Paramedic/EMT or Dual Paramedic

[Alex Woo]

I've worked Dual Medic in NYC, Solo Flycar in Westchester, Rockland, and Orange, & Dual Flycar in Rockland. It has its pros & cons but I did like the Solo Flycar the best...

[tniuqs]

I've worked Dual Medic in NYC, Solo Flycar in Westchester, Rockland, and Orange, & Dual Flycar in Rockland. It has its pros & cons but I did like the Solo Flycar the best...

So how do you like working an arrest by yourself ?

[Richard B the EMT]

Presumption on my part, but probably the EMTs were pumping, while the Paramedics "played with the plumbing", i.e. establishing IV lines, and setting up the 12 lead EKG.

No offense intended to any Paramedics or ALS providers with that statement, by the way. I'm BLS, and spent much time "pumping" while the Paramedics did their part of on scene treatment, just the pecking order, is all.

[tniuqs]

Richard: It was moreover a query to the single Medic Fly Car as this was Mr Woo's preference .

Just wondering how he managed to provide ALS in a single person capacity, this is leading towards something, to be quite honest.

cheers

[kndoug1]

Hi everyone.

So, I'm curious. Throughout my internship, which is coming to an end soon, I've worked with my preceptor and his partner who are both paramedics in a large service that runs dual paramedic trucks. They do hire EMTs part time if you're in paramedic school (I work part time for them as well, sort of) and are about to hire several EMTs full time. But so far, my only interaction with a BLS crew has been during an ALS intercept for a BLS only truck coming in from the next county over.

I've never worked with an EMT before in an ALS capacity, and pretty much all of my exposure has been in a dual paramedic setting, so I'm curious as to what kind of staffing your services maintain, and your own experiences working on paramedic/EMT and dual paramedic trucks. What are the benefits/cons to each model? Do you have a preference?

So I've been looking through this conversation and I am amazed at how different each state is. I recently finished EMT school and did several ride outs on both ALS dual medic rigs as well as BLS medic/EMT rigs. There are pros and cons to each. I spent 3 days on a BLS EMT/Medic rig and I noticed that the EMT really doesn't do much. The medic really does to everything...all the EMT does is hand them things and drive. However, it is a great learning opportunity for the EMT. The crew that I was with, the EMT asked a lot of questions and seemed to be gaining as much out of the calls as I was as a student, and he had been with the company for over a year. So it's good from a learning standpoint, but other than that, I find that the realationship between the ALS and BLS providers on the rig are not so great. And, when you are going code 3 to the hospital and your patient crashes, I have seen that that is much easier to deal with when you are on a dual medic rig. The BLS/ALS combo rigs make it hard becuase of the limitations of the EMT. I spent 3 days on a dual medic rig at the local fire station as well, and not only were the relationship between partners better because there was no "I'm better than you" attitude, but the calls ran smoother because BOTH people were able to do the same things for the patient. Both were able to start lines, give meds, etc, so if one would start something, the other could finish it no problem. Here in California, out FD run dual medics, but most other private ambulance companies will run ALS with 1EMT and 1 Medic or sometimes dual medic...but they only run BLS with 2 EMTs... After being on both rigs, I have found that being on the dual medic rig to be much more beneficial to all because, like I said, there is no "I'm better than you" or "I'm in charge". The patients on the dual medic rigs seemed to be more at ease, and I think that largely was due to the fact that no one was there for no reason. Everyone was doing somthing to help the patient, so the patient could feel confident that no matter who ended up staying in the back with them, that they would be taken care of...but that's just a personal observation.

[Richard B the EMT]

KNDoug1, It is not just differences between US States, or Canadian Provinces. I live in the Queens County section of New York City. My local section has the county line to Nassau, where A-EMTs can start IVs. However, if one of these A-EMTs should wander over the county line into Queens, the same A-EMT is not recognized as one who is allowed to start an IV.

Note my mantra below. Follow local protocols.

[Kiwiology]

We generally have two Paramedics (ILS) or one Paramedic and one Intensive Care Paramedic (ALS)

There should be at least one person on a vehicle who can interpret an ECG, start a drip and administer at least a basic range of drugs eg adrenaline, salbutamol, GTN, glucose, morphine .... two is better.

[Alex Woo]

Well first of all Happy Holidays.... Hope all was well & all the best for the New Year...

I was working Westchester EMS; where we provided solo fly car ALS. Each solo unit covered 35 to 4 Sq Miles. The EMT/Ambulance were all volunteer.

I remembered in 2006; I responded to a home w/ an elderly male who was having an MI. I'd BLS'ed n ALS'ed him; waiting for the Amb but there were Volunteer FD who hadd arrived and they were gr8t. They'd assisted w/ V/S and O2 tanks but foremost hands. When the Amb came; the pt decided to go into VT arrest and I unsync'ed cardioverted him twice; he stablized and was alert n txpt'ed him 30mins away to the nearest hosp.

What I'm saying is that it depends on all ppl onscene. Solo was fine because the BLS/FD were good & they cared. Most were gr8t because they listened. I had fun in my 3 yrs at West EMS. I was confident and was open-minded which made me a very gd Medic; I never panic and was able to lead.... Dual or Solo; it all depends on the person from BLS to ALS....

[AlbertaEMT]

So, as a rural EMT with ALS chase available let me tell you how my Christmas Eve went. Had a cardiac arrest. EMR level fire is on scene performing CPR. My EMR partner and I (EMT) arrive and note CPR in progress with AED. I run a 4-lead to determine Asystole (AED keeps barking "no shock advised"), gain IV access, insert King LT airway, and continue to monitor the 4-lead and more or less supervise CPR (we had many hands) until the ALS unit arrives almost 30 minutes later to pronounce. ALS did no interventions at all based on time down and definitive signs I mentioned to him when he got on scene.

Now, I applied to Paramedic school much earlier this year and was denied admission because I have no ALS experience. We are a BLS only service at this time. Although, I have had Paramedics in our higher levels of command tell me they prefer to work with rural EMT's because our skill levels are usually higher. Even more so when I am the highest level on 100% of our calls until ALS chase shows up, which is usually between 20-30 minutes. But, has at times been longer. Now, you may ask why we are waiting on scene for ALS to arrive. But, if ALS is en route and intercepts with us, we would have to coordinate which route ALS is taking to scene, where they will leave their vehicle, how we will return them to their vehicle, etc. In the case of STARS (Helicopter Medivac), it is generally better to remain on scene where we have an established LZ.

So, I have no "experience" assisting ALS on a regular basis. But, I am the person that provides practically all the medical care to patients I am called to . There is the occasional call I can give to my partner, but they are few and far between.

I should also mention that we respond to areas that take us almost an hour to respond to in summer weather conditions. And the nearest ALS is 45 minutes from our home station in the opposite direction.

[tcripp]

Now, I applied to Paramedic school much earlier this year and was denied admission because I have no ALS experience.

Okay...I'm lost. Isn't a paramedic = ALS? If so, how can you have ALS experience in order to attend a school to become a paramedic?

No sarcasm here...