Will the real EMT's please Stand

[KAThomas]

:evil: The words/term "EMT" is to a truly upward bound Firefighter/Paramedic/Public Safety aspirant like a red kerchief to a bull.

It has been my experience that the term is used as though it is the dirtiest, filthiest term in the healthcare profession (more detested than fecal impaction). So filthy if fact that many other healthcare "professionals" completely disregard all assessment (primary or secondary) and information provided by the "EMT" or other prehospital care provider. If your patients are able to communicate... the Emergency Department (ED) staff asks the patient for all the information you so painstakingly gathered on scene or enroute. Come into a Trauma center in Los Angeles and you typically find other "Technicians" (Emergency Department Trauma Techs are, simply put, specialized EMT's) trying to whisk you away and disregard protocols on patient handling as though you "EMTs" simply drive the ambulance (now move along). Firefighter/paramedics often find that (if they turn around and go back in to wash their hands) their "medic line" is being taken out by RN's who "get a real line" and their EKG strip gets tossed faster than an anonymous and unaccounted for fecal smear. :shock: Well, why is that?

But before we go there (the trickle down theory) let's make the statement that there are many Firefighter (EMT- and Paramedic providers that disregard all assessment and information made by "first on" Basic Life Support (BLS) units. It happens so much so that many BLS units dawdle waiting for "Fire" because "they are just going to re-do everything anyway..." Hmmm. Oh, yeah, that's right we're just "EMT's". (So are all Firefighter's on the Engine's in SoCal). The lack of desire to upset the balance has divested us of legitimacy and will forever hinder our possibilities to be seen as professionals.

It would appear that EMT's in the private sector are likened to the McDonald's of EMS, you're too easy to replace than to stand up for. As long as that is the mindset we'll always simple move on or up to get away from being "an EMT". Paramedics are actually EMT-Ps... but they move away from that term and keep the "medic"... thus demonstrating the potency of the negative connotation EMT has dragging behind it (in the system). :?

Maybe I'm ranting but there is a tremendous amount of truth in this for the Southern California EMS system (LA & OC). :twisted:

[Boolancedriver911]

Oh great, just what we need another tool bag on EMT city....

[ccmedoc]

:evil: The words/term "EMT" is to a truly upward bound Firefighter/Paramedic/Public Safety aspirant like a red kerchief to a bull.

It has been my experience that the term is used as though it is the dirtiest, filthiest term in the healthcare profession (more detested than fecal impaction). So filthy if fact that many other healthcare "professionals" completely disregard all assessment (primary or secondary) and information provided by the "EMT" or other prehospital care provider. If your patients are able to communicate... the Emergency Department (ED) staff asks the patient for all the information you so painstakingly gathered on scene or enroute. Come into a Trauma center in Los Angeles and you typically find other "Technicians" (Emergency Department Trauma Techs are, simply put, specialized EMT's) trying to whisk you away and disregard protocols on patient handling as though you "EMTs" simply drive the ambulance (now move along). Firefighter/paramedics often what their "medic lines" being taken out by RN's who "get a real line" and their EKG strip gets tossed faster than an anonymous and unaccounted for fecal smear. :shock: Well, why is that?

But before we go there (the trickle down theory) let's make the statement that there are many Firefighter (EMT- and Paramedic providers that disregard all assessment and information made by "first on" Basic Life Support (BLS) units. It happens so much so that many BLS units dawdle waiting for "Fire" because "they are just going to re-do everything anyway..." Hmmm. Oh, yeah, that's right we're just "EMT's". (So are all Firefighter's on the Engine's in SoCal). The lack of desire to upset the balance has divested us of legitimacy and will forever hinder our possibilities to be seen as professionals.

It would appear that EMT's in the private sector are likened to the McDonald's of EMS, you're too easy to replace than to stand up for. As long as that is the mindset we'll always simple move on or up to get away from being "an EMT". Paramedics are actually EMT-Ps... but they move away from that term and keep the "medic"... thus demonstrating the potency of the negative connotation EMT has dragging behind it (in the system). :?

Maybe I'm ranting but there is a tremendous amount of truth in this for the Southern California EMS system (LA & OC). :twisted:

:shock: :shock: WTF?

[KAThomas]

Oh great, just what we need another tool bag on EMT city....

Nice response from an "Ambulance Driver" :!:

[ccmedoc]

Nice response from an "Ambulance Driver" :!:

Frighteningly appropriate though, wouldn't you agree??

[Boolancedriver911]

Will the REAL slim shady please stand up.........

[KAThomas]

Frighteningly appropriate though, wouldn't you agree??

I guess so... the idea here is that complacency breeds an environment that hurts all the good people to the point of forcing them away from what I consider to be an honorable and upstanding job & profession. First on shouldn't be first to wait... I gave oral glucose to a patient who had a BS of 27 by a family members Accucheck, pt meets the criteria... the Engine is waiting for the Squad... why? I did my job AVPU V/S ABC's O2 & Gluc... medics get a BS of 58... push D50 = b/s 157 package and were gone...

How many of my "peers" would wait... along with the 5 EMT/FF from the engine and watch the coma?

Here's a modified statement from the PHTLS book I provide to all my "new Hire trainees":

Our patients did not choose us. Rather, they present to us because of some traumatic occurrence that has resulted in injury or illness requiring our assistance. We, however, have chosen to treat them. We could have chosen another profession, but we did not. We have accepted the responsibility for patient care in some of the worst situations: when patients are at their most stressed and anxious, when we are tired or cold, when it is rainy and dark, and often when conditions are unpredictable. We must either accept this responsibility or surrender it. We must give our patients the very best care that we can – not with unchecked equipment, not with incomplete supplies, not with yesterday's knowledge, and not with indifference. We cannot know what medical information is current, and we cannot claim to be ready to care for our patients, without reading and learning each day. At the end of each run, we should feel that the patient received nothing short of our very best. (NAEMT PHTL 6th Ed.)

[Boolancedriver911]

I guess so... the idea here is that complacency breeds an environment that hurts all the good people to the point of forcing them away from what I consider to be an honorable and upstanding job & profession. First on shouldn't be first to wait... I gave oral glucose to a patient who had a BS of 27 by a family members Accucheck, pt meets the criteria... the Engine is waiting for the Squad... why? I did my job AVPU V/S ABC's O2 & Gluc... medics get a BS of 58... push D50 = b/s 157 package and were gone...

How many of my "peers" would wait... along with the 5 EMT/FF from the engine and watch the coma?

Here's a modified statement from the PHTLS book I provide to all my "new Hire trainees":

Our patients did not choose us. Rather, they present to us because of some traumatic occurrence that has resulted in injury or illness requiring our assistance. We, however, have chosen to treat them. We could have chosen another profession, but we did not. We have accepted the responsibility for patient care in some of the worst situations: when patients are at their most stressed and anxious, when we are tired or cold, when it is rainy and dark, and often when conditions are unpredictable. We must either accept this responsibility or surrender it. We must give our patients the very best care that we can – not with unchecked equipment, not with incomplete supplies, not with yesterday's knowledge, and not with indifference. We cannot know what medical information is current, and we cannot claim to be ready to care for our patients, without reading and learning each day. At the end of each run, we should feel that the patient received nothing short of our very best. (NAEMT PHTL 6th Ed.)

Ok, now you make sense.....that is dumb to stand there and wait, but seems like that is what happens alot of the times. BLS protocols differ from state to state, unfortunately.

[JPINFV]

Well, with 110 hours of training, do you expect to not be on the bottom of the totem pole? I've worked for 2 years in OC for an IFT company and have dealt with hospital providers that ranged from wanting me to essentially recite the patient's entire packet to just wanted a chief complaint. The simple fact is that doctors and nurses are going to be doing their own assessment, regardless of who gives them report. They aren't going to be saying "Well, the EMT (B or P) told me that the lungs were clear, so I guess I don't have to listen to them."

To be honest, the problem with Southern California EMS is as simple as it's fire based. Fire fighters who do not want to be involved with EMS at all are forced to become medics and, simply put, no one can put forth a proper effort if they are uninterested in the job. I've ended up running transports following calls where the fire department refused to let their private ambulance crew transport a patient to a hospital outside of the closest. They [the fire medic] was going to BLS the patient anyways, so there was no medical need to go to the nearest receiving.

This situation, especially in Orange County, especially hits the basics because they do transport patients that should be ALS every day. This is, in large part, because there are no private paramedics. So, it is either a 911 call or it is a BLS transport. This means that a patient with a confirmed electrolyte imbalance gets transported BLS, with all the risks associated with it (lack of care if anything does happen).

Furthermore, with 18 hospitals [soon to be 19 with Kaiser Irvine], most transports are well under 10 minutes. This means that acutely ill patients who do need paramedic care do end up being transported by basics. Of course this does tend to leave a bad taste in a bunch of emergency room staff's mouth (I'm looking at you, Huntington Beach and St. Joseph's). Of course the basics get the short end because they don't choose who the nursing home calls to transport.

As far as the basic v paramedic terminology, personally I have changed to how I refer to the levels (I generally try to not call basics "EMT"s), but that is really neither here nor there. As long as 110 hours is considered enough to provider emergency care and, as is the situation in OC, paramedics are restricted to the fire department, the situation will not, nor could it, change.

As far as the fire department basics responding on an engine, what exactly are they going to do? If you have the scene under control, the fire department basics should be assisting you with you, the ambulance basic, in charge of patient care until the paramedics arrive. It's your ambulance and your patient. You, the ambulance basic, should be in charge regardless of the amount of brass some fire officer has on his uniform (I'd have no problem telling a fire chief that was a basic where to sit and spin if he tried to give me any medical direction on a medical patient).

[ccmedoc]

JP...Is a fire paramedic dispatched to every call, or do you have the option to transport without them clearing you..I'm just curious, and may have missed it somewhere else.