What should the Basic-Medic Partnership look like?

[NREMT-Basic]

It is with fear and trepidation that I start this new topic which I know has been covered in other threads as well as in passing in threads about other topics, but I think its important enough to risk putting my neck on the chopping block. I will do my absolute best to be assertive and constructive and hope that others will do the same.

When I began my coursework toward EMT-B certification in January of 2006, I was blissfully ignorant of the differences in scope of practice and level of responsibility between basics and medics. I am glad to say that this confusion on my part was rapidly cleared up within the first few weeks. However, I had to good fortune to be taught by a Medic who had been at it long enough to have a 1 digit Medics license number in the State of Illinois. He demonstrated to us the differences between what basics and medics do. But we also were trained to perform the interventions that fall within our scope of practice as Basics. The scope of Paramedics was very rarely mentioned. One reason for this is that in Illinois, as I am sure in many other areas as well, the law requires that an ambulance be crewed by an EMT who had achieved the level of Basic. So we do have quite a few BLS only services in our state. We do however also have a good number of services that use crews that are ALS/BLS combinations, in large part to eliminate the need for an ALS intercept since the medic is already on board.

What we were not taught to expect, however, was the sort of unspoken code that seems to exist which places the Medic in the role of Master and Commander of each crew and relegates the Basic to the role of driving, taking vitals, cleaning and restocking. We were taught that basics have a scope of practice for a reason and that it is to be used either on a stand alone basis or in conjunction with and ALS/Medic crew partner. Over time I have found a distressing trend in which many medics seem to hold the attitude that a basic should be seen and not heard, carry the jump kit and only do what he is told by the medic, eliminating the process of the basic utililizing his skill set to achieve the absolute best possible response outcome.

Here is where I wish to be especially careful in this discussion. When I was in EMT training, I had the good fortune to work with medics who observed me, knew what I was able to do, trusted me to know what I was supposed to do and capable of doing and we were able to just work together in a flow of each crew member working together toward the best possible outcome of the patients emergency. I was not required to ask before gaining a set of vitals, nor did I have to ask when i chose to repeat them en route. I didn't have to ask before beginning my assessment of a patient, but rather to gather information and pass it along to the medic who is admittedly saddled with the more complex tasks and has a great deal more training and experience. I didn't have to ask if I should administer oxygen, give ASA, assist with nitro because these were parts of my basic protocol and the medics with whom i worked trusted that I have learned what I was supposed to learn and would not do anything to harm the patient or impede more complex, difficult and consuming interventions.

It was honestly not until I joined the City, that I began to experience the sentiment that basics are drivers and should shut up, take orders from the medic, never question anything (i was taught by my medic instructor that if you truly have a concern about the medics course of treatment, that you had a duty to question it within the scope of your knowledge) and treat the Medic with an almost reverent awe. When I began coming into this forum, I started experiencing something that made. I have experienced a number of medics who call into question the value of the basics skills by indicating that they would either chew out or report the basic for raising a concern or acting autonomously. I was taught that a basic does what he does so that the medic need not worry about it. but for that to happen, the medic must hold in mind that the basic has a degree of training (for me 176 classroom hours and 50 clinical) and once that basic has proven him/herself, he should be allowed to function in the capacity for which he is trained. Of course, this brings up the point about the level of education and training and experience of the basic, but the same can be said of the medic partner. It wasn't until I got to this forum that I started hearing medics say things like "MY ambulance, MY patient, MY treatment." In my field training, the entire situation was a matter of the basic and the medic working together, side by side, complimenting each others skills for the good of the patient. It was not until I got hear that I heard that a basic shouldn't question the medic about ANYTHING, and if so not while on scene. Again I was trained that if something being done by the medic really concerned you, that you were allowed to ask him as your PARTNER if he wanted to do this or that,or could something else work. Its not a matter, as I have seen so many medics indicate in these forums, that the basic is trying to undermine the medic in anyway. Like the medic, the Basic is only concerned with what will produce the best outcome for the patient. During my clinicals, I also established enough of a trusting working relationship with my medic partners that they didn't feel they needed to question me regularly either and when they did it was more like a pop quiz than what the hell do you think your doing. I did my clinicals with the largest of the 4 private services in my city. Sometimes I would be a third person in the rig, and on a couple of occassions, even functioned as the defacto emt on a rig because the service was short staffed that day.

What I am trying to say is that Basics are trained and to be sure, there are good ones and bad ones. Speaking for myself, I feel well trained and educated because I worked very hard to get that way and that work earned me the respect of the medics who were working as my preceptors. During training I would frequently make the enroute report to the hospital because the medics felt comfortable enough with me managing a BLS patient, that I would be in the box and the Medic would drive.

All of this is really a long way of saying that I would like to hear from as many folks as possible what they think the ideal Basic-Medic relationship should look and function like? Do certain medics actually want their Basic partner to bow and scrape to them. I ask this because I have seen it, or rather read about it a great deal since coming here. I look forward to any and all input from basics and medics and hope that they will be constructive in nature and not of the "if the basic upsets me I am going to throw him out the back of the rig" variety.

I cant wait to see what you all have to say.

[NREMT-Basic]

The fact that the poll options list the affirmative in both caps and lower case and the negative in only caps was mistake in typing and I am not sure how to access this to edit it. Sorry about that and if anyone wants to tell me how to edit it, I would be most greatful.

[Just Plain Ruff]

to me we are a team.

The medic is ultimately responsible for everything that happens to that patient so this might be where you have gotten the feeling that emt's should be seen and not heard but I believe that in order to run an efficient crew that you need to be partners.

I have never treated my emt's as fodder and gophers. We've always sat down on our first day and got to know each other.

I explain my expectations and they explain theirs.

It is a two way street.

Would I prefer dual medic trucks, sure if your service can afford to run dual medics but many many services cannot.

There have been times where I've hated my emt partner and vice versa but in the end I've been pleased.

Medics who have the attitude that Emt's should be seen and not heard have too big an ego for my book. Not that I don't like those people with that opinion it just isnt my opinion and they are entitled to their opinions just as I am entitled to mine.

In closing, you are a team, be it dual medics, medic and emt or dual emt's. If you can get along then fine, if your work relationship is strained then it's time to find a new partner.

It's like neighbors - you can't choose your neighbors but you can choose your work partners(sometimes. )

This is a great subject. Let's please keep it civil.

[Just Plain Ruff]

oops I misread the poll question. My answer is NO they should not have to run everything by the medic. but they do need to tell the medic what they did and if needed, WHY they did what they did.

[NREMT-Basic]

Ruff, thanks for being among the first to stick your toe in this water. Its been a sticky wicket in ems for a very long time. Thank you for your civil and considered opinion and I look forward to hearing more.

[AZCEP]

I've been on many scenes that required I not supervise everything my EMT partner was doing. Often they will be a bit more nervous when we arrive, and I've made sure to tell them, "Do what you need to, tell me about it later." If the EMT doesn't know what to do, then definitely ask. If they are unsure, they should not feel that they will be discredited or flogged publicly. Ask the question.

There was a time, that I probably was a bit more hesitant to follow that advice. I'm sure some of my partners would be willing to tell you that I micro-managed them to an early retirement. At this point in my career, let's just get the task(s) at hand done, and move on.

[Ridryder 911]

Okay, I have seen some insults on Basic levels, even maybe from myself but never specific more of the need of repair of standards of education and training. The competency level, how and what is trained is horrible.

As well, most of the post I have seen was mainly directed of not so much not allowing Basics to perform at their job or function level more of being competent in those functions and role. No, they should never have to ask to perform within their role & function as long as it does not interfere with current treatment. This is there job and function .. then do it.

Now, part of the problem is EMT's and EMS personnel do not have a real "scope of practice".. ( remember this was shot down....uhumm cough by volunteers and basics).

Each system is unique.. yes there are some that treat basic EMT's as drivers and actually that is what they prefer to be.. I have seen many that is all they ever wanted to do & have no desire in patient treatment at all. The same as in ER that I have sen physicians that would not allow an RN to establish an IV until after they have examined the patient. So there is usually no real written rules.. it is all dependent upon the Captain of the Ship. Even if there is protocols, orders , etc..

Yes, it sucks.. but that is life ..roll with punches and either form committees, complaints, to either change it or accept it.

[NREMT-Basic]

Youre right about scope of practice. I should have used "protocols" or the every popular "algorhytms". And i will admit that though I got an excellant education as a Basic, have well developed skills and am only lacking in experience having only had my license for a little less than a year. I feel fully confident acting within my Basics protocols in any situation and have no qualms with "taking orders" from my medic partner. And I also know that there are times to step and and assist your partner without asking and times to hold back and see if they need you. I have no delusions that I have the knowledge, education, training or experience that my medic partner would have. That being said, I am trained to a certain level of pre-hospital emergency medicine and am not going to just play the driver. Certain states have EMT-A ambulance atttendants. Illinois isnt one of them. Actually we used to but we did away with it about 20 years ago. I have something to bring to the table and one thing that I have found helps bond with the medic partners I have had so far is that when I am taking vitals, do assessments, talking to the patient, which I tend to do for a variety of reasons while the Medic is getting us a line established, I write them down in a pt care notebook and before I crawl into the front seat to drive, I had the medic my notebook to ease his/her communication with our receiving facility so that he can make his call in quickly and get back to his patient. Sometimes if we are on scene for more than 10 minutes or so and I have done all the things that I need to do at the moment, I will let the medic know i am going to contact the hospital and then get us moving. This way he has the choice to either say no, lets wait, or tell me that he will call the hospital or tell me to go ahead and make my 30 second report and then get us underway.

I must agree with you, that the level of training of many basics is awful. However, I dont fall into that category because I educated myself. My instructor would give little bits of information, get procedures or symptoms wrong, etc and I spent alot of time studying to make sure that even though the EMT training program in this medical system was complete crap, that when I got out I was ready to go. Unfortunately, we have alot of emts now that are just out of high school and dont study, dont go over notes, dont ask the important questions, dont repeat practical interventions over and over and over again until they are second nature. My first time out i was the third one on the rig and the emt was so bad that halfway through a 12 hours shift, I asked to be given to a different crew. We arent all bad, but the ones that are REALLY are.

[NREMT-Basic]

Hey Kids-

The number of posters doest match up with the stastics from the polls....a little while ago it was just about even. If youre gonna vote in the poll, please post and let us know why you believe what you believe.

[Ridryder 911]

.

..........."because I educated myself. My instructor would give little bits of information, get procedures or symptoms wrong, etc and I spent a lot of time studying to make sure that even though the EMT training program in this medical system was complete crap, that when I got out I was ready to go". ......."Unfortunately, we have a lot of emts now that are just out of high school and dont study, dont go over notes, dont ask the important questions, dont repeat practical interventions over and over and over again until they are second nature."......

You see you answered it yourself. Not, all Basics are created equally. Personally, within the past ten years + one or two, since the revision of the Basic curriculum, the mindset, the poor knowledge that the majority receives cannot be assumed as being responsible, and having adequate knowledge from most or all Basic EMT's. Yes, it is a shame.. but Medic's have became a "mother hen" figure protecting their patient, themselves. I have heard many say .." I much rather do it myself, then have to depend on someone else to do it, or screw it up".... although not a good attitude I agree, but rather the product of being burned multiple times, it is much easier to live with having a "Paragod attitude" than being in the hot seat.

So it will be dependent on the medic the good experiences, trust, and hopefully they will not as well have a grandeur attitude...

Good luck,

R/r 911