Should EMTs Have to Babysit Their Medics?

[Don1977]

ABSOLUTELY NOT. The two should be practiced together. As I have said in the past, in the real world of medicine there are no such things as ALS and BLS. There is patient care. The mantra you bring up is what is used by people that try to make themselves feel better about their position. BLS really is nothing more than first aid practiced in the back of an ambulance.

As for your story about the medic who went to the hospital without "lights and whistles," I'm not sure what the point was. Are you being critical of his decision not to use lights and whistles? If you consider that decision poor patient care you might want to review some of the literature on the use of lights and sirens. I am not sure if there is any literature to support the use of whistles in an ambulance but I would guess that they would not be very effective since traffic may not be able to hear them. I don't know if there is any state that recognizes the use of whistles as an emergency device either.

I do agree with BLS before ALS, do you start an IV before you assess a patient??? but I also feel if the medic doesnt want to use L&S then thats his/her discretion. Just my 2 cents.

[ERDoc]

I do agree with BLS before ALS, do you start an IV before you assess a patient??? but I also feel if the medic doesnt want to use L&S then thats his/her discretion. Just my 2 cents.

Assessment is not a BLS skill. The subject of real assesment just skims the surface in EMT classes. I would argue that assessment is an ALS skill. The whole thing of BLS before ALS is just bull.

[Don1977]

Assessment is not a BLS skill. The subject of real assesment just skims the surface in EMT classes. I would argue that assessment is an ALS skill. The whole thing of BLS before ALS is just bull.

I disagree, but respect your opinion...

[ERDoc]

I disagree, but respect your opinion...

I can respect that, but you will find there are many more that feel the same way. There is not much you can learn about doing an assessment in a 120 hours course. In medical school we spend over 50 hours learning to take proper history and over 100 hours learning how to do a proper physical exam.

[Ridryder 911]

I can respect that, but you will find there are many more that feel the same way. There is not much you can learn about doing an assessment in a 120 hours course. In medical school we spend over 50 hours learning to take proper history and over 100 hours learning how to do a proper physical exam.

Notice a pattern here (other than the funny boxes)? The ones with higher education are saying and describing the same thing and many of the ones with lower ratings are saying the same thing?

Really folks, the reason many of you disagree is because you cannot understand patient care!

There is really NO such thing as BLS care and ALS care. Rather it is appropriate care! The stupid labels of the so called BLS and ALS when in reality it is one thing = medical care. Only in EMS we have to dumb it down into categories, BLS or ALS ! Allowing different levels of categories thus allows one not to feel inadequate in not being able to do or provide something or doing it the most correct way to begin with. Categories only encourage mediocre care to exist.

R/r 911

[Don1977]

Rid, I can respect that term "appropriate" care. Thank you

[Dustdevil]

Its not about BLS/ALS skills..the education needed to realize when to use them or not is. Just because the medic didn't want to bust backside to the hospital, doesn't mean he/she was lazy. It is most likely that it was not as serious as you anticipated. Why get the patient all jacked up for nothing?

Because the protocols say we can! That's good enough for the EMTs. :roll:

The simple fact is that paramedics tend to run hot with patients a lot less often than EMTs do, but there is a good reason for that. Having over ten times the education and experience of an EMT, a medic can better determine the patient's condition and needs. Comfortable with that information, they don't have to bust arse to the ER, as an EMT would do, just because they're either stumped as to what is going on, or stumped as to what to do for them. Seems like this has already been said here multiple times, yet some people FAIL to get it. And that is why their input is resented by paramedics. If all you want to do is mouth off, but not listen and learn, you're going nowhere as an EMT.

Calling a provider "lazy" because he deprived you of the cheap thrill of driving like a maniac is pretty selfish, low-level thinking. Definitely not medic material.

[suzeg487]

1. I'm guessing that "I run with a fire company" means she's a low-time volunteer. No paid professional uses that kind of terminology.

In the area where I work, this is exactly the terminology that gets used. We work at a hospital and run with a fire company. Most of the fire companies have paid crews to begin with.

2. Quality patient care is NOT your number one concern if you have FAILED to progress your education in fifteen years of practice.

I start paramedic school in the fall. I have been keeping up on any classes I can in the meantime. If you'd read my earlier post you would have known that.

3. Rehashing the same old weekend-long card courses every few years does not count as education. For that matter, neither does EMT school. ACLS is not going to give you anything of value until you have an educational foundation, which you seem to believe is out of your reach.

All I stated was to take it for the theory - one would think that something would be better than nothing at all.

4. As stated, if you really think paramedic education is important, you will find a way like the rest of us did. Trust me, few of us were rich either, but we figured it out. I guess you just don't want it bad enough. Or else, quality patient care simply isn't as big a priority as you say it is.

Money had nothing to do with it, time did. In addition to working multiple jobs, I'm also a Hospice volunteer and head up our Youth Aid Panel (in addition to taking care of house and raising a daughter....yeah, I know, WAH)

5. Paramedic practice is not about "skills," and your liberal use of the word in this context -- as if they were the Holy Grail -- is indicative that you have learned very little in fifteen years.

How do you figure?

6. As ERdoc and others pointed out, just because you took a few hours to read the ALS protocol book does not mean you really have the slightest clue what you are talking about. Just like paramedic practice is not about skills, it is also not practised from a cookbook. The medics you are questioning know a lot more than what the cookbook says. They know how to fully and properly evaluate an individual patient's condition and needs, and judge what is appropriate for them. Sometimes that isn't exactly what the book appears to say. If you decide to question this, you are treading VERY thin ice, because there is nothing more annoying or disposable than an EMT who thinks she knows more than she does.

The ER doc was reprimanding the MEDIC, not me. And I was not the one to point the medic's error out - he did it himself when he gave report.

7. Medics do indeed make mistakes. And sometimes those mistakes can be so blatant that even a n00b EMT can see it. If this is within your scope of knowledge (based upon what, a whole 120 hours of night school a decade and a half ago?), and you feel strongly that this will be adverse for the patient, it's time to mention it. If you are incapable of doing that diplomatically, then again, you aren't half the provider that you think you are. There is a darn good reason that most paramedic degree programmes include a speech-communications course in their curriculum.

I have no problem communicating with most the folks I interact with. The two that I do have a hard time with, ALL of us have a hard time with.

8. When in doubt, STFU. Taking ACLS and reading the ALS protocol book is about as useful as taking a week of karate. It's just enough knowledge to get you or someone else seriously hurt. And if you freak my patient out by questioning my judgement based upon that, you're definitely not going to be able to afford medic school, because unemployment doesn't pay that well.

Discussions aren't taken in front of the patient. If something needs to be talked about, we leave one crew member with the patient, and go out of earshot to discuss.

[fallout]

I have also seen medics over treat patients, too. When in EMT school, the teacher was a medic and a very damn good one at that, she always said that it is better to over treat than to under treat. I still follow that to this day.

I know people are going to and read this and post what they think, and that is ok by me.

That is why I wrote this, to get people thinking and talking.

Can't wait to see what they will say next.

till next time.

I do not think overtreating is a good idea. For example, giving epinephrine to every allergic reaction would be a bad idea.

The same goes for intubating respiratory distress or use of narcotics in chest pain.

I could go on endlessly, but the point is overtreatment does not benefit the patient, when your treatment has the potential for deleterious side effects.

[Dustdevil]

I have also seen medics over treat patients, too. When in EMT school, the teacher was a medic and a very damn good one at that, she always said that it is better to over treat than to under treat. I still follow that to this day.

I know people are going to and read this and post what they think, and that is ok by me.

That is why I wrote this, to get people thinking and talking.

You would do well to listen to them.

I sure hope your instructor explained that theory a lot better than you have, because it sounds like a very dangerous oversimplification of a complex theory. Perhaps he was referring to a specific task, like bandaging and splinting when he said that? I would hope so, because this little rule of his is a horrible idea when broadly generalised to all EMS treatment.