Difference between EMT-B, EMT-P, Paramedic?

[em783]

OK I know people are going to get irritated with this question, but I have done a search and can't seem to find the exact answer to my question. So I apologize in advance.

I just want to know what the distinctions are between the 3, and which one is most medically-relevant in the sense that it will offer the best experience.

But another concern of mine is that I don't have much time to offer to a course, so ideally it would be something that takes about a semester in length. Which would be the ideal position to seek in that case?

---

Members don't see this ad.

 

[Fiddlergirl]

I'm looking at getting certified as an EMT next year, so I've done some research on this myself. As far as I can tell, EMT-basic is the one offered at most community colleges, and will allow you to work as a paramedic. The rest seem to be extra training, along the lines of taking honors courses which would allow for better or higher-paying jobs. Does anyone else have more concrete information?

 

[Disinence2]

EMT-B Is EMT Basic. U will also see NREMT-B with means "National Registry, Basic EMT Certification"

EMT-B is for the most part for ambulance transportation services, or driving. From my experience in my state EMT-B's dont' do a whole lot of patient care (although they are trained to do so). Find out what u will be doing before you spend all the money on the cert!!

EMT-I's can do everything an EMT can do, except in some states they can start IV's. This is getting phased out slowly though i believe.

EMT-P is a paramedic, which can give drugs, intibate, all that stuff. Thats about a 2-3 ordeal, and in my opinion not worth goign through as a "pre-med" activity

Hope this helps

 

[BuckerPark]

OK I know people are going to get irritated with this question, but I have done a search and can't seem to find the exact answer to my question. So I apologize in advance.

I just want to know what the distinctions are between the 3, and which one is most medically-relevant in the sense that it will offer the best experience.

But another concern of mine is that I don't have much time to offer to a course, so ideally it would be something that takes about a semester in length. Which would be the ideal position to seek in that case?

If people get irritated, it's their problem...not yours.

The three levels that most states have are EMT-Basic, Intermediate, and Paramedic. As a rule, each level requires a semester of training and you must complete the previous level before advancing to the next.

That said, if you only have one semester to do things in, then you are only going to be able to finish Basic class.

As far as the responsibilities of each level, that can vary by state also. For the most part, a Basic has limited skills and often ends up assisting the paramedic (on an advanced life support ambulance). In my state, they can only give two or three "drugs" and can do "blind" intubations. Thats about as invasive as it gets.

Sounds like you are interested in the experience. That also will depend on where you are at. In an urban area, you might get your share of 911 calls. But another component to EMS is the non-emergent transport of patients from one facility to another. If you have no prior patient exposure, EMT-B may be a great route to go. You'll get to work with lots of people. Caution, though: just don't expect it to be crazy and exciting all the time since you will (a) have limited skills as a basic and (b) will often be doing non-emergent transport if/when you use your new license to get a job.

 

[gotmeds?]

EMT-B Is EMT Basic. U will also see NREMT-B with means "National Registry, Basic EMT Certification"

EMT-B is for the most part for ambulance transportation services, or driving. From my experience in my state EMT-B's dont' do a whole lot of patient care (although they are trained to do so). Find out what u will be doing before you spend all the money on the cert!!

Depending on where you work, you may be part of the 911 system as either a partner to a paramedic or as a transport unit for a paramedic from the fire department. The bulk of EMT-B work, howevever, is interfacility transfers. You will get a lot of patient "contact" but will not administer meds or perform any invasive procedures.

EMT-I's can do everything an EMT can do, except in some states they can start IV's. This is getting phased out slowly though i believe.

All true. Some places also allow EMT-Intermediates to intubate and give a limited number of meds. In some rural areas, they essentially take on the same role as a paramedic, albeit with a more limited scope.

EMT-P is a paramedic, which can give drugs, intibate, all that stuff. Thats about a 2-3 ordeal, and in my opinion not worth goign through as a "pre-med" activity

The training is actually around 1300 - 1400 hours (about 10 times as long as EMT-B training). If you do it full-time, you can do it in as little as 9 months, but it can also take as long as 1.5 - 2 years. In some places it takes even longer. Medics can intubate, start IVs and intraosseous lines, give drugs, perform needle thoracotmies and cricothyrotomies, defibrillate, cardiovert, pace transcutaneously...basically all the fun stuff. I wouldn't recommend it as step toward medical school -- it's a little too much of a sidetrack if you already know that you want to be a doctor. But as a job, it's great.

 

[Julius Erving]

You also may see EMT-D for dispatch. Even less patient care, but really easy to get into, and any initials EMT will help your application. Just mentioning, "I'm working as an EMT" in an interview will be a plus.

Basic is a nice license. Even though the medic will be in charge of caring for the patients for the most part, you still get great experience b/c you are standing right there during history taking and initial physical exam (or helping).

 

[Dr. Syzygy]

The training is actually around 1300 - 1400 hours (about 10 times as long as EMT-B training). If you do it full-time, you can do it in as little as 9 months, but it can also take as long as 1.5 - 2 years. In some places it takes even longer. Medics can intubate, start IVs and intraosseous lines, give drugs, perform needle thoracotmies and cricothyrotomies, defibrillate, cardiovert, pace transcutaneously...basically all the fun stuff. I wouldn't recommend it as step toward medical school -- it's a little too much of a sidetrack if you already know that you want to be a doctor. But as a job, it's great.

Though the EMT-P teaching program may only be the 9 months that you say, there is also an apprenticeship type thing where there are a certain amt. of hrs of experience needed (I think at least a yr) before you can be considered a qualified EMT-P (Paramedic). This cert. usually is done like night school. It's not just a course since you need to take electives as well. EMT-B though is just a course. I did mine last summer for free with the agreement that I volunteer for the minimum of 2yrs with my township's EMS.

 

[spicedmanna]

I'm looking at getting certified as an EMT next year, so I've done some research on this myself. As far as I can tell, EMT-basic is the one offered at most community colleges, and will allow you to work as a paramedic. The rest seem to be extra training, along the lines of taking honors courses which would allow for better or higher-paying jobs. Does anyone else have more concrete information?

Working as an EMT-B is most definitely a worthwhile experience, particularly if you work as part of a 9-1-1 service. EMS is a state-operated system, and thus varies by state. I recommend checking with your state authority for further information on certifications and how to obtain them.

EMT-B's are the entry level position in EMS, and requires a minimum of 110 hours of classroom time for certification, per DOT recommendations. Most states programs will exceed DOT specifications to meet their own needs (for instance, Maryland requires 131 hours). In some states, community colleges will offer programs that lead to state or national certification. These classes are usually about a semester long and relatively straightforward, but can be time-consuming. You will be required to pass a state practical examination and a written test, and in many states, a clinical internship and become affiliated with an approved provider, to become certified. EMT-B's provide care and transport of the sick and injured at the basic life support (BLS) level.

If you work as part of a 9-1-1 service, you will typically ride on the ambulance unit and be charged with emergency patient care and transport that does not typically involve any invasive interventions, advanced airways, the administration of most medications (with the exception of prescribed nitroglycerin, oral glucose, activated charcoal, prescribed albuterol, and the automatic epipen), or any advanced cardiac life support. Your job is to basically perform the necessary patient assessments, make any appropriate BLS interventions, and stabilize, immobilize, and transport the patient with the appropriate priority, if needed. The advanced airways and invasive treatment are the domain of the paramedic (EMT-P), who provide advanced life support (ALS) service, are trained in advanced cardiac life support procedures, IV therapy, intubation, and can administer a larger array of medication.

 

[KaraKiz]

A somewhat related question....

For those of you who have had experience riding in ambulances, what does it mean when the lights are on but the sirens are not? I heard it means that the patient in the ambulance is deceased and they are transporting them to the hospital, but also that as long a the sirens are not on, it doesnt mean anything - could just be paramedics trying to get through traffic. Any truth to this?

 

[spicedmanna]

A somewhat related question....

For those of you who have had experience riding in ambulances, what does it mean when the lights are on but the sirens are not? I heard it means that the patient in the ambulance is deceased and they are transporting them to the hospital, but also that as long a the sirens are not on, it doesnt mean anything - could just be paramedics trying to get through traffic. Any truth to this?

I haven't taken EVOC, so I don't know for sure. However, the Guidelines for Safe Ambulance Driving, from the Operations section of my AAOS textbook, states that you should, "use the siren as little as possible en route," "use your siren if you turn on the emergency lights, except when you are on a freeway." The use of the "emergency mode" (lights and siren) is determined by the priority of the patient and used to request the right of way. Calls that aren't critical don't usually require the emergency mode of operation. Dead people aren't critical, obviously; they don't typically require the use of lights and siren during transport.

Use of Warning Lights and Siren

Three basic principles govern the use of warning lights and siren on an ambulance:

1) The unit must be on a true emergency call to the best of your knowledge.

2) Both audible and visual warning devices must be used simultaneously.

3) The unit must be operated with due regard for the safety of all others, on and off the roadway.

Individual state/jurisdiction protocols can provide more or less leeway.

 

[Wizard of Oz]

I think that my state has done away with EMT-I, but I agree with the others regarding their job responsibilities.

EMT-B here is a 4-month, 2 nights/week, 4 hours/night plus clinicals. Paramedic is more like a 2-year program. Paramedic pay is quite low in my state.

It is pretty common for ER Techs at local hospitals near me to be EMT-B trained (likewise you can also be certified as a patient care tech), but many would find that boring (blood draws, caths, wound dressing changes, set up for suturing, etc.)

What is your goal in undertaking this career? Salary? Contacts? Since this is on a pre-allo forum, I'd caution that it's not that much of a positive for med school applications (better to put more time into studying for the MCAT). You will see some good stuff every once in a while as far as it being a job is concerned though.

 

[NEATOMD]

A somewhat related question....

For those of you who have had experience riding in ambulances, what does it mean when the lights are on but the sirens are not? I heard it means that the patient in the ambulance is deceased and they are transporting them to the hospital, but also that as long a the sirens are not on, it doesnt mean anything - could just be paramedics trying to get through traffic. Any truth to this?

Running with lights and siren is called, "Code" or "Upgraded" and lights only is often referred to as "Downgraded", no lights and sirens is usually referred to as "No-code" Many (mostly law enforcement) refer to driving like a banshee with no lights and siren as "Stealth Mode." The slang term used for running L&S is "running hot."

Getting to your question. It varies on protocol for each state, region, or medical director. But, in general I usually drove with lights only to a scene at night when I didn't want to wake people up as I drove by their houses. Mostly, because there isn't much traffic at 2AM and so, it's not worth waking up people to get to a nursing home for a person that fell and hurt her hip last week.

I also rode lights only on highways and interstates quite alot. The reason here is quite simple: The dang siren gets annoying after about 5 minutes, it'd drive you crazy. Once, I left it one for a 2 hour drive because traffic was bad and the thing overheated and shorted out (It was pretty hilarious sounding when it was overheating 😀 ) Eventually, I got to the point where I'd drive "No-code" on the highway except when there was heavy traffic or I really needed to get somewhere. It turns out this is usually safer because people do really stupid things when they see the lights and sirens (another tale for another time).

Ambulances drive no code when they have a patient that is either stable or dead, so they shouldn't have lights on at all. There is no justification in this case for putting lives in danger (Yes, as I alluded to earlier, driving with Lights and sirens is dangerous). Sometimes, on long transports, they will go code or downgraded also.

Anytime you see lights or sirens, you should yield. If the lights are on, it's for a reason.

Edit: One more time, when you use lights only is when you are backing up an emergency vehicle (that may just be a state law though).

 

[NEATOMD]

As an aside. If you ever call 911, don't tell them you are going to drive to meet the ambulance (bad idea in the first place), and that you'll have your flashers on. I've got news for you: At night, when those strobes are going...every car looks like it has its flashers on! So, by the time the medics realize you were the car they were supposed to roundezvous with (either by spotting your break-lights or via radio com with dispatch) they're going to be a quarter mile or more down the road by the time they stop.


And... don't follow ambulances on the interstates! It's dangerous and annoying. And, yes...we have direct radios to state/local police. I never called anyone in, but I rode with quite a few people who did. Plus, many officers will pull you over if they see you doing this. (spicedmanna mentioned this but removed it for some reason).

 

[spicedmanna]

don't follow ambulances on the interstates! It's dangerous and annoying.

👍

 

[gotmeds?]

Though the EMT-P teaching program may only be the 9 months that you say, there is also an apprenticeship type thing where there are a certain amt. of hrs of experience needed (I think at least a yr) before you can be considered a qualified EMT-P (Paramedic). This cert. usually is done like night school. It's not just a course since you need to take electives as well. EMT-B though is just a course. I did mine last summer for free with the agreement that I volunteer for the minimum of 2yrs with my township's EMS.

The numbers I gave include the internship portion which is 480 - 720 hours out of the 1300 - 1400 total. Baiscally it breaks down to around 500 hours didactic (class time), 200 clinical (hospital time), and 700 hours of internship (field time). All of this can be done in as little as 9 months but usually takes longer. During the internship, you're basically working the same full-time shift as your preceptor but you're not getting paid. So yes, it's probably not a realistic option for a pre-med, unlike the EMT-B, but it's definitely much more satisfying work.

 

[Captain Fantastic]

The numbers I gave include the internship portion which is 480 - 720 hours out of the 1300 - 1400 total. Baiscally it breaks down to around 500 hours didactic (class time), 200 clinical (hospital time), and 700 hours of internship (field time). All of this can be done in as little as 9 months but usually takes longer. During the internship, you're basically working the same full-time shift as your preceptor but you're not getting paid. So yes, it's probably not a realistic option for a pre-med, unlike the EMT-B, but it's definitely much more satisfying work.

Sounds just like my medic class:
~500 hours Didactic
448 hours Field Internship (Ambulance)
144 hours Emergency Room
36 hours CICU/TICU
30 hours Anesthesia/OR
24 hours Labor & Delivery
24 hours SICU/BICU
24 hours MICU
16 hours NICU
16 hours PICU
8 hours Psych
8 hours Respiratory Therapy
4 hours Autopsy

Plus a ton of required skills like...
20 successful intubations
75 successful IV starts
50 12-lead interpretations

Around here the quickest you can get through is a year and most people take 18 months. I've only seen a handful of pre-meds go through. The juice isn't worth the squeeze, as they say.

 

[chad5871]

I Love Wikipedia!

 

[KaraKiz]

And... don't follow ambulances on the interstates! It's dangerous and annoying. And, yes...we have direct radios to state/local police. I never called anyone in, but I rode with quite a few people who did. Plus, many officers will pull you over if they see you doing this. (spicedmanna mentioned this but removed it for some reason).

Thanks for all of the responses! I always wanted to know what that meant..

And in reference to the quote above, people do that?? I stay as far away from lights and sirens as possible...

 

[greytmedic]

Thanks for all of the responses! I always wanted to know what that meant..

And in reference to the quote above, people do that?? I stay as far away from lights and sirens as possible...

Lights and sirens=Driver wants traffic out of way for emergency call
Lights and no sirens=Emergency call but no traffic; sirens get annoying
Sirens and no Lights=Somebody flipped off the lights without telling the driver (he/she thinks they are still on)

Actual use of lights and sirens is debateable since the average time saved is only about 3 minutes and usually not worth the increased risk posed to crew, patient, and public. In many states, ambulance and fire truck emergency lighting are only "courtesy lights" which "request" the right of way. In Illinois, for example, the Illinois Vehicle Code (IVC) only dictates that police units are emergency vehicles and are designated as such with or without emergency lighting and sirens. You will get a ticket for failure to yield to an emergency vehicle, however, so use the old adage, "For sirens and lights, pull to the RIGHT." In most instances the ambulance's insurance carrier dictates that when ever emergency lighting is used the sirens must be activated. If an accident ever occurs with an ambulance during emergency transportation the first question out of the insurance company is, "were the audible warning devices activated?"

And as for following behind ambulances with lights and sirens don't do it. I have radioed the police several times about people following the ambulance through traffic and even through red lights. It has been both random vehicles, taxis, and even family members. Once the family was following the ambulance to the hospital and went through several red lights. I had the police intercept them several blocks from the hospital and follow them. The next red light they went through the police pulled them over and gave them a ticket.

Anyway, sorry for the long rant. I worked last night and had several calls, including a full arrest that was an all around $hitty call, and now I am just trying to stay awake between classes.

 

[NEATOMD]

Sirens and no Lights=Somebody flipped off the lights without telling the driver (he/she thinks they are still on)

or... ambulance crew is deaf.

OR... the ambulance crew members are blondes

PS: I don't mean to offend anyone. But, I've worked with some really ditzy medics.

 

[SurgeonUFO]

I'm on my local ambulance squad. We're in a small, fairly rural area, but we've got 24/7/365 coverage. Teams can be as little as two Basics (though there's always an I on call.) The squad can't run medics, even though we've got a couple of medic-certified people, they can only "act" as I's. I've finished my Basic course, just have to take the test, and just having CPR certification, I've had tons of patient contact. It really is an incredible experience.

 

[braluk]

Wheres DKM? He'd answer this pretty well also. Speaking of which I havnt seen him around here in a bit

 

[Sublimelvc]

I've been working as a medic for a few years and can attest to the many unintelligent driving maneuvers people perform when they see an emergent ambulance:

1. Slamming on their brakes as hard as possible (my favorite).
2. Moving over to the left (especially funny when there is no shoulder on the left)
3. Slamming on the brakes at an intersection and then being rear-ended by the guy behind them.
4. Hysterically throwing down their cell phone and crying.
5. Moving into the right lane of traffic when another car is already there.
6. Doing absolutely nothing (usually old people)
7. Making some erratic departure from the road that was obviously not the person's original destination (ie. getting off an exit ramp)

BTW, I also only drive lights (no siren) late at night, which is when I work

EMS is great because you get to personally interact with tons of patients, do ALS and always have a safety valve in case things get out of control (a medical control doctor you can call via radio)

 

[DropkickMurphy]

Wheres DKM? He'd answer this pretty well also. Speaking of which I havnt seen him around here in a bit

Sorry...I was out of town visiting my girlfriend.

EMT-I's can do everything an EMT can do, except in some states they can start IV's. This is getting phased out slowly though i believe.

Yes they are being phased out in most places (although I think the better idea would be to slowly phase out the EMT-B credential leaving a first responder (for your cops, firefighters, etc), an EMT (at the current EMT-I level (a few drugs, intubation and IV/IO access)) and paramedic.

For those of you who have had experience riding in ambulances, what does it mean when the lights are on but the sirens are not? I heard it means that the patient in the ambulance is deceased and they are transporting them to the hospital, but also that as long a the sirens are not on, it doesnt mean anything - could just be paramedics trying to get through traffic. Any truth to this?

Absolutely no truth to it. At least around here, we very seldom turn on the siren (or the lights) unless we are in traffic because of the limited (or no) benefit for L&S transport as someone mentioned before. Even cardiac arrests at the service I worked for are normally transported (in the few cases we do bother to transport (normally the resuscitation in the field is unsuccessful and we terminate resuscitative efforts)) without lights and sirens for most of the transport.

Though the EMT-P teaching program may only be the 9 months that you say, there is also an apprenticeship type thing where there are a certain amt. of hrs of experience needed (I think at least a yr) before you can be considered a qualified EMT-P (Paramedic). This cert. usually is done like night school. It's not just a course since you need to take electives as well. EMT-B though is just a course.

As an EMS instructor, I must say you've got it completely wrong for the most part regarding paramedic education. Most paramedic programs (including the ones I have taught at) are normally held during the day. Most of them you do your clinical rotations while you are still taking your lecture courses or immediately following them. It is not (at least not in any of the four states I have worked) done as an apprenticeship after you graduate. There are not "electives" in most paramedic programs- at least not in the sense of the traditional college style gen ed elective ("I need one more medical class to graduate! I think I'll take "Emergency Geriatrics"! ) . At the programs I taught at you could "elect" to do more rotations in a given area, but it was not for credit and you didn't get anything out of it other than a little additional experience.

You were however correct in regards to the EMT-B education being a single course. Anyone else have any more questions?

 

[gotmeds?]

A somewhat related question....

For those of you who have had experience riding in ambulances, what does it mean when the lights are on but the sirens are not? I heard it means that the patient in the ambulance is deceased and they are transporting them to the hospital, but also that as long a the sirens are not on, it doesnt mean anything - could just be paramedics trying to get through traffic. Any truth to this?

One of my biggest peeves from movies and TV is how often you see a dead body being put in the back of an ambulance and then the ambulance transports the dead body to...well...who knows? The funeral home? All of this with the lights and sirens on, of course!

Dead bodies do not go in ambulances. If someone in declared dead at the scene by the medics, the body is not transported. If you are stupid enough to declare someone dead in your ambulance, then you have to keep your ambulance parked where it's at, with the dead body sitting inside of it, until the coroner gets there.

Also, people cannot be declared dead on the way to the hospital. If you are transporting someone, they can be declared (actually formally pronounced) dead at the hospital.

 

[DropkickMurphy]

If you are stupid enough to declare someone dead in your ambulance, then you have to keep your ambulance parked where it's at, with the dead body sitting inside of it, until the coroner gets there.

Also, people cannot be declared dead on the way to the hospital. If you are transporting someone, they can be declared (actually formally pronounced) dead at the hospital.

This depends on where you are at, because neither of those is technically correct everywhere. One, we can terminate resuscitation on the way to the hospital- we do it all the time, particularly on blunt trauma patients who arrest en route. If we do, we just take the patient to the morgue instead of the ED. Ditto goes for if we call it on scene with the deceased in the ambulance. If we call it on scene without loading body, we can release the custody of the body to the cops.

 

[WestcoastMedicine]

EMT-D does NOT stand for Dispatch. When Defibs were first being put into ambulances an EMT-B or even A at that time were not trained in its use during EMT school. If you went for additional training to be certified to use a defib, you were then an EMT-D. In NJ atleast they are no longer using this designation, because the training for defib use is now part of the standard EMT-B curriculum.

I would have a few words if caution. If you are going to get your EMT training at school, if they offer it there, a few months before you apply to med school it is NOT worth it. You will not get much experience from it and won't really impress the adcom that much. If you worked as an EMT or a Medic for years, that will impress them. If you worked at an EMT for years and that is what made you decide to go into medicine, that will also impress them and give you something to talk about. Getting it 3-4 months before interviewing is really not going to do anything for you.

Just my 2 cents

 

[Karina 07]

This is a rather morbid question, but it just came to mind and I might as well ask or I'll always wonder....

So a few years ago a friend of mine died in a car crash and was pronounced dead at the hospital. I don't see ANY way how he could've actually been alive once the ambulance got there -- he was driving an experimental car that didn't have any structure to it whatsoever and was just a couple of feet tall and got steamrolled over by a van coming the opposite direction when the experimental car swerved over into that lane, full speed on a highway.

Some poor girl who was in the crew trailing the experimental car actually tried to do CPR, apparently, but I also heard things like his head was smashed open.

Why did they bother taking him to the hospital?

I don't know, I was never pushy about finding out the details, maybe there was some way that he actually clung to life until the ambulance got there, but I HIGHLY doubt that.

 

[DropkickMurphy]

Why did they bother taking him to the hospital?

He may have actually had vitals on scene- believe me I've seen people with completely crushed heads (buy a watermelon, climp up on your roof and drop it onto your driveway to get an idea) who still have a pulse on our arrival. The other possibility could be that because the bystander started CPR, some agencies are mandated to continue to work the case until they get to the ED.

 

[spicedmanna]

This is a rather morbid question, but it just came to mind and I might as well ask or I'll always wonder....

So a few years ago a friend of mine died in a car crash and was pronounced dead at the hospital. I don't see ANY way how he could've actually been alive once the ambulance got there -- he was driving an experimental car that didn't have any structure to it whatsoever and was just a couple of feet tall and got steamrolled over by a van coming the opposite direction when the experimental car swerved over into that lane, full speed on a highway.

Some poor girl who was in the crew trailing the experimental car actually tried to do CPR, apparently, but I also heard things like his head was smashed open.

Why did they bother taking him to the hospital?

I don't know, I was never pushy about finding out the details, maybe there was some way that he actually clung to life until the ambulance got there, but I HIGHLY doubt that.

Ouch!

EMT-B's aren't able to pronounce death at the scene, actually. In the absence of a legal DNR order, other similar advance directive, or an order from medical control, they must initiate emergency care. There are cases where death is obvious:

1) Obvious injuries that are incompatible with life
2) Presence of dependent lividity
3) Presence of rigor mortis
4) Putrification

The above are considered definitive signs of death. In any case, it's wise for the EMT-B to call medical control, given them the scoop, and ask them to pronounce it.

EMT: "Doc, I got a guy with his head missing..."
DOC: "Yeah, he's dead; time of death..."

Obviously, there are cases that are not as clear-cut, where any signs of death that might be present are presumptive. Begin CPR, or other emergency care, and consult with medical control, which you should do for any high-priority patient, anyway.

 

[DropkickMurphy]

Ouch!

EMT-B's aren't able to pronounce death at the scene, actually. In the absence of a legal DNR order, other similar advance directive, or an order from medical control, they must initiate emergency care. There are cases where death is obvious:

1) Obvious injuries that are incompatible with life
2) Presence of dependent lividity
3) Presence of rigor mortis
4) Putrification

The above are considered definitive signs of death. In any case, it's wise for the EMT-B to call medical control, given them the scoop, and ask them to pronounce it.

EMT: "Doc, I got a guy with his head missing..."
DOC: "Yeah, he's dead; time of death..."

Obviously, there are cases that are not as clear-cut, where any signs of death that might be present are presumptive. Begin CPR, or other emergency care, and consult with medical control, which you should do for any high-priority patient, anyway.

For obvious death (transection, decapitation, putrefaction, rigor mortis/livor mortis, etc) we don't- at least most services- EMT-Bs don't have to request medical control authorization to withhold resuscitation attempts. In 10 years, I've never seen it happen. In my experience, the only times most services call in to medical control for this type of thing is to stop ALS level resuscitations that have failed or for trauma cases that don't meet preset standards for scene death.

 

[spicedmanna]

For obvious death (transection, decapitation, putrefaction, rigor mortis/livor mortis, etc) we don't- at least most services- EMT-Bs don't have to request medical control authorization to withhold resuscitation attempts. In 10 years, I've never seen it happen. In my experience, the only times most services call in to medical control for this type of thing is to stop ALS level resuscitations that have failed or for trauma cases that don't meet preset standards for scene death.

Thanks for the clarification. I suspected as much.

 

[DropkickMurphy]

Thanks for the clarification. I suspected as much.

No problem.....that's one of the reasons I'm in on this thread. This is my area of expertise 😀

 

[gotmeds?]

This depends on where you are at, because neither of those is technically correct everywhere. One, we can terminate resuscitation on the way to the hospital- we do it all the time, particularly on blunt trauma patients who arrest en route. If we do, we just take the patient to the morgue instead of the ED. Ditto goes for if we call it on scene with the deceased in the ambulance. If we call it on scene without loading body, we can release the custody of the body to the cops.

I stand corrected. This was not the case where I worked. Once the patient was dead, we no longer had anything to with the body. If a patient arrested enroute due to trauma, we would continue resuscitation until we got to the hospital (this was a big city so we were talking 5 - 10 min tops). Traumatic arrests on scene (blunt or penetrating) were declared dead and the body was left on scene. If you declared someone dead after loading him into the ambulance, you'd be stuck waiting for the coroner to arrive, with a dead body in the back of your bus the whole time.

 

[greytmedic]

I have been in both kind of systems. Where I worked that was urban, once we called in a triple zero (zero pulse, zero respirations, zero heart activity(asystole), with other signs of prolonged down time) we left a monitor strip with the cops and they secured the scene until the coroner came and carted the body off. Where I work now, more rural area, when we call someone we wait for the coroner and then we take the body to the morgue in the ambulance. We don't have to request not to work the patient, we just have to call and let med. control know so we can get a documented pronouncement time.

As for your friend who died in the car accident, if there are no signs of obvious death, ie, decapitation or gray matter on the street, we will work the traumatic arrest even though the survival rate is about .02%. It might seem like a waste but it's better odds than the lottery.

Once we start ALS intervention we only stop treatment when the patient is successfully intubated and has been showing asystole for more than ten minutes despite treatment. I have never stopped resuscitation because I always reach the hospital before the ten minute window. This also means that I can say I have never had anyone die in the back of my ambulance.👍 They might die before we get there or die after we drop them off, but no one has ever died in the back of my ambulance.

Disclaimer: These policies and procedures are from the areas I work or worked, they may differ slightly area to area.

 

[DropkickMurphy]

They might die before we get there or die after we drop them off, but no one has ever died in the back of my ambulance.

The old "There will be no dying or multiplying in my ambulance" (for the non-EMSers on the forums: they either die on scene or at the hospital; likewise for births).

 

[em783]

Wow, so much information! Thanks people....ok but now I'm kind of in a quandary.

So if all those hours of training are required for even the Basic EMT certification (which is what I'm interested in), is this is even feasible? I even called some local training schools and a lot of them are in the middle of their classes, or had just begun conducting a course, and so weren't accepting new students. I'm really interested in just getting exposure to taking the basic vitals, or at least observing it in a hospital/ambulance setting. But then again, from what I understand it requires not only a lot of training for that, but if I even want to consider hospital-based EMT work they only consider EMT professionals or those with a lot of experience. Is that so?

Lastly, does anyone know of any kind of position as simply volunteering for the EMS but not necessarily having the EMT license? Since a lot of you work/teach in this line I figure this is the best place to ask.

 

[spicedmanna]

Wow, so much information! Thanks people....ok but now I'm kind of in a quandary.

So if all those hours of training are required for even the Basic EMT certification (which is what I'm interested in), is this is even feasible? I even called some local training schools and a lot of them are in the middle of their classes, or had just begun conducting a course, and so weren't accepting new students. I'm really interested in just getting exposure to taking the basic vitals, or at least observing it in a hospital/ambulance setting. But then again, from what I understand it requires not only a lot of training for that, but if I even want to consider hospital-based EMT work they only consider EMT professionals or those with a lot of experience. Is that so?

Lastly, does anyone know of any kind of position as simply volunteering for the EMS but not necessarily having the EMT license? Since a lot of you work/teach in this line I figure this is the best place to ask.

If you have no intention of becoming an EMT-B, but want some exposure to prehospital care, most rescue squads/fire depts are nice enough to let you ride-along as an observer on the ambulance or medic units, provided you sign a release form. Depending who you ride with and your level of training, the crew may let you get more or less involved. You will be playing mostly a supportive role ("hand me this or that", etc.), however.

If you want to eventually become an EMT-B, you can simply join the squad as a volunteer. Most volunteer squads in my area will allow you to ride if you are a volunteer and pass the physical, despite not having an EMT-B certification. You will not be allowed to perform any unsupervised patient care, but you will receive training in the basics of assessment and transport, and you will work under the charge EMT-B/medic in providing care to the patient. Doors open up when you volunteer, because you can eventually take the certification class for free. After riding as the third for a certain amount of time, you can then "pre-aide", or practice being a charge EMT-B under appropriate supervision. This is also generally when volunteers take their certification class, although plenty of volunteers will obtain certification sooner.

 

[DropkickMurphy]

hospital-based EMT work

It's not really "EMT work".....it's being a patient care tech, which is akin to being a nurse's aid/orderly in most places. It really varies from hospital to hospital what the requirements are. Honestly, EMT courses aren't that many hours (under 200 in most states) in length. They are in dire need of being improved in quality and length.

does anyone know of any kind of position as simply volunteering for the EMS but not necessarily having the EMT license?

Not unless you just want to drive (and even then, most places will want you to be certified (there is currently no licensure for EMS providers)). Your best bet would be a free clinic if you don't want to get the certification. You could learn to do vitals, etc there.

 

[spicedmanna]

Your best bet would be a free clinic if you don't want to get the certification. You could learn to do vitals, etc there.

Great suggestion. 👍

 

[greytmedic]

Not unless you just want to drive (and even then, most places will want you to be certified (there is currently no licensure for EMS providers)).

I have my EMT-paramedic license from the Illinois Department of Public Health(IDPH). If a government has a statute that grants an individual the right to perform within a scope of practice that is a license. The NREMT is not a license, it is a certificate. Some states accept the NREMT certification as proof of completing the necessary requirements to recieve licensure, but other states, such as Illinois (only for paramedic level, now) do not recognize the NREMT certification and have their own requirements for licensure. For any confusion about certification vs. license see the legal opinion on NREMT.org. For example, when I first started in EMS I had my NREMT-B that I recieved in the military. When I wanted to start on the civilian side, I could not practice until I recieved licensure from the IDPH. I later took the paramedic class and now have my IDPH license but I have never been certified as a EMT-P. More later...I just got a call.

 

[DropkickMurphy]

I have my EMT-paramedic license from the Illinois Department of Public Health(IDPH). If a government has a statute that grants an individual the right to perform within a scope of practice that is a license.

True, I forget that Illinois (where I have my EMT-I) classifies it as a license. *smacks forehead* Over in Indiana (where I live), the equivalent credential is called a certification because we can't be credentialed outside of the auspices of a licensed ALS agency (NOTE: I hate Indiana's EMS system for a myriad of reasons).

 

[beanbean]

Some thoughts from an EMT and former EMS-Instructor....

Although EMT-B class seems like quite a few hours, most of the work occurs in class (lecture and practical training). Most college students find the class fairly easy from an academic standpoint and the number of hours spent reading/studying is not bad compared to a regular university course. Honestly, common sense will take you far.

The experience you receive working or volunteering as an EMT-B varies greatly from region to region. In CT most smaller towns have volunteer ambulance associations which provide basic care and often intercept with a paid service for ALS (paramedica) care when needed. Others are combination paid/volunteer and ride with paid medics and volunteer EMTs. If the town I live we usually ride with 3 person crews (EMT-driver, Paramedic or EMT-I, and another EMT). Larger towns and cities have paid services provide EMS service. Others combine EMS with the fire service. Call around in your area to see what types of opportunities exist.

Technically in CT if driving an ambulance with emergency lights on, the siren must also be on. Of course this is annoying and often not done, but if involved in an accident, the ambulance operator can be at fault if only the lights were on. I usually transport with no lights or sirens unless traffic is a real issue. A big, white box with flashing red lights seems to be a moving target for stupid people.

In my area we don't transport dead people and the rules for pronoucing on scene are as described above for EMT's. Paramedics have more options pronouncing on scene if ACLS care has been futile. I personally feel traumatic arrests should be called on scene more often than they are since the ROSC rate is basically zero.

I wouldn't trade my EMS experience for anything...21 years as a volunteer. Even as an MS4 I still ride occasionally. Best of luck to you whatever path you choose.

 

[NEATOMD]

If the town I live we usually ride with 3 person crews (EMT-driver, Paramedic or EMT-I, and another EMT).

Woah...that sucks. I hate crowded rigs. It's so much easier when you've got room to move, especially if you don't have a regular partner. Having a regular partner is good because you learn how each other works and become really efficient. Having people in your way slows you down, gives you headaches, and makes you want to strangle someone. I really hope you are not having to run in "Vanbulanaces" (I really hate them).

A big, white box with flashing red lights seems to be a moving target for stupid people.

No joke... So friggin' frustrating. It's no wonder so many medics develop road rage.

 

[greytmedic]

Although EMT-B class seems like quite a few hours, most of the work occurs in class (lecture and practical training). Most college students find the class fairly easy from an academic standpoint and the number of hours spent reading/studying is not bad compared to a regular university course. Honestly, common sense will take you far.

If you have a little extra time for a semester I would suggest taking an EMT-B class. All the classes I have been involved with were taught as night courses at a local community college. The college listed them as a 3 credit hour class, and they met two nights a week from 7-10pm. The material is definitely easier than most general education classes at a university. If you can pass a basic biology course, EMT-B will be a cake walk. The hours needed for clinical and patient contact time vary from area to area, but can usually be accomplished in a couple of weekends. Since the classes were taught at a community college they followed the college's calendar, so try finding a class that starts over the summer or next fall.

If you really want to get started with your experience there are a couple of different options. You could try finding one of the EMT-B classes that only takes two weeks. These, however, are usually taught from like 8am untill 4pm for two straight weeks. You could also try finding a First Responder course. First Responders vary from area to area, but many times a university campus uses college students to staff a first responder group or volunteer fire departments use first responders until an ambulance can get to the scene. This activity is area specific and you'll have to investigate what is used in your area. First Responder courses are usually less than a semester and allow you to perform only very basic treatment, but ambulance crews may use first responders on scenes for extra hands.

One of the best ways to get involved in EMS is to see if a local EMS provider allows ride-alongs. If they do, ask to observe for a couple shifts. Ask lots of questions, bring offerings of food, and ask to help with everything (including cleaning the station's bathrooms). If they like you they will point you in the right direction for your area.

 

[em783]

OK thanks for the help .... it seems like everyone with experience as an EMT or Paramedic has been pretty pleased with their experiences and it sounds like a great introduction to the medical world. I have done a lot of shadowing in my day, but am really looking to take that to the next level with some direct contact. I'm going to try and look into the free clinic volunteer-work and ride-alongs with the EMS.

Question, though...when you all call these places or if any of you have ever worked in clinics before, do you ask in terms of placing yourself as a volunteer, for shadowing, or to have a position that entails having some contact? I've never done this kind of cold-calling before and am just curious as to how y'all would approach it.