Will the real EMT's please Stand

[AnthonyM83]

I also work in LA and have had a slightly different experience or perhaps just a different perspective.

Yes, EMTs are at the bottom of the totem pole, but I'm rarely treated as just an ambulance driver. Provided I'm concise and can give the information they want while giving my report, the nurses and doctors usually listen. I've found that whether they re-interview the patient during triage depends both on chief complaint and on confidence while giving my report.

Considering how many new EMTs they see daily, and how many EMTs don't care about medicine and simply repeat what's on the FD's paramedic run-sheet, it would be negligent for them not to do a quick assessment themselves. I think a lot of EMT - ER Staff conflict can be resolved by learning more about why they do things.

During critical traumas, EMTs do get little attention, usually because paramedics are there (and they usually don't get much attention either because everyone's carving into the patient), but that's mostly because they're trying to do THEIR own assessments, which with critical patients is really quite necessary.

On 911 calls, most EMTs for my company try to do as much as possible. We hire a good crowd and while many don't like medicine, they do want to be FFs, and want to make a good impression for the arriving fire engine. While FD usually takes over while arriving, they almost always pay attention to my report and VS, as long as I look like I know what I'm doing. If I don't know the medics, they'll sometimes re-assess all (some areas just treat all their EMTs like garbage, though, especially those they don't know).

The part where we are really treated poorly is when they don't help us move a patient, give ambulance crew the crappy tasks, yell if not done to their liking, correct us on how to work our equipment, critique on our decisions, push us around...but the medical stuff at least with my company we have a good rep.

And big picture, I do see why EMTs are like fast food workers (low pay, replaceable, etc). They honestly don't have much responsibility. It all falls on the FD. Their patient even after transfer of care (so FD says). They are medical authority on-scene and telling a captain where to sit if interfering or outright defying that medical authority's transport decision WILL cause you problems and I'm sure your company will see you as a liability. They care about keeping the 911 contracts with the county more than individual employees (usually).

We don't HAVE to know any real protocols realistically...you can work as an EMT for years and never have glanced at the protocols...just kinda figured it out based on watching what people do, not knowing why...many EMTs choose this path. And there's always someone ready to fill your spot, another FD hopeful...

Of course, the fire based system is basically the root of it....

[Dustdevil]

Yes, EMTs are at the bottom of the totem pole, but I'm rarely treated as just an ambulance driver.

And, knowing you as I do, I don't doubt that for a minute. It's usually not that hard to size up a provider's competence and potential. And -- although there are exceptions and misjudgements -- you're generally going to be treated according to that size-up. Now, just think of your initial impression of others at this forum, and think of how comfortable you might or might not be with them on a scene.

There are basic providers out there who I look forward to seeing on my scenes, and give them all the respect and appreciation they deserve. But there are others out there who are not only worthless, but they carry a chip on their shoulder about it, making even their personality unbearable. They reap what they sow, but they'll whine like victims for their entire career.

It's pretty easy to tell who is who in this discussion.

[NREMT-Basic]

Here is a question I have had since starting with the fire department and it would be nifty if we could actually discuss it instead of turning it into another excuse to bash basics (though I doubt that can happen) or even entire states. My department has three stations. Since EMS was taken away from the FD itself and the FD's ambulances were removed from the stations, we now have one ALS ambulance in our district of about 40,000 people. Of course ,if the ALS crew is otherwise occupied, we can get mutual aide. But in the realistic world where we have 1 ALS crew with 2 paramedics and a fire department with 90 firefighters of who maybe 15-20 are EMTs and the rest of MFRs, what are we supposed to do if I respond to the station to a medical call and I get on the truck and I am the only EMT? When we get to the scene do we just stand there and pretend that we dont know what to do and wait for the ALS Cavalry to save us all. Yes, ALS care means advanced, but if we are waiting and a patient is crunking, if the EMT (me or whoever it is) knows what we are doing, should we just let the patient circle the drain and hope the mutual aid ALS rig gets there in time. In the best of all possible worlds, we would have insta-medics on all calls that come into the FD. But we dont always and thats just the reality of the situation. We act as first responders. If we get there and can do something but somebody thinks we should wait for the ALS crew and the patient goes up the spout we are going to get hammered legally. While all the medics here will have a fit, there are times when the EMT's are the medical incident commanders until ALS arrives. We dont all live in the bright and shiny world where there is a medic on every corner and a chicken in every pot. Sometimes a Technician-Basic has to take over when a Technician-Paramedic isnt available. And when I said I would ask my chief, that was a typo because I was talking about FDs. I meant to refer to my paramedic or medical control. I started with one thought and finished with another And no, just because I know how to interpret a glucometer reading and administer oral glucose and when not to, it doesnt mean I am going to give atropine.

(Here ends the hopeful, constructive part)

And by the way, when did the language filter come down. We want to be taken as professionals and yet we refer to the places that our colleagues work as "god forsaken shitholes." Come on guys. They're only going to see you as professional as you act. That was one of the more mean-spirited posts I've read lately. An interesting knew use of the quote-clip-paste technique though and you do get style points for all your pretty colors. Other than that, mostly useless. Yes Virginia, there is a Santa Clause and yes, Basics in Illinois are TRAINED and EDUCATED in the use and admin of glucagon. Also, a about giving glucagon to a "decreases LOC" patient: Can that patient swallow? Does he show signs of stroke when evaluated with something like the Cincinnati Stroke Scale? If the answers are yes and no respectively, he is altered, can swallow and has a low glucose, day below 45-50, then I will cut open the tube and start giving it instead of waiting for the medic who will walk in the door, ask for my assessment and do the same thing anyway. Decreased LOC (level of consciousness) does not ALWAYS mean total LOC (LOSS of consciousness). LOC can refer to the degree to which the patient is altered or it can refer to GCS. I woulda thunk a medic would know that

Come on ahead, and visit us in Illinois. We'll leave the light on for ya. Just put a sign in your car window that says "Drag me to another state before extricating and treating me" so we don't waste our time.

[NREMT-Basic]

And, knowing you as I do, I don't doubt that for a minute. It's usually not that hard to size up a provider's competence and potential. And -- although there are exceptions and misjudgements -- you're generally going to be treated according to that size-up. Now, just think of your initial impression of others at this forum, and think of how comfortable you might or might not be with them on a scene.

There are basic providers out there who I look forward to seeing on my scenes, and give them all the respect and appreciation they deserve. But there are others out there who are not only worthless, but they carry a chip on their shoulder about it, making even their personality unbearable. They reap what they sow, but they'll whine like victims for their entire career.

It's pretty easy to tell who is who in this discussion.

Actually, for accuracy's sake, MFRs are at the bottom of the totem pole.

[ccmedoc]

:scratch:

I'd love to post an answer, but my eyes crossed half way through the first paragraph..I'm not sure what the question was?? :shock: :shock:

[Scaramedic]

And by the way' date=' when did the language filter come down. [/quote']

Umm about two weeks ago, didn't you get the memo? It was attached to the memo about the cover sheets for the TPS reports.

When you mention that your supervisor or Chief dictates your treatment in error as it was, I take it back.

Thank you.

Ahh your too sweet. :oops:

[NREMT-Basic]

/ That's funny right there, I don't care who you are. Its not often that someone slaps me around and I enjoy it (without paying for it that is). Maybe its the cold medicine. So with this memo that now allows cursing, is there a list of the 7 words we cant use?

Here's the way I see it: Somebody or a group of somebodies smarter than most of the people on this site put together says that in Illinois, EMTs give glucose, glucagon, O2, nitro, ASA (assisted admin) and epi. I also think we should have a national standard for EMS protocol and use the NHTSA model and bring the education of EMTs and Medics up to meet it. I know its naughty to say that medics are also undereducated, but anybody thats gonna be sticking needles in necks should go to school for more than 18 months. Then of course there was the medic that tried to start an IV in the back of my mothers hand and stuck it in a tendon, but you know, really, the problem is only with Basics.

By the way Scara, how much did you have to pay for your mod status?

[Scaramedic]

We can use 'shit' now because in case you haven't noticed it's OK to use on TV now. :roll:

The other six are still banned though I'm sure.

A six pack of Coors, bottles. :wink:

[wbgraidermom]

I have been doing this for 14 years and I know how it feels to get a PMH, CC, and meds and have it not matter. Wish it did. Working for a private company, I have been dispatched to a scene for a "BLS" call with on other crew(s) and have it turn into an "ALS" call and have to wait for them. but we never have fire onscene for any of our calls unless it is an MVA and then we do.

This is a good topic for discussion. Glad someone brought it up. Would like to hear what other states and companies have to say on this.

p.s. I'm from Pittsburgh, PA.

[akflightmedic]

Great discussions!

I love the TPS reference. I just watched that episode two nights ago, otherwise I would not have had a clue what the hell you were talking about!

I do not like the titles:

Technician-Basic

Technician-Medic

Correction is:

Technician Basic

Clinician Medic

Huge difference as technicians follow manuals, rules, guidelines without much latitude for independent thought or critical thinking. Not saying they do not posses these skills, I am saying there is no need for them to use them as it is irrelevant to the treatment they need to provide.