying you're wrong about your own department and I apologize if it came off that way. I'm just saying that it's not like that in a lot of other places.

 

[cavalier329]

If an EMT blows a line, punctures an artery then there would be some serious legal issues at stake for the hospital for allowing a worker to do something outside of their scope of practice, beyond their certification. That is unless the hospital were to train and certify you themselves.

It is risky to do anything outside of your EMT-B cert for obvious legal reasons. However, if the hospital is willing to pay and certify you as a phlebotomist or something along those lines then thats a different story.

Good luck trying to find something like that. Im not aware of any hospital in NYC that will do this for an EMT.

Make sure you DO NOT do anything outside of your certification without proper licensing. This is a good way to get sued.

 

[pseudoknot]

ED techs aren't working under a prehospital scope of practice so that stuff doesn't apply. In some states at least, phlebotemists don't need to be certified by anyone.

The bottom line, as I said before, is that all this stuff varies a lot regionally and the OP should check things out offline and locally. Maybe being an ED tech sucks in NYC but it's a great job in California and Virginia.

 

[cavalier329]

At the University of Virginia, where I am, an ED tech works under their EMT-B. Here, like NYC, EMT-B's DO NOT take blood or start IV's as this is not covered under the Virginia state EMT-B curriculum.

 

[cavalier329]

1-2 years as an EMT-B is also required to be an ED tech at UVA

 

[jbar]

it depends on the state. In Colorado EMT-Bs can take a short (like 24 hr) class and be certified to start IVs. So where I was in CO al the techs were EMT-Bs with IV cert. Also you could have an EMT take a phelbotomy class and be certed as both an EMT and a phlebotomist.

 

[cavalier329]

right, but an EMT would not be allowed to work in an ED under his/her cert and start IV's without some additional training to do so

 

[pseudoknot]

At the University of Virginia, where I am, an ED tech works under their EMT-B. Here, like NYC, EMT-B's DO NOT take blood or start IV's as this is not covered under the Virginia state EMT-B curriculum.

Techs at MCV start IVs. After on-the-job training. It's OK dude, like I said, not everything is the same at every hospital. Let it go.

 

[cavalier329]

im clarifying your information. If you go back and read, your initial posts seem to indicate that an EMT-B will start IV's without formal training if you are in areas like Va and Cali.

I made it clear that formal training is required because this is not legal under your EMT-B. Now, in your last post is the only time you indicated formal training is necessary to do it.

Stop posting incorrect information and I will "let it go"

 

[pseudoknot]

im clarifying your information. If you go back and read, your initial posts seem to indicate that an EMT-B will start IV's without formal training if you are in areas like Va and Cali.

I made it clear that formal training is required because this is not legal under your EMT-B. Now, in your last post is the only time you indicated formal training is necessary to do it.

Stop posting incorrect information and I will "let it go"

I didn't say formal training was required because it isn't (in some places, including VA).

http://www.washingtonpost.com/wp-dyn/articles/A4924-2004May31.html

I haven't posted anything incorrect.

Anyway, this is really stupid and everything important has been covered already.

And again, EMT scope of practice issues are irrelevant when working in the hospital.

 

[cavalier329]

id continue to humor this but my orgo book is calling my name and i feel this has only continued for the sake of arguing. Pointless.

Bottom line, read my first post...this is probably what you will find.

 

[MedicFL]

Working here in FL I have been to at least 12 different ED's and EMT's do much more in the ED than they would on a rig. At all the ED's they can draw blood and only two of them allow them to start IV's though.. Since your working as an ED Tech your EMT scope goes out the window... Many of the ED's will hire you without your EMT and train you in house..

 

[cavalier329]

our conversation thus far has basically said that with formal training that is reasonable to expect. However, without it and having just your EMT, that activity is a HUGE liability. I am unaware of hospitals who allow EMT's to take blood and start IV's without formal training to do so.

If you read the article pseudo put up, you will see that while it may not be ILLEGAL to do those tasks mentioned, it is certainly a big liability for the ED tech and the hospital. That isn't something you want in a country that is so friggin sue happy.

 

[MadMack]

our conversation thus far has basically said that with formal training that is reasonable to expect. However, without it and having just your EMT, that activity is a HUGE liability. I am unaware of hospitals who allow EMT's to take blood and start IV's without formal training to do so.

If you read the article pseudo put up, you will see that while it may not be ILLEGAL to do those tasks mentioned, it is certainly a big liability for the ED tech and the hospital. That isn't something you want in a country that is so friggin sue happy.

No one is going to let an ER tech stick someone without at least some training. If an LPN can come into a room and poke around in the back of my hand with a catheter trying to hit one of my veins, then there's no reason an EMT can't. The scope of practice for the Emergency Medical Technician Basic does allow for the starting of IV lines, if allowed by medical direction; it also allows for intubation, if allowed by medical direction; they can also perform some phlebotomy, again it comes down to medical direction. That said, the medical direction for most EMT programs doesn't allow for that to be taught, as EMT's are only allowed to perform those procedures if specifically allowed by medical direction. However, the line is drawn very clearly at drug administration; basics cannot flow anything through the lines. It takes about an hour of explaining for someone to understand how to start an IV. After that it comes down to practice.

Also, there's no more liability for an EMT starting an IV then there is anyone else starting one, so long as they've both been trained to do it.

 

[cavalier329]

The scope of practice for the Emergency Medical Technician Basic does allow for the starting of IV lines, if allowed by medical direction; it also allows for intubation, if allowed by medical direction; they can also perform some phlebotomy, again it comes down to medical direction.


show me a protocol that says this for an EMT-Basic

 

[jkelly2]

http://www.miemss.org/home/LinkClick.aspx?fileticket=PcFzAVnOA4M%3d&tabid=106&mid=534

Page 199

 

[MedicFL]

The scope of practice for the Emergency Medical Technician Basic does allow for the starting of IV lines, if allowed by medical direction; it also allows for intubation, if allowed by medical direction; they can also perform some phlebotomy, again it comes down to medical direction.


show me a protocol that says this for an EMT-Basic

County I used to work in LEE county EMT's with an in house training class were allowed to start NON medicated IV's, under the direct supervision of a paramedic on scene.. Polk County also allows it. ET'S tubes I have never heard of an EMT doing them...

 

[cavalier329]

the protocol you gave me was for CRT-I and EMT-PARAMEDICS....not basics

 

[cavalier329]

it would be INSANE to believe that any EMT-basic is able to intubate or start a line without training....just by calling medical control.

You DO know you can kill someone by intubating them incorrectly and cause serious damage by starting a line the wrong way.

 

[MadMack]

it would be INSANE to believe that any EMT-basic is able to intubate or start a line without training....just by calling medical control.

You DO know you can kill someone by intubating them incorrectly and cause serious damage by starting a line the wrong way.

The Medical Director for the EMS service is the Physician who establishes what the standing orders (protocols) for the EMS service are. We refer to any decision coming from our Medical Director as medical direction, because thats what it is; either online over the radio or off-line through our standing orders.

Starting lines isn't generally covered in the Basic books, because in states that recognize the Intermediate certification, it falls outside of the Basic's scope of practice; however, in Florida we don't recognize Intermediate and we allow EMT's to start IV's in medical direction allows them. A number of departments in Palm Beach County decided that Basics could be trained to start IV lines if they wanted the training. Again, its not rocket science to start a line; it just takes practice.

As far as intubation goes, the material is covered in the Basic text and the questions are present on the NREMT-B exam, however whether or not you can do it is up to your service/department's Medical Director.

Scope of practice is going to vary from service to service and department to department and state to state. Arguing about what is or isn't in an EMS provider's scope of practice is silly, with seven years in the field you should know that. Also, you can't call medical direction for permission to do a procedure that you're not trained on, I mean, you could but the Doc would never clear you to do it.

 

[cavalier329]

the argument essentially revolves around some saying that EMT-B's without training to do so can start lines/intubate.

Whether simple or not, without the training, it is outside the scope. We've all agreed on this. Of course scope varies from region to region, however the whole meaning of scope remains the same...if you dont learn it, you can't do it.

If there is training, then by all means go for it. Some suggested earlier that medical direction could allow it without the EMT having any formal training...this is ridiculous and it probably puts the MD's ass on the line if it were to happen.

Now if the training is available, as it is in Florida, then it would make absolute sense to allow this to happen. But like I have stated before, as long as the EMT is trained to do so...whether the procedure is as simple as putting a bandaid on whatever.

ASA was only recently introduced into our protocol. We are now allowed to give two baby ASA's to the pt if there were the correct symptoms and taking into account any contraindications. Before this, I believe we were allowed to assist the pt. taking their own ASA.

See, this is an example of an extremely simple procedure...its like popping M&M's...and even with a possible stroke, 2 baby ASA probably will not do much...but regardless, our cert was on the line if we did it prior to it being in protocol and even now if we arent "trained".

CYA...regardless of simplicity

 

[leviathan]

See, this is an example of an extremely simple procedure...its like popping M&M's...and even with a possible stroke, 2 baby ASA probably will not do much...but regardless, our cert was on the line if we did it prior to it being in protocol and even now if we arent "trained".

I hope you aren't giving ASA to someone manifesting sign/symptoms of a stroke. And for MIs, ASA reduces mortality by about 50%, so it's wrong to say ASA "probably will not do much."

 

[drpeter]

Hello i wanna ask if i am a medical student third year of my education is it possible to work as a paramedic, EMT thank you!

 

[MadMack]

Hello i wanna ask if i am a medical student third year of my education is it possible to work as a paramedic, EMT thank you!

In order to work as a Paramedic you need to have A) valid Paramedic certification in the state in which you reside, B) valid BLS, ACLS, PALS, ITLS and EVOC certifcation. Depending on what kind of service you're going to work for there's varying probationary periods before you can practice as a Paramedic. If you have your medic certs, feel free to ask more questions, but if you're lacking that, not much sense in continuing that line of questioning.

 

[drpeter]

Thank you for your patience and your answer
Regards!

 

[cavalier329]

I hope you aren't giving ASA to someone manifesting sign/symptoms of a stroke. And for MIs, ASA reduces mortality by about 50%, so it's wrong to say ASA "probably will not do much."

Those are contraindications, obviously. What I said was, the 161 mg we are allowed to give at once probably won't do much for anyone, whether they are stroking out or not. Though, Im not willing to see if I am right or not.

The reduction in mortality is actually between 13 and 25% give or take. And those numbers are if a low-dose ASA therapy has been in place. One time 161 mg treatment will probably do very little. A dose of about 300mg may assist more in the field. Evidence does suggest that this helps in an emergency but basically, a dose of about 161 mg cant hurt. Protocol for 911 dispatchers in some areas actually allow them to suggest 161 mg ASA for chest pain. Chances are, you will not get a dispatcher who is going to ask the disqualifying questions for ASA...so basically 161 mg probably won't be lethal if its contraindicated.

161 mg is almost insignificant, we should be allowed to give more. But then I think about the kind of EMT's that are out there and some are idiots...so maybe its a good thing to continue to make it as difficult as possible for EMT-B's to kill someone...

 

[jkelly2]

the protocol you gave me was for CRT-I and EMT-PARAMEDICS....not basics

Go back and read it again...
"20. Peripheral IV access for CRT, CRT-(I) & EMT-P, and IV access for EMT-B approved by the EMS operational program"

You'll never finish your certification if you don't read the full protocol!

 

[leviathan]

Those are contraindications, obviously. What I said was, the 161 mg we are allowed to give at once probably won't do much for anyone, whether they are stroking out or not. Though, Im not willing to see if I am right or not.

I don't think you understand, or I'm not understanding you...you would never give ASA to someone who was stroking out, unless you had a portable CT scanner being towed behind your ambulance.

 

[cavalier329]

of course you wouldnt give ASA to someone stroking out. However, what I said was that the 161 mg hasnt been shown to exacerbate a stroke iif it had been taken by the pt. Not saying that this makes it OK to administer it to a pt with stroke symptoms, but 161 mg is really too low to do much of anything. But I will stress again, regardless, ASA should not be given to pt's with signs of stroke!!!!!

EDIT: Sorry I went to pg 199 on the pdf file and not the actual pg 199 of the protocol. Though if you read it, you will see that the protocol doesn't say that any EMT-B can start a line if medical control allows it. The protocol states that the "invasive" skill is approved for "Program Approved Option" EMT-B's with IV Technician training.

So again, my argument hasn't been disproved. Everything I have been shown still requires outside training beyond the average scope of the EMT course

 

[MedicFL]

the protocol you gave me was for CRT-I and EMT-PARAMEDICS....not basics

SO what is your point Cavlier if an EMT has to take a 2 day in house classes to start IV's so what? EMT-B's are still starting lines so why the argument? And who ever your medical director is needs to get with the times 161mg of ASA in an MI has long been proven to be not enough, in fact most systems are giving 324mg of ASA. Caviler you sound like an EMT-B is that your level of training?

 

[cavalier329]

yes, that is my level of training. Which would explain why it sounds that way. And Im not arguing with you, I said numerous times 161 isnt enough.

And the argument began because someone said EMT-Bs can do lines without training because it is simple. I made it clear that this wasn't the case and that training to do so was required.