A call to arms! EMT-B's defend yourself!

[Dustdevil]

As for the above statement which I quoted, can you quantify this please? What does "just fine" mean, and by operating status quo or "just fine" does that mean we should not improve or strive to do better?

That's one of the biggest problems we face. A combination of ignorance. Ignorance to the fact that things really are bad, and apathy towards ever improving. Everything is "good enough" as it is. It's "working." Working "just fine," according to this guy.

And heaven forbid that anybody ever have to change or improve themselves. We wouldn't want anybody to feel bad about themselves, or have to go back to school. Let's just let everybody think they are an irreplaceably crucial element of the EMS system, even if they're not. In fact, let's just let anybody with a CPR card call themselves a Paramedic, so they all know that they are equally important to the overall system. More "I'm okay, you're okay" psychobabble crap.

Sounds to me like he's worked one place his whole career, because he obviously doesn't have a clue what is going on in the "rest of the country" he presumes to speak for. I hope he is more lucid on a good night's sleep. Otherwise, I am glad I don't live in his district.

[batjka104]

Well, it would be even better if two doctors were manning the ambulance. But it's just no way in hell it's going to happen.

Most small-town EMS's are struggling to keep even BLS ambulances staffed. Let alone having medics around the clock. EMT-B's provide a level of care to people that otherwise would not get any care at all.

Also, in big cities and in the suburbs availability of hospitals in close vicinity to any call actually makes ALS providers not as crucial. That is, as long as BLS can stabilize the patient enough for a 5-minute ambulance ride.

In places with long hospital rides role of a medic becomes more and more important.

So, to summarize, ALS is more important to rural areas, when BLS is sufficient in urban and suburban areas.

As far as the scope goes, IMHO, BLS should be educated and trained to allow them to perform limited ALS procedures. Such as intubations and saline IV's, as well as glucose injections and needle decompressions.

[Dustdevil]

So, to summarize, ALS is more important to rural areas, when BLS is sufficient in urban and suburban areas.

As far as the scope goes, IMHO, BLS should be educated and trained to allow them to perform limited ALS procedures. Such as intubations and saline IV's, as well as glucose injections and needle decompressions.

[Michael]

Thanks, AK, for your thoughtful (as usual) reply about lawsuits. It has gone into the cement-mixer of my contemplations.

[batjka104]

Dust,

Aren't you in favor of educating EMT-B's more? So, there you go! Expand their scope of practice, give them limited ALS skills, make them understand the responsibilities.

What is the problem with that?

[Dustdevil]

Dust,

Aren't you in favor of educating EMT-B's more? So, there you go! Expand their scope of practice, give them limited ALS skills, make them understand the responsibilities.

What is the problem with that?

I suppose it is possible that we are talking about the same thing, but with different terminology.

If your extra education adds up to about two years of college, I'm all with you. That's about what it will take to adequately educate them regarding their new responsibilities. So, now what you have done is expand the curriculum and the scope of practice, right? Guess what. You just eliminated the EMT-B as we currently know it, which is exactly what I advocate.

So yes, I suppose we are in agreement after all.

[Mediclcems]

Ok...after reading all this my head hurts! I see may good points given by people I have great respect for and many that I also do not agree with. I believe the original point was what are basics good for, please correct me if I am wrong.

I have been with LCEMS for five years. I also worked in the ER as a tech for 3 years prior to that. I have seen incompetence on all levels, EMT, RN, MD. No one is perfect.

Many of you think we as basic EMTs are not good for anything. And I must say, many basics are good for nothing. The worth of the person is dependent on that individual person. You can not group all of them together to be judged. Some basics want to learn and strive for education while others are here to be drivers. So for those of us who watch, listen and ask questions, this is for you.......

Basics are not merely drivers but the ones who deliver you and the patient to and from the scene safely in a timely manner.

Basics are the ones who can recognize a trauma alert at 3 in the morning when the paramedic is treating another patient of a multiple victim MVC and get said patient packaged, IV started, and airway secured without direction.

Basics are the ones that recognize a patient in respiratory distress from the doorway and is already pulling the proper equipment out of the bags as the paramedic is doing an assessment.

Basics are the ones who run the 12 lead on the cardiac patient who looks like crap. (We may not always be able to read the 12 lead but we know you need it)

Basics are the ones who know what meds are needed for that patient who decided to code in the back of the unit while the paramedic gets the airway secured.

Basics are the ones who stand with the paramedic in the ER as the nursing staff/ER doc is bitching because there is no IV and the patient just took a dump or they feel the pre hospital treatment was inadequate and assure them it wasn't and they did everything they could for the patient.

So yes, a basic EMT is a basic EMT. What that person chooses to learn is what makes them a good EMT-B. Not all of us are just out there to be drivers and that is all they will be if they choose not to take advantage of the resources available for education.

All of the things I mentioned above were not taught in a EMT-B course. Those are things learned from experience and self education. If you as paramedics want more from your EMT than just a driver, help motivate them to get the education and learn from you. You are the greatest resource for your partner. However, if you do nothing but belittle your partner and treat them like dog crap on your shoe, you will never have anything but a driver and a reputation as an asshole.

LET THE FLOGGING BEGIN!!!!! Just be gentle Dust.

[whit72]

Batjka wrote"

Such as intubations and saline IV's, as well as glucose injections and needle decompressions.

Why in the world would you allow a BLS provider to perform a skill that is practised in the field about as many times as Dust agrees with me on a subject.

As far as ETI, that is even being questioned at the ALS level, if there isn't enough tubes to go around for the ALS providers what makes you think when the basic has to performed he will be successful?

Come on I am advocate for BLS providers in the field however, you cant be serious about these two procedures. The facts of the matter is we are having a hard time proving the that pre-hospital ALS interventions are beneficial to the patient, in certain circumstances. Why would we broaden the scope of practise for the EMT when we cant prove that interventions the ALS provider is practising are beneficial.

As far as Dust I love you too. I bet you got beat up a lot when you were growing up

I don't question the essential need for ALS providers in the field, never have. To assume one is needed on every truck is sticking your head in the sand. I see how an educated competent medic can improve a pts condition in a certain situation drastically. I have also been witness to the competency of the EMT being able to handle the majority of EMS calls successfully. See the difference, I comment on things I have witnessed or have experienced. I don't make sweeping generalizations about a whole level of provider on the actions of a few.

To state I don't have the tools, education,experience, or ability to determine if a pt. requires a intervention I cant provide is bullshit. I understand the capabilities and limitation of my profession. Assessment isn't one of them. I am sorry you haven't had the benefit of working with any competent EMTs. I have also had the pleasure of working with some highly incompetent medics. Good thing for you I don't I don't assign guilt by association. I am sure Dust is a very competent provider, I don't question your capabilities. I don't feel compelled to, I don't judge you or ridicule you. I truly don't care what you opinion of me is, one way or another. I would however enjoy the pleasure of working with you some time. I will reserve my opinions of you till then. See I believe nothing of what I hear and only half of what I see. So although you talk a good game. I am not so sure you could get your self out of a paper bag without assistance until I witness it with my own two eyes. EMS has made me skeptical, so my apologies, I will withhold my opinions of your competency and abilities.

As far as the post, I am sorry I go off topic. When 75% to 80% of all EMS calls are BLS. I think the paramedics should be justifying their role in EMS. Not the other way around. . I can handle 7 out of 10 calls on my own. I think my existence is justified.

I do believe the EMT needs more education. A&P, chemistry, biology, psychology amongst others. Two semesters would be sufficient, ER rotations and ride time. I had pre-reqs to apply to my EMT class. Why shouldn't they now? We are not educating doctors here, we are educating pre-hospital providers. Recognition is our most important trait. Not how many meds I can push, or tubes I can put in you.

[vs-eh?]

Once again, vs-eh, you disappoint me. I have seen you bring legitimate points to a conversation, and I have seen you provide quality input to discussions, but those tend to be few and far between.

You purposely comment in an argumentative manner. As I don't live in Ontario, I looked up the Ontario PCP guidelines. A quote directly from the Ontario Paramedic Association website ( http://www.ontarioparamedic.ca/faqs.html) indicates: "The Primary Care Paramedic (PCP) is a graduate of a Ministry of Health approved college Paramedic Program, has obtained A-EMCA certification, and is employed in an emergency medical service. The function of a PCP is to provide emergency patient care, cardiopulmonary resuscitation (CPR), patient immobilization, oxygen therapy, basic trauma life support, blood glucose testing, and non-emergency patient care and transportation. "

That appears to sound very similar to EMT-B... but, I will research further.......

Any level of EMS provider, at least superficially, will appear similar. This is especially true to the skills driven, "I can do this and you can't, ergo I must be better/more educated" EMS provider.

That program that a PCP has to graduate from is a highly competitive 2 year college program (within the last 7 or so years). That A-EMCA exam is a 6 hour provincial exam. Both of those (generally) are needed prior to employment. Employment itself is also very competitive, and certainly no easy walk. EMT-B programs seem to range from 120 to 200 hours. Ambulance practicum hours ALONE in most programs in Ontario are double to triple that time.

If all a BLS provider (PCP) needs is the education that EMT-B's get, then why doesn't Ontario simply only require that? Why is EMT-B training useless in Ontario and basically throughout the rest of Canada? Why did Ontario move from a 1 year to 2 year program 7'ish years ago?

I don't know what type of education Alberta requires for their EMT-A/PCP, but I assume it is 6 months to 1 year. Would you be ok with allowing people who picked up their EMT-B to simply challenge your process and be PCP's in Alberta? Would you want a provider that is heralded for being able to put on a cardiac monitor or say "Hey, that box is purple" as some type of star of BLS EMS? If you think all of this is ok, then well....

I still can't believe that people argue this and say that EMT-B sounds pretty similar to PCP, hey they are both BLS, etc...It's not the same. The list for what makes a good PCP would not include what people have mentioned and would likely include being able to discuss treatment options, patho, drug interactions, etc... THAT IS A GOOD BLS PARTNER, not setting up a bag....

Come on...

[James_ffemt]

Ok, so here goes..... First of all I do think that EMT-B's are important and so are the EMT-P's. There are many different settings that bot can be utilized in and I think it depends on where you live and what you have to work with. EMT's (basics) are a vital part in the system I work in. Yes we are ambulance drivers and taxi attendants but when it comes down to it we do our job that we are hired for. When I am working I am working with a EMT-P but sometimes there are just two basics on board. When working with a EMT-P I am responsible for vitals, bleeding control, BVM, O2, hooking up leads, etc. I was told a long time ago that when working with someone that has more knowledge than you that you should always try to think ahead and be ready if they ask you for something. I think this should be the same for the EMT-B working with a paramedic. Know what they are going to do next before they do. Working well together is the key to all of this. Having knowledge of the situations we encounter on a day to day basis is good. I have worked with some basics that will load the pt. and go get in the driver's seat until time to head for the ER. Those guys don't need to be working. I enjoy the hell out of my job as and EMT-B. I try to learn as much as so that I can give the best pt. care I can. I feel as long as I do my job within the scope of practice as an EMT-B I take a load off the paramedic I am working with. And, I feel that if I stay a step ahead of him/her that I make things go smoother in the back of the truck.

Now, working two basics on the same truck....When you get an ALS call I think all of us have had the pucker factor. But, you just have to do what you can and get the pt. to the ER as soon as possible. In our area we are often short paramedics and can only have two basics. That's rural America for you. The two basics do the best they can and use their training and experience. Now, for those of you that are thinking it...they are not two green basics thrown on a truck with each other. We have 3 or 4 basics with 20+ years experience and many with 5+ years. So we don't have newbies on the truck caring for pt's.

In the perfect world we would all become EMT-P's and all trucks would have at least two per truck. Ok, so we don't have a perfect world. The basics that are in it to make a difference in someone's life are a vital part of the EMS system and their Paramedic partner. The one's that are in it just because need to get out. I encourage all basics to stay current on all their skills and know what their partner expects when working an ALS call.