Basics Doing Advanced Patient Care - Good Or Bad?

[Timmy]

Your comments remind me of my younger days on this site! I was 16, had basic life support qualifications and got a little over excited/naive on many occasions. I do, on the odd occasion reflect on my past posts from many years ago and feel nauseas at some of the stupid things I wrote but appreciated the blunt advice given to me by senior providers on this site. I then became a student paramedic and my world came crashing down! It appeared that in reality I knew nothing at all and soon learnt to grow up.

I’m now 20 and have a Diploma of Paramedical Science, Diploma of Nursing and front line emergency care qualification and I still know nothing… I’m also a second year Bachelor of Nursing student and still dread killing someone in an exam because I don’t have enough knowledge… In reality I’m never going to know it all but I’m doing my damn best to become the best health care professional I can be and to provide the highest level of care to optimise positive patient outcomes. After next year, providing all goes well with the nursing degree I hope to start on a paramedic degree.

I’m only an LPN (I think that’s what you Americans call it) I really have no experience, defiantly have minimal ALS experience. I’ve worked in a sub acute hospital for 18 months doing my Diploma of Nursing through hospital based training, as soon as you mentioned anything ALS everyone went weak at the knees. I’m trained to cannulate, insert nasogastric tubes, insert LMAs, catheterise and so on but rarely get a chance because the RNs frown upon LPNs doing anything above basic patient care. They’ve only recently improved the LPN training to run in line with the nursing degree but most RNs refuse to acknowledge our existence. But when I think about it, what would I want if I was sick? A young LPN with 2 years training or a RN with a 3 year degree and graduate education?

Back in the day I thought my volunteer events first responder service was the bees knees, now I spend most of my time bickering with our headquarters about improving our education, training and recourses because quiet frankly, the quality of some first responders is laughable. I still volunteer with this organisation, in fact I’m actually a manager… You ask why? I also asked my self the same question when I was assessing a group of Nuff Nuff’s in there vain attempt to gain a basic resuscitation certificate (AED, BVM, OPA) running around the room like a pack of morons, they clearly had no idea or understanding and subsequently didn’t pass. Perhaps I’m fighting an up hill battle in thinking I can make a difference to the quality of education, skill and person who is given a uniform and placed in a position of authority only to have the State Paramedics laugh in our face every time they come to transport a patient a hospital. I now only roster my self on with members who are competent and have some idea on how to provide good patient care. I mean, this organisation has some pretty major event contracts that are worth BIG bucks, yet they don’t have the number of volunteers to staff such events which means they let the Nuff Nuff patrol out of there box…. Don’t get me wrong, 90% of this organisation is ok, we do have quiet a number of well known Paramedics, Nurses and Doctors who volunteer but it only takes one Nuff Nuff to screw up all the good work. Then I look at the American system, your emergency EMT’s are less qualified than our volunteer event standby first responders so maybe things aren’t so bad…

So in conclusion, I’m sure what I’ve written is pointless but I can speak from experience… Having BLS doing emergency care is not the best move. There needs to be a greater level of education and training to be fair to the people your providing care to.

[uglyEMT]

So I would be a sub Nuff Nuff. what would that be a Duff Nuff

Seriously though.... My school instructor I think said it the best.

" After this 120hr class you will be expected to save people's life, a hair dresser's class is 400hrs, I guess their hair is more important!!"

I think a truer statment has never been said. 120hrs of class time and we are thrown out into the world as EMTs. Definatly feel we should have ALOT more education and training. Some folks want more responsiblities with their "education" level In no way shape or form should it happen.

[Lone Star]

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.

tracymae,

What I find disconcerting is the fact that you’re giving triemal04 hell, but you’re quoting MY post. I can’t figure out who you’re actually replying to. In the post you’ve quoted, (mine), I can’t see anything in there about ‘hating basics’. If anything, I’ve revealed the thought process I had at the time I got my EMT-B. I’m not the first EMT-B to think like that and I won’t be the last to think like that. Just because I can look back and relate the errors in my thinking at the time, does NOT qualify as ‘hating Basics’. I was an EMT-B for 12 years. I think that more than qualifies me to be able to point out the errors of my own thought processes at the time!

I’m sure that you’ve had to have some sort of education above and beyond EMT-B to become a Medical Assistant, and a Pathology Assistant. We would presume that with that ‘higher educational level’ you of all people, should be able to see how woefully undereducated the EMT-B really is!

With the credentials you’ve stated, I find your lack of attention to detail concerning, to say the least!

Seriously though.... My school instructor I think said it the best.

" After this 120hr class you will be expected to save people's life, a hair dresser's class is 400hrs, I guess their hair is more important!!"

I think a truer statment has never been said. 120hrs of class time and we are thrown out into the world as EMTs. Definatly feel we should have ALOT more education and training. Some folks want more responsiblities with their "education" level In no way shape or form should it happen.

When EMT-B’s feel that their education isn’t ‘enough’ ….that’s got to say something!

It’s not that EMT-B’s are hated on this site; it’s the ones that think they can save the world with their minimal education. I’ve been through the EMT-B course twice now, (the first time about 14 years ago, and again about a year ago): I can see how much it’s changed and how much more ‘inadequate’ it’s become!

In retrospect, seeing how minimal the EMT-B course has become: the idea of expanding their scope of practice based on this curricula, is insane at best.

[Timmy]

So I would be a sub Nuff Nuff. what would that be a Duff Nuff

Not at all, I've never meet you or worked with so so I don't pass judgement.

So I would be a sub Nuff Nuff. what would that be a Duff Nuff

Not at all, I've never meet you or worked with so so I don't pass judgement.

[uglyEMT]

Not at all, I've never meet you or worked with so so I don't pass judgement.

Not at all, I've never meet you or worked with so so I don't pass judgement.

Its all good Buddy I was just joking with you had one of my HAHA moments but as usual type does not come across as well as in person.

[uglyEMT]

When EMT-B's feel that their education isn't 'enough' ….that's got to say something!

It's not that EMT-B's are hated on this site; it's the ones that think they can save the world with their minimal education. I've been through the EMT-B course twice now, (the first time about 14 years ago, and again about a year ago): I can see how much it's changed and how much more 'inadequate' it's become!

In retrospect, seeing how minimal the EMT-B course has become: the idea of expanding their scope of practice based on this curricula, is insane at best.

It really does Lone Star. I felt I was a disservice to the public at first and sometimes feel I still am. I know experience has alot to do with it as well but as far as education alot I feel is just glossed over. 1 day for peds a day for burns we spent more time learning to fill out a PCR and how to ask a patient to treat them then we actually learned vital stuff like BP and lung sounds. The education needs to come up and if it does I feel alot of the "I can save the world" types will fall bny the way side. The class I took had a very high attrition level, 68%, and I noticed the ones failing or droping out were the ones that thought they would just get by under the radar and when you talked to them about calls they were on or what-have-you unless it was a major trauma the call wasnt worth their time. I actually had someone tell me it was a crappy slow night because all they got was a stupid guy in respitory failure yet it was a "cool" or "great" night if there was an MVA even if everyone RMAed needless to say that guy didnt last long.

After speaking with many of you on this site from out of the country I do feel we are under educated by a long shot. We need PROPER education especially on the basic level. Honestly I feel it should be a college course, 120hrs clinical and ride time, and finally get rid of the basic title and have it as EMT, Paramedic. Combine the B and I catagories and as stated previously make the cert a college course. I would leave the 120hr course for the high schoolers that want to see if they want to be EMTs. Not a certification by say a permit of sorts. Let them go through it, PASS, and issue a permit of sorts to allow them on squads or ride along (no patient interaction other then verbal) and get a true feel for what we all do. Then if they want it by all means get into the real course work and become a certified EMT.

Doing all that I think will weed out alot of the problems. But so far with todays current teaching, HELL NO, do not add more ways to kill a patient to the list. I did add on another thread though that (well in NJ anyways) checking glucose levels shouldn't be a paramedic level thing. I feel as a basic we should be able to put a drop of blood on a strip and press on.

That brings up another problem I see today. Nothing is the same.. what is allowed in county A is disallowed in county B (or state for that matter) It should be nationally uniform. I was part of a bistate terrorism training excercise about a month ago and OMG what a cluster. Some EMTs were doing things that they normally do in their SOP while others were not allowed to do in theirs and it took a while for the Coordinators of each triage area to finally just find the right combinations of folks to get the job done. Not saying it didnt work or wasnt a good exercise but took a little while, but then again this was good because the folks running the thing took alot of notes as to update their "playbook" so to speak.Would just be a whole lot easier if it was uniform. Just look at FF all their training is universal so they can go to another country and still fight a fire effectively alongside another. Picture a basic going to another country we would be laughed at, either that or patted on the head and told good boy go sit over there and let me do it.

Again these are my personal feelings and observations as a basic and nothing more. I kow it seems like I am being a *&^% but thats the way I see it, we have peoples lives in our hands with 120hrs under our belts.

[Lone Star]

Well said!

I've long advocated a 'national scope of practice'. Aside from some minor deviations, I would presume that every other professional in the Allied Health Care field has pretty much the same scope of practice; whether in New Jersey, Florida, California or somewhere in between. This is a step that D.O.T/NHSTA/NREMT/NAEMT needs to take.

While firefighting training/education isn't quite 'universal'; it IS close enough that I could fight fire in GA with little effort in school, since I was certified in MI.

Some 'advantages' that the Fire Service has over EMS include:

1) They are governed by appropriate agencies. EMS should be governed by an entity similar to the AMA, since what we do is MEDICAL in nature.

2) The Fire Service has moved on from the whole "My title is more impressive than yours, so I get to be in charge!" mentality. While most departments have a 'universal rank structure', there are some 'deviations' (just what in the heck is a 'Water Sergeant' anyway?). Ultimately, they have a set structure to their hierarchy. EMS is still trying to create new 'certification levels' rather than just adopt a 'universal set of titles'. Granted we ARE included (even if indirectly) in the medical field, do we REALLY need 'specializations' in the field? The Doctors have earned all that 'alphabet soup' after their names because of YEARS of formal education. Do we really need to flaunt the 'certifications' we've attained after mere HOURS of education? (And the bare minimum hours at that!)

EMS really needs to get past the "Me got bigger title, Me hero!" chest thumping and wake up to the fact that we are SEVERELY undereducated. The sooner that we admit this, the sooner we take a giant step toward being recognized as deserving the respect of professionals! As long as EMS resists this; the longer we will be treated like the 'bastard stepchild' of Emergency Services, and the illegitimate offspring of the medical profession.

[Aeromedic]

This is an issue that has always been near and dear to me. I have read a lot of "Monkey Skills" comments, and yea, starting an IV or Intubation aren't that hard to do. But the time spent in class learning When to do it, How to do it right and most importantly, How to fix it when something goes wrong. Do I think EMT-B's should be trained to set up 3/4/5/12/15 leads, Heck yes. Emphatically, yes, do, please, but not in a diagnostic capacity. If I intercept, have an initial strip to look at, great. If I can have a 12 lead set up for me while I'm getting a line, doing a history, etc... great. Worst case scenario with a bad 12 lead placement is I get a useless strip. If they weren't trained, I wouldn't get a strip at all. All this being said, ECG's are a different animal from Drugs and invasive procedures.

Lives are saved with BLS. Maintain Airway, Assist Breathing, Start CPR, Control Bleeding. Drugs are nice, drugs are good, but they can't replace rock solid BLS skills. Everybody has a place in EMS, and if B's were useless, we wouldn't have them. A lot of it comes down to cost. Medics are expensive to train, to hire, to pay and most of all, to outfit with all the goodies that they need. A Basic car to rapid respond, rapid transport and run with an AED and be able to pre-place for 12/15 lead makes a HUGE difference in EMS. If I can get to an intercept with an initial strip, patient packaged and ABC's looked after, I've got it made.

A lot of this debate comes down to one of my biggest pet peeves... Overuse of ALS Skills. Not everybody needs an IV, and sometimes Oral Glucose is just as good as D50. The only drugs that NEED to be carried all the time are Epi and Oxygen. Those two save lives hands down. Cardiac drugs are nice, but they don't always work. Pain control is nice, but it can create huge headaches if you aren't COMPLETELY sure of your assessment pre-administration. Any ALS drug kit can kill somebody in countless ways (and it does sometimes), and that is with trained paramedics. I personally think this debate is less about skills and saving lives and more about feeling important and "needed". ALS Guys/Gals need to give BLS Guys/Gals credit for their work more often and show more appreciation, and most importantly, keep in tune with their BLS roots.

Those are just my thoughts on it though.

[JakeEMTP]

What we need to do is forget this BLS/ALS Bullshit. It is all pt. care. If I was the pt., I would hate it that an ambulance shows up and can offer me O2 and a ride. I would deserve a educated assessment by a educated provider and if I needed further interventions, then I could get them then. Not wait for the ALS truck to show up.

Aeromedic, I'm surprised you don't have more confidence in your pt. care abilities. From your post it sounds like your more concerned with making mistakes than treating the pt. I can get a 12-lead in less than a minute. I don't need someone to do it, although it is nice. We ride double medic here. Everyone gets a thorough assessment and immediate transport and interventions if required. Does every pt. require advanced interventions? Of course not. However, when they are, pt. care is not delayed because we're waiting for advanced providers to get there.

Another thing, Basics are for the most part, unable to determine if an intercept is necessary due to their lack of education. Another reason to have all further educated providers. In most Countries, EMT-B's wouldn't be aloud on a ambulance due to their limited education in EMS. Why do we allow it here?

Anyway, these are my thoughts. After being a member here for a considerable amount of time, and having taken part in many of the same debates as this, I think I'm done with this thread.

[BushyFromOz]

Dude, you have completely missed the point like the last monkey did

This is an issue that has always been near and dear to me. I have read a lot of "Monkey Skills" comments, and yea, starting an IV or Intubation aren't that hard to do. But the time spent in class learning When to do it, How to do it right and most importantly, How to fix it when something goes wrong. Do I think EMT-B's should be trained to set up 3/4/5/12/15 leads, Heck yes. Emphatically, yes, do, please, but not in a diagnostic capacity. If I intercept, have an initial strip to look at, great. If I can have a 12 lead set up for me while I'm getting a line, doing a history, etc... great. Worst case scenario with a bad 12 lead placement is I get a useless strip. If they weren't trained, I wouldn't get a strip at all. All this being said, ECG's are a different animal from Drugs and invasive procedures.

You have not presented any argument here that an ALS provider cant do.

Lives are saved with BLS. Maintain Airway, Assist Breathing, Start CPR, Control Bleeding. Drugs are nice, drugs are good, but they can't replace rock solid BLS skills.

Again, nothing here that an ALS provider cant give

Everybody has a place in EMS, and if B's were useless, we wouldn't have them. A lot of it comes down to cost.

Really? then why are other countries dropping 'basic" type providers off their vehicles. This garbage isn't the norm,, you just too lazy or comfortable to move the self imposed US status quo

Medics are expensive to train, to hire, to pay and most of all, to outfit with all the goodies that they need. A Basic car to rapid respond, rapid transport and run with an AED and be able to pre-place for 12/15 lead makes a HUGE difference in EMS. If I can get to an intercept with an initial strip, patient packaged and ABC's looked after, I've got it made

Again, nothing an ALS car is not capable of providing, other than you get out of doing some work

Overuse of ALS Skills. Not everybody needs an IV, and sometimes Oral Glucose is just as good as D50. The only drugs that NEED to be carried all the time are Epi and Oxygen. Those two save lives hands down.

Aspirin? corticosteroids? CPAP to name a couple. We don't carry this stuff for shits and giggles you know, it either sustains life, or reduces morbidity and mortality, either or its better for the patient. If your only out to save lives and forgetting about easing suffering and improving outcomes you've got rocks in your head.

Cardiac drugs are nice, but they don't always work.

Oh come on now, do you really believe this is a valid argument? We know that early intervention in cardiac conditions improves outcomes

Pain control is nice, but it can create huge headaches if you aren't COMPLETELY sure of your assessment pre-administration.

Pain control is essential. To not provide it is inhumane, barbaric and downright negligent

Any ALS drug kit can kill somebody in countless ways (and it does sometimes), and that is with trained paramedics.

I personally think this debate is less about skills and saving lives and more about feeling important and "needed".

Wrong it about providing appropriate ASSESSMENT and care by appropriately educated health professionals. Its like that assinine argument "Its only GTN"

I bet i can kill someone quicker with GTN than any other drug in my kit.