medic001918

Depends on the hospital as to weather they will accept our labs drawn in the field. Not all hospitals do so for whatever reasons they may have. If a hospital will accept them, I'll draw them. Shane NREMT-P

With more theories coming out that support permissive hypotension, I have placed saline locks in trauma patients. But, this is usually only a secondary point of access after they have a bag of fluid already in place. If the receiving hospital will not accept labs from the field, having a well placed lock can help the hospital to pull labs quickly. It has seemed to have worked well for me so far and the hospital usually appreciates it. Shane NREMT-P

Would I like to see more education? And a longer curriculum? Yes, I would. But like Dust said, this is the best we've got and it's the system in place. So if you're questioning if as a paramedic I'm educated enough to perform the procedures and administer medications, then how could you begin to think an Intermediate would be qualified to do so? I'm all for making the paramedic program a bachelor's level program. I see no drawbacks to the concept, and only positives. The paramedic program that I completed was an associate degree level program, which is better than some of the certificate programs that exist. Shane NREMT-P

As a basic, I did yearn to be on the cutting edge reserved for the higher level of care. Guess what? I did something about it. I enrolled in a paramedic program, studied non-stop and became a paramedic. My desire to be on that edge was fulfilled w/o taking any shortcuts. It's the proper education thing. As far as the "Paramedic save lives, EMTs save paramedics" statement, that was recently picked apart here. Do we need to go through that again? I think it was pretty well shattered last time it came up. While you're right that I'd rather have two competent basics instead of a lazy medic, a paramedic is still the higher level of care with more training and education to draw from in the decision making process. They SHOULD be making better decisions and intervening more than a basic can and does. Shane NREMT-P

+1. The majority of EMT-I (in my area) are of short duration and insufficient to allow these procedures. As far as what your class involved to allow you to push narcan, I'm confident that it's nowhere near what the average paramedic goes through in order to be allowed to perform these interventions. So if you want the interventions, go obtain all of the proper knowledge behind them. It's part of the paramedic skill set, go to paramedic school and you can give narcan all you want. Otherwise, I still don't feel that it's an intermediate medication. Others seem to agree with me. And as usual, noone has explained any medical reason why an intermediate would be giving it and how it benefits the patient? However, many people have explained the rationale of why intermediates should not be giving the medication. So if your class was so thorough, you should be able to explain how the drug works, potential side effects (and management of the side effects) and when and why to give it. Please include some A&P in your explanation of the how's and why's. This is all part of standard paramedic level education, for a paramedic level drug. Noone here is against people learning or saying that they can't learn. They can in fact learn. It's just the means in which they go about obtaining the education. A shortcut class does not make up for a thorough education based on a solid foundation. This foundation doesn't appear to be taught in the EMT-B course, and only lightly touched upon in the Intermediate course. To obtain a broader scope of practice, obtain a broader general knowledge of medicine through the proper education. Want to play with paramedic level medications and interventions, go to paramedic school to adequately prepare yourself for the practice. Shane NREMT-P

You're kidding, right? A medical directer putting on a a quick training course and allowing someone to give narcan doesn't sufficiently cover anatomy & physiology as well as pharamacology. There's a reason why anatomy & physiology is multiple semesters with a class dedicated to it. Understanding A&P is where you begin to understand pharmacology. So how many hours do you think is appropriate to add in order to administer narcan? A one day, 8 hour course? Think you'll be able to cover it all there? It's not just when to administer the medication, indications and contraindicatinos. It's the potential for side effects and the management of the patient experiencing them. If you want the added interventions, go obtain the appropriate education. An EMT-I course and/or a one day course to "add" the medication is not enough to be safe with it in my opinion, and that of many other experienced providers. A medical director can provide a quick training, true education takes time. As far as your d-stick comment, I can honestly say that's never happened to me. In an attempt to be rather thorough, nearly every patient gets one done. As far as what gives us "the right to talk about intermediate actions?" That's easy, we're higher educated and have a larger understanding of the big picture. Since we have the education behind us to practice at your level and beyond, we have a solid grasp of our opinions and can explain why we feel that way (reread the thread, there's no need to explain it once again). Paramedics don't have certain procudures because we don't have the education behind us to perform them safely. That's just the way it goes. If we want those additional procedures, take your education to a higher level and obtain the education and licensing to perform them. Don't try to dumb down one aspect of medicine in order to add an intervention that has the potential for great harm when performed on a lower level. A large part of being a paramedic is understanding what could happen, and having the ability to manage it if it does. An intermediate does neither in the case of narcan administration. Shane NREMT-P

Inflate our egos? I don't see any medics here asking for more skills than what they have. Especially out of this thread. In fact, I've seen medics explain repeatedly and clearly why we don't feel that EMT-I's should be giving medications. What I have not seen yet, and doubt I will see, is a logical explanation of why an EMT-I would need to give narcan (or other meds)? The only rationale so far is that it might save a medic a few seconds. That reasoning is hardly worth while in my opinion. I also tend to be of the opinion that if someone's giving a medication on my scene, I want them to have the same level of care (and responsibility) that I carry. I'm not going to explain why some EMT or EMT-I screwed up a medication dose based on my order. I'd rather draw up and give the medication. If there's a problem, it falls on me and noone else. There's very few calls (if any) that I can recall being on that I would have found it greatly beneficial to have someone else handing me medications already drawn up. So the question remains, explain why an EMT-I should be giving Narcan or other medications? And my additional question is where did this topic turn into a discussion of paramedic ego? If being able to explain logically why you feel the way you do about something is having an ego, then I'm happy to have mine. My opinion on the matter still stands. Shane NREMT-P

Here we go again. Haven't we discussed the basic level providers giving IV's enough? Do a search and you'll find lots of discussion about this very topic. I'm sure noone's opinion has changed since the last time we discussed it. Shane NREMT-P

Nobody has really given a valid reason as to why the EMT-I would need to give Narcan (or most other meds for that matter). Why is that? Is it maybe because there really is no valid reasoning for it? That's my guess... Shane NREMT-P

+1. If you've covered so much in your I class, I'm curious as to what the rest of the time spent in paramedic school is used for? It's not just practice. On paper, an Intermediate is an ALS provider. However, in practice (in Connecticut) they are vastly different. Please, tell me what your I class required for didactic's and clinicals? I would be shocked if it's even one quarter of the time spent in paramedic school. My questions remains...if you can think like a medic, and the practices are so similar then why bother going to paramedic school? You're already practicing the medicine. What incentive is there? And more specifically, what is gained? I'm not trying to pick a fight either. I just want to know. As I've mentioned, I spent more time sitting in A&P then the length of the full I course in Connecticut. How is it that an intermediate can come out with the same depth of knowledge and understanding in less than the time spent studying A&P alone? Shane NREMT-P

+1. Here we go yet again. My question is why does it seem like many EMT-I providers feel the need to compare the I class to the paramedic class? As well as comparing the two scopes of practice. There are many significant differences in the two levels of care, due mainly to the level of education involved and the knowledge of the theory. The EMT-I class here is about 140 hours, how is it that it can be compared in terms of class content to a paramedic program with over 1200 hours of instruction and clinical time? The answer is that it can't be. An intermediate is taught more of the skills and not enough of the theory (other than general overview). Most medics do and should go into greater depth on the A&P level. An understanding of A&P is the basis for good assessment and proper treatment of patients. We spent greater than 120 hours covering A&P alone in paramedic school. This lack of education is the largest reason why the limits are set in terms of what you can and cannot do. This is true at any level. An EMT is limited by education, just an EMT-I is, and just like a paramedic is. This theory contiues right up the chain with any healthcare provider. Education is the largest limiting factor. If EMT-I class was "about the same" as paramedic school, why do something over 1-2 years that can be done in a few months? You do it to have the larger understanding and the ability to provide a higher level of care competently. I still feel that many services using EMT-I's as advanced level providers are taking a shortcut method to save money. I'm done ranting. Shane NREMT-P

There's no connection I can think of between being on a blood thinner and high flow O2. If the patient is a stabbing victim that has abdominal and/or thoracic trauma along with a decreased pulse oximetry reading then they are going to get high flow O2. More importantly, it would be a good time to listen to lung sounds and start looking for the cause of the decreased reading. It could be anything from hypovolemia, shock, dirty/bloody fingers, aspiration (due to the facial trauma) pneumo, respiratory insufficency, etc. It doesn't sound like you did anything wrong. If there is a connection between being on a thinner and high flow O2, I'd love to hear it. Shane NREMT-P

So someone who writes a clear, concise post promoting that education would help to further our field is being a "fucking ass-hole?" I'm a little confused here. While dust is often abrasive, he's passionate about his view points. And more often than not can certainly back them up with solid theory. You have to respect that in someone. He's not just saying that education is the answer, he's saying that and then explaining why. If you disagree with it, feel free to post your viewpoints for debate. And don't forget to back them up with some theory. It goes a long way. Shane NREMT-P PS-A personal attack on someone really does nothing for you. Your post was quite a contribution to this thread. Not sure what we would have done without it. If you have a different point of view, let's hear it.

Here's some advice for the test. Study the skill sheets and practice until you feel comfortable with them. Study the book until you know it very well. If you do both of those things, the test should be rather easy. If you're a poor test taker, there isn't much that anyone here is going to be able to tell you that will help. Provided he was in a good class with a good instructor and put enough time and effort in, the test should come naturally. Now that the advice is done with. I agree with others that there are too many different levels of providers allowed to do too many different procedures. There doesn't seem to be enough knowledge behind many of these programs to do this effectively. I like Rid's idea of limiting it to one or two providers. That would simply things and help to provide a standard of care across the board. Unfortunately, too many areas are going to say they can't afford that level of care or that it's too time demanding for people to do. But that's already been addressed more times than we would all care to remember. I see this "enhanced" EMT as a way of getting closer to ALS care w/o paying for it. The problem is that it's just enough information to be dangerous. Not so much to the provider, but the patient that you're ultimately treating. I wouldn't want someone who took only part of the training deciding what medication I need in order to fix my emergency. I want someone that has the benefit of a full training program behind them. There's a reason why paramedic schools are as long as they are. And also a reason why many have a high dropout rate. It's not the material itself, it's the amount of material you have to learn and understand in a short amount of time. For those who want to perform advanced procedures and skill sets, there is a way to do it. It's called paramedic school. Don't take a shortcut. A good paramedic program (do your research before signing up) will provider you with the capability to perform at an ENTRY-LEVEL paramedic position. This will provide you with the knowledge, practice and skill set to be an adequate provider. There's no need to step through EMT-B, enhanced, I and paramedic. Especially since everything you cover in most of those classes will be repeated in greater depth in paramedic school. You're not learning something that won't be covered. Go to paramedic school, study hard and ask questions. Then after all the testing is done, you'll have a learners permit to go out and start practicing as a paramedic. There's always something left to learn and a test means you've met a minimum standard. Reach above and beyond that standard to provide the best care possible for your patients w/o taking shortcuts. Shane NREMT-P

I realize you said nothing about reading EKG's as a basic. In fact, you said that you would not be doing so. I asked the question of if you're not able to read it, why are you doing it? nsmedic393 actually provided a good answer. And if your system will have the capability to transmit EKG's, I'm all for it. Otherwise, in my opinion you open up the door for people to try to interpret and base decisions off of what they see with not enough education. Shane NREMT-P

+1. A great post. Education really is the answer to furthering out profession and the key to solid clinical decision making. Shane NREMT-P

In a case where they are sending the EKG to the receiving facility it would change my feelings. Here we don't send our EKG's though. We are responsible for interpreting them. We can notify the hospital via radio of anything that we see coming in. Under this system, it would open up too much room for interpretation of treatment where the provider doesn't have enough education to make appropriate decisions. Like you said, I'm not against basics having more skills. But before that can happen, they need more education. Shane NREMT-P

You're right on as far as the scope of practice confusion. It happened here on multiple occassions. They would put the patient on the monitor and not see anything so they would either not call or cancel the medic. If this were to be allowed, the protocol should probably state that if you're going to put the patient on any kind of cardiac monitor, ALS is to be requested or not cancelled. This would aid to avoid that issue altogether. Shane NREMT-P

A good point rid about having assistants. My concern, and maybe it's jus because it has already happened here, is that people will try to "read" the EKG and make a decision based on what they see on it with minimal training. At least in hospital, they have the doc there to run the EKG right over to. I don't have a problem with it, as long as they are not making decisions based on it. Shane NREMT-P

I have to agree with your partner. If an EMT-B is going to perform a 12-lead but not be able to read it, what's the point? This also opens the door for an EMT-B to make a decision based on what they percieve from a 12-lead. This happened here in Connecticut and they found that BLS providers would obtain an EKG and rule out the need for an ALS intercept based on what they saw. If a basic can't read it, it probably shouldn't be done by them. It doesn't take that long for a paramedic to obtain a 12-lead. Shane NREMT-P

First of all, AMEN to rid. As usual a well informed and thought out post. Very well done. Now, on to this comment. Basic's do have a place in the prehospital system. I work with a rather competent basic and he is a valuable asset to the truck. But to ask if a medic remember's the ABC's is kind of off topic. As a medic, ABC's should be at the top of the list. This isn't something that a medic should have to look at their basic partner to do. It should be done by both providers and without hesitation. As an ALS provider, it is BLS before ALS. But there comes a point when BLS isn't enough to get the job done. As a paramedic one can move on provide the extended care and advanced procedures required. I never belittle my partner and I'm the first to admit that he is very helpful to getting the job done. But a basic has their limits. Just as a paramedic does. That's why we transport patients to the hospital, so that they can reach the next teir when we've reached our limits. The hospital staff can do more than we can. It's all about knowing your limits and doing the best that you can within them. And the current BLS curriculum is extremely limited providing minimal (at best) interventions that can be performed for a patient. Shane NREMT-P

+1. The tone that someone uses to say something is citical. I don't mind someone calling someting to my attention, or discussing ideas. But I don't care that much for EMT's telling me what I need to do. This happened to me last week on a call, and unfortunately for the crew that was there they didn't know what they were talking about. This is the exception rather than the rule since most crews are competent. Use the proper tone and make suggestions. Shane NREMT-P

Unfortunatly, the job does cause much stress in relationships. It's the nature of the job I suppose. Look at divorce rates for similar jobs...police officers and firefighters. It takes a different kind of person to deal with all of this. The overtime is also part of the job. Unfortunately, we can't predict our workday. We don't know when someone is going to call 911 and when we're going to be the closest to the call. If people could preschedule their emergencies, the job itself would be much less stressful. But once again, that just isn't life. As for the joking, that's a common part of EMS. It's a way of dealing with things. Most of our encounters with people on the job are not when they're having a good day. We often see people having what may be the worst day of their life. So we learn not to take it to heart, and jokes are a way of coping. It doesn't make it right, or easy to understand. However if you ask many people involved, they will tell that it is part of the job. I understand that she's your wife, and not their girlfriends...but close relationships are forged when you're thrown into the situation of working that closely with someone. By relationship, that doesn't mean romantic, a friendship is still a form of a relationship. You learn to become very close friends. You talk about just about everything. And you might even make jokes towards one another. It doesn't mean anything is going on. Until you see something developing, I wouldn't be too concerned. My best advice is to keep your relationship healthy and strong. Show her that you support her. Cherish your time together. Go out and do things to make sure your relationship is in the right place. As long as it is, I doubt your wife is going to wander away from you. You shouldn't feel like you're competing with anyone at this point in your life. Communicate with your wife. Share your concerns with her and have an open conversation about it. Learn some more about the nature of the job and understand what it entails. It's certainly not a normal nine to five. Communication and trust are they keys. Understanding is a close third to those qualities. Shane NREMT-P