Basic vs. Medic

[Dustdevil]

In the system that I ran in, we were side by side with the medics, learning valuable skills. Skills that we may be able to get as medics, if the hours of training were there to allow for the ability to gain the experience instead of just skill chasing to we can pass.

Wonderful. But again, we ask that you pull you head out of the cave you work in and see the big picture of EMS nationwide, where the vast majority of those who want to enter EMS simply cannot do so until they are already a paramedic. Not every system is operating in the dark ages like yours, where any wanker with an EMT patch can volunteer to first respond, or get a job working on a 911 ambulance. Hell, in another thread, even you were advising an EMT to go to ANOTHER STATE just to get 911 experience. WTF?? You would have to be an idiot to exclude the potential greatness of those people from consideration in favour of some wanker who drove an ambulance and took vital signs for two years. Those aren't skills. Those are chores that any numbnut junior high student can master in a weekend. Again, that contributes NOTHING to a candidate's potential for success as a medic, so it's pointless.

You're a smart guy, and you have nearly two decades in this game behind you. And you are now in a position to seriously influence the next generation of providers, as well as the future of our profession as a whole. It's time to stop parroting the old skool conventional wisdom without giving it any serious thought, and use your head to envision a future of how things should be, instead of just how they've always been.

[firedoc5]

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

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.

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.

Maybe I'm just too "old school" or just too old. It's not the age but the mileage. Yes, four years experience in the field and classroom is very beneficial, but not necessarily mandatory. Some may say it's "paying your dues". But if you're playing with yourself instead of paying attention, learning (which you never stop learning), and getting experience in diverse situations, that's your business. Would you prefer someone having run 5 "codes" or someone who has the experience of 50 or more?

One thing which has always seemed somewhat lacking is just good ole fashion common sense, like getting into a fight with a Hell's Angels member.

A good accurate trauma assessment in the field is crucial. You don't just "load and go" or just give a quick look, thinking that surely someone down the line will just pick up what you missed or didn't bother to check. You may need to bring the condition of a patient to the attention of that someone down the line so they can be further assessed more quickly. And the assessment should be repeated, over and over. ER staff expect a full patient assessment, whether it be trauma or medical. And any change in the patient's condition from the very first assessment (yours) to the next can help immensely. The "beloved" trauma assessment from doctors, nurses, etc. with all the bells and whistles, AND your's together is a true assessment.

I'm not here to argue, cuss & discuss, and get into any p!ssing contests. And we could go round and round and round. Everybody can say what they think and go on.

[Dustdevil]

Would you prefer someone having run 5 "codes" or someone who has the experience of 50 or more?

I believe we already covered that. Asys and I would both just as soon have someone with NO experience whatsoever, so we don't have to break all the bad habits they picked up from the retards and numbnuts they worked with on the volly squad or transfer ambulette. I am quite capable of educating these people, but I do not trust nine out of ten EMT schools to do so. Look at how many idiots come out of school saying they were told that they should forget about the book after they graduate. Unfortunately, they do. Consequently, I have to spend valuable time rehashing what they should already know. Things they think they know, but they don't. Then they cop attitudes when I tell them that they don't in fact know WTF they are doing, making it even harder to train them. No. Forget it. I don't need that. They don't need that. I want intelligent, mature, educated people who are professionally committed and quick on the uptake. That's all. And NONE of those qualities come from working as an EMT-B for any amount of time.

A good accurate trauma assessment in the field is crucial. You don't just "load and go" or just give a quick look, thinking that surely someone down the line will just pick up what you missed or didn't bother to check.

Exactly. That's why I would rather have the greenest paramedic in the world instead of the most experienced EMT-B. Somebody who is actually educated to do an accurate assessment (which is a LOT more than taking vital signs and feeling up the patient) in the first place. Better yet, somebody who is actually educated to help me do something about it. Two minds are better than one. A basic is not another mind. He's just a pair of uneducated hands.

You guys aren't going to win this one. The math simply isn't going to allow it. An EMT contributes nothing to me that the first responder firemonkeys can't do. An EMT contributes significantly less to me and the patient than a second medic would. And all that "experience" being an EMT simply contributes nothing of measurable benefit to their potential success in paramedic school. It does, however, cause me a lot of extra work trying to turn them into something more than in my way. If you want to cling to that worn out old, disproven theory because you prefer the status quo to progress, be my guest. You certainly won't be alone. But you will continue to be one of the biggest reasons that EMS is going nowhere. I hope you're proud of yourselves.

[akroeze]

Question from a non-American. Looking at the scope of practice, what is the difference between a First Responder trained individual and an EMT-B trained individual?

[spenac]

Question from a non-American. Looking at the scope of practice, what is the difference between a First Responder trained individual and an EMT-B trained individual?

Not much. In fact at my old job the protocols stated ECA ( Texas First Responder ) were to work under EMT-B protocol. So they actually could do same job with even less "education" than the EMT-B.

[firedoc5]

That's why I would rather have the greenest paramedic in the world instead of the most experienced EMT-B.

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You should want the greenest paramedic over the EMT-B. If an EMT-B has many years of experience and they are still an EMT-B, then that should tell you something. Either they don't have the initiative to advance or they just can't cut it. It's the experienced EMT-B that becomes the green paramedic that you want. It's all relative.

[WANTYNU]

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

Because debate and discussion, with the recognition that the other party has a point is something adults do.

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.

Money is always a factor, but (in a perfect world) it should not be when concerning patient’s treatment.

In a case of Paramedics, the adage “Two is better than one” is true. The reasoning is simple, because Paramedic DIAGNOSE a patient’s condition, and then TREAT it, this is invasive, and if done wrong can have detrimental outcomes. When in a hospital environment you often see two or more doctors confer on a diagnosis, before they start a treatment regime.

Why deny this same benefit to the patient in the field?

Be Safe,

WANTYNU

[speedygodzilla]

Sometimes it seems less like a debate and discussion and more like this is the way it is because that is the way I it. I see many times when others assume about others education and experience and seem to think it is inferior to theirs. I think I am more tired of beating a dead horse per say. Key point:the recognition that the other party has a point is something adults do [over and over].

When in a hospital environment you often see two or more doctors confer on a diagnosis, before they start a treatment regime.

Why deny this same benefit to the patient in the field?

I work at a stand alone ER and we always just have one doctor (per shift) who makes the decision. Very few of the doctors ever call another doctor for a decision on a patient. Actually the ones which call other doctors more often seem to be the doctor that doesn't know what is going on and is treating for the wrong diagnosis. We have plenty of serious patients walk in and the majority of our doctors never have us call another doctor or let alone do it themselves. I think that in most cases, the well majority, can be handle well by a well educated and experience paramedic and EMT.

[ERDoc]

Here we go with the same old stuff. I think it has been said ad nauseum. Education is the key. Experience is useless without education. All experience is just another word for making the same mistakes over and over. To make experience a useful tool you have to have a strong knowledge base. If we are going to increase the education of EMTs, why not just educate them to the level of a paramedic? Do away with EMTs all together and require everyone to become a medic. Make it a college level degree. I feel like I've said this somewhere before.

[spenac]

I feel like I've said this somewhere before.

I agree sounds familiar as do all the other dead horses that are being beaten in this debate. There is nothing new under the sun ( Ecclesiastes 1 : 9 ).