NREMT-Basic

Eh....not so much. There's dead and then there's DEAD. One sometimes comes back, the other never does. Ive seen both.

What about MRSA/VRSA? :shock:

Off topic, but sort of related: This reminds me of a discussion we had on fire extinguishers in the fire academy. The D/C was talking about how he had been called to inspect after a small fire in an office building. Upon arrival, he was told that none of the extinguishers had worked. He asked if they did inspections. yes they did. Who did them? The security officer. Ok lets talk to the security officer. "How do you inspect your extinguishers Ms. Security Officer?" "Well, if they have their seal and pin and the gauge has the right pressure, I dont do anything. If the pin is missing, I put some twisted copper wire in there. If the seal is missing, I reseal it with a twist tie and if the pressure guage is low, I shake the extinguisher until the pressure comes back up." D/C cites the company for improper maintenance of fire apparatus. Back to topic...if we could teach teachers the signs of anaphylaxis and given that there are no contras to epi in the case of anaphylactic shock, couldnt we make these as fool proof as AEDs. Its just a thought. Hell, college students snorting ritalin (sp?) get a bigger cardio boost than with epi. One dose and they are climbing the walls for 48 hours.

Just FYI, the National Registry doesn't set protocols. It never has. It doesn't have that much authority. I do agree with you about Dust not saying anything if he doesnt have anything constructive to say, but then we would never hear from him. :shock:

Ummm....so would you. P-R-O-T-O-C-O-L-S!!! :roll:

Probably one person mentioning the search function would have been sufficient. Its like a bunch of old school marms.

So Dust- We have heard that pnemonics are useless and only stupid people who attend poor quality programs need to use them. In a previous thread we heard your assertion that elementary school teachers have better skills than Basics, but what you havent done is offer offer the assistance that the original poster asked for. So I will... If the original poster wishes to PM me, i will be glad to help in any way I can.

Maybe I am wrong, and Dust will certainly point it out if I am, but I dont remember things like giant hives or swelling of the tongue and lips after eating a granola bar being in list of signs of an MI. But I guess if we didnt make statements like its hard enough for a paramedic or even an physician to tell the difference between an MI and anaphylactic shock then we can continue with the theme established by the title of this thread which is that school teachers can provide better levels of care than EMTs. Im sorry, but I have seen several MIs and several cases of anaphylaxis and have never confused the two. But, we got another chance in a back-handed way to bash Basics, so I guess the thread is a success.

I generally say, in a very loud voice, "No. Its not supposed to burn when you pee."

Lone Star- Bravo Zulu for your post. Its the most straightforward, no BS post on this topic that has been written in the thread. Im a "yellow helmet" in training and so can understand your passion for doing both and I agree that one person can be good, even excellent at both. Today was the first day that we trainees were in full gear for a small live burn (dumpster full of pallet wood). We were just getting ready to start and the FTO came up to me and said he had a present. My department, do to political machinations of the last few years has a private EMS agency housed where the FFs used to be quartered and the FFs respond to the post from home. Since the private agency took over medical, most of our FFs got frustrated and let alot of their certifications slip so we have a department full of MFR's and a dozen or so EMT-Bs. In any case, the TO came up and slapped a SOL on my helmet I thought it was a very nice gesture and this man of 30 years experience let me know that he too believes one can be good at both. Im glad you survived your illness and are working to get back at it. Im only sorry that the politicos which are to be found under the rugs over every department found way to show you the door when your jacket is clean. I know it sounds cliche, but thank you for your service, stay safe, keep your helmet on and your head down. "Everybody Goes Home!"

My apologies then. Its not a term that I had seen used in that way. You learn something new everyday. Thanks.

Whenever you make rash generalizations like "any firemedic" you instantly lose traction. You can say every, always, never, etc. You have to ask yourself what is the first goal of a firefighter AND and EMT....to prevent people from dying. Also, "firemedic" is a meaningless term. It is misleading in that it makes it sound as if a firefighter who is also a medic or EMT is going to be trying to prevent a fire from getting in the ceiling and trying to finesse a medical intervention at the same time. Firefighters are not taught emergency medicine in the same course where they are learning to knock down flames. They learn fire science and fire fighting and have either gone through an EMS program first, or have a year or so to achieve whatever level of certification their department or agency requires. A person can be a firefighter or a medic OR a firefighter AND a medic, but there is no such thing as "firemedic." That's a term coined by folks who have an axe to grind with those who can master more than one set of skills in a lifetime. Put the axe away, Brent. Its not cutting. And for the record, if, while functioning as a firefighter, I make a rescue and end up tubing a patient, I'm not going to be talking about the heat of the fire and new and nifty ways to use a halligan. Im going to be talking about the fact that I was able to take a patient without an airway and give them one.

Wendy- Your points are well taken as are those of the others who look at firefighters as eternal adrenaline junkies...you know the type that would like to sky dive while eating blowfish sushi. I don't fall into this category and never have. I cant say that getting in an ambulance and hearing the sirens kick up on a priority call doesnt get my heart going in an exciting way, as I think it does for most of us. For me, while I am not training as a firefighter to face my own personal demons, I will certainly be doing that. I hate being hot more than watered gin and earaches put together and fear being burned more than anything else I can think of. The thought of becoming a crispy critter and living scares the be-jeezus out of me. The reason for me going through firefighter training at the regional (as opposed to local) level is about furthering my training in emergency services and management. As I started my training in emergency management, I realized how many of its procedures and policies are based on fire service guidelines and so I felt that it behooved me to train in this area and gain experience in it. I have a great passion for medical/technical rescue and as soon as I am eligible for it (ie have finished FF2 training) I will start that training. Im also not a training junkie I just feel that moving into ES requires as much experience as varied a spectrum of emergency responses and services as I can. I will honestly say that I started in EMS intending to be a career medic and have developed more of an interest in emergency and disaster management. I agree that not all FFs are good EMS providers and vice versa. I also dont agree that it should be a requirement that all firefighters become EMTs or paramedics. I dont know when the two became inextricably linked but it has happened and will probably continue for the forseeable future as a more "all-hazards" approach to emergency response becomes the norm. My personal goal is through education and experience to become the best I can be in terms of emergency management and services. If nothing else, I live smack dab on top of the New Madrid fault and want to be ready for what geologists say is coming our way in 5-7 years. I face a strange experience with the fire department I am training with in that I am an EMT in a sea of MFRs with an in-house private EMS agency that we respond with to medical calls. This is one reason that I am working in the best way I know how for the standardization of EMS responder levels, education and training on a national level. I hope any of this makes sense. I havent had my nap or my geritol today so who knows. Again, thanks for your considered response and thought provoking comments. Finally, if anyone can figure a way to download the youtube video that started this thread and send it to me, I would be grateful. For reasons I wont go into, I am currently using a dial up connection which makes viewing such videos virtually impossible. Id like to put in on my flash drive and run it on the computer at the fire station. If you're able to do this, please PM me for an email address. Graci!

Michael- While I appreciate the elegance of your extended metaphor, I cant say that I agree. I think firefighting and EMS share much more overlap than you express and are not, as you seem to suggest, mutually exclusive. More than one poster so far has expressed upset that firefighters or fire departments should stay away from EMS. From a practical standpoint, I can say that its not going to happen for a VERY long time, if it ever does. Further, would you say that a combat medic, who in this day an age is trained in as much combat as he is in medicine (he is, after all, a soldier...a combatant) does not possess the subtlety to detect subcutaneous emphysema secondary to a blast lung injury? Would you say since he is trained in the use of rifle and bayonet and grenade that he does not and cannot possess the delicacy required to tend to a thermal burn in the field? You seem to say that one can either be a brute or a poet, but never the twain shall meet. I am first and foremost an EMT and am now receiving firefighter training as a part of my overall emergency services career. But to somehow suggest that because I can use a halligan bar or an axe, I cannot also use a delicate Morgan flush lens really doesnt seem to ring true. I have a rather extensive liberal arts education and an affinity for Sufi poetry. Does that mean that I can also not muster the force of will and body required to fight an internal structure fire? I will be trained to cut apart a car, but does that mean that I cannot exercise the delicacy required to evaluate and care for the infant extricated from that vehicle. The old image of the brutish firefighter who is always covered in soot and grime whether or not he is on the fire ground died a long time ago. Unfortunately, the perception of those not associated with the fire service that this is what a firefighter is has not. I work with and around firefighters who hold master's degrees. One is a nurse. One is an English teacher. Some are auto mechanics and garbage collectors. But I assure you, when it comes to medical care they are not some kind of fumbling oaf simply because prior to rendering that medical care the forced open a door with a sledge hammer. Their sensitive perceptions have not been scarred by the 3500 degree heat of a burning propane tank so that they cannot exercise the delicacy required to care for a frail elderly patient or coach a frightened parent through CPR over the phone. The blast furnace of an industrial fire does not melt their ability to think in the subtle ways necessary to render emergency medical interventions. Would you have the same attitude regarding someone who is an urban search and rescue operator or a collapsed structure rescue technician and also a paramedic? It seems that such ideas are more based on the on the old historic biased view of the brutish firefighter than in any real fact, but sadly, the opinions you express seem to be, in large part, the reason that non-fire service paramedics have disdain for fire service based paramedics.

Dwayne- Thanks for your comments. I suppose I could blame my often bombastic disposition on my mother's side of the family being Scottish and my father's being Irish, but that would be an easy out. I tend to be passionate about things in which I am involved and so when I step in, I REALLY step in. As my LEO father always told me "Never bring a knife to a gunfight." In any case, I due wish to apologize for my conduct. While I feel that if I want to make an ass of myself in a private message I have the right to do that and expect that it be kept private, I will say that I was out of line. With grad school, recruit academy, job hunting, etc there tends to be a lot of pressure on my cork these days. Also, more practically, I tend to yell first and think later. While Ive done so in the past and in the past said I will work on it, I want to re-iterate that its not a part of my character that I am proud of and I will continue to work on thinking first, then posting. Again, thanks for your kind words of encouragement. Stay safe and don't play with the siren. :wink:

Dwayne- I appreciate your thoughtful post. I'll try to address it point by point. Last Saturday when I was in Academy class, there were I think 5 or 6 calls toned out. I believe the breakdown was (over the course of 4 hours) 3 medical, 1 rescue, 1 residential fire and one call the nature of which I cannot remember. I agree that it is an efficient system for EMS responders to be posted in their rigs around their response area. However, this would be impractical for fire trucks, engines and ladders for a number of reasons. First, are you really going to put 5 unpaid volunteers in an engine at their post for several hours at a time. If you know the cost of keeping an ambulance full of fuel, imagine keeping a fire apparatus sitting somewhere with its engine running on 100's of gallons of diesel. It takes a great deal of energy (fuel wise) to fire up an engine or tender and the engineer not only has to deal with the function of the truck, but its systems, hydraulic pressures, etc which need to be monitored while the truck is running. Its just not practical or feasible. Also, while some people will look twice if they see an ambulance sitting in a parking lot or driving around town with its lights off, imagine not only the public concern but the logistical nightmare of driving a fire engine around a given area for say....12 hours. Again, in addition to the astronomical cost, its a logistics nightmare especially given the accidents that can occur when a fire engine is just trying to turn a corner in a non-emergent situation. You mention the need for fire fighters to have kitchens, loungers, etc. We have 5 private ambulance agencies in my area and their posts look more like comfortable homes than an emergency post. Anytime you have people posted away from home and not moving around constantly, these kinds of facilities are required. This isnt unique to the fire service. According to the NFPA, there are approximately 800,000 firefighters in the US. 75% of that number are some variant of volunteer, either paid on call, paid per call, or unpaid. Sitting around waiting for a call is not possible for the 12 or 24 hour shifts that most paid firefighters work. People have to earn a living. Many firefighters who are not paid or are paid per call will stay at the station or in quarters when they are not at their "career" jobs. However, when a municipality makes the decision to remove EMS response from a fire department and outsource it, and then house the paid EMS crews in what were formerly firefighter quarters there really is no place for a firefighter to wait between calls. So the department with which I train has established that we respond to the station from home and to the fire ground from the station. Some of the younger firefighters without family obligations will stand around the firehouse for hours on end on weekends, evenings, etc, but I am sure you can see how this is practical only for the minority. Before EMS was outsourced at the my department, we had a large number of very well trained and experienced EMT-Bs and paramedics. Now we have mostly MFRs and only a handful of EMT-Bs because those who were operating at a higher level before did not see the point in maintaining a certification when they chose to be unpaid volunteers and they were not going to be allowed to use the skills and certs that take large amounts of time and money to maintain. It just wasnt practical. So now we have a situation where if 5 or 6 FFs respond from home, and 1 of them is an EMT, that person may be in charge of that medical call until the private ambulance service arrives. Sometimes they get there before fire/rescue and sometimes after depending on their call volume on a given shift.

Yes it slows down fire response, logically, when you remove firefighters from the building where they were quartered and they respond to the station from home, change into bunker gear and deploy from there. You are right. There are alot more medical/rescue calls to be responded to. And the fire department is the first response agency. It is quite ironic that we are the first response agency yet we cannot be quartered at the station. As for what they are training me to do, Im not sure I understand the question. If you mean what am I training with the fire department to do, it is to be a firefighter and I will also be serving as a first response EMT. Im not sure if thats what you meant. An IMSERT thing? You lost me there. Could you explain please?

Massive budget? What planet do you live on? The department I am training with recently got a referendum of 1 cent sales tax increase in their district for 3 months. First increase in budget in several years. Many of the FFs are still buying their own gear above and beyond what they are issued to be as prepared and effective as possible. I understand that certain EMS providers are threatened by fire based ems response, but is the constant slander and insult to firefighters really necessary. Shall we just close up shop and let EMS agencies learn how to use fire extinguishers so they can fight industrial and residential fires. With my department, you'll be happy to know, primary EMS was taken away from the fire fighters several years ago as was the department's sleeping quarters so that a private EMS agency could set up shop in the fire stations and then whine about having to get out of their recliners and put their clothes back on during sunday football games. As a result, there can be no duty fire crews because there is no place to quarter them which in turn slows down fire response.

Brent- I know you are a dispatcher, but out of curiosity, what is your EMT licensure level?

Roll your eyes all you like. I anticipated you being pretty vocal about this. For the record, EMT-B's already perform invasive procedures so thats not performing LIKE a medic, its performing AS an EMT-B. As for not being able to help yourself with the disaster response comment, you could have refrained from the nasty comment, but chose not to. As for training and going to school, well I'll send you a copy of my CV if you like. The kinds of degrading and insulting posts you generally make surrounding this topic are one of the main reasons that discussions degenerate into arguments, worthless 9-page threads and personal attacks. You also threw bait out hoping for a heated and angry response, but your "bait" is even smaller than Spenac's so I wont bother with it either. NEXT.

I know that you like to argue, but as I said, I am not going to stoop to the level of arguing about what Basics do. As for the statement that Basics do nothing, you're wrong and I will leave it at that. Also, its not excitement, just information. You threw out the bait, but Im not biting.

I agree except that I would want more than an increase of a "few clock hours" if I am going to be giving narcan and d50. I'm always curious as to why some people are never satisfied with advances. People have been saying (and you know who you are) that EMTs need more training than 120 hours. I myself spent 280 hours on my EMT-B, which still isnt excessive by any standard, but more than double what is usually quoted by Basic detractors. You say no change but a few more clock hours, but what do you think those clock hours would be spent doing? As for the point which is sure to come up that EMTs dont have enough chemistry, pharmacology, etc I think if we are going to start giving drugs like D50 and narcan, that could very well be true. However, with very few exceptions, I know very few medics who can explain and "diagram" the complete pharmaco-kinetics of every single drug they push. They know its basic and essential actions, its indications, contraindications and complications. Heck, probably more than 50% of the drugs on the market today say in the accompanying monograph that "exact mechanism of action is unknown." If the MDs and other scientists that create a drug and get it on the market doesnt know how it works, I have my doubts that a street-level EMS provider of any level has has the training and spent the research time and cash to figure it out. Every level of provider has its limitations. Some are just dont acknowledge it.

If you read the report, in its 42 pages, it does not in fact indicate that EMT-Basics will become more constricted in their scope. What the report does say is that AEMTs will be required to prove proficiency in all skills required by EMT-Bs in addition to the additions. While the AEMT is essentially a Basic with additional skills and protocols, the NHSTA considers the EMT-B and the AEMT to be different animals. As I say, the new classifications will be MFR, EMT, AEMT and Paramedic. If you read the 4.0 NHSTA report carefully, what they are recommending is a fundamental change in title and a specific change in scope. What they are hoping to accomplish here is a rather large step toward a national scope which would be the best thing to happen to EMS since we stopped using hearses for ambulances. There would no longer be, under the NHSTA classification, any such animal as an EMT-B. The one thing those of us that are now Basics would lose is the ability to say "yeah, but a Paramedic is an EMT too" because under the new system, which I am all for and am working very hard at the grass roots level to see go as national as possible, Paramedics are no longer EMTs (ie EMT-P) and an EMT is not an EMT Basic...but rather simply an Emergency Medical Technician. I live 20 minutes from the Wisconsin border and since the department I am now training with can be called under MABAS to assist with calls with medical aspects in Wisconsin, I how hold EMT-B certification in IL and WI. I have to say that once you get past EMT-B in WI, their classification system is a mess and confusing even to those who work solely in that state. In any case, Ive read the NHSTAs report several times this morning and there is no discernible truncation of the scope of what would be called simply an EMT, formerly known as an EMT-B. I even read it again after reading your thoughtful post and I simply dont see any removal of protocols from EMTs under the new system. I think phasing out the EMT-I classification at the national level is an extremely good idea. I know that my home state of IL is considering the AEMT level and I will be first in line to train for it. I know there is the argument that if you want to push drugs, become a medic, but there is also the equally legitimate argument that not all providers wish to become medics. Thanks for keeping the first response to this new thread civil.

In its Scope of Practice Model 4.0 (and previous editions) the NHTSA has introduced what appears to be a replacement of the unwieldy old EMT-I classification that a lot of states have seemed not to know what to do with for so long. They are calling it the Advanced EMT. If you read the Scope of Practice which you can find at ems.gov, you will see that this level is the standard EMT-B with the following additions: 1. IV access 2. IV Narcan 3. IV D50 4. Inhaled Nitrous Oxide for relief of pain/discomfort 5. I/O access 6. Glucagon These are in addition to what the NHTSA standards already include for Basics. I'm not putting this here as a source of argument and I refuse to engage in argument over it because it is more simple to say that I disagree with those that say that EMTs have no business pushing meds, starting lines, etc. I will say that the standard argument, largely made by paramedics, has been that BASICS shouldnt be performing these interventions but that the NHTSA has beaten those medics to the punch by eliminating the EMT-I level and replacing it with AEMT. I know some states already use this level, but the NHTSA states that it is attempting to streamline and increase standards of training and education. Yes, education. So the new levels would be, in the states that adopt the new Scope whole-cloth would be: MFR, EMT, AEMT, Paramedic. I guess the new level would end the element f the argument which says that Basics shouldnt push drugs since these providers would not be Basics.

Well, I had hoped not to feel compelled to post in this thread, but this one started my water boiling. When I came out of EMT school, I had the bear bones basics that EMT-Bs are taught. Now, I haven't been an EMT-B for 15 years and since my emergency services priorities change, I may or may not become a paramedic. But to say that as an EMT-B you cant learn without becoming a paramedic indicates a very closed mind. Does it them follow that if you become a paramedic with 15 years of experience the only way you get any better at patient care is to become a critical care nurse or an MD or even a physician's assistant. Sorry but this one just doesn't wash. When I was getting my EMT-B, I was taught about mass casualty incidents and triage, as an example. Since becoming an EMT, I have joined a response organization which only deals with mass casualty incidents. And not just car accidents or the like but incidents of terrorism, accidental or intentional chemical or nuclear releases, etc. So I haven't become a paramedic, but I took a topic that I learned precious little about in EMT school and expanded upon through further training and education and am now better prepared to deal with patients in these kinds of situations (again I use MCIs as an example). Im trying to turn over a new leaf and not just post flaming responses out of anger or frustration. I dont always succeed but I am trying. But this kind of ignorant response does make me angry. And I use the word ignorant not as an insult, but to indicate perhaps narrow thinking and an attention to reality. In addition to coursework on bio-terrorism, I have also taken much of the main NIMS/ICS sequence, courses that dealt specifically with what I as a basic can to when treating a gunshot wound and also learned how in much greater detail how to work with a paramedic, any paramedic and not just my partner, to be more highly skilled and valuable as a member of the patient care team and not just a maker of cots and driver of ambulances. I guess I just dont understand the mindset that says that within the framework and protocol of a specific job, you can never get any better without getting a different job. While I know there are alot of paramedics and others who believe that a Basic shouldnt be doing things like combi-tubes, I recently read a study published in Japan that said that combi-tubes should be the first line of defense in terms of an emergency airway adjunct. Now, whether one agrees with that or not, I felt that since it is an opinion shared by segments of the EMS community of which I am part, it behooves me to learn what advances have been made in the use of this intervention and to learn how to implement them should I be called upon to perform this intervention. We can always get better at what we do and there is ALWAYS more than one way to get better. Some people may want to spend their entire career as a secretary, but they can always be learning about new technologies and policies, etc in the field of office management. I know I am a better EMS provider now than when I got my EMT-B and I havent started paramedic school yet (if ever). The improvement in my skills is measurable. I think this argument is just entirely based on a false assertion that different ALWAYS equals better.