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

[EMS49393]

I haven’t taken the time yet to respond to this post for one simple reason, I’m at work. I work a rather busy station. It takes time for me to craft a response to this rather insightful post.

It would be fair to say I do much more paramedic bashing at work then basic bashing. I expect a lot from a paramedic. I expect them to perform a comprehensive, detailed assessment of not only their patient, but the scene around them. I expect them to be confident, knowledgeable, and in control. I expect them to be able to calm a family and/or bystanders when working a critical patient. I expect them to be honest when dealing with patients, family, and co-workers. I expect them to clean up their own messes, both physical, and emotional. I expect them be in charge of their own education, and not blame anyone when they wait until the month before recertification to take a refresher class. I expect that they know what is right, and they do what is right. I expect a paramedic to be an educated CLINICIAN.

I expect an EMT-B to not confront patients, bystanders, or myself in a manner that may be seen as hostile. I expect them to recognize from my body language, and orders, that a patient is having a life-threatening emergency. I shouldn’t have to tell anyone that CPR needs to be performed, that quick patches need to be applied, that I need things set up quickly, completely, and correctly. I expect them to safely transport the patient, any family member, and myself safely, at all times. I expect a basic to be a safe TECHNICIAN.

The differences between basics and paramedics should never be likened to that of fruits. There is a great deal of difference between the two, and you do not necessarily need to be a basic before you can be a great paramedic. The same things you learn in that first aid course, are repeated in your paramedic courses, only in greater detail. Along with first aid, we are taught advanced anatomy and physiology, pharmacology, advanced medical terminology, better assessment tools, and how to interpret them. We are educated, or at least we should be educated.

My friends that are basics, not everything in EMS that is bad is your fault. There is a great deal of accountability that must be made on the part of the paramedic. Most choose to go to inferior medic-mills. Some choose a degreed program complete with a variety of required collegiate level course. In all honesty, I am a great fan of the basic, only because I detest the medic-mill. I would much rather be in total charge of patient care, than to have an a medic with me that can’t tell the difference between a pink patient and a blue patient.

I had the opportunity to work as a double paramedic truck last year. My partner went through a paramedic puppy mill. He had no confidence, no tact, and lousy skills. The most important thing he lacked was a good education, and it was reflected in his patient care. There was one particular instance where he had worked a shift with an EMT, and I had not yet arrived to relieve that EMT. The ended up on a cardiac call, and this man could not start an IV. The skill was not his downfall. His downfall was his lack of education, followed by his lack of confidence because of his poor education. I met them about 40 minutes from the ER. I went on the truck, assessed the patient, and took charge of the call. That should NEVER happen to a paramedic that is allowed to function on his own.

Currently I work with a basic. She is golden, and I’d work with her over most paramedics any day. She drives safely. She anticipates my needs with little direction. She knows her limitations. She is a technician. She knows she is more than allowed to ask questions, when it is appropriate. She does not undermine me or confront me. She never asks me why she can’t just give a drug, because she knows my answer. No drug pushing allowed on my truck unless you can tell me what the medication is, how it affects the body, what the contraindications are, the five rights, etc. If you can’t talk me into it, there is no giving it. She knows she doesn’t have the required education to answer my questions. Unfortunately, neither do many of the paramedics I work with.

So, how do we fix this problem? Do we continue on the path to sure destruction, as we have been for years? Or, do we take it upon ourselves to say enough is enough. There needs to be education, appropriate testing, and licensure. Do away with paramedic puppy mills, and require a paramedic to obtain a degree before they are eligible to test for their license. Require them to obtain a four year baccalaureate education before they are allowed to function independently on an ambulance. Education, good education, is the key to the success of this profession.

I am treated the same as the medic from the mill, despite years in college and a piece of paper that says I spent years in college. People do not see a paramedic that has taken A&P, microbiology, English Composition, psychology, statistical methods. They just see a paramedic. I find when I run on a patient that has been treated by a paramedic before, I spend the first five minutes undoing all the damage that paramedic did. I hear how horrible, inconsiderate, mean, and stupid paramedics are. Occasionally, very occasionally, I hear how one shines.

If you want to do a job, do it well. If you’re a janitor, take it upon yourself to know what solution clears the most grime the fastest. If you’re a physician, know what to do to help your patient, and keep them from deteriorating and/or dying, or to ease the suffering when they are dying. I don’t care if you’re an EMT-B, but you better know your limitations and stop tossing one ridiculous reason after another about why you should be able to administer a drug. If you want to be a paramedic, choose your education wisely. No excuses, you are an adult, and this is your life. Excuses are for people that need a reason to do nothing.

Everyone likes to get something for free, but consider how much it is really worth. You may find out, in time, that the free paramedic “education” that took you six months to complete is really worth what you paid for it.

[EMS49393]

Dust is spot on with his description of the PUM. How do I know? I currently work for a PUM. I thought I'd try it, heck I've tried many of the various forms of EMS.

My favorite? Hospital-based. They required far more education than any other type of service. As I was departing, there was talk of JCAHO putting their hands into any EMS that was hospital-based. I see that as a great step. Safety, education, and appropriate patient care are paramount with a great EMS system. It's just so hard to find.

[towheadedmule]

Dust, there were references to whether basic level or medic level was better. We don't have that argument many times in our system, at least not on a mass scale. There is some grumbling, But they don't usually last long. Some of the long standing basics know how to use the system to break a paramedic. No comment on the morality of this from myself tho.

We do run a lot of double para trucks. They are not usually assigned to one another, more of ad hoc groupings dependent on the schedule for that day. It has more to do with the turnover in basic members (mainly a product of low pay).

In the end, I care little for the color of patch on the arm, but rather the partner I have. Did we make it home, nobody died on the truck, had some fun and provided the best patient care we could. Did we learn anything?

Sorry about not being more clear.

R

[Scaramedic]

We do run a lot of double para trucks. They are not usually assigned to one another, more of ad hoc groupings dependent on the schedule for that day. It has more to do with the turnover in basic members (mainly a product of low pay).

R

I know that feeling. We were so low on Basic's I was running with Director of Ops. The one before the one we shall not name.

[towheadedmule]

My "basic" yesterday was the DirOps that started EMSA in Jenks. Made for a interesting day, giving me history lessons of posts, stations, corp HQs over the years.

In the last 4 shifts, I have been with 3 different Paras. In the morning I work with yet a different one.

[Dustdevil]

Okay, but I'm still not sure why you believe that this argument exists less often in a PUM than in any other type of system. I don't understand how that might be. There was plenty of it in the PUM I worked for.

[towheadedmule]

I wouldn't know about all PUMs, of for that matter tiered systems. If I expressed that view my apologies. I should keep my opinions of Fire based EMS to myself.

I do know that I don't hear a lot of sabre rattling at my system and in my division. As for the other division and services, I can offer no opinion.

[Dustdevil]

Fair enough. I wasn't trying to call you out or anything. I just thought that you had possibly made some observation about the atmosphere within PUMs that had eluded me. I'm always looking to learn something new. Thanks.

[emtannie]

OK, back to the original poster's request...

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.

Having worked in management, and working closely with the current management at my service, I suspect that some of the issue comes from the top. EMT's are told that they are every bit as good as medics from the top brass....

I realize that some of you are sucking in a great gulp of air right now... but let me explain further...

The bean counters look at the bottom line... They want the most for the least dollars. When Joe Bean Counter can put 2 EMT's on the road instead of 1 medic, Joe BC is quite proud of himself for doing his job and providing a service for less money. He has a degree in accounting, not a B.Sc. in paramedicine. He has no clue what the difference is, and at the moment, he really doesn't care.

Joe BC then comments to EMT Bob "You are just as important as paramedics" which Bob interprets as "EMT's are just as good as paramedics."

I have worked with medics who were less useful than a burnt out highway flare. I have worked with EMT's who were less useful than a burnt out highway flare under a snowdrift. I have worked with medics who I found to be amazing, insightful, compassionate providers who were more than willing to answer any questions I have had after the call. I have worked with EMT's who were also amazing; yes, they don't have the education, knowledge, background, and skills of a medic, but they are still very good at what they do. So don't get me wrong - I'm not saying EMT's are useless.

Part of going to a full medic system isn't just getting past the excuses listed by the original poster. It is changing management, budget committees, whoever the board or council is that controls funding.... we need to change them from looking at EMS as "we can put more bodies out there for less money" to looking at it as "we can provide better care if we have medics on trucks." Having fought for funding, I have met numerous administrators who have no clue what the difference between a medic and EMT is - they only know an EMT is cheaper to pay for.

Given the choice, would you want a medic or an EMT taking care of your loved one in a critical situation? We should always be striving to provide the best we can. We should always be pushing ourselves to learn more, understand more, and teach others more. We should always be educating the public, the community we are in, so that they understand we are more than just "ambulance drivers" and that there is a difference between EMT's and paramedics.

Being satisfied with the status quo eventually means that we slide backwards... we have to continually move forward and try to improve. For EMT's this means being the best we can be as EMT's, and learning everything we can from the medics we work with rather than bashing them, and hopefully, eventually becoming a medic. For medics, this means also being the best we can be, not bashing EMT's, and always trying to educate those who are trying to learn more.

And Wendy - phenomenal post... everything I wish I could have said and didn't have the words....

[CBEMT]

As I was departing, there was talk of JCAHO putting their hands into any EMS that was hospital-based.

My full-time EMS job is part of a JCHAO-accredited facility. We were DEFINITELY given the once-over at the facility's last evaluation (prior to my joining the staff).