"First Responders" on Ambulances

[scott33]

ZippyRN wrote: first respondershave ap lace - but that place it probably best met by current US EMT_B qualified staff

ZippyRN wrote: i'm not sure there is a place for providers with 120 or so hours of training on emergency ambulances

Firstly, the EMT-B should be seen as just that... a basic EMT. An introduction to prehospital emergency care.

However, (Zippy) comparing them to UK FR's or SJA AA2 is doing EMT-B's a discredit. I am not going to have a go at either, but I think you personally, are basing your opinion solely on the basis of training hours. You said in another post, it took you 6 years to become part of an ambulance crew in SJA. ("SJA member for 17 years, 10 as an adult member 4 as ambulance crew"). It shouldn't take 6 years to get on a rig; you could be an MD in that time. I assume you took a leave of absence.

The EMT-B curriculum is normally covered over 6 or so months (not including pre-entry requirements of various corps / FD's; which in my case, included the equivalent of FAW and FPOS). All final practical assessments for the EMT-B (from a random 15 or so stations) are taken in one day. There aren't separate courses / modules for AED, splinting, spinal immobilization, moving and handling, trauma & medical assessment, med gasses etc (as there are in SJA). It's all covered in 1 course. The written final covers any, and all, of the above.

This 1 course also includes hospital-base clinical rotations, and precepted ambulance practicum assessments, through having current status as a riding member of (or affiliation with) an ambulance corp / FD. This adds considerably to your much-quoted figure of 120 hours, which is for classroom time alone.

EMT-Bs can also use (with some state additions or restrictions):

· Nebulized albuterol

· Epi-pen, epi SQ

· Blood sugars / Oral glucose

· Activated charcoal

· Pediatric AED

· GTN / ASA for C/P

. Combitube

. PASG

They can:

· Pronounce life expired

· Request medivac at their own discretion

· Set up, and act as, incident command at an MCI

Most of the US forum users will not see what the big deal with this is... until they compare it to the SJA scope of practice, which you have stated on this forum is a "bit more than a EMT- B when it stands alone". This is simply incorrect, and maybe you can provide us with a link to their SOPs, and not just your opinion, which is entirely biased. I am NOT talking about SJA members who just happen to be HCP's. I mean the plumbers, the teachers, and the bankers, who make up much of the US voluntary system. This is where the big difference lies.

Some parts of the US ONLY have coverage by EMT-Basics. They don't go calling the "real ambulance service" when things go tits-up... They are it, and they have to work with what they have, and in a few places thats all that is needed. Again, there is NO PLACE in the UK, where the SJA are the sole prehospital providers for the area. It will never happen.

UK FR's neither drive, nor operate from ambulances (I am sure there have been some exceptions) So I don't know what analogy you were trying to make with them. They have their role in the UK, but have little in common with US EMTs.

I think we all agree the EMT-B is a fairly fundamental, easy course, and a stepping-stone to the really interesting stuff. But you and I both know they have way more scope than your "Advanced" SJA provider. I admire SJA vollies (I think that's the word) who would stick out the fragmented training, the militaristic bureaucracy, and resentment from NHS ambulance staff, just to volunteer in their limited capacity. All power to them; but lets put things in perspective... A slower pace of learning doesn't mean more advanced training.

See you on the other side of the pond...

PS...

ZippyRN wrote: if you use decent european or japanese sports touring bikes like a Pan European or a BMW rather than an asthmatic, slow, poorly balanced, poorly handling, twin, chrome laden be tasselled heap that passes for a motorcycle in much of the US - panneirs and top box

Totally with you on that

[Dustdevil]

However, (Zippy) comparing them to UK FR’s or SJA AA2 is doing EMT-B’s a discredit. I am not going to have a go at either, but I think you personally, are basing your opinion solely on the basis of training hours.

Which is exactly as it should be.

Sorry Scott, but I am unimpressed. Obviously you have fallen into the trap of confusing SOP's for quality of education or care. Cramming a handful of extra skills that the student gets insufficient education on does nothing to increase my confidence in a provider. Education increases my confidence in a provider.

And you would be wrong to say that clinicals and internship add significant time to an EMT course. They still usually end up below 200 hours, which is nowheres near what it should be for the primary care provider on an ambulance.

[scott33]

Education increases my confidence in a provider.

No argument there.

And if EVERY SJA member were able to utilize their skills and education they trained so long for, on a daily basis, I would be eating my words.

However, they are not, and never have been, a front-line emergency service, and rarely get to answer 999 calls on their own. What does this do for skill-retention?

I wish I could say differently, but they are very much resticted in their scope, and therefore, incomparable with the Basics in the US who in most cases, answer up 911 calls daily (with or without ALS).

Not having a dig, its just the way it goes in the UK. The NHS still run the roost.

[Dustdevil]

Ah, understood. I have to agree then.

I was looking at the arguement as more of a defense of EMT training and SOP here than a comparison to SJA.

[andymascall]

Absolutely no way - they are first responders and in the uk only get a minimal amount of training - I imagine how I would feel if it were a member of my family in the ambulance - and who I would expect to be treating them - and I know who I would choose

[zippyRN]

ZippyRN wrote: first respondershave ap lace - but that place it probably best met by current US EMT_B qualified staff

ZippyRN wrote: i'm not sure there is a place for providers with 120 or so hours of training on emergency ambulances

Firstly, the EMT-B should be seen as just that… a “basic†EMT. An introduction to prehospital emergency care.

it is simply not enough - the equivalent UK VAS provider is still considered a first aider with extended skills

First Aider

induction -16 hours ( three skills tests) , manual handling ( principles and basic casulty handling) 3 + 4 =7 , first aid course 24 contact hours ( three skills tests), paed resus module 4 hours = 51 hours and that excludes documentation training, radio training and other induction topics which are outside thenational training verification system

Add in the enrichment modules for first aiders / " first aid post attendant " + enrichment

medical gasses - 6 contact hours,

AED 4 contact hours

Patient handling - 4 hours

Fractures 1 - 6 contact hours

Fractures 2 / PHFM 12 contact hours

FAPA completion min 16 hours - we are running it as 20

another 48 hours and we've not touched anything to do with vehicles or driving ...

there's another 20 -30 hours to cover the missing parts of Patient transport attendant + the driving course , never mind the Ambulance completion module and emergency driving

However, (Zippy) comparing them to UK FR’s or SJA AA2 is doing EMT-B’s a discredit. I am not going to have a go at either, but I think you personally, are basing your opinion solely on the basis of training hours. You said in another post, it took you 6 years to become part of an ambulance crew in SJA. (“SJA member for 17 years, 10 as an adult member 4 as ambulance crewâ€). It shouldn’t take 6 years to get on a rig; you could be an MD in that time. I assume you took a leave of absence.

quota for access to training - not all SJA members are offered the option to become Ambulance trained - there isn't he requirement as most of the core work is event cover which needs first aiders and first aiders with extended skills

The EMT-B curriculum is normally covered over 6 or so months (not including pre-entry requirements of various corps / FD’s; which in my case, included the equivalent of FAW and FPOS). All final practical assessments for the EMT-B (from a random 15 or so stations) are taken in one day. There aren’t separate courses / modules for AED, splinting, spinal immobilization, moving and handling, trauma & medical assessment, med gasses etc (as there are in SJA). It’s all covered in 1 course. The written final covers any, and all, of the above.

so one final written and a random assesment rather than several hours in total of writtens and a 20 + skills tests some specific ( e.g. the gases ones) most total patient care with different emphasis and different levels of equipment available.

the seperate courses allow for a building block approach with first aiders extending their skills either as they have the time and incliniation to do modules or to meet event specific requirements e.g. trackside staff at motorcross or equestrian events need gasses and both fractures modules to cover thecommon presneting complaints trackside

This 1 course also includes hospital-base clinical rotations,

which are interesting, but of little value in the grand scheme of things

and precepted ambulance practicum assessments, through having current status as a riding member of (or affiliation with) an ambulance corp / FD. This adds considerably to your much-quoted figure of 120 hours, which is for classroom time alone.

good , but can you get the ticket without or with a token amount from some providers? - what you or your servicedoes to deal with deficiencies i na national standard doesn't change the big picture

EMT-Bs can also use (with some state additions or restrictions):

· Nebulized albuterol

· Epi-pen, epi SQ

· Blood sugars / Oral glucose

· Activated charcoal

· Pediatric AED

· GTN / ASA for C/P

. Combitube

. PASG

They can:

· Pronounce life expired

· Request medivac at their own discretion

· Set up, and act as, incident command at an MCI

Most of the US forum users will not see what the big deal with this is…until they compare it to the SJA scope of practice, which you have stated on this forum is a… “bit more than a EMT- B when it stands aloneâ€. This is simply incorrect, and maybe you can provide us with a link to their SOPs, and not just your opinion, which is entirely biased.

salbutamol - no - as it is a POM

epipen - yes

glucometry - no but not all NHS techs do glucometry either

charcoal - not a pre-hospital drug in the Uk at all

AED- depends on the device

aspirin - yes, GTN -patient's own

combitube - not used in the UK at all

PASG -not used in the UK at all

pronounce life expired - depends on circumstances

requesting assistance depends on agreement with NHS service

act as incident command - yes

NO SOPs as JRCALC governs, training materials are protectively marked , other stuff locality dependant to take account fo the 35 or so different NHS ambulance services and the arrangements between the VASes and the services over requesting assistance etc.

I am NOT talking about SJA members who just happen to be HCP's. I mean the plumbers, the teachers, and the bankers, who make up much of the US voluntary system. This is where the big difference lies.

Some parts of the US ONLY have coverage by EMT-Basics. They don’t go calling the “real ambulance service†when things go tits-up… They are it, and they have to work with what they have, and in a few places thats all that is needed. Again, there is NO PLACE in the UK, where the SJA are the sole prehospital providers for the area. It will never happen.

no , because the Uk has a properly constructed emergency ambulance system funded from taxation - as well as theabilty to use VAS resources , or maybe the cat c 999s and Urgents i've gone to on Support shifts were just an illusion, maybe the inter-hospitla transfers were just an illusion as well....

UK FR's neither drive, nor operate from ambulances (I am sure there have been some exceptions) So I don't know what analogy you were trying to make with them. They have their role in the UK, but have little in common with US EMTs.

limited training hours and content = limited deployment options

I think we all agree the EMT-B is a fairly fundamental, easy course, and a stepping-stone to the really interesting stuff. But you and I both know they have way more scope than your “Advanced†SJA provider.

this is the point - they don't they don't have minor injuries skills, they don;t have the underpinning knowledge , they don't have the sheer opportunity of the contact time with faculty to acquire skills

I admire SJA vollies (I think that’s the word) who would stick out the fragmented training,

no fragmented training in any of the counties i work with

the militaristic bureaucracy,

don't know what you are on about ... not the organisation i am a member of

and resentment from NHS ambulance staff,

don't believe the hype

just to volunteer in their limited capacity. All power to them; but lets put things in perspective... A slower pace of learning doesn’t mean more advanced training.

it's not a slower ppace it 's more aobut the quality and depth rather than the quantity of bums on seats

[Dixieladyff]

In the career choice I would say that FR should not be on a ALS truck. The company I work for does not allow it and I can clearly see those reasons. However I am sure there are some folks who have been FRs long enough that they have a vast amount of knowledge and could handle themselves very well. On a BLS truck I don't see any reason why not. As long as they have their EVOC. However the FR is not allowed to be the care giver in the back. That is how it works for our company and I think it is a good idea. BLS trucks have strict rules and only take pts from hospitals to nursing homes, or doctor appointments, etc..... I have ran emergency on a BLS truck only because the pt became combative, and we needed to return back to the ED quickly. (I would also like to add that the nursing staff at the hospital stated the pt was not violent when we picked him up.) I don't have a problem with FRs in the field, I think it is great because most of the ones I know who start out as a FR on a BLS truck are just working up the ladder to medic. They gain a vast amount of knowledge by experience and are easily able to connect what they are learning in the books with the real EMS world. We have them do ride along with us all the time, and it is nice to have a ALS truck show up with a FR, Basic, & medic.

In the volunteer field, I think FR are a big asset. I also run with a volley department. I think they are a great asset.

More to the point I think each step in the field has its place and I think as long as we are all working together as a team within our own scope of practice, giving the pt the best care we can provide that together we make a kick a?? team! Anyone who has the heart to get out there and do the job, is going to be putting their all into what the job is really about providing the best pt care possible. Just my .02

[scott33]

more aobut the quality and depth rather than the quantity of bums on seats

Fine, but how often do they get to use these extended skills? How often do SJA actually run codes? How many cat A calls, do the SJA cover on a daily basis as a matter of routine (including emergency respose to and from the scene within the 8 minutes)? Big difference.

Training should go way beyond that of the minimum requirements to get your EMT-B / AA2 cards. On the job training should go on for years (particularly as a volunteer) on a building block basis, as you put it. I don't see how progression can be made, when you are not frontline ambulance crew. Whether or not SJA training is more in-depth, is irrelevant when you cannot utilize what you have learned. I could read a book on how to fly a 747; it doesnt make me a good pilot.

I agree with you, the hours for EMT-B is not enough, and on its own teaches very little. However, that is our entry-level certification...not our highest Accolade (non-HCP). The EMT-B is of no use if you are not a member, in good standing, of a corp or FD. Big insurance issue.

maybe the cat c 999s and Urgents i've gone to on Support shifts were just an illusion, maybe the inter-hospitla transfers were just an illusion as well....

Category C Non life-threatening calls = not an emergency.

and resentment from NHS ambulance staff,

don't believe the hype

I don't...but I do believe my Brother; an NHS SRP of some 10 years.

You still haven't convinced me that the AA2 is in any way, shape, or form, a " bit more than an EMT- Basic". The comparison between drug interventions, airway management interventions speak for themselves (I forgot to add IM Narcan in some states).

Apologies to the SJA members on the UK forum. Nothing personal. :wink:

[zippyRN]

Fine, but how often do they get to use these extended skills? How often do SJA actually run codes? How many cat A calls, do the SJA cover on a daily basis as a matter of routine (including emergency respose to and from the scene within the 8 minutes)? Big difference.

perhaps my colleague could answer that who happened across a cardiac arrest while single manned this morning , going to collect his crewmate before coming on duty ....

as for inital management ask the community First responders who are part of SJA schemes - particuarly those in the rural wilds of the county who can be on scene for 15 minutes waiting for a crew

Training should go way beyond that of the minimum requirements to get your EMT-B / AA2 cards. On the job training should go on for years (particularly as a volunteer) on a building block basis, as you put it.

which it does - but equally the system is different - the route to crew is very different - it's virtually impossible to turn up and say " i want to crew " .. becasue of the systems in place to make sure appropriate perople are selected to have a significant sum of money invested in them

I don't see how progression can be made, when you are not frontline ambulance crew. Whether or not SJA training is more in-depth, is irrelevant when you cannot utilize what you have learned. I could read a book on how to fly a 747; it doesnt make me a good pilot.

firstly SJA crews are frontline - they are frontline on public duty - they are frontline on ambulance support - they are a alternative frontline response in this case - if they didn't exist paramedic vehicles would go to the calls - middle tier as aconcept in some services was born entirely out of the experience of using VAS crews

I agree with you, the hours for EMT-B is not enough, and on its own teaches very little. However, that is our entry-level certification...not our highest Accolade (non-HCP). I don't believe the EMT-B is of any use if you are not a member, in good standing, of a corp or FD.

neither is anything beyond first aid courses or perhaps AED if a VAS member leaves the organisation

Category C Non life-threatening calls = not an emergency.

so the (confirmed) renal colic that was rolling round the floor unable to get up wibefore analgesia wasn'r an emergency? or the little old chap on warfarin with the ever growing haematoma wasn't an emergnecy - both people who got Ambulance care a hell of a lot sooner becasue of VAS ambulance support work than if they had had to wait for a Paramedic vehicle to be free

then there's the GP urgents who are far sicker than most 999 patients - that would the ones that end up with paramedic responders out them and go into the resus room on arrival at the ED ...

I don't...but I do believe my Brother; an NHS SRP of some 10 years.

one person in one locality

You still haven't convinced me that the AA2 is in any way, shape, or form, a " bit more than an EMT- Basic". The comparison between drug interventions, airway management interventions speak for themselves (I forgot to add IM Narcan).

Apologies to the SJA members on the UK forum. Nothing personal. :wink:

you can teach people anything, it's the underpinning knowledge and the assessment skills that tell - it's also the stuff like minor injuries management , illness management , pathophysiology knowledge and the like ...

[scott33]

OK Zippy... :roll: