NREMT-Basic

oh Dust...you...you..sweet talker you. LOLOL.

You know, in as much as I could, I have tried to remain constructive even when I was getting personally bashed rather than bashed as an EMT. I am just as guilty of making some personal comments to others. But if you repsond to a thread which has a particular topic and you cant manage to confine your tirade to the topic at hand, but only post for the purpose of personal attack, then (Somedic) you are indeed a small and petty person. I agree that the basic (i dislike the use of the abbreviation emt when referring to a Basic, since Medics are infact also EMTs, as much as they fight it they are still a technicians) takes his orders in the immediate from the Medic. However, my authority to practice as a Basic, doesnt derive from the medics license at all, since if it did we couldnt have basic/basic rigs. My authority to make any decisions or provide any interventions is derived solely from the Medical Director under whose license and whose license alone I operate. Im not sure if thats a concept not understood by many, or if there are states in which that is not the case. Here, ultimately, the final word on anything I do is the medical director. I experienced on Thursday what may prove to be one of the single most gut wrenching experiences of my EMS career whether I decide to stay a Basic for 20 years or move on to become a medic. At a roll over accident scene, I held a mothers lifeless infant in my arms after the child had been ejected from the vehicle because she had not been restrained, but rather was being held on the mothers lap with the drivers window part way down to clear the fog on the windshield. Though the child was dead when I arrived on scene in my POV at the same time fire-rescue arrived on scene (responding as ems with local volunteer dept) there will never be a time in my life that I wont wonder if I had gotten to that part of the scene a few minutes earlier, if that child could have been saved. Likely she was gone the moment she hit the pavement on the freeway and in a way I hope that is the case because she must have suffered horribly if briefly if it wasnt. So yes, my view of things has been pretty angry for the last few days and for that I apologize as I do for taking my anger out in so many of my posts. Im not asking for anyones sympathy or even asking for a free pass for being a jacka** because I have had an experience that just about everyone in our field of endeavor has had or will have at some point. Im just tellin ya where im at. They say you learn more from those with whom you disagree than from those with whom you agree so I will try to bear that in mind. That being said, I am not fond of personal abuse or attacks and i have always thought it to be one of the great shortcomings of the internet that so many people are moved to say things both about and to other people that they have never met that their conscience and humanity would never allow them to say to another person face to face. But thats the world we live in. Letters have given way to emails and hurtful words are flung like edged weapons at people we will likely never see. We cant know each others realities as the vast majority of us will very likely never know each other as anything more than clever little names and avatars next to posts. Thats a shame I think, especially when the people flinging the barbs at each other do the same jobs and fight the same battles. And so it is with new found respect for the agreeable and the disagreeable alike that I bow out of the City for awhile to gain some perspective which can only be had in the real world and simply cannot be gained from a pseudo reality which consists of flickering pixels and thoughts sent around the world almost as fast as we can think them. And so, in the words of one of my great heros, Edward R. Murrow....Good Night...and Good Luck.

When I started this thread, I had honestly hoped that there would be constructive dialogues that all parties concerned could learn from and perhaps even improve their working with their basic or medic partner. As the basic vs. medic conversations always do, however, this has turned into a p***ing contest and about that I am truly sorry. With a singular exception, all medic posters have said hey, i have some pretty clear cut expectations, I am more trained, I make the decisions, etc and that is the way that the ALS system is set up. I have no problem with that. I do have a problem with medics who cannot seem to understand that if something goes wrong in the box with the patient, it has just as much potential to damage the career of the basic as it does the medic. Medics are not the only ones licensed and therefore are not the only one whose licenses can be pulled. NSMEDIC- I truly learned alot from your posting and I thank you for it. Like you, I think that Basics should have much more didactic and hands on time than they do. I am all for the NREMT taking it over, and having Basics and Medics be licensed on the national level. I agree that American basics for the most part are undertrained and this is do in no small part to a broken EMT educational system. I think that Basics should have the level of education raised to a two year degree across the board in each and every state. That being said, I also believe that we cannot set one educational standard for Basics and another for medics and I hold and have for sometime that if a Basic should be trained over the course of two years, then a Medic should be required to complete a course of study and practicals that takes a full four years and is the EMS equivalent to a bachelors degree. I hear lots of medics wanted to up the edcuational requirements for Basics but these same medics will cringe and spit if it is proposed that they should also be held to a much greater educational level than they now are. Its not about turn about being fair play, but rather that it logically follows that a longer programs for Basics would make them better and train the to be able to participate more fully in patient care, and the same would hold true for Medics. When I signed up for emt school, i was surprised that it only took 5 months, but i was even more surprised to learn that with all that a medic must be able to do at the drop of a hat, that it is commonly held, at least in the US, that a medic can be fully trained and prepared to take on the full responsibility for patient care in a year or 18 months. Something just doesnt track correctly there. Also NSMEDIC, in case I have led you to believe i meant something to the contrary, I want to make it clear that the ONLY circumstance under which I would point out an error on your (meaning any medics)part is if i was as you indicate one hundred percent certain and beyond any doubt that you (medic) are about to perform an intervention or give a drug which I KNOW is incorrect and will hurt or god forbid kill a patient. If the circumstance did not meet that criteria however or if i turned out to be wrong and had questioned you during patient care, I would expect to get hit with both barrels both by the medic and the ops manager and I would not see it as out of line as being grounds for the basic getting suspended or in the case of a constant pattern of this sort of thing, getting fired. I dont agree that that the Basic shouldnt talk to the medic at all while the medic is carrying out his interventions with the patient so long as that exchange back and forth has to do ONLY with the situation at hand, as in "Can I hold that for you? Do You need more light would it help you if I held that instrument in place for you. Im not talking about sports or tv conversations or blabbing about women or cars. It seems that if a surgeon can do his job and be talked to and give answers at the same time, a medic should also be able to do this. As for small talk, there is plenty of time for that in quarters between calls. Now...Somedic. I have no inferiority complex about being a basic and my fortitude is just fine thank you. Again you do not seem to be able to participate in a quality conversation about the topic at hand, but rather compensate for what I can only assume are some feelings of inferiority on your part which you need to make up for by insulting others and degrading them. In the end, you dont accomplish anything and to the people who are interested in constructive dialogue you seem like a petty, bitter, self-loathing over compensator who is trying to make up for deficiencies i shudder to think about by belittling others. And for the record I will write posts that are as long as i wish them to be unless admin asks me to keep them shorter. You should hardly talk about longwinded posts. So take your special operations tactics and your fireman driver and go away. thank you. I suppose next you will be singlehandedly managing a mass casualty incident. Oh well. You really arnt worth the time it would take to write anything further. Have a nice day.

Asysin- Ill be snookered if I can ever figure out which side of the fence you are on. I like ya, but I cant figure you out. If you read my post very very very carefully, you would see that while i discussed various configurations of tactical medicine, I also said that it is a rare beast indeed. Those qualified to teach it are few and far between and those qualified to practice non-military tacitcal medicine are practically non existant. I said that both EMS and Tactical operations would have to be severly overhauled if not completely scrapped and rebuilt to have what could be truly called tactical ems. While I feel I am a well trained basic emt and also well trained in the bare bones basics of live fire real time tactical operations, I would never be so bold as to say put me in coach I am dumb enough and feel lucky enough today to take my tactical shotgun and my ballistic shield/drag stretcher and run between the bullets to bring back that wounded SWAT Captain. I know that I dont need to explain to you the education that basics recieve in terms of their scope or that basic tactical civilians (aka me) are taught the tactical use of a sidearm, shotgun, long rifle, move and shoot maneuvers, defensive and offensive driving, etc. I dont know what your tactical background is. I was once told when I asked someone why so many medics in the city have the little special ops cartoon next to their names that i would be shocked to know how many medics who post here at the city also operate "in the dark." I am still holding my sides to keep them from bursting with laughter. And as I said...i think the best way for tactical and ems to meet is staged a hundred feet apart. I think for most of the people that think of themselves as warrior medics, the notion is truly something like peeing your pants in a dark colored suit, it gives you a nice warm feeling and nobody else actually knows the difference. Oh by the way, at what rate and quantity is blood lost by an open midshaft femur fracture where the femoral arterty is compromised? I think that broken limb could sometimes be fairly significant. Thats it. I had my fun poking my nose into the world of those who practice paramedicine "in the dark." Im going to go play somewhere else now. Oh and do try to refrain from lumping all of us "charming emts" together. I do not share their opinion about what a medic can do to manage a trauma.

Somedic- you could have been more condescening and pompous but Im not sure how. Just as you feel that you as a medic are the standard of care, I find your attitude to be symbolic of the attitude which is all too common among medics. I dont need your permission to say or do anything as far as my opinions or anything else are concerned. And quite frankly, I find your egotism so distasteful that if we were ever to be put in the same rig with you, I would request a new partner or leave the service if I couldnt be reassigned. Tell you what...next time you go on a call BLS or ALS, leave your basic partner back in quarters and make the run yourself. Where I come from they call that an attitude adjustment. I have seen many basics refuse to work with medics with the very same attitude you have. As for Asysin- I appreciate your thoughtful and considered opinions and would work for free if necessary to have a partner who is as open minded and analytical as you. You clearly show the difference between Paramedics and self appointed Paragods. I dont intend to post any further on this thread. I opened it and have made my opinions known. I look forward to the input of many others.

Oh no, nbsp! More idiots. Or was Irwin the idiot for dying. I can never tell.

Well since I disagree with you on almost every counterpoint you make, i wont address each one save to say that I have used a earlier version of this device which was not as refined as the current marketed model and it does with ease most of the things you say a OPA does. An OPA offers no substantial protection for teeth or soft tissue, like the soft palate. This device which seals itself to the roof of the mouth like a upper denture plate virtually eliminates the concern over broken upper teeth and eliminates the chance of tearing the soft palate or other tissue. The way the side struts fit into the mouth aides in protection of the cheek tissue and the brackets which fit over the bottom teeth do a fair job of protecting them as well. I have no opinion on the light option whatsoever, though i fail to see how too much light obscures the glottal opening, but ok. In any case, I have used the earlier versions of this device, I like it and have even found that in many cases it provides a more secure airway than an OPA. I agree to disagree and respect your educated and experienced opinion.

Do you honestly think that responders and agencies that chose to purchase this device are whackers. If it makes damage to a patients teeth less likely, facilitates ET intubations in dimly lit homes or at an accident site at night, increases the ability to visualize the cords or reduce the risk of tracheal or esophageal damage when using a combitube, it seems to me that its not a bad thing. Not to mention that it has the very real potential of making it easier for a inexperienced emt, or anyone for that matter to assist respirations with a bag valve mask since it almost acts like an OPA as well. If you dont like it, dont use it. Im just not sure why you feel the need to call anyone who does something that you wouldnt do a whacker or otherwise insult them. I like ya man, but you should add curmudgeon to your bio. Do you prefer modern ambulances or recycled hearses. And yes, in an ideal situation, the breaking of teeth during an intubation isnt a concern. But why not use something that eliminates the risk altogether. One of my preceptors (a medic) broke a total of 6 teeth on two patients in one shift while i was with him. Expertise and what should happen is great, but accidents happen an I personally am all for anything that cuts down on the likelihood of them happening.

Every hospital in my area has a dedicated system for the use of these little devices and has a mechanism in place so that no harm can come to their main system. I say if this little thing saves one life, its not that much of a scam. Besides, this medictag device does not need to be plugged into the USB of a networked computer. A stand alone machine that somebody uses for word processing and the like that isnt connected to anything but itself can access the information on the medictag so long as the computer has an available USB port. As an aside Rid, I know you hav alot of experience and knowledge in the area of EMS, hospital emergency care, etc. But I have also noticed a trend in your posts whereby you use alot of terms like "all, none, the vast majority, more than half, always, never" without supporting these with any quotable source. How can you say that most hospitals have a no outside device policy. We have three hospitals here in my home town, one of which is a level 1 trauma center and it is already making great use of the medictag. One of our hospital based Rescue squads has purchased a medictag for each one of its responders and since many of them are also firefighters and would seem more likely to become injured than your average emergency first responder, each responder is required to wear the device around their neck at all times while on duty. Unsubstantiated generalizations are ALWAYS bad.

I asked her and she said that she simply wrote a grant purposal saying that she wished to obtain the AED and that she wanted to have it because her school district has a large number of elderly teachers and support staff and the town she works in has no 911 responders. And it didnt cost her a dime. Pretty good deal I think.

Tactical officers can be trained to perform at the medic level while also carrying out their tactical operations and procedures ( special weapons and tactics) and Medics can be trained to function at the tactical level while also executing their paramedic protocals which have been modeled to fit the tactical role. Very Difficult? Yes, to be sure. Impossible? No. We arent talking black ops here and we arent even talking about the military. We are, as far as I can tell, talking about a swat or cert type model. I am an emt and I also have basic level tactical weapons and operations abilities learned while training with a well known, international civilian (non-military) tactical response service. Im getting the feeling from some of our military posters that never shall tactical and medical meet. Sure, I am trained at a basic level in both areas and wouldnt want to be put in a tactical EMS situation. Neither I nor the people I would be charged with caring for would be cared for at the optimum level possible since my training in both areas is, as I have said, at the basic level. I even have a certain amount of training in combining these two specialties. That doesnt mean I should be involved in tactical EMS. But it also doesnt mean that an individual cannot be trained to work in an intense tact. medic operation or that there is only one way to achieve such training. I must also say that what I learned from my tactical training was that tactical EMS is an extremely rare animal since there are few individuals or programs qualified to teach it and that most SWAT type organizations use municipal or private responders staged at a safe distance until they are needed. This of course does not fit the definition of tactical ems. I am fascinated by the possibilities of this concept but also know that true tactical ems is a pretty rare beast and has a long way to go before its training and execution exist in anything like a standardized form with standardized protocols. In my admittedly limited experience there is alot of table work to be done before tactical ems can be the rule rather than the exception. As for me, I will stage my rig 100 yards from the tactical folks target until I stop hearing flash-bangs and someone contacts me and tells me that the scene has been secured. Remember to keep uour chins up and your heads down.

i believe the department of homeland security and the department of health and human services have grants for AEDs. My mother just got one through HHS for her classroom where she teaches. I might be mistaken but its a place to start

In the same realm as the old tubes of life that elderly folks or those with multiple health conditions used to keep in their refrigerator or freezer and then put the sign up on your door that says "tube of life in freezer"....Well here is the MedicTag. I have already ordered mine from medictag.com. Basically this is a little USB stick that you plug into the available USB port on your computer. It then walks you through filling out all of you medical information, meds, allergies, surgeries, primary care doc, what hospital you want to go to and all kinds of good things that the EMS responders would like to know. Of course for them to use it they would have to be with a service that has laptops in the rigs, but hopefully that will soon become a standard rather than a luxury. I have already ordered one for myself and for my parent and grandparents. Check it out at medictag.com. Its even got a little lanyard that you can wear around your neck. The big deal will be responders knowing that these things exist and knowing what to do with it when they find it, but the fact that its as USB stick with a red cross and MedicTag printed on it should help us figure it out.

But Dust- I looked up to you as head of the Warrior Medic clan. Now what will I do? My world is crushed. Send me a boonie, damnit. I dont want a farby one from US Cav. I wont one with some shiite on it. Or suni, either one. And about me coming to the desert to take complete leave of my senses for $500/day, sign me up, man!

I reviewed this video and reports about it so many times i feel like I have been tazered. But here are somethings to think about. One of the reasons a tazer is used is to incapacitate the subject into compliance. For the officers, teh only acceptible compliance was the subject standing up. A difficult task after being tazed 6 times. And yes, I listened with ear phones and counted six tazer deployments based on the neat little jolting/sizzling sounds. If you want him to comply, stop rendering him incapable of doing so. Do you think that the officers repeated deployment of the tazer may have been egged on by the student yelling "here's your f'ing Patriot Act." There were enough officers on scene that the tazer was unnecessary. I have examined enough footage of tazer depluyments to see that often they appear that the officer would rather use the tazer rather than run the risk of scuffing their boots or ripping the name tags of their shirts. The appropriate use of force here was an arm bar carry. These officers acted stupidly. No other word for it. Beause they wish to continue to taze the subject, they put themselves in the very real risk of falling subject to mob action. Their reaction was just stupid. No other word for it. While it may irk a policemen to not have a subject produce ID when requested to do so, thats not a reason to ramp up the use of force. Notice the police also did not identify themselves when requested to, which they are also required by law to do. He he OOPS. In fact, if you listen with some good audio equipment, you can hear the officer with the tazer threatening the girl asking for name and badge number by asking her if she wanted to get tazed too. What were all the other officers doing standing around..I think I counted six. That pretty much negates the use of a tazer when a subject is unarmed. I have also found through security training through a personal protection provider and having been on many police ride alongs, the number of times that an officer will yell "stop resisting" or "stand up or your going to get it again" is directly perportional to the number of bystanders and or news media filming the event. Or in this case a student with a video capable cell phone. The usual request to stop resisting when no bystander are present is made by twisting the wrist as far as it will go, using the thumb as a handle and putting the knee or boot in the middle of the subjects back or neck. Having a LEO put his full weight down on you makes it difficult to roll over, comply with requests to put your arms behind your back or pretty much anything else. Finally, the officer doing the tazing has been cited by at least two different police agencies, including the Santa Barbara PD and UCLA police just last year, for the excessive use of force. Unfortunately, (and my father was an Officer) there still exists the Blue Wall of Silence and such problematic officers are often allowed to stay on the job regardless of their actions in clear violation of departmental regulations govering the use of force or the compiled state statutes dealing with the same. I have a great deal of respect for police officers. But anyway you look at it, this gang blew it. At least the tazed student can now go to college for free and probably not have to work for a couple of years once he graduates.

Im guessing the medics were crouching behind ballistic shields while trying to recover the downed officer to, ummm, avoid getting their heads blown off. Or at least a reasonable facsimile thereof given that this was a simulation. Asy, if you are worried about the credentials of the McKay author, why dont you look them up. Since you are questioning an acknowledge expert in the field of tact med, the real question is what are your credentials and why dont you list them? God, after the last couple of days I would be so happy if someone would post a thread for people to submit their favorite christmas cookie recipe.

Asy- While I appreciate the thoroughness of your post, I think you misinterpret a great deal of what I have posted so far. When I say I am self-educated, I mean that I was instructed for the better part of EMT training by a complete incompetent, leaving me with no other choice but to self educate. I'm not running around without any idea of protocols, treating patients within my scope, based on my interpretations of crucial material. What I am doing is applying what little was taught by the instructor, my own constant study, preparation and questions asking of those who know a great deal more than I and functioning as a Basic in the capacity allowed by the DOT,NHTSA and the Illinois State Board of Healths EMS Board. Like you in your capacity as a Medic, I passed all written and practical exams with extremely high marks. When I did my clinicals, I had one medic report on his proctor report that he felt that I was more prepared to work in the field than many of the medics he had been sent recently by the same educational system. This doesn't meant that he thought I was better than those medics at operating at a Medic level, but rather that my skills, education and training at the Basic level were more complete and applicable that many of the new medics he worked with could function at their level of training, experience and education. When I say that I will question a medic about what he is doing, I don't mean that I am going to try to act as his little watchdog pretending that I know enough about everything to know that he is about to kill a patient. Rather I offer this as an example, albeit a rather pop-culture one. In an episode of MASH from the 1970s a doctor meant to give a patient MS and ended up giving him curare by mistake and paralyzing the patient and sending him into respiratory arrest. Do I have the pharmacological and algorithmic knowledge of a medic. Nope. Absolutely not. But what I do possess is a great deal of horse sense and an excellent set of observational skills. No, I am not going to say to a medic "are you sure you wouldn't rather give a higher dose of MS. My experience tells me the patient can handle it." I don't have that experience except to know that MS can send a patient in respiratory distress downhill like a rolling stone. But there again, I don't know how much or when it would be appropriate if ever, to give such a patient MS at all. So I don't question in regards to sizes of ET tubes, needle gauges, med combos which the medic is pushing or any other one of a million things that I don't know yet. But, if I happen to notice that the medic has grabbed the wrong vial or as was posted in another thread, that the patient is actually alive when the medic said he wasn't, I'm not going to stand by and not say anything whether we are alone in the rig or in a crowd of 200 people watching our every move. That would be stupid and also very hard to explain when asked in court if I noticed that the Medic grabbed the wrong vial, or the completely wrong med other than what he said he was going to give. If I noticed it, I am going to say so. I do not believe that I am a medic or even the most experienced Basic in the world (yet..lol) but I do know flagrant errors when I see them and medics are just as prone to them as any other medical professional. In my home state of Illinois, if we are assisting the medic (which I believe is the prime responsibility of a Basic in an ALS rig) and the medic is doing something or has made a mistake which we KNOW has gone wrong, we are allowed to do a number of things, all of which would be admittedly hard to justify during and internal run review let alone a law suit. That being said: we are allowed to refuse to follow a directive given by a medic if we are confident that the medics directive will cause harm or death to the patient. We are allowed to call dispatch, request another ALS rig, and "stand down" by removing ourselves from the ambulance until another unit, usually a supervisor arrives. We are allowed to distance ourselves from the situation by getting into the drivers seat and wait to be told to get underway. We are also allowed by law, in extreme cases, to contact medical control about our concern. Obviously all of these are extreme measures which would have to result from glaringly wrong moves on the part of the medic (like something that someone with no EMS training would recognize as being dangerous). I don't go around contacting med control if the medic blows a vein during an IV start, if the medic gets a little jittery and has to take time to compose himself to continue the intervention. In that particular case, I would do nothing but ask the medic in a very professional way what I can do to assist him. I don't labor under the false impression that I know more than a medic so it is my goal to first and foremost act as that medics assistant and secondly to perform autonomous functions allowed me under our state protocol. I don't need to get permission to break out the ASA and nitro for an MI patient, but what I always do, is get these meds from the cabinet to have them ready and then take vitals signs. I then tell the medic that I have ASA and nitro ready for administration per protocol and find out whether he has a reason that he wishes me to wait, or not administer the meds at all. If I am working with a medic who is having a hard time with an intubation, I don't have a total freak out. I simply acquire an appropriately sized npa and opa as well as a combitube setup....solely for the purpose of having them ready as a measure of last resort. More than likely though I would be assisting the medic with his intubation attempt by complying with directions he may give me such as performing the Sellicks maneuver to possible facilitate intubation. Of course I'm also going to do things that I was taught in basic school like have a Yankauer standing by during the intubation. But I also know that it may be more important for me to assist the medic by providing additional lighting during a difficult intubation, say in a darkened basement or on the pavement at a nighttime MCI scene. I am proud and honored to be a Basic, and do have the desire to become a medic. However, I am also proud to have been trained for my primary function which is to assist the medic. I have no problem with being given direct order and following them and even doing so if they are given in an insulting manner due to the tension of the situation. I also pride myself that, because of training in other fields, that when the medic partner and I are alone together, we can talk and relate to each other casually. But when the rubber meets the road I take pride in the fact that when given an order, I repeat it word for word as a form of acknowledgement and to prevent any confusion and I really don't have a problem with calling someone who has been a medic for 35 years (my preceptor) sir (or ma'am as the case may be) while we are on a call. I have been picked on for it by colleagues, but many times I have been heard to respond "prepare to assist with intubation, yes sir" or 325 mgs of ASA and .4 of nitro, yes ma'am." This has alot to do with the way I was raised. People who are my elders or my superiors are to be treated with respect. I also never call a doctor Doc, or say something like "hey nurse, could we get some help over here?" Having gone through a paramilitary based private security training course and having worked in the field of personal protection and facility protection, I tend to see EMS as a sort of paramilitary operation. I am given an order and follow it unless I can prove beyond a shadow of a doubt that it was wrong and would cause harm or death. My demeanor on the radio reflects my paramilitary training, as does my interaction with my medic partner, my appearance, dress and deportment. Not only are these the polite and proper thing to do, they bring into the field an aspect of professionalism which I think we can all agree is sorely lacking. So I don't feel silly at all when I say ".30mg of Epi, yes sir." If i respect my medic partner, 9 times out of ten that will be reciprocated. I have also been on BLS rigs where, even with my limited time in the field, I expect anyone with less field time than me to act the same way. I don't care about being called sir, but experience trumps just about everything in EMS. Learn one, Do one, Teach one. Thanks Asy and I look forward to getting alot more posts in this thread.

Im gonna sound dumb with this post but it wouldnt be the first time and at least this time I know it in advance. As I move toward beginning medic training sometime in the next year or so, I have been thinking about what kind of medic work I wish to do and have been very interested in tactical ems for a long time. Does a person wishing to be a tactical medic also need to be a police officer in all states or are there specialized tactical ems response teams which may be private or municipal in which the medics may perform other duties, eg 911 response and also be called into action as a contracted tactical ems team that has a working agreement with law enforcement bodies, etc. My assumption is that tact. medics are also trained in the use of tactical special weapons and tactics and are armed. Is this the case or have I missed the mark. I have come across a few school which teach tactical ems and offer courses tailored both to EMTs and Medics. I would greatly appreciate any information which you could provide. Thanks alot.

I did alot of pre-studying before starting emt classes, including take several medical science classes like biology, a and p, medical terminology etc. Good for you for being proactive. Keep it up, the results will be worth it and you will pass the NREMT with flying colors and be confidant in your knowledge and education. By the way, the Basic NREMT is not that difficult. It echos almost word for word the information contained in Brady's most recent edition of Pre-Hospital Emergency Medicine. You will see as you move along that they NREMT is put together in chunks and pretty much in the order that you will cover things in class: medical legal, roles of the EMT, a and p, ob/gyn, EMT pharmacology, trauma emergencies, medical emergencies. I know I have these out of order but if you look at the Brady text, you will get a really good idea of what will be on the NREMT. Furthermore if you contact the NREMT, they will tell you the number of questions on each topic contained in the exam or at least the percentage of the questions that each topic makes up. Its also nice when you get your letter stating that you passed (cause you are a smart prestudier and will pass) you get a break down of what percentage of each topics questions you got right. For me, after passing the exam, this was a good way to be able to go back and know what i needed to review before the first time I went on a call on the job as opposed to being in school. Theres also a EMT-Basics pocket guide out there which is a great little thing to use to review and which you can keep in your pocket when you do your clinicals. Best of luck, and study hard.

An interesting sidenote: While I was putting together this thread, I decided to call a friend of mine who had been hired for a full time, paid, 24/48, 911 response service in a rather densely populated city in Wisconsin. I asked her how the job was going and she started sobbing, which went on for about a half hour. She then went on to tell me that she had quit the service after receiving so much harassment and verbal abuse from her (female) medic partner. She went on to relate that the medic constantly yelled at her in front of crowds of people on scenes, would spend two or three hours being generally abusive when they were in quarters between calls and on most days was told, and I quote "Don't even talk today. You are a Basic and I am the Medic. I am in charge of this ambulance and everything in it. It is mine. Don't ask me any questions, because you are too stupid to even know what questions to ask. Just take the cot in and out of the ambulance, carry the jump kit and med box when necessary, drive me to calls, clean the rig, collect your pay check and go home." When my friend went to the operations manager she was basically told that the medic was right. My friend the Basic, achieved perfect scores both on her practical exam and the NREMT written exam and was told that she was a pretty damn good rookie. Now, Illinois may not be the best state in the Union to receive EMT training. You pretty much have to rely on training yourself and realize that you are only actually in the class so that you can sign up to take the NREMT. Most of the instructors are horrifically underqualified, have been off the street for a minimum of 10 years and, as was the case with my instructor, can not pronounce medical terminology with more than two syllables. And yes the instructor was a Basic and the only thing that salvaged EMT school for me was the fact that she was replaced at the mid-term by a 35 year veteran paramedic. Oh and I should mention that that Medic who made her mission in life to destroy the emotions of my Basic friend...she had had her medics license for 3 months after having been an EMT for 1 year. I know that I promised a civil conversation on this topic and will do my best to keep it that way. But any medic that treated me that way would find themselves on the end of the punishment that some of our City colleagues have said was appropriate for Basics that get "out of line" or "uppity": I would have thrown that Medic under the wheels of the rig. There is no reason, NONE, NEVER for one professional to talk to another that way, no matter that the medic is the supervising EMT on any crew. I have heard many of these kinds of stories from many EMTs. Most of us Don't mind that you tell us what to do, or even if you give us "orders" (While I am over hear dealing with this, go over there and get a traction splint on that femur."( Most of us recognize the difference in education, training and experience. But when a person gets such an inflated opinion of their worth in the world that they feel it justifies them to be abusive to those with less training, but sound skills based on their protocols, well lets just say I think anyone like that, regardless of any profession, should get the treatment that that student got at the UCLA library: set tazer to 50,000 volts, attach to genitals, pull trigger until unconsciousness ensues. REPEAT. I Don't believe that this is the attitude of the majority of the countrys medics and not the ones that proctored me, but I think that there is an undercurrent of this kind of an attitude out there, bubbling just beneath the surface and honestly, in my experience so far, it tends to come from poorly trained/educated medics who are uncertain about what they themselves are capable of. While I have heard a number of insults against basics on the City, I haven't heard anything this bad, even when the comments were directed at me. TO me, this is unexcusable BS. I am not throwing down the gauntlet here for a Basic Medic war, I would just like to hear from as many members of the medic community here at the City and see what they think. I would also like to ask the following question: If you are a medic, what is something that you have said to a Basic, especially your partner, that you now feel was totally out of line and that you made amends for. TO be fair, Basics get full of themselves too and get mouthy and argumentative. Medics and Basics who are partners should endeavor day in and day out to develop a working relationship with each other, to be able to count on each other. While it has been indicated that many medics want their Basic partner to prove themselves before giving them autonomy in interventions, I should think as has already been stated that every Basic should expect the Medic to do the same. During my clinicals I was paired with a Medic who was fond of missing IV sticks and on two separate occassions stuck an IV start into the muscles in the A/C space and then not being able to figure out why he couldn't get a flash. WIth all respect an admiration to the people that are willing to go through medic school and take on that enormous responsibility, your partner, medic or basic, doesn't work for you, he works with you, the ambulance and everything in it belong to the service and you are both professionals with your own particular skill set at a given time. That should be a chance for communication and growth as a professional on the part of both parties and not an excuse for the person with more training to be abusive. I have tried to be very respectful here (ok except for that tazer comment) and hope that the responses will be the same. If anyone feels that I have been disrespectful, please feel free to tell me in open forum and I will respond in open forum. I look forward to many constructive discussions. Remember, every partner is somebodys child or husband or wife. Abuse and insult are never appropriate as the order of the day. Thank you to all of you who have posted so far and I look forward to hearing more. Remember....whether you are a basic or a medic, play nice. And in case you are curious, I have a great deal of respect and admiration for medics, have learned a great deal from all of them that I have known and certainly from the ones who frequent the City. There are a few particular medics I look forward to hearing from so I cant wait to see if they post to this thread. Stay safe and be well. Thanks again for playing along.

Hey Kids- The number of posters doest match up with the stastics from the polls....a little while ago it was just about even. If youre gonna vote in the poll, please post and let us know why you believe what you believe.

Youre right about scope of practice. I should have used "protocols" or the every popular "algorhytms". And i will admit that though I got an excellant education as a Basic, have well developed skills and am only lacking in experience having only had my license for a little less than a year. I feel fully confident acting within my Basics protocols in any situation and have no qualms with "taking orders" from my medic partner. And I also know that there are times to step and and assist your partner without asking and times to hold back and see if they need you. I have no delusions that I have the knowledge, education, training or experience that my medic partner would have. That being said, I am trained to a certain level of pre-hospital emergency medicine and am not going to just play the driver. Certain states have EMT-A ambulance atttendants. Illinois isnt one of them. Actually we used to but we did away with it about 20 years ago. I have something to bring to the table and one thing that I have found helps bond with the medic partners I have had so far is that when I am taking vitals, do assessments, talking to the patient, which I tend to do for a variety of reasons while the Medic is getting us a line established, I write them down in a pt care notebook and before I crawl into the front seat to drive, I had the medic my notebook to ease his/her communication with our receiving facility so that he can make his call in quickly and get back to his patient. Sometimes if we are on scene for more than 10 minutes or so and I have done all the things that I need to do at the moment, I will let the medic know i am going to contact the hospital and then get us moving. This way he has the choice to either say no, lets wait, or tell me that he will call the hospital or tell me to go ahead and make my 30 second report and then get us underway. I must agree with you, that the level of training of many basics is awful. However, I dont fall into that category because I educated myself. My instructor would give little bits of information, get procedures or symptoms wrong, etc and I spent alot of time studying to make sure that even though the EMT training program in this medical system was complete crap, that when I got out I was ready to go. Unfortunately, we have alot of emts now that are just out of high school and dont study, dont go over notes, dont ask the important questions, dont repeat practical interventions over and over and over again until they are second nature. My first time out i was the third one on the rig and the emt was so bad that halfway through a 12 hours shift, I asked to be given to a different crew. We arent all bad, but the ones that are REALLY are.

Ruff, thanks for being among the first to stick your toe in this water. Its been a sticky wicket in ems for a very long time. Thank you for your civil and considered opinion and I look forward to hearing more.

The fact that the poll options list the affirmative in both caps and lower case and the negative in only caps was mistake in typing and I am not sure how to access this to edit it. Sorry about that and if anyone wants to tell me how to edit it, I would be most greatful.

It is with fear and trepidation that I start this new topic which I know has been covered in other threads as well as in passing in threads about other topics, but I think its important enough to risk putting my neck on the chopping block. I will do my absolute best to be assertive and constructive and hope that others will do the same. When I began my coursework toward EMT-B certification in January of 2006, I was blissfully ignorant of the differences in scope of practice and level of responsibility between basics and medics. I am glad to say that this confusion on my part was rapidly cleared up within the first few weeks. However, I had to good fortune to be taught by a Medic who had been at it long enough to have a 1 digit Medics license number in the State of Illinois. He demonstrated to us the differences between what basics and medics do. But we also were trained to perform the interventions that fall within our scope of practice as Basics. The scope of Paramedics was very rarely mentioned. One reason for this is that in Illinois, as I am sure in many other areas as well, the law requires that an ambulance be crewed by an EMT who had achieved the level of Basic. So we do have quite a few BLS only services in our state. We do however also have a good number of services that use crews that are ALS/BLS combinations, in large part to eliminate the need for an ALS intercept since the medic is already on board. What we were not taught to expect, however, was the sort of unspoken code that seems to exist which places the Medic in the role of Master and Commander of each crew and relegates the Basic to the role of driving, taking vitals, cleaning and restocking. We were taught that basics have a scope of practice for a reason and that it is to be used either on a stand alone basis or in conjunction with and ALS/Medic crew partner. Over time I have found a distressing trend in which many medics seem to hold the attitude that a basic should be seen and not heard, carry the jump kit and only do what he is told by the medic, eliminating the process of the basic utililizing his skill set to achieve the absolute best possible response outcome. Here is where I wish to be especially careful in this discussion. When I was in EMT training, I had the good fortune to work with medics who observed me, knew what I was able to do, trusted me to know what I was supposed to do and capable of doing and we were able to just work together in a flow of each crew member working together toward the best possible outcome of the patients emergency. I was not required to ask before gaining a set of vitals, nor did I have to ask when i chose to repeat them en route. I didn't have to ask before beginning my assessment of a patient, but rather to gather information and pass it along to the medic who is admittedly saddled with the more complex tasks and has a great deal more training and experience. I didn't have to ask if I should administer oxygen, give ASA, assist with nitro because these were parts of my basic protocol and the medics with whom i worked trusted that I have learned what I was supposed to learn and would not do anything to harm the patient or impede more complex, difficult and consuming interventions. It was honestly not until I joined the City, that I began to experience the sentiment that basics are drivers and should shut up, take orders from the medic, never question anything (i was taught by my medic instructor that if you truly have a concern about the medics course of treatment, that you had a duty to question it within the scope of your knowledge) and treat the Medic with an almost reverent awe. When I began coming into this forum, I started experiencing something that made. I have experienced a number of medics who call into question the value of the basics skills by indicating that they would either chew out or report the basic for raising a concern or acting autonomously. I was taught that a basic does what he does so that the medic need not worry about it. but for that to happen, the medic must hold in mind that the basic has a degree of training (for me 176 classroom hours and 50 clinical) and once that basic has proven him/herself, he should be allowed to function in the capacity for which he is trained. Of course, this brings up the point about the level of education and training and experience of the basic, but the same can be said of the medic partner. It wasn't until I got to this forum that I started hearing medics say things like "MY ambulance, MY patient, MY treatment." In my field training, the entire situation was a matter of the basic and the medic working together, side by side, complimenting each others skills for the good of the patient. It was not until I got hear that I heard that a basic shouldn't question the medic about ANYTHING, and if so not while on scene. Again I was trained that if something being done by the medic really concerned you, that you were allowed to ask him as your PARTNER if he wanted to do this or that,or could something else work. Its not a matter, as I have seen so many medics indicate in these forums, that the basic is trying to undermine the medic in anyway. Like the medic, the Basic is only concerned with what will produce the best outcome for the patient. During my clinicals, I also established enough of a trusting working relationship with my medic partners that they didn't feel they needed to question me regularly either and when they did it was more like a pop quiz than what the hell do you think your doing. I did my clinicals with the largest of the 4 private services in my city. Sometimes I would be a third person in the rig, and on a couple of occassions, even functioned as the defacto emt on a rig because the service was short staffed that day. What I am trying to say is that Basics are trained and to be sure, there are good ones and bad ones. Speaking for myself, I feel well trained and educated because I worked very hard to get that way and that work earned me the respect of the medics who were working as my preceptors. During training I would frequently make the enroute report to the hospital because the medics felt comfortable enough with me managing a BLS patient, that I would be in the box and the Medic would drive. All of this is really a long way of saying that I would like to hear from as many folks as possible what they think the ideal Basic-Medic relationship should look and function like? Do certain medics actually want their Basic partner to bow and scrape to them. I ask this because I have seen it, or rather read about it a great deal since coming here. I look forward to any and all input from basics and medics and hope that they will be constructive in nature and not of the "if the basic upsets me I am going to throw him out the back of the rig" variety. I cant wait to see what you all have to say.