batjka104

Anyway, after thinking about this subject some more, I have to agree that more education will make one a better EMT or medic. Faces of people in my class still flash before my eyes, and most of those people should stay the hell away from human beings in need of help. Granted, almost all of them had college diploma or were college students with all the classes described above. Go figure!

I guess I didn't make myself clear. I definitely agree that education should come before "skills". All I'm saying is that getting an education and not using it is a waste of time and money. What's the point of getting an MD if you are sweeping streets afterwards? Well, I guess I'm repeating myself. I would like to state that all I said above is pertaining to EMT-B's only. Obviously, paramedic scope does not need "expanding". And if you think that the education for the scope is not there, I will concur, as this subject is not my strong point. It's just my position that EMT-B's education and scope should be brought closer to the current paramedic curriculum.

After all, why not set a requirement for anyone entering the field as EMT to have a college diploma? That would get educated people into the field. Will they be better at patient care? Perhaps they will be. But only because college graduates are a better human material than a bum off the street with a GED. That's the only reason. The patients, however, will get the same limited treatment that any housewife can provide with a home first-aid kit. I am all for expanding the EMT course hours and practicals to give more in-depth knowledge. But demanding that a Basic, in its current status, go through a two-year college is a little extreme.

Khanek, You could have said the same thing without trying to insult your opponent. Maybe that's where your education is lacking. Now, to defend my position. You are saying that a person should go through two-year college, take all science and math and whatever courses, and then be able only to perform but a simple procedure. Why would anyone do that? With more education should come more responsibility. Otherwise, it's a wasted knowledge. Like hiring a PhD to clean the lab. Maybe his education will allow him to better communicate to his fellow cleaners and to calculate the best way of running the broom. He would also know all the chemicals he's mopping up from the floor. But it's a complete misuse of resources. The more educated one is, the more his education should be put to use. How about making Basics go through a 4-year college? Will they be any better at splinting a fracture? If we are talking about making EMS a true medical profession, then the need for more education is apparent. But let's make an EMT a MEDICAL PROFESSIONAL, and not an ambulance driver with a 4-year diploma in their pocket.

Education broadens your horizons and in general attracts a better human material to the job. Look at how many places require a college degree when it's not really needed for the job. But in reality for lower-level providers extensive education does not, in my opinion, improve standard of care. Because even with all the education they are still not allowed to perform anything beyond simple procedures. Once the scope is extended, then and only then can we advocate for more education.

I tend to agree with Dusty that volunteer EMS brings about a lesser standard in patient care. However, it will be in place in the foreseeable future until EMT-B requirements are raised. In that case it's going to be extremely difficult for a person with a full-time job to acquire the necessary certification, and they are not going to be able to volunteer. If one day Surgeon General issues a decree that all EMS are to be brought up to a new level, and federal funds are allocated to provide communities with necessary financing, that will be the end of EMT-B's and the volunteers. But US should consider itself lucky compared to some other places like Israel, where I had an opportunity to volunteer. The whole countrywide EMS system there is volunteer-based. And, it gets no funding from the government or municipalities. At the beginning of the Second Lebanon War MADA was $10 million in the hole and considered shutting down. In the whole country!!! In the middle of a war!!! That's what I call stupidity in action. So we in the US are not so bad after all. Anyway, the change to the system should come from above, not from the ranks. The ranks are simply too inert to do anything, and the municipalities are unwilling to take up extra costs of hiring professionals. So, if you want to bring about a real change, lobby your congressmen and other politicians. Just my two cents

Hey, I completely agree that if the medics are available EMT-B's are not needed. Because it's a higher certification level, and paramedics can do everything BLS can do and a LOT, a LOT more. That's totally understood and does not need to be explained. The only reason BLS exists is because medics are not available in volume, especially in smaller communities. Basics are the cheap labor, the illegal immigrants of EMS system. Does the patient care suffer a little? Perhaps. Does it have a profound effect on the patient outcomes? Probably not. Things are going to change with comprehensive health care system that will encompass all aspects of prehospital, as well as hospital, care. When people will be able to make a living (maybe even good living) being an EMT. Like nurses. But this dream reform is not happening any time soon. So, I will continue to volunteer as Basic and provide the limited care that I can. And I will try to further my education in EMS field as time and family allows. Once again, I would like to stress that not teaching Basics medical skills and limiting their scope to simple procedures should give way to expanded classes and expanded scope. Perhaps the intermediate level should be the "Basic". That's all, folks. Yeah, and those sirens, they just make my heart sing! :-)

Thank you very much, Your Highness. You are so extremely polite and kind, I am very impressed! Anyway, maybe my intubation argument was not great. I admit it. When I have more time, I will back it up. Basics in their current state are useful on their own as they take the patients to the hospital in expedient manner while stabilizing them to the best of their training and education, as described by Medical Director. I, however, advocate expanding the education and training of EMT-B's to make them better providers. I think that CE classes should be put in place (or the original course expanded) to allow Basics to perform limited ALS skills that would benefit trauma patients. Medical stuff will still be ALS's domain, as it requires a great amount of education and time. And understanding. As far as hypoglycemia goes, I would hope that a EMT-B can recognize it and treat accordingly. And if the patient is unconscious, be able to intervene with glucagon or D50.

When talking about IV, I mean starting the line so that it can be utilized by appropriate personnel in the ER. If a patient loses a lot of blood, it is difficult to put in the line. Glucagon IM should definitely be an option for EMT-B's. It's easy to administer and has a great effect. D-50 also should not be a problem, given that an EMT can gain IV access. A lot of medical calls are hypoglycemia related, so why wait for an ALS rig to show up to administer? Chest decompression? You have a point there. Maybe in some area it's not as needed. But still, a simple skill that can save a life. And pneumothorax is already explained in the BTLS course in detail. Intubation is needed for unconscious situations. Gaining a definite airway improves survival chances. And combitube is simple enough to install (even though I've never done it). But that's all off-topic. The point is, we started discussing why EMT-B's are needed, and it turned into discussing why they make bad ALS partners. BLS should be able to be dispatched on its own. And with some expanded scope and better learning it should be able to pull its own weight.

We are in agreement in a way. I don't think two years of college are needed to bring EMT-B's to the level you are talking about. That would put a huge strain onto the whole EMS system in the United States. I think that one full college-level semester (4 days a week) would be able to cover a great amount of relevant material. As I understand, you are advocating having better educated people in EMS in general. Not because an Associate Degree is really required for their job, but because it would bring better human material into the profession. To be a good EMT one does not need 2 semesters of physics and English. Anatomy, however, is a must. Current EMT-B certification, of which I am in possession, is good enough for first responder level. And it does help save lives. But to be efficient, as I said, EMT-B's scope of practice should be expanded to at least Combat Life Saver level, and should include the skills listed above (glucose injections, IV saline or Ringers, needle decompression and ETT or Combitube). My 200-hour course was decent, but I wish it had ran longer and required more ER experience.

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?

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.

Well, my EMT course was 200 hours. That's in New York City. And then I also took the 80-hour Israeli MADA course that was a complete bullshit. But the 80-hour course still allowed me volunteer :-) Their 200-hour course also allows you to start IV lines. There's very little theory. Just practice.