emt-i

[95-Henry]

As an experienced EMT-I, the best advice I can give is "Don't listen to the paragods (oops i mean paramedics). You do what you feel is right for you. Don't get me wrong, I respect those that are at the paramedic level as long as they don't let it go to their head and they remember that "it all starts with the basics". I work full time for a paid service as a shift supervisor. I have 2 paramedics who work under me and they are very good people, and very competant at what they do but as an Intermediate I can do every thing they can do except push narcs and I didn't have to spend $10,000.00 on training. Yes I would like to become a paramedic but it is not feasable for me to do it at this time. Good Luck

[EMS49393]

What if I ordered a cheeseburger, and I got a top bun, the cheese, and the meat, with no bottom bun. The bottom bun is the foundation on which the burger is built just as education is the foundation on which a good provider is built. A good paramedic program is the entire burger. The partial program that is most EMT-I programs is the equivalent of the burger without its bottom bun. Hard to eat, and not very appetizing. Food for thought.

Before you EMT-Is beat me up over this, I was once one of you. My education was inadequate for the amount of trust put forth by my medical director. and it was evident when I was questioned about why I did things. My answer was the standard, "the protocol says so." Now I can explain my reasoning behind every treatment I render or withhold. I'm a person that will never see the value of EMT-I. You either go big, or go home. Excuses are for people that don't want to work on figuring out how to accomplish a goal.

[Scaramedic]

My experience with EMT-I's is very limited as only one service I have worked for allowed EMT-Intermediates. However that agency did not pay the Intermediates any more than it did the Basics. Why Not? Because the unit still had to have a Paramedic on board, hence the intermediate was unnecessary in the greater scheme of things. So if you are going to go for an Intermediate level I would check with agencies you are thinking about working for to see if it's worth the time.

95-Henry when you use the phrase "Paragod" on this site your shooting yourself in the foot as far as credibility goes. Just because someone disagrees with a position of yours and is a Medic it does not automatically make them a Paragod. Also if you can do "everything" a Paramedic can do except push drugs, then what good are you? Administration of medications is the cornerstone of ALS, so essentially your a Basic with "skills." Lastly what kind of system allows an Intermediate to be a supervisor over Paramedics? Explain to me how your 180hr course outweighs (in my case) 1800 hours of study at a University level? I can not imagine an Intermediate showing up on scene and second guessing a Paramedic. Sorry but if your system has you supervising Medics, in the words of Dustdevil your system sucks.

[AZCEP]

Guess what, when those paramedics you are supervising need something done on a scene, they will not be asking your opinion about how to do it. They will follow the guidlines they are allowed to, then talk to someone up the medical chain of command. In most cases, you will be eliminated. If it is a company operations issue, you might get consulted. The paramedic on scene is the medical authority until relieved by someone of equal or higher level. You don't qualify.

Sorry. Go back to school and learn all about how this works.

[95-Henry]

Definitely MY BAD for using the term Paragod! I apologize to all I offended. However, I stand by my opinion that EMT-I's are a necessary and valuable asset to any service. Also I am offended by being called a "basic with skills". As far as me being a supervisor over paramedics, our system is not messed up. It goes by seniority, experience, organizational skills and the ability to act under pressure. The paramedics that work "with" me have no problem with it. Unlike some services, we work well together. We all know what needs to be done and we get it done. There is no arguring, long discussions or second guessing! It just gets done and that's what counts. Again I APOLOGIZE TO ALL I OFFENDED!!!!!!!!!!

[JPINFV]

As far as me being a supervisor over paramedics, our system is not messed up. It goes by seniority, experience, organizational skills and the ability to act under pressure.

It is interesting that you did not mention "ability" (and general management or oversight ability has nothing to do with "pressure"), education, or "merit" in your list. Being able to claim you've been something for X amount of years or with a company for Y amount of years does not mean that you can do the job. I'll admit, when my company promoted an EMT to an oversight (BLS company) and the big thing in the announcement was that he was an EMT for 13 years, I laughed. If you've been a basic for 13 years [talking about the guy at my company], hopefully you've had some sort of education that's usurped EMT-B training in terms of importance (AA in management?). It's like saying a RN is in charge of board certified doctors because the RN has been an RN longer then the doc's been board cert'ed.

The paramedics that work "with" me have no problem with it. Unlike some services, we work well together. We all know what needs to be done and we get it done. There is no arguring, long discussions or second guessing! It just gets done and that's what counts.

So, um, what happens with complicated cases or when you and a paramedic disagree with a treatment option? If you think that every case is straight forward that you just go and do things without any "long discussions or second guessing," and if you defer treatment options to the paramedic, then you aren't in charge.

[primemedic01]

Ok, I think we can all agree that the EMT-I is the most unorganized pre hosptial provider level in the United States. With the Basic, there is basically one curriculum throughout the country, that almost every state follows. Same with the medic. Then, with the EMT-I, there are over 300 separate curriculum's that are utilized by all 50 states. The I-85 course is generally the basis of the original pre hospital provider, the paramedic, which was then built upon to what we know as the medic today. Then the Basic, which was created to allow services to hire people that could handle the "basics" of trauma and medical emergencies, and save communities time and money.

As we all know in 1985 the DOT created the middle level, the intermediate, hence I-85, which was the EMT-B with IV therapy and slightly more advanced assessment. No meds, no EKGs, no defib, no ET, etc. In theory this is a 64 hour course. In 1999, with a growing demand for more advanced pre hospital care, the DOT decided to revise this level with the I-99. This went ahead to include 10 Meds, interpreting rhythms, defib, ET tubing etc, with a standard course being approx 400 hours, which was the same course length as the original "paramedic". The problem today, is that there are so many variations of both these I-85 and I-99 curriculum's, that it has become a complete fuster cluck. I believe that the only two states to utilize the complete I-99 are Maine and Colorado. Some don't use any, some use the standard I-85, and like NH, some have courses that use the I-85 as a basis, and have built upon it to include 10 Meds, Rhythms, Defib, ET etc. The NH curriculum is approx 200 hrs plus clinical time. The problem though, with taking it in NH, is that unless you are going to work in NH, you are kind of screwed. In Mass, it is generally the same course, except, you need to have 10 ET tubes in the OR in order to get your license. In NH this is not needed. Which means you need to accomplish this on your on time, which can be extremely difficult to do in Mass with the number of people that are trying to get it done. If you go to Maine, you don't have sufficient training because they utilize the full I-99. There is also a reason that makes it difficult to use NH training in VT, but I can't recall exactly what it is off the top of my head, so I'm not even going to try.

So basically the EMT-I has become the bastard child of EMS. It definitely depends on where you live and where you work as to whether or not it is even worth it for you to waste your time. It is definitely a waste of time in Mass because there is such a high concentration of medics, that finding a job is damn near impossible. In NH it makes a little more sense because the job opportunities are definitely there. I still agree with most though in saying that you should go big or go home. And I'm saying this even while I am right now in an EMT-I class. I am taking for the fact that, I don't have a very big background in A&P and Pathophysiology, so I'd like to do this, strengthen by basic skills more, and also start the process of learning all I can in advanced medicine. I absolutely plan on starting my education in paramedicine by next fall, and I think I will be able to learn a lot more and a lot easier (not saying that by taking the intermediate I will blow through the medic course, I know this is absolutely not the case), but I definitely have a better understanding for what is being thrown at me than someone who is fresh out of a basic class. And hey, I have the time and money to blow. If you're still with me after that long drawn out rant, thanks for listening.

[JPINFV]

^

Paragraphs. Please use paragraphs.

[primemedic01]

I apologize.

I'll remember that next time.

[JPINFV]

Thank you, it's much easier to read now.