Basics Doing Advanced Patient Care - Good Or Bad?

[Timmy]

I say thank god we only have Advanced Life Support and Intensive Care Paramedics were I come from!

[Just Plain Ruff]

One thing that cracks me up is that I am also a Medical Assistant. I was trained on EKG interpretation. I do not know if it is at the same level of a Paramedic, but I am aware of some interpretation. As a Basic, I'm not even suppose to touch the monitor. I can also give injections, as a Medical Assistant, not as a Basic (except the epi pen).

Diabetics give themselves injections, patients give them selves Lovenox injections, B-12 injections, do you think they had any kind of training? No, the nurse said, "Poke here."

Tracy, I mean no disrespect here but let me ask you this.

Do you know the actions behind the drugs that as a medical Assistant you are able to give? Do you know the pathology behind why one drug does one thing while another acts a different way.

Do you know why you are giving a medication to a patient or are you just going by what the MAR says to give? If you are just going around giving medications to your patients without knowing what that medication is really going to do for the patient then do you have any Business giving medications to anyone?

I'm a diabetic, I give myself daily injections of a medication called Byetta. It is to help me with my diabetes by lowering the blood glucose level as well as regulate my pancreas. It was developed from Gila Monster Venom. I know that if I take it on an empty stomach I know that my blood sugar will fall. I also knwo that a side effect (good one to me at least) of this medication is weight loss.

Using diabetics or heart patients that give themselves injections as a reason for you as a basic to be administering medications is an improper analogy. Those patients who are giving themselves medications usually are better versed on the medication than you are as a medical assistant and those patients are better informed of why they have to give the meds to themselves.

I don't understand why a medical assistant can give medications anyway. With no pharmacology or a very basic pharmacology knowledge I have seen medical assistants giving many injections yet they usually cannot tell me why they are giving the meds. Physicians do their patients a disservice when they have a person with no training in medications giving me or anyone else a med. That's a recipe for disaster and I'm sure that medication errors and adverse reactions occur with surprising frequency yet are not reported because they happened in the confines of a private physicians office.

Your argument that you can train someone to do something has been put out there but do you train that same person what to do when the unthinkable happens? I'll bet your training doesn't encompass that aspect does it?

Honestly, the thought process that a basic can do everything a medic can do SCARES THE HELL OUT OF ME. With 400 hours of classroom work and 48 hours on the ambulance, sure EMT's can do what I can do after 2 years of school and clinicals.

I guess the next thing the do more with less education group will advocate is Open heart surgery by Nurse Practitioners.

This is what gets me, we as a society want to get more for less. More money for less effort, more this for less of that.

What ever happened to working for it. To prove yourself and then getting more and more responsibility. We have raised a generation of "I want it now" kids who are now in society as a whole as "contributing" members but they want to take the short cut.

I went to school for 2 years to get my paramedic and when I see these people advocating for more responsibility on a EMT's training level, I want to say NO NO NO NO. I worked for my medic and they should also have to work for theirs. Am I holding those whiny little snots back from their dream, nope, not at all, I'm merely making a stipulation that they put in the same level of commitement that I did, and giving advanced skills to someone with 3 months of education rubs me the wrong way.

Tracy, I look forward to a reply.

[maverick56]

I went to school for 2 years to get my paramedic and when I see these people advocating for more responsibility on a EMT's training level, I want to say NO NO NO NO. I worked for my medic and they should also have to work for theirs. Am I holding those whiny little snots back from their dream, nope, not at all, I'm merely making a stipulation that they put in the same level of commitement that I did, and giving advanced skills to someone with 3 months of education rubs me the wrong way.

I agree with you 100%, Ruff. I do often start IV's and have intubated as a basic, however, I am currently 1/2 way through medic school and the medics know this. They also know my military background and are confident in my ability. We're actually encouraged to get as much skills and assessment experience as we can, whether we're working or on a scheduled clinical shift. Any such procedures are always under the medic's supervision and anything we do we have already covered in class and in clinicals. It's an integral part of the education process here. But every Joe-Blow Basic doing advanced skills, unsupervised and without the education to back it up? Goes against everything we're trying to overcome as a profession - we need to be more than trained monkeys with "skills", training without education is dangerous.

[uglyEMT]

I agree, basics shouldn't be doing Paramedic level anything. Yes we can assist the Paramedic with things, the local ALSes here encourage it, he gets the IV in while we hang the bag and get the drip flowing. Helping intubate we usually do but I haven't personally. Meds, we usually confirm dose and correct medication for our paperwork, I go a little further and ask the medic why. Its just information for my knowledge and nothing more but I like to know WHY something is being done and not just that it IS being done.

I feel the amount of time and effort medics put into their education and training shouldn't be diminshed to anyone. Yes are there a few things I personally feel a basic should be taught (the administration of asprin or starting IVs, not the meds just the IV line for example) and that the crash course EMT-B program should be lengthened as well as rotations in both the ER and in the Rigs. But I dont think everything should be taught in this manner.

I think a large problem thats out there now is the lack of civilian education as to what we actually do. These TV shows make it seem like everyone is a medic, we can do anything in the field, and we save people all the time. We were on a CPR call the other day using the AED while ALS was enroute and a family member wanted to know why were wernt starting IVs or reading ECGs (Im on a BLS only rig) like they do on House or <puke> Trauma. It made me ponder on our way back from the ED. People see these shows and think thats how it really is and it puts us all in a bad light when they think we are not doing something because thats what they did on ______ (insert show title)

[Lone Star]

Just as the EMT-I (or whatever the hell it's called in various states) is an inappropriate thing to have. For instance, in Oregon it is possible to go from nobody to EMT-I (which has a huge scope of practice...not a lot less than a paramedic) with only 260 hours of education. Think that's appropriate? Think that's a proper education for all that they are now allowed? The fact that people are starting to wise up to that fact and remove EMT-I's is great.

I don't know how things are done in the Pacific Northwest, but in GA, the EMT-I course (while combined with the EMT-B course) is 200+ hours IN ADDITION to the 120 or so hours of EMT-B. Since the EMT-B course must be successfully navigated first, by my figures; this equates to about 360+ hours to achieve EMT-Intermediate (and this is only the I/85 status). Here in GA, that’s what it takes to reach the MINIMUM level to be able to treat patients in the field. An EMT-B in GA usually does nothing more than chauffer (if they can get hired at that level at all!).

Said it before and I'll say it again: make the minimum for a paramedic a degree, and people will either fall into line or get out of the way.

This is a point that I’ve been trying to make for a while. Far too much of the emphasis on the curricula standards set forth by the D.O.T, NHSTA, NREMT and state and local governing boards for EMS place far too much emphasis on ‘minimum hours required’. This whole concept only serves to turn out students that have no real understanding of the human body, the systems that comprise said human body and how they actually function. By limiting this knowledge, we also limit the understanding of the effects of our actions and how they affect the various body systems.

The whole post by tracymae is so rife with misconceptions and errors in critical thinking; I don't even know where to begin!

Regarding knowing the physiology of modalities. The only cliche I can think of is "you don't know what you don't know."

While I was an EMT-B, I never understood this comment. As I delve deeper into my education, I find this statement to be more and more accurate. The EMS educational curricula structure is sound, each level is a building block placed on the level before it.

The biggest problem I have with the whole curricula is that its focus is only on the ‘minimal education needed’. This is especially evidenced by the ‘patch mill’ schools that are churning out the woefully under-educated EMT (at any level).

I admit to falling into the ‘We don’t need no higher education’ group as I started out on my EMS career. While I realized that the EMT-B was the thinnest part of that very fine line between the patient and ‘dead’, I felt that I had all the education I needed to go out and ‘save every patient’ that I came in contact with.

I won’t be the first ‘former EMT-B’ to ever agree with that statement, and I know I won’t be the last! As one progress through their educational process, they can’t help but come to the realization that “So THAT’S why we do that!”.

name='maverick56' date='22 June 2010 - 11:33 AM' timestamp='1277220801' post='244399'] training without education is dangerous.

This has got to be one of the best ‘in your face’ comments I’ve heard in a long time! While I don’t agree with some of the things in the post that comment came from, I have to say I LIKE that last line!

[Just Plain Ruff]

Sorry to revive an old post, but I was doing a search and found this topic... and I'm just blown-away. I can't understand why people would advocate only having paramedic level certifications! Paramedics are great for IFT's, less so for pre-hospital care IMO. And... not wanting to expand basics or intermediate levels. The majority of pre-hospital calls don't require paramedics! Are we in favor of saying that everyone in the hospital needs to be a doctor!? No, ridiculous! Basics - or at least intermediates - since this level requires clinical rounds - should start seeing IM or IN Glucagon, D5 and/or D50, IM or IN Narcan, pain control in the form of Nitrous Oxide, CPAP... glucometry, pulse oxymetry, etc... Mass has already stripped D5W from I's and is on its way getting rid of I's and not adopting the A-EMT standard, which makes me want to move. Everyone is loading their services with Medics needlessly and they're not getting any experience, but have substantially more ability to do harm. I say keep paramedics to a minimum in most urban or suburban 911 systems, they'll do just the calls that require them and keep them very good at what they do. The education needs to be expanded as well as the scope of practice for B's and I's. Or, I's to the as-and classify B's as Inter-Facility Technicians. And, how about doing away with the "Basic" "Intermediate" and "Paramedic" and call them "Paramedic 1" "Paramedic 2" "Paramedic 3"...

I'm just so tired of seeing services employ all ALS and dispatch ALS on every call. I'm think its a detriment to patient care and a waste of money and resources. Our job is not to fix patients, but to treat and transport sick people to the hospital in a timely fashion.

I can't believe I just read this drivel.

Can you give me valid statistics that most calls don't require a paramedic. A large majority don't but how many stroke or heart attack patients have been saved by a strictly BLS crew?? Oh that's right, you don't need a medic. Tell that to the heart attack patient who got the aspirin and the nitro and the morphine which put less strain on his heart and he got to the hospital in a timely manner.

ALS is not a waste of time. Your premise is flawed.

When you have a heart attack and the only crews available are BLS crews let's see how you feel then.

What about the diabetic who has a blood sugar of 20 and unresponsive? What the hell is a bls crew going to do for this patient other than give the "golden vapor - oxygen" and transport. All the while when the patient is unresponsive the bls crew is requesting medic back up.

Wow, why the heck did I open this thread to echo Bushy's response.

[tracymae]

Tracy, I mean no disrespect here but let me ask you this.

Do you know the actions behind the drugs that as a medical Assistant you are able to give? Do you know the pathology behind why one drug does one thing while another acts a different way.

Do you know why you are giving a medication to a patient or are you just going by what the MAR says to give? If you are just going around giving medications to your patients without knowing what that medication is really going to do for the patient then do you have any Business giving medications to anyone?

I'm a diabetic, I give myself daily injections of a medication called Byetta. It is to help me with my diabetes by lowering the blood glucose level as well as regulate my pancreas. It was developed from Gila Monster Venom. I know that if I take it on an empty stomach I know that my blood sugar will fall. I also knwo that a side effect (good one to me at least) of this medication is weight loss.

Using diabetics or heart patients that give themselves injections as a reason for you as a basic to be administering medications is an improper analogy. Those patients who are giving themselves medications usually are better versed on the medication than you are as a medical assistant and those patients are better informed of why they have to give the meds to themselves.

I don't understand why a medical assistant can give medications anyway. With no pharmacology or a very basic pharmacology knowledge I have seen medical assistants giving many injections yet they usually cannot tell me why they are giving the meds. Physicians do their patients a disservice when they have a person with no training in medications giving me or anyone else a med. That's a recipe for disaster and I'm sure that medication errors and adverse reactions occur with surprising frequency yet are not reported because they happened in the confines of a private physicians office.

Your argument that you can train someone to do something has been put out there but do you train that same person what to do when the unthinkable happens? I'll bet your training doesn't encompass that aspect does it?

Honestly, the thought process that a basic can do everything a medic can do SCARES THE HELL OUT OF ME. With 400 hours of classroom work and 48 hours on the ambulance, sure EMT's can do what I can do after 2 years of school and clinicals.

I guess the next thing the do more with less education group will advocate is Open heart surgery by Nurse Practitioners.

This is what gets me, we as a society want to get more for less. More money for less effort, more this for less of that.

What ever happened to working for it. To prove yourself and then getting more and more responsibility. We have raised a generation of "I want it now" kids who are now in society as a whole as "contributing" members but they want to take the short cut.

I went to school for 2 years to get my paramedic and when I see these people advocating for more responsibility on a EMT's training level, I want to say NO NO NO NO. I worked for my medic and they should also have to work for theirs. Am I holding those whiny little snots back from their dream, nope, not at all, I'm merely making a stipulation that they put in the same level of commitement that I did, and giving advanced skills to someone with 3 months of education rubs me the wrong way.

Tracy, I look forward to a reply.

You completely took everything I said the wrong way. Maybe it was my rambling. I DO NOT BELIEVE I SHOULD BE ALLOWED TO PERFORM ALS AS A BASIC. I do believe that people can be trained. I have had pharmacology, it was pretty extensive. When I discussed being a Medical Assistant, compared to an EMT, it was in the context of being able to do things as one and not the other. It was not being compared to being a medic or wanting to get training and not work for it in medic school.

There have been several posts regarding how useless Basics are. If you do not have the basics skills then you have nothing. My point is that why do medics feel the need to degrade a basic when if you don't know the ABC's your Narcan and D50 do not mean squat.

I do know why I give injections and what the indications and contraindications are and what to do when something bad happens. I have instructed patients many times on the use of home injections. It was probably a Medical Assistant that trained you on the use of Byetta. I am completely aware of it and its uses. As a Medical Assistant, I am required to obtain CEU's and on going training. Although there are many Medical Assistants who were grandfathered it. I am not one of them. I went to school for 2 years as well for Medical Assisting and Medical Office Management (and a couple of other degrees that have nothing to do with this). However, I do not think that I am better than anyone else because I have a higher education or higher skill than anyone else. I used the example of the First Responder. I do not feel that I am better than them because I am one level higher than them. And I do not feel that they are useless or that I would not want them to respond to MY emergency. They are trained on ABC's and that is the most important thing with any call. It is nice to have I's and Medics, but with out the ABC's, there's a dead patient. That was my point.

My post did get to be a lot of ramble. Mostly out of frustration. I see posts everyday about the respect EMS demands, yet EMS professionals do not respect each other. Much like the Medic/RN relationship. Each thinks they are better than the other. The RN feels that the Medic is full of crap because the RN had a more extensive A&P and Pharmacology course. I have been in the medical field since I was 14. I have seen the bickering and it makes me sick. I am here for the patient. Not to show off my credentials.

I was also a Transplant Coordinator, which was on the job training. They usually require RN's, LPN's, or Medics. I was fortunate to have a fabulous mentor that taught me everything I needed to know. I did not perform ANYTHING if I did not know what I was doing or what the consequences were and what to do if something else needed to be done. I assisted in many organ recoveries, inside the body cavity, all with an associate's degree, AND a lot of mentoring. I'm just saying it's possible. It may not be something that everyone can do. I also built a kidney preservation lab for the number one rated hospital in America, because there is no training or manual on kidney preservation. I learned what I know by trial and error and mentoring with physicians. There is no school for it. So, when I said that people can be trained, I was not speaking of all basics or that they should be. I was just saying that I was able to be trained.

So, once again, I was not advocating for Basics to provide ALS. I was rambling on about how it's all fine and dandy that you can start an IV and give Narcan, but that doesn't mean crap if the person doesn't have an airway. Being a higher level of care does not mean you are more important. ALL EMS PROVIDERS ARE IMPORTANT. That was my point. If EMS wants respect from the public and other public safety professionals, we should respect each other first.

Don't take what I am saying out of context. Unfortunately you do not know me, you do not know the type of person I am, or how I convey myself. I stated in my first post that I was not looking for a bunch of haters. It was a post to open peoples eyes to respecting each other in OUR field. I am not hating on Medics or nurses, your skills or knowledge, and I am not saying that you are unimportant. I am not looking to come kick your ass, but I will if I have too! That's a joke. I am also very sarcastic. You just do not know me to understand the way my words are flowing,

It is very difficult to convey in writing, much like a text. Why can't we all just get along!?!?!??! Maybe that's all I needed to say in the first place. Good day to you!

I don't know how things are done in the Pacific Northwest, but in GA, the EMT-I course (while combined with the EMT-B course) is 200+ hours IN ADDITION to the 120 or so hours of EMT-B. Since the EMT-B course must be successfully navigated first, by my figures; this equates to about 360+ hours to achieve EMT-Intermediate (and this is only the I/85 status). Here in GA, that's what it takes to reach the MINIMUM level to be able to treat patients in the field. An EMT-B in GA usually does nothing more than chauffer (if they can get hired at that level at all!).

This is a point that I've been trying to make for a while. Far too much of the emphasis on the curricula standards set forth by the D.O.T, NHSTA, NREMT and state and local governing boards for EMS place far too much emphasis on 'minimum hours required'. This whole concept only serves to turn out students that have no real understanding of the human body, the systems that comprise said human body and how they actually function. By limiting this knowledge, we also limit the understanding of the effects of our actions and how they affect the various body systems.

The whole post by tracymae is so rife with misconceptions and errors in critical thinking; I don't even know where to begin!

While I was an EMT-B, I never understood this comment. As I delve deeper into my education, I find this statement to be more and more accurate. The EMS educational curricula structure is sound, each level is a building block placed on the level before it.

The biggest problem I have with the whole curricula is that its focus is only on the 'minimal education needed'. This is especially evidenced by the 'patch mill' schools that are churning out the woefully under-educated EMT (at any level).

I admit to falling into the 'We don't need no higher education' group as I started out on my EMS career. While I realized that the EMT-B was the thinnest part of that very fine line between the patient and 'dead', I felt that I had all the education I needed to go out and 'save every patient' that I came in contact with.

I won't be the first 'former EMT-B' to ever agree with that statement, and I know I won't be the last! As one progress through their educational process, they can't help but come to the realization that "So THAT'S why we do that!".

This has got to be one of the best 'in your face' comments I've heard in a long time! While I don't agree with some of the things in the post that comment came from, I have to say I LIKE that last line!

triemal04.......you should read my post again. I am NOT advocating that Basics provide ALS. The major post was to support respect between the different levels of care. You are the reason EMS does not receive the respect it is demanding. My point is that it is great that you can push meds, but without the ABC's you have a dead patient, so why do you feel the need to rag on Basic level EMT's. I was not advocating that I deserve to do things outside of my scope of practice. I was comparing levels of care with in the health professions. Such as, a Medical Assistant and EKG's. I find it ironic that an EMT-Basic is not taught any interpretation and is not taught the use of a 3 lead or 12 lead.

I am rambling again, because there is so much frustration. You think you are better than a nurse too, just like they think they are better than you.

Be nice to each other in the field and the public and other public safety professionals will be nice to you! I bet you hate to be called an ambulance driver!

I've traveled the country on organ donation. Perhaps you gained some CEU's from me for an elective. You have no idea what my critical thinking skills are. Ok, I have wasted too much of my time on you already. Check out my reply to the first hater I had. He was much more cordial. You totally missed the mark, you may need a critical thinking refresher course. Read the whole, not just want you want to see bro.

[Just Plain Ruff]

[

First off Tracy, you started this.

You said that medics are nothing without basics. I believe that that was your direct quote or at least close to it. But re-reading it I realize that you said that medics are nothing without knowing the basics. Your use of semantics threw me and for that I apologize.

You also call me a hater. I am nothing of the sort. I simply asked you to respond to what I called some glaring misconceptions that you posted in your reply to the thread. Before you start calling me a hater you should get to know me better. You joined a month ago so you don't know me nor my thought process. So don't call me a hater.

You also arrogantly stated in your thread this "P.S. Don't be hating on me because I can intubate as a Basic in Ohio! :-)

Don't be hating on me now! I'm a newbie:-)"

That to me was gloating that you can intubate as a basic in Ohio and I find that scary that basics can intubate. But that's another thread topic if you ask me.

Plus, why do you assume that just because I'm a medic I've forgotten the basics. You made a lot of assumptions on your thread.

I know a lot of basics out there who don't even know the basics. To put als procedures (which I feel Intubation is a advanced skill) in the hands of someone who has less than a semester of college is just wrong. Sorry if that rubs you the wrong way but that's my belief. you can disagree with that thought process but sorry that's my opinion.

As for the assumption that you have on who gave me the byetta instructions, I was taught by my personal physician about the medication. A medical assistant did not have to show me how to give myself a injection. My physician is the one who educates all her patients. She runs a small practice. I do know in other practices that medical assistants play a vital role in the practice and they give education out all the time. That's a good thing if they themselves are taught right.

Your post in my opinion was arrogant and full of misconceptions. Again that is my opinion.

I do appreciate you calling me a nice hater though.

[BushyFromOz]

My point is that why do medics feel the need to degrade a basic when if you don't know the ABC's your Narcan and D50 do not mean squat.

Your point is irrelevent.

The people here do not "hate" basics, they dislike the certification that is EMTB. It, and any other position similar to it in developed 1st world countries is nothing short of criminally and professionally negligent in what is supposed to be a medical profession. More over, medics will degrade other medics who do not perform their job properly, so be still your bleeding heart because another medic would just as soon rip me a new ass for being incompetent as they would any basic.

Lets be clear, any provider that cant do their ABC's is useless no matter what their certification is, ergo, your point that medics forgetting ABC's is irrelevant.

Furthermore, the multi tiered EMTB, EMTB IV, EMTA, EMTI whatever other title you can come up for what amounts to first aid with some "Kool skilz lolz", the system some of you people are so proud of is not the norm, it is either an anomaly in the rest of the world or becoming an antiquated half arsed measure that remains because of 2 reasons - people are resistant to change and buearocratic bean counters trying to save a buck, it never has ANYTHING to do with patient care.

However, I do not think that I am better than anyone else because I have a higher education or higher skill than anyone else.

Damn right, you should be better than them, and if your not better than them hand your cert back in. Just as the intensive care guys should be better at my job then i am, in fact, i expect them to be better than me. If there is any your going to be the highest clinical level or in control at any scene, you are automatically placed in a position of leadership and responsibility, there fore you should be better than those below. And yes, i do think i am better than a nurse at my job. Whether or not I choose to be an arrogant ass about it though is a different matter.

if EMS wants respect from the public and other public safety professionals, we should respect each other first.

If EMS wants respect from HEALTH PROFESSIONALS and the public, we need to have a modern evidence based approach to complex patient management, which includes when NOT to intervene, based in solid educational framework that caters for the actual need of our stakeholders, and that includes lobbying governments and national collegiate's to get rid of these half arsed certifications right around the globe. You show me an EMS system worth having and ill show you a system where ambos are educated in years (not months or hours), registered with a collegiate who provides a proper continuing education program, proper effective clinical governance and the ability to actually treat the patients they attend.

Wait wait....here, i have one for you to think about....

I don't have the links to the evidence but I'm gonna post it anyway, you'll say prove your case, i say prove me wrong

In nearly EVERY system, the single most prevalent reason why people call for an ambulance is acute pain. Therefore, any provider who is incapable of providing effective pain relief is pointless, useless and promoting suffering and is NOT meeting the actual needs of the majority of patients.

Medics here don't hate basics, medics here cant fucking stand mediocrity

I say thank god we only have Advanced Life Support and Intensive Care Paramedics were I come from!

Seriously dude, some days in here i REALLY appreciate what we actually have. Edited June 23, 2010 by BushyFromOz

[aussiephil]

Medics here don't hate basics, medics here cant fucking stand mediocrity

Bushy, if they cant stand mediocrity, why do they put up with me, I mean, I strive for mediocrity!!!!!