Basic vs. Medic

[akroeze]

[AZCEP]

Whoa there akroeze.

I've never bought into the "EMT saves..." argument.

Eliminating the EMT has already been done for us. With all of the add-on skills that seem to be so important to so many, there are very few truly BLS providers anymore anyway. Now we just need to make it official. Use the 120 or so hours as an introduction to prehospital patient care, force these people to use it as a prerequisite in a degree pathway, and move them into a level of provider that can actually be useful.

[triemal04]

Just my 2 cents, so bear with me. Can it be beneficial to work as a basic before becoming a paramedic? Sometimes. Can it be detrimental? Sometimes. Should it be required to be a basic for X number of months before starting medic school? Maybe sometimes. Should that happen always? No. Confused yet? Good. Welcome to the wonderful world of EMS education in America.

The "skills" and so-called education that an EMT-Basic recieves is lacking and extremely minimal. I think pretty much everyone can agree on this, as well as agree that everything that a basic is taught in class is covered again in paramedic school in much greater detail, and during the internship those skills will actually be performed. So if that's the case, why should someone have to be a basic before a medic? Short answer, they shouldn't. There is no special knowledge or training that an EMT-Basic receives that a paramedic doesn't. So scratch that.

The field experience that the average basic get's isn't going to be much better. With the state of EMS today I'm going to go out on a limb and say that the majority of basic's are employed in some form of interfacility transport work; not all, and maybe not a majority, but a very, very large percent. What kind of experience will someone gain doing that for a year or two? None for the most part. So it's pointless to go out and do it. Add in that some people seem to learn to ignore what their patients are saying because "it's just another transfer, so who cares," and if anything it can be harmful for their future. For those lucky enough to work for a 911 ambulance service it can be a bit of a different story, if they're really lucky. They will be able to see what happens in the field versus a classroom and get some introduction to what people look like in various stages of extremis, so that's not bad. But given their lack of education and training, mostly what they'll be doing is watching and driving. Is that bad? Not really, and it can be beneficial. But it shouldn't be a requirement. The caveat to that is if someone is lucky enough to work as part of a 3-person crew (don't laugh, they are out there). The opportunities for more exposure to patient care is there but again, no reason that this should be a requirement.

Going through medic school isn't just class work; the internship and clinicals are a huge part of it and often the most beneficial to people; all the knowledge in the world won't help you if you can't perform an assessment and actually think while doing a skill. And honestly, this is really the only reason that having prior experience as a basic might be beneficial. I know from a lot of the (younger) people that I've seen that many have problems talking to their patients when they first start. Simply talking to them, not figuring out what the problem is (though the lack of communication doesn't help) can be the hardest thing that is done. Learning how to do that, and how to do it in a way that allows you to do your job can take awhile. Throw in learning how to perform your skills/assessment in a less controlled environment, and problems can easily arise. Of course, all it takes to overcome those problems are time and effort on the part of the intern and their preceptor. Which is where the problem comes in, since many internships are very short. If you can remove part of what needs to be learned (how to talk to an very proud 85-year old WW2 vet who can't stand snot-nosed little pukes like you without pissing him off more) then the rest will come much more easily. So in this case, having some prior experience as a basic (assuming that you did have to talk with a patient) can definitely help and make things easier.

Of course, extending the length of the field internship would be a much better way to solve that problem, but for some reason I just don't see that happening. I guess for me the bottom line is different for everyone. If your internship only runs 200 odd hours and you're an introvert who hates to talk to strangers...you need to learn how somehow, and preferably do it before your internship. If you can speak comfortably with anyone...not so much. Same goes if your internship lasts for months and months and months and months and months...but unfortunately not many do. The answer to this will really vary from person to person AND program to program; and that is how it'll stay until there is a set standard from EMS education in the US that is way above what it is today.

Anyway, enough rambling for now. Cheers.

[ccmedoc]

Same old same old..... =; ](*,)

[speedygodzilla]

I find myself asking why we can't just get along?

I believe I have said this before, but of course it comes down to money. However I believe the right medic and EMT-B can make a great team and partners just as a doctor and a nurse, Nurse and CNA, Nurse and RT, cashier and sacker. It isn't called a team for nothing. Even when you have two paramedics that crew together I believe that they swap out the calls and one fills the EMT spot and the other as the Paramedic.

In the systems with paramedic only how is the pay and finical condition of the company compare to regular ALS service? Just curious. I would thing that we can't charge the patient more for two paramedics rather than one but we still have to pay both at the paramedic level. How often are two paramedics needed for a patient, and why can this not be filled by responding another medic or supervisor? I understand why we do not have many paramedic only rigs. This may just be a side note but I thought I would throw it out their. Too many Chiefs not enough Indians.

[Asysin2leads]

Sometime's it's the "simpler skills" that can trip you up. Unfortunately you do have to learn things you don't want to learn or want to do. I know, it sux.

Yeah, I can intubate someone with one lung, a mouthful of broken teeth on the floor of the projects but the whole boarding and collaring thing continues to elude me. DAAAHHHH Where does the strap go again??? DAHHHHH

I'm always amazed when someone says that they went EMT-A, to EMT-I, to EMT-P in 12 to 18 months. And I've seen some of them struggle because of that. It use to be you had to have three years as a "A", to get into a "I" class. And had to be a certified "I" for one year to get into a "P" class. So a minimum of four years. I'm not going to go into detail all the other criteria needed also to advance.

So, you expect someone to take four years of playing with themselves before they can become an entry level paramedic. Hmmmm, go get a BA or BS in something, or end up being a rookie paramedic. Decisions, decisions. Look man, maybe it takes some people three years to figure out the blood pressure cuff before they move on to IV's, but some of us are quick learners. If you can pass the course and do the job, let them do it, and stop standing in their way. Just because other people wasted their time and money approaching their education the way a five year old approaches a cold swimming pool doesn't mean the rest of us have to suffer for it. BTW, usually the other criteria for getting into paramedic school in that system has to do with Captain Cletus of the local squad liking you or not. That has to go too.

But, I know a lot of Basic's that can run circles around some paramedics, especially with a trauma assessment. And yes, it's true when they say EMT-A's save Paramedics. But a good Paramedic should save and support Basic's and I's also. It all comes around

Well, let's see, if the only thing I had to worry about on scene was doing vitals, bagging and squeezing the pelvis, I could probably have it down super perfect to. Unfortunately, doing the stuff that actually really helps the patient tends to take precedence. If all I did was make coffee, I could probably run circles around people who make coffee, make doughnuts, and run the register. And the only time a basic has ever saved me is when they told me to not pick a fight with the leader of the Hell's Angels, but I don't think they teach that in Basic class. Look, I appreciate Basics very much, I can use all the help I can get, but wake up to the fact that there is nothing mystical about any of the skills. There isn't. Even your beloved trauma assessment, you know what the first thing they do when you wheel your trauma into the bay is? Another trauma assessment! A lot better one! Done by doctors! And nurses! And they have things like really bright lights, and sonograms, and x-rays! That is a trauma assessment!

Now get over yourselves already.

[sevenball842]

So I think we all are in whole hearted agreement that the education lacks substance and distance. Especially the field internship of the medic. If we could somehow extend that quite a bit, then we would stop chasing our skills, ie. "I need 5 more I.V.'s, one intubation, electricity, and a drip". From there we would actually start gaining our true experience, and learning the difference between sick and not sick just by looking at someone. We would be able to tell if someone was yanking our chain to avoid the blue light special (P.D.). The only logical question left is....HOW?

How do we change what is required of Medics, so that it becomes entry level, without losing the valuable experience of working the streets as a basic first.

By the way, by my saying "working the streets", you have to understand that I worked in a multi-tiered system where the medics were non transporting. My experience as a basic differs greatly from those who rode systems where basics were glorified wheel chair operators, keep that in mind.

[JPINFV]

By the way, by my saying "working the streets", you have to understand that I worked in a multi-tiered system where the medics were non transporting. My experience as a basic differs greatly from those who rode systems where basics were glorified wheel chair operators, keep that in mind.

Just because the medics don't transport doesn't mean that the basics aren't more than glorified gurney van operators. The only time they aren't is if they work in a system that doesn't have medics as a first response option. Those areas generally kinda of suck at EMS anyways because of either local politics and/or locals who won't pull their head out of their ass long enough to fund a proper EMS system.

[sevenball842]

[Dustdevil]

Dust devil, although I appreciate your input into this topic, I fear that you completely mistook

my words, causing you to chase your tail around in circles until you are dizzy.

Nice attempt at historical revision, but we all read what you said in your initial posts. Sure, you flip-flopped and equivocated on several issues after you realised that nobody agreed with you, but the fact stands that your initial purpose here was to lecture us on how irreplaceably crucial EMT-Bs were to EMS as a whole, and how horrible we were for daring to say otherwise. Yes, you are credited with being civil after that first post, as well as engaging in intelligent, literate, and contemplative discussion after the fact, and I respect that. But, despite that you say you are on-board with education, you still can't seem to separate yourself from the original notion that one must drive and ambulance and provide first aid for some years before entering paramedic education, and that it is a necessary thing to assign half of the EMS workforce to do just that. You can't have it both ways. Either we are going to elevate education across the board, or we are going to continue to have a fragmented work force, with the resulting lack of professional standards, identity, respect, and rewards.

You seem to be an intelligent guy, so it is confusing to me that you don't get it. That's what leads me to wonder if this isn't all about personal motives, not related to the betterment of the profession. After all, there are a lot of losers out there who get a real toss out of having Basics to impress and push around. Their ego is boosted by the ability to shove their patch under the noses of a subordinate. The ability to pawn the dirty, grunt work off on a peon. The ability to tell the clueless that they are the "highest level" of EMS provider, instead of just another ambulance driver. It's sad and disgusting, and is yet another factor that holds EMS back.