NREMT-Basic

At the risk of getting blasted yet again, the purpose of a student doing clinicals is not to make the nurses lives easier. The purposed of clinicals is for doctors and nurses to teach you what you need to know and then supervise you doing it. When I was in clinicals and was asked to fetch coffee of make copies, i went to the nearest phone and called my instructor who promptly let the ED know what I was there for and that I was no a gopher. "Learn one, do one, teach one."

Dispatched C3 to attepted suicide. Arrived on scene to find EDP very drunk and high on cold medicine. Her husband was tired of dealing with her and called us. After telling us she wanted to go to the hospital, we gave her her choice of any one of the three EDs and she informed us that she couldnt go to any of them because she was the crisis intervention social worker for all three. The week before, she had signed a refusal to go to ED because she had a headache, but informed EMS that she was a brain surgeon and didnt want anyone taking care of it but herself--that is self brain surgery to remove the offending whatever. Because of AMS we couldnt have her sign a refusal. Transported to the hospital while she slept in the cozy ambulance...on her way to a 72 hour psych hold. Gotta love those EDPs.

I agree completely that ems personnel in high risk areas should be allowed to wear their own body armor if it is not provided by your service. The only thing that I would add (and this gets into classes of armor) is to make sure that you purchase or are furnished with armor which is not only ballistic proof but sharp proof. As someone who wears armor under my uniform, I made sure that what I purchased was designed to repel both ballistics and sharps. The problem with alot of personal armor is that yes, it will stop a bullet and may do so even at a close range (if you dont mind broken ribs) but that same armor may be useless against someone with an icepick, the point of which is narrow and thin enough to find its way between the fibers of the kevlar and directly into your soft and mushy parts. I had no idea this was the case until I bought my armor and was advised by my now retired veteran police officer father to get armor that also stopped sharps. One question I would ask is how many of us that wear armor wear it under the shirt and how many over. I have read numerous studies that departments who have officers wear armor over their uniforms have a higher incidents of officers finding themselves in need of that armor. It can often act like a "shoot me" sign. Stay safe and keep you heads down.

Ace- Its no secret that you and I agree on...well pretty much nothing. And while this list is aimed at physicians, it is clearly a valuable asset to anyone and everyone who cares for people in times of need, from the first responder on his first day to the critical care paramedic in his 35th year. I for one am happy to see a list of practice tools which offers advice which includes introspection, the elimination of ego and the absolute primacy of the patient's needs in pre-hospital emergency care. I haven't been an EMT for that long, coming as I do from a long background in academic medicine and while I dont think I will stuff this whole list in my brain for memorization, I will print it and put it in the pocket of my tac pants and everytime I feel fed up with a patient or am moved to think that they are simply whining or looking for attention,I will make myself read this entire list. Maybe there are patients who are just looking for attention, but as my guru has so often said (himself a veteran of two tours in VietNam as a combat medic and 36 years "in the box" as a paramedic back in the world) patients who call us seeking attention or comfort are just as much in need. After all the acid that is spewed about protocals and egos on these forums, thank you for posting this. May we all aspire to treat our patients as we ourselves would wish to be treated. "First, do no harm"

In the time I have been a member of this site, I have seen so many valid discussions which turn into spitting matches of EMTs vs. Paramedics. One of the things that it seems might help is to remember the EMS concept that a Basic is an EMT, an Intermediate is an EMT and, though they are often want to admit it, a Paramedic is an EMT...I can just see medics all over the world having small MIs when they read that. First of all, we simply must stop comparing the training of EMTs of any level in the US to that of our brothers and sisters in Canada, Australia and elsewhere. The training and scopes of practice are simply not the same. An EMT here is not the same as an EMT in Canada. Secondly, I disagree with the fact that the training of EMTs (as one author noted, particularly basics) is insufficient. In my experience both as someone who has spent a year in medical school and is now a National Registry EMT-B/D, when people start complaining about training being insufficient, it is most often not the fault of the training, but the fault of the one being trained. Maybe people should start asking themselves, did I LEARN material and interventions or did I memorize it long enough to get through an exam. I think often, especially with students at the basic level, the latter is the case. As far as clinicals go, my training program required 20 hours of clinical time divided between ambulance and hospital. I completed almost 3 times that many hours, including 24 hour shifts in Level I trauma centers, where I assisted physicians and nurses, administered treatments to patients whose care was placed in my hands and regularly performed neuro exams on patients. Perhaps the best question to ask is not whether the training is sufficient, but whether you took full advantage of the opportunities for training and learning made available to you. I have seen students in clinical settings, both Basic and Paramedic, sitting in lounges drinking coffee waiting for the next "interesting case." When we begin to argue about who is well trained and who is not, perhaps we should be intelligently discussing who took advantage of the opportunities made available to them and who sat around on their thumbs until their shift was over so the nurse manager could sign off on a "clinical rotation." As for BLS vs ALS, this question doesnt even exist in my area. Every single crew has a BLS Basic and an ALS paramedic. There is never any need to see what a patient needs and then call for an ALS intercept. ALS providers are already on scene ON EVERY CALL. In fact, several of our private agencies have three person crews consisting of a Basic and two Paramedics. Whether you are training to become a Basic, a Paramedic, a CCP or a Basic or Medic specialist, the question is not how good was the training, but rather how well did you train. Yes, I plan to move on to Paramedic level. But I am also proud to be an EMT-Basic. I worked very hard during my 176 hours of training (not 120) and came away feeling that I had mastered the skills of assessment, splinting, patient stablization, bleeding control, labor and delivery, wound care, breathing treatments, scene size up and the 100 other things that we were trained to do. If you are an EMT and feel that your training was insufficient, then by all means have the good sense to get out of the ambulance and back into the classroom. If you are a Paramedic who feels that the Basics with whom you work are ambulance drivers, why dont you let them participate in the patient care they were trained to give. Basics and Paramedics should work together, hand and glove, not servant and master.

There were two valuable lessons in this post: 1. Ambulance services that can afford a brand new ambulance in a "pretty quiet" area should look toward throwing their personnel a bone in terms of payment...if only pay per response. 2. That cats are white meat. I did not know this and it expands my dietary horizons. Please note: no animals were harmed during the creation of this post.

You asbsolutly did the right thing. We must mantiain the highest standards if we are to care for out patints. Well done an I am sorry for the lost of you partner. That is never easy no matter how it happens.