Can't we just be....Co-workers

[mobey]

Of course everyone realizes how the threads on this forum almost always end. Some newbie will jump in saying something stupid about basics doing an advanced treatment or how they should be able to expand their monkey skill set, because it doesn't look that hard. Then an experienced member will jump down their throat, 5 people will back him/her up, the newbie will leave the site, admin locks it, and round and round we go.

So I would like to see a series of well thought out posts from both EMT's and Paramedics. I am in a service where the general consensus is "A good EMT is as good as any Paramedic". Believe me i deal with it everyday, and I can tell you it comes down to the fact that these people have no idea what a paramedic is. Perhaps if I could get some well thought out opinions/facts from some experienced members here, I could help them understand why we need to go ALS, and some basics here could learn a thing or two as well.

Perhaps if we don't direct these posts at eachother, and just post generally, this will not turn into a mud slinging contest.

The point of this thread is to have a link to some quality posts, where we can direct newbies when they put their foot in their mouth, instead of derailing and locking every freaking quality thread that hits this forum.

So as an EMT trying to change an EMT system to a Paramedic service here is the excuses i have hit from the other EMT's. (No knee jerk reactions please)

Paramedics "waste" too much time on scene.

Paramedics all think there god and treat EMT's like $hit.

We don't do enough cardiac arrests to warrant a Paramedic.

2 good EMT's are as good/better than 1 Paramedic.

Paramedics waste valuable time starting I.V's on traumas when they should be transporting.

Paramedics lose their BLS skills and we(EMT"s) end up picking up the slack.

*Now remember these are people who for the most part have never worked in an ALS system, please take the time to intelligently educate us on the subject*

[MSDeltaFlt]

Paramedics "waste" too much time on scene.

-Some do. The good ones don't.

Paramedics all think there god and treat EMT's like $hit.

- Again, some do. The good ones don't.

We don't do enough cardiac arrests to warrant a Paramedic.

-True ACLS/PALS/NRP/PHTLS is code prevention. That's where a medic shines in my honest opinion.

2 good EMT's are as good/better than 1 Paramedic.

-Not in code prevention. See above.

Paramedics waste valuable time starting I.V's on traumas when they should be transporting.

-Not the good ones. They get them enroute.

Paramedics lose their BLS skills and we(EMT"s) end up picking up the slack.

-A good medic has strong basic skills.

Hope this helps.

[Eydawn]

In response to many of the common statements below, here are my thoughts.

Paramedics are thinking about things from a much different perspective than EMT-B's. As an EMT-B, I was trained to look for obvious signs and symptoms and taught simple, quick, important skills that would presumably allow me to follow the adage of "do no harm" in most cases. However, what I was not taught was how to see past the obvious.

It is much easier for me as a Basic to care for a broken arm... to provide chest compressions to a pulseless patient... to place oxygen on an elderly woman with shortness of breath... for this is what I have been taught.

When the paramedic looks at the broken arm, he (used for simplicity... not excluding female paramedics) may be thinking of hemodynamic compromise from severed vessels. He may be thinking of long term nerve damage, of how much pain medication may be appropriate for the patient dependent on a whole host of factors, or of what he might be missing in terms of other, more serious life threats secondary to the trauma that caused the broken arm.

When the paramedic sees the pulseless, apneic patient, he knows that he must rule out a whole host of things and is thinking about physiology and pharmacology that we cannot even begin to understand at the Basic level. Is the patient in asystole? V-fib? A-fib? What drugs are appropriate? What continuing care can I provide enroute? Is it possible to ensure this patient's airway remains patent? Are there comorbid factors?

As a Basic, the most we can think to do is start the IV for the medic (in certain areas), and provide BLS airway support and chest compressions while the medic does the *thinking* work.

Same deal for the elderly woman with shortness of breath. We are taught the magic 15LPM NRB spell... but when that is not enough to fix the problem, we are left empty handed until the woman reaches the point where we must physically force air into and out of her lungs for her. The paramedic's brain engages and runs through the complexities of the human respiratory system, searching for the answer that may save the woman from being intubated- or from dying.

The key difference here is that yes, the physical supports that we provide as Basics are very important... but the mental toolbox we work from is much smaller. The paramedic may leave the physical skills to you because he knows you can handle them... but a good medic would never dare ask you to find the solution to the problem, because he knows you haven't been given the right tools.

It's like having a kid's carpentry set, and having a basic idea of how to hammer a nail into two boards to fasten them, and then being confronted with building a new wing onto Buckingham Square Palace with just your kiddo sized tools. It's not a personal affront to you, nor the medic being lax in what you've been trained is important... it's them using the most important thing they've got-- their education and assessment skills.

Paramedics are important for every type of call. There are always hidden subtleties. Ok, maybe not on the stubbed toe... but there's an exception to evey rule. Medics may seem arrogant because some have arrogant personalities... but others seem like "know it alls" or "paragods" simply because they're busy thinking at a different level and don't always have time to break it back down to the level where you, the Basic, can completely understand it. Them telling you just to do whatever they told you to do is because they're focused on the patient. Helping you learn and helping you to understand the complexities of the human body is best done off scene, where there is actually time to dissect what was going on.

A paramedic may choose to spend more time on scene because doing so may give them time to figure things out that speed up the in-hospital process. Starting IV's, when the patient is more stable, may save the trauma team valuable seconds in-hospital when the patient decompensates. Although we as Basics may not always understand what the paramedic is doing, or why, we have to trust that their higher level of education means they have some competence and our job is to do our best to support them. We do the same for the doctor or the RN in the ED, right? We know they've got more education and think about things differently than we do. The same goes for our medic partners.

I hope this helps clear some things up. Knowledge without explanation can seem like arrogance... and may be, but give people the benefit of the doubt and realize your own limitations before attacking Paramedics.

Wendy

CO EMT-B

[mediccjh]

In response to many of the common statements below, here are my thoughts.

Paramedics are thinking about things from a much different perspective than EMT-B's. As an EMT-B, I was trained to look for obvious signs and symptoms and taught simple, quick, important skills that would presumably allow me to follow the adage of "do no harm" in most cases. However, what I was not taught was how to see past the obvious.

It is much easier for me as a Basic to care for a broken arm... to provide chest compressions to a pulseless patient... to place oxygen on an elderly woman with shortness of breath... for this is what I have been taught.

When the paramedic looks at the broken arm, he (used for simplicity... not excluding female paramedics) may be thinking of hemodynamic compromise from severed vessels. He may be thinking of long term nerve damage, of how much pain medication may be appropriate for the patient dependent on a whole host of factors, or of what he might be missing in terms of other, more serious life threats secondary to the trauma that caused the broken arm.

When the paramedic sees the pulseless, apneic patient, he knows that he must rule out a whole host of things and is thinking about physiology and pharmacology that we cannot even begin to understand at the Basic level. Is the patient in asystole? V-fib? A-fib? What drugs are appropriate? What continuing care can I provide enroute? Is it possible to ensure this patient's airway remains patent? Are there comorbid factors?

As a Basic, the most we can think to do is start the IV for the medic (in certain areas), and provide BLS airway support and chest compressions while the medic does the *thinking* work.

Same deal for the elderly woman with shortness of breath. We are taught the magic 15LPM NRB spell... but when that is not enough to fix the problem, we are left empty handed until the woman reaches the point where we must physically force air into and out of her lungs for her. The paramedic's brain engages and runs through the complexities of the human respiratory system, searching for the answer that may save the woman from being intubated- or from dying.

The key difference here is that yes, the physical supports that we provide as Basics are very important... but the mental toolbox we work from is much smaller. The paramedic may leave the physical skills to you because he knows you can handle them... but a good medic would never dare ask you to find the solution to the problem, because he knows you haven't been given the right tools.

It's like having a kid's carpentry set, and having a basic idea of how to hammer a nail into two boards to fasten them, and then being confronted with building a new wing onto Buckingham Square Palace with just your kiddo sized tools. It's not a personal affront to you, nor the medic being lax in what you've been trained is important... it's them using the most important thing they've got-- their education and assessment skills.

Paramedics are important for every type of call. There are always hidden subtleties. Ok, maybe not on the stubbed toe... but there's an exception to evey rule. Medics may seem arrogant because some have arrogant personalities... but others seem like "know it alls" or "paragods" simply because they're busy thinking at a different level and don't always have time to break it back down to the level where you, the Basic, can completely understand it. Them telling you just to do whatever they told you to do is because they're focused on the patient. Helping you learn and helping you to understand the complexities of the human body is best done off scene, where there is actually time to dissect what was going on.

A paramedic may choose to spend more time on scene because doing so may give them time to figure things out that speed up the in-hospital process. Starting IV's, when the patient is more stable, may save the trauma team valuable seconds in-hospital when the patient decompensates. Although we as Basics may not always understand what the paramedic is doing, or why, we have to trust that their higher level of education means they have some competence and our job is to do our best to support them. We do the same for the doctor or the RN in the ED, right? We know they've got more education and think about things differently than we do. The same goes for our medic partners.

I hope this helps clear some things up. Knowledge without explanation can seem like arrogance... and may be, but give people the benefit of the doubt and realize your own limitations before attacking Paramedics.

Wendy

CO EMT-B

=D>

[Scaramedic]

To be honest I never encountered this Basic vs Medic crap until I started posting on these boards. I think a lot of the problem here is that some Basics and Medics use the anonymity of the web to say things they wouldn't say in the real world. :wink:

[Just Plain Ruff]

Scar, do you really look like your avatar?

and I also never encountered the basic versus medic thing prior to emtcity.

Anyone for a moratorium on this stuff?

[Eydawn]

So the idea of a reference thread to throw at the n00bs appeals to no one save myself and Moby, huh? Friggin' AWESOME.

Glad to see that people are interested in just silencing it so they don't have to see it anymore, rather than attempting to do something productive about it!

Sorry... too many carrots. I'm kind of rabbity at the moment. AKA in a kicking and thumping mood!

Wendy

CO EMT-B

[akflightmedic]

First, yes scaramedic does indeed look like his avatar. I know as I had breakfast with him a couple years ago and it was damn scary.

Second, the medic vs basic has been alive and well in several of the states I worked in...plus, revelation time, I was a basic who said many of the same things UNTIL I went to paramedic school and learned how wrong I was.

Fortunately for me, I was only a basic about 3 months before going to medic school. I learned how wrong I was on so many different things.

Third, Wendy...will you marry me? Your posts, they are so stimulating, so well thought out. Emotional orgasm (braingasm) almost every time I read one; and then the fact that you can kick and thump...spank me you "rabbity" creature!

[Scaramedic]

Scar, do you really look like your avatar?

No, that's my wife when she wakes up in the morning.

[Scaramedic]

So the idea of a reference thread to throw at the n00bs appeals to no one save myself and Moby, huh? Friggin' AWESOME.

Glad to see that people are interested in just silencing it so they don't have to see it anymore, rather than attempting to do something productive about it!

Sorry... too many carrots. I'm kind of rabbity at the moment. AKA in a kicking and thumping mood!

Wendy

CO EMT-B

The problem as I see it Wendy is the reference posts would just be ignored. Much like the site rules are glossed over in the quest to get online and start posting. Yeah we could make some sticky threads that address those issues but getting people to read them is a horse to water situation.

AK, I still have nightmares about that breakfast! :shock: