EMT-I cert..

[fiznat]

How many of you guys bothered to get your EMT-I cert? Here in Connecticut the level is pretty much bieng phased out across the board, my company wont even pay extra wages for I levels. Still though, I found a class and I was thinking about getting it. I really feel kinda useless as an EMT, and I would be really excited to learn how to start/maintain IVs, use combitubes, push dextrose etc etc..

Just wondering if anyone here is an I tech and could offer some insight into how much you actually do, and if you think its worth it just experience wise and "feeling useful" haha. By the way I'm applying to med school this year so I dont plan on getting my medic-- I would just like the experience and the cert.

Watcha guys think?

---

Members don't see this ad.

 

[southerndoc]

Have you thought of paramedic school?

Where in CT are you? If you're ever at Y-NHH, be sure to say hello!

 

[ISU_Steve]

It doesn't sound like it is much in the way of an improvement, so (and I'm an EMT-I in Illinois) I would recommend you just stay as an EMT-B if it is not going to improve your pay or grossly increase your skill level (which it doesn't sound like it will).

Here it's a big improvement in what we can do from basic to EMT-I, but in your shoes, I'd suggest just staying as an EMT-B for the time being.

 

[izibo]

Might as well just get your medic.

 

[fiznat]

I realise getting the medic seems like the most logical step, but honestly I dont have the time for it. Any decent medic class around here is at the very LEAST a year in length, with regular (lenghty) classes and at a high cost ($4k+). If everything goes according to plan, within a year I should be just about ready to take my MCATS and apply to med school-- hardly enough time there to really justify spending that kind of money and time to get a certification that I wont really be able to use.

I am interested in the -I because I want to learn how to start IVs, use combitubes, and begin my dive into A+P and pharmacology. Granted it isnt a huge jump in pay or skills, but I nowadays I'm pretty much willing to take as much as I can given the time/money that I have available. What say you guys about getting the -I simply for experience, given the fact that I cant get my medic right now...?

Southerndoc: I am actually up north, I work for AMR in Hartford so I'm mostly frequenting that *other* level 1 trauma center haha. Where at Yale do you work? If it is in the ED I would REALLY love a chance to pick your brain about it if you wouldnt mind... maybe over email or even in person? Let me know!

 

[southerndoc]

fiznat, I would skip the EMT-I. Starting IV's, using Combitubes, etc. isn't that glorious, and it won't really advance your level for starting medical school. I would suggest concentrating on building solid basic-level EMT skills, patient assessments, etc. if you are not willing to go the paramedic route prior to medical school.

I am an ED resident at Y-NHH. Feel free to drop me a private message from here, send me an email, or say hello if you're ever down in NH.

 

[Emergency!]

If the EMT-I is going to be phased out, then I'm not sure its worth your while. I am an I in Ohio, and I do get paid more and have a greater level of responsibility. Since we are desperately short of medics, having the I card at least allows me to take transfers that have IV's hanging.

The better option than actually taking the class is to find yourself a good medic partner. A good medic partner will teach you a lot and allow you to "assist" with a lot of things - setting up IV's and nebulizers, putting the monitor on, getting meds out for them, etc. You can learn a lot from them w/out taking the class.

CT doesn't allow basics to intubate? Even with a combitube? Wow!

 

[southerndoc]

CT doesn't allow basics to intubate? Even with a combitube? Wow!

In light of recent research, it seems some paramedics cannot intubate well. There is a movement to decrease the number of paramedics (i.e., limit fire department ALS first response to BLS). The reason is a lack of procedures, or rather a dilution of procedures among too many paramedics. This is exactly what happened in Lincoln, NE.

 

[ISU_Steve]

Also the decrease in the number of medics could have something to do with, as the push for EBM in emergency medical services moves forward, there is more and more evidence that patients are best served by BLS transport and minimal interventions (at least in urban settings). This pisses off a lot of the more gung-ho medics out there, but you can't argue with evidence without evidence of your own....

 

[captaindargo]

In Georgia, EMT-I is the entry level for EMS... at least that is what the state wants it's try to phase out EMT-B here. I started a EMT-I class in May and will not be finished with it until end Oct. We just start practicing with a combi-tube, yeah. Does anyone think it hurt me that I'm taking this class when i start classes in the fall.

 

[southerndoc]

Georgia is not phasing out EMT-B's. In fact, they just phased them in a few years ago. Traditionally Georgia "basic EMT's" have followed the 1985 Intermediate curriculum, which current Georgia EMT-I's follow. This means that EMT-I's in Georgia start IV's, use Combitubes, EOA/EGTA's, PASG, defibrillate (AED), apply traction splints, administer D50, epipens, NTG, and ASA. This is the same as what Georgia EMT's have done for the past 25-30 years.

When Georgia became a national registry state, it chose to certify EMT's as EMT-I's. This continues to this day, but practice is limited to the 1985 curriculum (to the items mentioned above). Meaning EMT-I's in Georgia cannot intubate, administer drugs other than those listed above, etc.

Georgia EMT-B's were created a few years ago for the sole purpose of staffing fire engines and other first response personnel. EMT-B's cannot staff an ambulance in Georgia unless the agency has applied for an exemption. To my knowledge, not a single exemption has been approved.

 

[captaindargo]

Georgia is not phasing out EMT-B's. In fact, they just phased them in a few years ago. Traditionally Georgia "basic EMT's" have followed the 1985 Intermediate curriculum, which current Georgia EMT-I's follow. This means that EMT-I's in Georgia start IV's, use Combitubes, EOA/EGTA's, PASG, defibrillate (AED), apply traction splints, administer D50, epipens, NTG, and ASA. This is the same as what Georgia EMT's have done for the past 25-30 years.

When Georgia became a national registry state, it chose to certify EMT's as EMT-I's. This continues to this day, but practice is limited to the 1985 curriculum (to the items mentioned above). Meaning EMT-I's in Georgia cannot intubate, administer drugs other than those listed above, etc.

Georgia EMT-B's were created a few years ago for the sole purpose of staffing fire engines and other first response personnel. EMT-B's cannot staff an ambulance in Georgia unless the agency has applied for an exemption. To my knowledge, not a single exemption has been approved.

All I know is what the teacher told us... EMT-I is the entry level and that there are very few EMT-B left in Ga.

 

[southerndoc]

All I know is what the teacher told us... EMT-I is the entry level and that there are very few EMT-B left in Ga.

There are very few EMT-B's in Georgia. That's because it just created the certification level two or three years ago and most people go through EMT-I school instead of EMT-B so they can staff an ambulance.

 

[Doczilla]

EMT-Is in a paramedic system are essentially treated as EMT-Bs, but in a rural system without much ALS they get to stretch their legs a bit.

Regarding the paramedic intubation success rate, the studies have not been showing medics in a good light. I've been reading these studies with some concern. Then again, I've got a bone to pick with most paramedic airway training and protocols.
1) Initial training can be excellent, with practice on mannequins and dedicated time in the OR being precepted. During field time, tubes are few and far between. In my graduating class of 100, there were 25 tubes during field preceptorship.
2) Practice is dismal once initial training is complete. Few EMS agencies have any requalification in endotracheal intubation apart from occasionally showing up in the office and tubing a mannequin in front of a training officer or doing the usual motions in ACLS class. OR time is rarely actively encouraged and almost never mandatory, though may be available. OR time with pediatric patients is extremely rare.
3) Devices and techniques for managing difficult airways are often not greatly utilized in the protocols. Most ambulances carry a combitube (because they have to), but providers almost never practice with it and may not even know where it is located. Needle or surgical crics may be allowed, but are rarely practiced, especially on something approximating real anatomy.
4) Difficult airway courses are available, though usually optional.
5) Failed ETT attempts are often not explored in the QI process unless there is a complaint or bad outcome.
6) Feedback from receiving facilities on providers' airway management is rare unless the ED doc calls the medic supervisor in a rage.
7) EMS systems often look only to those close to EMS to provide training, i.e., ED nurses and docs and experienced medics in the same system.

I think there is a prescription for this before we start knocking back the protocols.
1) Require OR time with initial medic training, to include pediatric patients. This is likely more a matter of convincing the anesthesiologists to allow it than anything else.
2) Require OR time yearly for all paramedic employees to practice their skills. Encourage more frequent visits to the OR for practice. Quarterly would be good. Maintain an open door policy for all medics who wish to practice.
3) Hold a difficult airway course for all paramedic employees. Include practice on surgical or needle crics using pig tracheas. If nobody locally is qualified to teach the course, send out to somewhere else or import instructors from a training organization.
4) Evaluate tools like the gum bougie, LMA, King LT airway, retrograde intubation, and various trach devices like Peritrachs or Quicktrachs or Nutrachs for possible inclusion in the medic's armamentarium.
5) QA any failed ET attempts with the receiving facility and the responding medic. Is it simply an anatomy issue? Equipment issue? Training issue?
6) Encourage physicians from the receiving facilities to give feedback to the transporting medics on an informal basis.
7) Encourage reporting of "near misses". Most hospital pharmacies with extremely low error rates are that way because they encourage all employees to report the times they "nearly" did something wrong, like if they reached for the wrong medication bottle since it looks just like the right medication bottle. Could an intubation have taken longer than expected because the 10cc syringe got dropped and they couldn't easily find another one? Would putting the ET tubes in order by size simplify things? Is there something needed that isn't in the airway bag and has to be sought elsewhere in the rig?
8) Expand the instructor pool. Include physicians from other specialties like anesthesiology, surgery, and medicine. Utilize ICU nurses, CRNAs, combat medics, and RTs to teach and impart their expertise.

Even in the busiest services with the sickest people, medics frequently don't get the practice to prevent certain critical care skills from degrading. EMS agencies have to recognize the need to invest in the training to maintain these skills. It's an ongoing investment with few tangible monetary rewards.

'zilla

 

[ISU_Steve]

Wow, Doczilla, I couldn't have said it better myself. You summed up exactly what I've been advocating for several years. Thank you.

 

[credfield]

.