should we do away with EMT certification

[scott33]

given i have an indepdent scope of practice can adminster medication on my own initiative andperform all the skills and more of the 'normal' Paramedics, plus all the other skills i have to have to work as an RN in an emergency care setting ...

Simply not true Zippy and you know it.

And as for what you can do outside of your hospital environment...

[Kiwiology]

I think we should remove EMTs from EMS and just go with Paramedics. The scope of practice is severely limited from what I have seen, and we can sit here and argue the appropriateness of EMT-Bs intervention ability in servere medical and trauma emergencies until we are blue in the face.

From what I know, I don't think it is appropriate in many situations and really feel bad for those rural communities who must rely on BLS only services (many of whom are volunteer) because they don't have the call volume to get ALS resources.

If we staff every ambulance with two Paramedics then how do we account for those services who get very few calls?

I hate to play devils advocate, but, injecting the required funding to put Paramedics on ambulances out in the boon docks where they might get one or two calls a week does not really seem sensible.

[Dustdevil]

Simply not true Zippy and you know it.

Are you familiar enough with UK nursing, and Zippy's practice, to make that accusation?

[scott33]

Yes, I lived there for over three decades, and still have many family and friends who are currently RN's, of all disciplines (except paeds) in the UK. I also did a handful of undergrad (open) uni credits with a view to going into nursing in the UK, before I came here.

Zippy's hospital appears to be the only one in the UK where the nurses are all autonomous prescribers, and Doctors are inferior (in practice) to the Nursing staff. I don't doubt he is a smart guy, but sometimes he believes his own hype.

If practice in the UK were that advanced, it would take someone like me a little longer than 20 days (overseas nursing programme) didactic and clinical to obtain my NMC pin number.

It's a good system, but no better than anywhere else, though it should be noted that penny-pinching will always equal compromise.

[unknown]

Folks folks folks folks…

WE ALL got our place and our purposes….. we could debate this forever……….

I have been privy to attending classes that had mainly nurses and medics in attendance. Working in the environment that I do work in I am subjected to both RN’s for EMS work as well as paramedics. The nurses that I know that are medics also will jump to make sure you know they where medics first. They are proud of that and they keep that medic licensure up just as they do their RN. I have a very good friend that is a flight nurse, she was a nurse first and is now going for her medic’s licensure….. a little reversed yes however she feels the knowledge base is a plus and it will make her much more marketable. Now that being said I have posted before on my experience of taking a class with RN’s and Medics. The initial fact was scary. Many ( I am smarter than to assume all or most) nurses have NO prior field experience and so paramedics bring a lot to the table for that fact. Many states that fly RN and Medics on the helicopters require the nurses to be EMT-B certified before they can take a flight in that state, HHHMMMM why EMTB when they are RN already?? Seem odd?

NO it doesn’t. EMTB’s have their own ability that they bring to the table making the team a well rounded whole. Knock us all you want, dispute me all you want I stand firm in my belief we have our place. As a partaker in PHTLS class with the medics and nurses I learned a very valuable lesson and I now understood why many of our long standing EMT’s in the community has never gone to medic school- now I understand why they have repeatedly told me a good EMT will always save a medics @ss. Not my words, just sharing what I have been told. My experience in class would also explain why my flight nurses and medics always tell me there is no such thing as JUST AN EMT…… they are very correct in this statement. EMT is trained to focus on other aspects, medics focus on a more in depth approach, while the nurses and medics in my class was concerned with ripping a patient out of the vehicle and strapping her down with this iv, that med, advanced air-way……I was the only one to address the following simple steps,

A: I was the only one who stated scene safety BSI

B: I was the only one to initiate exposing my patient for assessment

C: I was the only one to appropriately address the bleeding control and splinting of the fractured femur.

My statement to the aggressive evasive approach was all the IV’s in the world won’t do a bit of good if the patient is bleeding PINK!!

The nurses and medics that day learned a lesson as well as I did. We all do have our place in the field and else where. They learned that all the advanced skills in the world won’t do any patient a bit of good unless the basic approach is used first. Even a medic or nurse has to think on a basic level at times, the hardest problem to solve may have the most simplest of answers………

I do not think that complete BLS crews have a place in rural settings. This I will say adamantly. Maybe in an urban area a BLS crew can run the BLS call’s, but in a rural setting too many factors get in the way. Even the most simple of all BLS runs could turn bad with an extended transport time to the hospital….. Where is the ALS support then when you need it? Just as far away as the ER. This is why our helicopters fly so much in many areas…….but that is another topic for a new day.

Leave the EMTB alone. We all make the big happy world of EMS go round……..

[JPINFV]

EMT is trained to focus on other aspects, medics focus on a more in depth approach, while the nurses and medics in my class was concerned with ripping a patient out of the vehicle and strapping her down with this iv, that med, advanced air-way……I was the only one to address the following simple steps,

A: I was the only one who stated scene safety BSI

B: I was the only one to initiate exposing my patient for assessment

C: I was the only one to appropriately address the bleeding control and splinting of the fractured femur.

An error or mistake on part of the paramedics and RN does not necessarily validate the role of the basic. Especially for the paramedics, it is an indictment on the poor quality of paramedic education and training. Two of those points, especially the first, fall in line with things that people normally do without even thinking of it. I know that when I'm on scene, I'm not actively thinking/saying "scene safety." That doesn't mean, though, that I'm not evaluating the scene for hazards and addressing them appropriately.

[spenac]

WOW this dead horse is still being beaten? :shock:

[frontcrawl]

A: I was the only one who stated scene safety BSI

B: I was the only one to initiate exposing my patient for assessment

Very interesting! You hold your hands up as if to demonstrate that you do infact have gloves on, right? I'm looking into expanding this technique, pointing at traffic signals and shouting out the indicated signal seems like a good place to start. I've learned a lot by watching videos of Japanese train drivers on Youtube.

I'm glad I'm a failed-three-sections-of-the-EMT-B-practical-going-back-to-retest-in-febuary!

I can concentrate on stuff that the EMTs with all high-falutin advanced skillz don't do, like breathing and blinking. Now if you'll excuse me I have to exhale.

BSI SCENE SAFETY EXHALE

*exhales*

BSI SCENE SAFETY INHALE

*inhales*

BSI SCENE SAFETY BLINKING STAND CLEAR

*blinks*

[Dustdevil]

...I have posted before on my experience of taking a class with RN’s and Medics. The initial fact was scary. Many ( I am smarter than to assume all or most) nurses have NO prior field experience and so paramedics bring a lot to the table for that fact. Many states that fly RN and Medics on the helicopters require the nurses to be EMT-B certified before they can take a flight in that state, HHHMMMM why EMTB when they are RN already?? Seem odd?

Everything you just wrote sounds odd, but not in the way you think. Talk about believing your own hype. :roll: Gimme a break. They require that because there are about 40 hours (being generous) worth of monkey skills offered in an EMT-B course that simply is not covered in nursing school. Bandaging and splinting, spinal immobilisation, and extrication. Big deal. Nothing medical about that. When you have both educations, you'll be qualified to comment upon them. Until then, be careful or you'll hurt your back trying to blow smoke up your own arse.

EMTB’s have their own ability that they bring to the table making the team a well rounded whole.

Or you could just give your RNs a week of monkey training and get rid of EMTs altogether. They don't give you a well rounded whole. They give you a lame player that is good for only the most basic, menial tasks, usually not related to patient care, which is pretty darn useless in ninety percent of the scenes. Especially since you already have half a dozen firemonkeys running the scene before you get there.

Knock us all you want, dispute me all you want I stand firm in my belief we have our place.

Really? What place is there on a two man unit -- ground or air -- for a person who is qualified for nothing more than basic first aid? People call EMS because they want professional medical care, not a wannabe who is a 120 hour expert in the two least used skills in EMS, bandaging and splinting. I wouldn't even hire an EMT-B as a dispatcher.

As a partaker in PHTLS class with the medics and nurses I learned a very valuable lesson and I now understood why many of our long standing EMT’s in the community has never gone to medic school- now I understand why they have repeatedly told me a good EMT will always save a medics @ss. Not my words, just sharing what I have been told.

Yeah, and like all the other idiots who perpetuate that parrot line, you like it because it validates your personal worth, which is tied up in the crowning achievement of your life; a month of night school. You lack the perspective to actually see it for what it is, and repeating that just makes you sound as silly as the rest of them. It's a lie. It's rah-rah BS cheerleading, trying to pump you up and make you think you actually have professional worth and feel good so you'll overlook the fact that you're getting paid little. No EMT with any real experience actually believes that nonsense, unless they are just retarded.

EMT is trained to focus on other aspects, medics focus on a more in depth approach, while the nurses and medics in my class was concerned with ripping a patient out of the vehicle and strapping her down with this iv, that med, advanced air-way…

You make it sound like the EMT is designed to be a specialist in some role that nobody else on the scene has. I suppose if you consider carrying the stretcher and my bags for me a special role, then yeah... you're very valuable. Otherwise, you bring one skill to the table that is worthwhile: CPR. And every other person on my scene, including the cops and half the bystanders, have that skill. That leaves you about as valuable as them. Less actually, because you I have to pay.

…I was the only one to address the following simple steps,

A: I was the only one who stated scene safety BSI

B: I was the only one to initiate exposing my patient for assessment

C: I was the only one to appropriately address the bleeding control and splinting of the fractured femur.

This is where it is clear that EMT school is the only "education" (using the term very loosely) you have in medicine. You clearly lack the experience and perspective necessary to understand the education of other providers, as well as their roles in medicine. The reason you observed what you did is because EMTs are trained to function menially from a cookbook list of "steps" to deal with every situation. They have very little actual understanding of the implications of that skill, but they have these cookbook steps burned into their brain (if they are decent, which isn't a given). Conversely, nurses are educated to understand concepts of patient care, both broad and focused, as well as the skills and interventions necessary to deal with them. Nurses don't work from a cookbook. Nurses use medical judgement to determine what is appropriate for their patient. That is a concept that is difficult for somebody with nothing more than a 120 hour first aid course to understand, so I'm not expecting you to comprehend, but if you stay in the field long enough, and get an education, one day the light will come on over your head, and you'll realise how silly your current beliefs are.

Nurses are just as religious about BSI as any other provider. It's just that the concept of BSI is an inate concept that they function within, not just a line out of a cookbook to be verbalised. We aren't taught to verbalise BSI in nursing school. We are taught to just do it. It is the epitome of ignorance to assume that your verbal dumping of your steps as you do them somehow makes you a critically important member of the team. How many real scenes have you ever been on? Have you ever actually heard a provider verbalising BSI and scene safety? If you have, you were either a student being reminded, or you were working with a rookie. Or an idiot. Which brings up another very real possibility in your above class scenario; you may be working with idiots.

My statement to the aggressive evasive approach was all the IV’s in the world won’t do a bit of good if the patient is bleeding PINK!!

You would do well to do more real intelligent studying, and get more real experience, instead of focusing on memorising cute little sayings that you hear people around you say. Otherwise, you're going to end up one of those annoying people who has a lot to say, but nothing to really offer. It appears as if you may be on that track.

The nurses and medics that day learned a lesson as well as I did. We all do have our place in the field and else where. They learned that all the advanced skills in the world won’t do any patient a bit of good unless the basic approach is used first. Even a medic or nurse has to think on a basic level at times, the hardest problem to solve may have the most simplest of answers………

Uhhh... yeah. But if the nurses and medics in your system lack the ability to think on a basic level, they suck, which does not surprise me in the least. But just because your medics and nurses suck, do not assume that suckage is the norm, or you will again be dead wrong. If your nurses and medics suck, they suck. Period. Don't try to give them a break by making excuses for them, like, "Oh, they just need a good EMT to help them!" No... that doesn't mean they need an EMT. It just means they suck.

I do not think that complete BLS crews have a place in rural settings. This I will say adamantly. Maybe in an urban area a BLS crew can run the BLS call’s, but in a rural setting too many factors get in the way. Even the most simple of all BLS runs could turn bad with an extended transport time to the hospital….. Where is the ALS support then when you need it? Just as far away as the ER. This is why our helicopters fly so much in many areas…….but that is another topic for a new day.

No, keep going! This is the one thing you got right! I'd forget all that other nonsense and stick with this point, because it is a winner! You might even redeem yourself with it. :wink:

Leave the EMTB alone. We all make the big happy world of EMS go round……..

There's only one EMT-B on this earth that makes me happy or my world go round, but she's a nurse too. And the day she becomes a medic, I will have no other use in the world for any EMT-B.

[zippyRN]

Yes, I lived there for over three decades, and still have many family and friends who are currently RN's, of all disciplines (except paeds) in the UK. I also did a handful of undergrad (open) uni credits with a view to going into nursing in the UK, before I came here.

Zippy's hospital appears to be the only one in the UK where the nurses are all autonomous prescribers,

I never said that , i have said i can adminster medication on my own initiative - this is via PGDs - although our Cardiac NPs are all Independent prescribers, our Elderly 'inreach' NPs are prescribers and some of the Emergency Dept NPs are Prescribers ... the rest of us just have to make do with PGDs

and Doctors are inferior (in practice) to the Nursing staff. I don't doubt he is a smart guy, but sometimes he believes his own hype.

in termso f hands on practical skills a lot of the junior doctors are lacking especially compared to the Emergency care / unschedueld care / assessment unit Nursing staff ...

If practice in the UK were that advanced, it would take someone like me a little longer than 20 days (overseas nursing programme) didactic and clinical to obtain my NMC pin number.

It's a good system, but no better than anywhere else, though it should be noted that penny-pinching will always equal compromise.

yep penny pinching equals compromise in that the numbers of NPs in the ED is bare minimum to provide 12-14/7/365 , in that they have removed the 'specialist nurse' Emergency care Staff Nurses to save money ( well they've moved us and are still paying our specialist nurse salaireis but as pay protection and we're still doing the parts of our role that can be applied to our new clinical areas - and looking at reintroducing some of the skills but adjusted to the new areas e.g. IR(ME)R referrer status ...