DustDevil Exposed !!

[NREMT-Basic]

So now you know what I would do in a situation or that I do what's easy for me? Would I call for an ALS intercept in needed if I were running on a BLS only service. Sure I would. Would I call for a helo dust off if one were needed. You bet ya? Do I do what's easy for me or the absolute bare minimum to get and keep my certs? Not on your life. I keep up and improve my skills and skill and knowledge set by doing more CEU hours (practical and academic) in one year than my state requires in 4. Last month alone I completed 60 CEU hours. So please, whatever you do, do not assume that you know that I take the easy road or for that matter that all basics do. That kind of smacks of another paramedic/DD notion that all Basics are really just wannabe Medics who cant hack it. In my situation, there are three paramedic programs in my area and there are constant waiting lists for them. We have one program that has a 3 year waiting list. I do plan on becoming a paramedic when it is feasible and suits me to do so. That is to say, when I want to. But not all basics are just wannabe paramedics who cant hack it. Some basics have no intention of ever becoming a medic. We have a basic in one of our systems who has been a EMT-B for 25 years and is VERY good at what he does and has no intention of ever becoming a paramedic.

One of the other problems with the kind of arguments that Dust makes is ASSUMING that Basics arent capable of doing anything but driving. It is a hugely common assumption that paramedics make and its a stupid one. The reason that so many Basics end up pushing the cot and driving is because their so called superior paramedic partner never bothers to find out what they are capable of. Most medics dont ask. A Basic has alot to contribute during a call, but to hear alot of medics tell it, they would he happier to run the entire call themselves, without assistance and then jump up and drive the rig themselves too.

[JPINFV]

Ok, I'll ask. What drugs are you able to administer to a cardiac patient besides oxygen? How about patients with shortness of breath? Can basics in your area start IVs? How about intubate with an endotracheal tube? Again, just because you and your friends are superstar EMT-Bs who go above and beyond the call of duty in terms of education does not mean that the percentage of EMT-Bs that do so are representative enough to be able to justify a larger scope of practice.

In my area, EMT-Bs are limited to O2, positioning, and vital signs as an independent provider. That's not much to offer, unless you are also counting all of the paramedic assist "skills" like hooking up a monitor and priming an IV. Those "skills" [quotation marks because they aren't really hard] can be taught in less than 5 minutes.

[NREMT-Basic]

Ok, I'll ask. What drugs are you able to administer to a cardiac patient besides oxygen? How about patients with shortness of breath? Can basics in your area start IVs? How about intubate with an endotracheal tube? Again, just because you and your friends are superstar EMT-Bs who go above and beyond the call of duty in terms of education does not mean that the percentage of EMT-Bs that do so are representative enough to be able to justify a larger scope of practice.

In my area, EMT-Bs are limited to O2, positioning, and vital signs as an independent provider. That's not much to offer, unless you are also counting all of the <http://www.emtcity.com/phpBB2/results.php?searchTerm=paramedic&submit=submit>Paramedic</a> assist "skills" like hooking up a monitor and priming an IV. Those "skills" [quotation marks because they aren't really hard] can be taught in less than 5 minutes.

OK. I'll bite, but then I will also tell you at least one place where you reasoning is flawed, since you have been more than willing to do that for me. You asks what drugs I can administer in a cardiac "situation" besides O2:

Nitroglycerin - standing order for 3 doses of .4mg Q5M on scene or en route the ER

ASA - standing order for 4 tabs@81mg/tab for a total administration of 324 mgs

And of course like the Basics in your area, we can place the patient in a position of comfort which may be lateral recumbent or semi-fowlers, but of course that is not the drug intervention you asked about.

No. EMT-Bs in my area (IL region 1) cannot start IVs, though there is discussion at the state level of uptraining Basics to place I/O caths and including it in their protocol (EMS personnel do not have scopes of practice. There is a difference) While I am not allowed currently under my protocol to establish an I/O line, it is an intervention that I am trained to perform and feel competent in my skill to do so. Since we are on the subject of IV access, why do medics always use this as the gold standard. The attitude seems to be "if you cant start an IV, then you are useless" when in fact in non-cardiac or extreme blood loss, most IVs are started because the receiving facility will have a fit if it is not. Ive seen more Medics than I can count establish an IV cath and not hook it up to anything simply so the hospital is happy. Ive also seen an alarming number of medics who are so vastly incompetent at IV access that they should never be allowed to pop and IV start pack, let alone actually start one. We have a medic in my area who is nick-named Bloody Mary because her IV starts are so bad there we end up with blood all over the patient, the floor of the rig and the cot. But yeah....not being able to perform basic skills consistently is a problem specific to Basics.

As far as shortness of breath, i have a standing order in my region for an albuterol neb treatment.

ET intubation: I would be interested to see how many patients that call EMS and get an ALS response require intubation. There is also a new study in Japan that says that Combi placement should be the first line of airway protection (after re-adjusting the airway, etc) because it is faster and generally does not require multiple tries. Also, the "combi" technology has increased to the point where it is no longer simply a cram and slam procedure. But by all means, if I have a patient who cannot maintain a patent airway, I will call for an ALS intercept and wait for the paragods.

Here is where you reasoning starts to run afoul of logic. You say that Basics are under-trained, under-qualified and essentially incapable of providing outstanding patient care. But when you are presented with and EMT-B who goes out of his way to increase his skills and knowledge so as to better serve his patients, you say that is the exception. Please show the statistic that says that the majority of Basics do not work very hard to provide excellent patient care and work regularly to increase the level of that care.

Also, one mistake that both you and DD make is to indicate that because a medic has more hours of training than a Basic, that care rendered by a Basic is "inferior." Obviously neither of you understands the word inferior. It means of a lower quality. Because a Paramedic can provide a great number of interventions in no way correlates to the quality of the care any more than it would to say that because one provider is a nurse and one is a doctor that that nurse is inferior. They are two separate sets of training. One is called BLS and one is called ALS. While ALS is by definition more advanced, it does not mean that the BLS provider is inferior. Simply more limited. An example would be a basic and a paramedic packaging a patient with potential c-spine injuries. Simply because one provider is a basic does not mean that his level of care in packaging that patient in line with protocols for suspected/possible spinal injuries is inferior simply because he is a basic. Its just a fallacious argument.

I agree that it might be a good thing to have Basic education increased to require a two year degree, but it should be an associate of applied science and not just a general AA degree with EMT training tacked on. But if we are going to essentially quadruple the amount of education for basics (the usual basic course takes about 6 months by the time all is said and done), then lets quadruple it for paramedics. So instead of the average year and a half, lets make it six. By doing this we can ensure that neither basics nor medics are providing inferior care.

[WANTYNU]

OK. I'll bite, but then I will also tell you at least one place where you reasoning is flawed, .... By doing this we can ensure that neither basics nor medics are providing inferior care.

Allllll Righty then, hummm, do you feel better now? :roll:

-w

[AnthonyM83]

Did you completely ignore my post or are you getting to it?

[Dustdevil]

Did you completely ignore my post or are you getting to it?

It seems clear to me that, as Dwayne suggested, he ignored the entire interview. In fact, almost every accusation he has tossed out here is refuted by the interview itself. I too wonder exactly what interview he listened to, because no intelligent and educated person could possibly come up with all this crap from that interview.

Anthony is correct, that I haven't even been here in four days. As much as I love EMT City -- and contrary to popular belief -- I do have a personal life. But, since none of these accusations have anything to do with what was said in that interview, they're not even relevant to this thread. This ignorance speaks for itself and is unworthy of a response.

I will, however, address one of Basic's many spurious points. I am not above the rules here. You are simply misreading the rules, which is of no surprise to anybody, since you obviously have a tendency to not clearly comprehend the written and spoken word. There is no prohibition against discussing the Basics and Volunteer issues here. The prohibition is against starting topics for the sole point of rehashing the obvious, and against personal attacks on others based upon their Basic or Volunteer status. I support those policies and remain in complete compliance with them.

And luckily, bashing firefighters is still within site policies.

[EMT City Administrator]

The prohibition is against starting topics for the sole point of rehashing the obvious, and against personal attacks on others based upon their Basic or Volunteer status.

:wink:

[dallasdame]

Everyone has to start from somewhere in any profession. Both Basics and Paramdics have good hearts (most of the time) and want whats best for the person they are helping. Usually, becoming an EMT-B is a stepping stone to what will follow in the future, which is mostly becoming a Paramedic. I am currently a RMA, EMT-B, and I'm going to Medic school. I like to be able to incorperate all of my medical knowledge in any job I do. I need the experience on the truck as an EMT-B so that I know what the heck I'm doing in the future. Even if that experience is limited to a few things, it's better than just jumping on the streets as a Medic with no experience at all. Am I ashamed to be a basic because I can't do much of anything??? Heck no. I'm proud I'm doing something honorable that is helping people in need. I personally could not care less if anyone ever said something negative about basics. The truth is I know I'm smart, I know I'm working hard to become someone more educated on how to better help the public, and I know there are people out there that truly appreciate it. I hope my fellow EMT-B's will feel the same. I certainly wouldn't take anything that is said personally.

[Asysin2leads]

Everyone has to start from somewhere in any profession. Both Basics and Paramdics have good hearts (most of the time) and want whats best for the person they are helping.

Not for nothin', as they say across the river, but I find a good knowledge of pathophysiology, pharmacology, anatomy and physiology, psychology, first aid, CPR, airway management, ambulance operations, and assessment skills usually are what's best for a patient. Not that having a good heart isn't a prerequisite, I'm just saying...

[JPINFV]

I hope my fellow EMT-B's will feel the same. I certainly wouldn't take anything that is said personally.

Thank you for that realization. Saying that the system is broken doesn't mean that the people who work under the system are necessarily broken.