"First Responders" on Ambulances

[Thunderchild145]

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.

Not true, actually. At least not here. I went through 240 hours of classroom time alone, add to that EMT basic clinicals (64 hours in the ER and 12 ambulance transports (which doesn't sounds like much but the criteria of a transport is just that. They have to get in and go to the hospital). I know my transports took me 60 hours. (4 days, 15 hours a day.). Thats 364 hours. A pretty far cry from "below 200". Is it a paramedic? no. Is it anywhere close? Still, no. Is it better than nothing? Yes.

FYI, standard contact time FR time here is between 48-80 hours. No required clinicals.

[xselerate]

hmmm... cfr's on the bus?

i came on scene once to find a cfr engine company doing cr... thats cpr without the pulmonary part. they looked at us and said "do you guys have an ambu bag? cause if not i'll try this peds one." the cfr was doing compressions with one hand and proping himself up against the floor with the other.

another time.... i come on scene and this cfr says "glad your here, i can't get this airway in." after a 1.5 second visual exam my response was "allow me to introduce you to rigor mortis."

no... cfr's don't belong in the back of a bus (or rig if thats what some call it)

[Nate]

Not true, actually. At least not here. I went through 240 hours of classroom time alone, add to that EMT basic clinicals (64 hours in the ER and 12 ambulance transports (which doesn't sounds like much but the criteria of a transport is just that. They have to get in and go to the hospital). I know my transports took me 60 hours. (4 days, 15 hours a day.). Thats 364 hours. A pretty far cry from "below 200". Is it a paramedic? no. Is it anywhere close? Still, no. Is it better than nothing? Yes.

12 transports, you would have that done here in 8 hours.

[Thunderchild145]

I'm just glad I got mine done, and managed to get some every day. One person in my EMT class went 2 weeks without a single call. They loved for him to come in, lol.

[NoOnesAngel]

The company I run with, all of our drivers are FRs or just CPR certified. Someone has to drive, they don't have delusions, they know they don't belong in the back of the truck. Yet, are willing to give a hand if you need it. I, personally, think it works out just fine. Especially considering at this current point in time, we're running a little low on Medics and Basics...

[csr]

I don't see a problem with having a Certified Medical First Responder (FR) as part of an ambulance crew. It may be due to my unconventional background coming from Government and industrial, mainly BLS, care.

I got my FR and then EMT certs while working at a State prison which had it's own Fire Brigade and EMS service for transport of inmates. 99% of the time, when transporting an inmate to a hospital or other medical facility in the prison Type 1 ambulance, the crew was a FR driver and a EMT who rode in the back with the inmate/patient. The FR and EMT were both Corrections Officers who would normally be working in the dorms or in the yard when not needed for the transport. Pill Call was also routinely handled by FRs who would issue prescribed medications and even insulin to inmates several times a day. There was also a Paramedic on staff who worked in the medical unit and was available if needed for an ALS transport.

Working now in Industry I often have to transport ill or injured empolyees in a facility owned van stocked with EMS gear. If the patient condition requires me to stay with him in the back of the medical van on the short trip to the local ER I have FRs who can drive for me. Most of the time I'm just providing a glorified taxi service. For ALS situations we contact a local private provider for transport.

Sure I've met some clueless First Responders.

At the Prison they, the FRs, sometimes taught the annual inservice first aid and cpr training every employee was required to attend. I was in class one day when the FR giving the class was describing the use of the Bag Valve Mask. He told the class that the BVM was "called an AMBLUE bag because when they first started making them they were blue but now the bags we use are clear." :shock:

Or the day the instructor was describing the different types of BSI gloves used at the prison. "There are only 2 kinds of gloves, powdered and powderfree. Most of the time we will be given powerfree because you don't want to get power on your uniform." When I asked about the availablity of Latexfree golves I was told by the FR teaching the class "There's no such thing as a nonlatex glove." I pulled out 2 purple nonlatex gloves that I carried in a pouch on my belt that I got from my VFD which had switched from latex a year before. Still not sure what to make of the development the FR asked "What would you need nonlatex gloves for?" I told him that they were for both the prevention of developing a latex allergy as well as to use when treating a patient with a latex allergy. The FR responded, "You can't get an allergy to latex." Since it was his class and not mine who was I to argue? I shut up and finished the day along with everyone else. :roll:

On the other hand I've met some competent FRs who knew their stuff and also knew their limitations and some, like me, who decided to go for their EMT-Basic. It's not uncommon for the local private ALS ambulance service to commandeer a volunteer Firefighter FR on a scene to ride in the back of the rig to assist the paramedic with compressions or bagging a patient while the Basic drives them to the hospital. It's happend to me a few times.

If having a FR as part of a BLS crew to drive the ambulance while 1 or 2 EMT-Basics can attend to a patient in the back doesn't cost a volunteer FD or rescue squad anything I don't see a problem. I'd even see a place where the FR could be the driver of an ALS unit with a Basic and a Paramedic on board doing medical care. On scenes the FR could assist by carrying equiptment and providing an extra set of hands for tasks such as compressions or bagging the patient. The FR gets good on scene skills and the Basic and/or Medic is able to concentrate on their tasks.

[JakeEMTP]

If having a FR as part of a BLS crew to drive the ambulance while 1 or 2 EMT-Basics can attend to a patient in the back doesn't cost a volunteer FD or rescue squad anything I don't see a problem. I'd even see a place where the FR could be the driver of an ALS unit with a Basic and a Paramedic on board doing medical care. On scenes the FR could assist by carrying equiptment and providing an extra set of hands for tasks such as compressions or bagging the patient. The FR gets good on scene skills and the Basic and/or Medic is able to concentrate on their tasks.

First responders do not belong on an Ambulance. Regardless if it is BLS or ALS the crew should include 1 Paramedic minimum. In a utopian world, crews would be medic/medic and a EMT. If it is a 2 person crew, than we can always get a FF to drive, they like the L & S.

[buddha]

To provide a historical perspective for many of you not old enough to remember these things, allow me to expound. In the state of New York, there was absolutely NO minimum level of care for ambulances until Article 30 was amended to require that a minimum of 1 CFR be in attendance on each ambulance call (1997). Prior to 1997, many ambulances ran with basic or advanced first aid, and the state requiring at least one person on the crew to be at least an EMT was seen as blasphemy in many areas. At the time, the NYSDOH CFR curriculum had grown well past the definition of CFR in the rest of the free world. The NYSCFR program had grown to about 90 hours, since many rural areas had no staff available. Our CFR's did immobilization, vital, O2, extrication, and many other things. Up until the year 2000, it was not at all uncommon to see ambulances staffed with 1 CFR and a fireman who drove. Article 30 was subsequently amended again and as of January 1, 2000, all ambulances in New York State were required to have a minimum of 1 EMT-B in attendance with the patient. Again, there was a huge outcry from the rural areas who felt this would destroy the system. NYS also at that time adopted a waiver process to assist agencies who could not meet the staffing requirement, and some ambulances ran up through 2002 with a CFR as the lead.

Here we are today, and believe it or not, as long as the patient attendant is at least an EMT-B - there is no statutory training requirement for the remaining crew member(s). Many times, my 2 person crew consists of myself and a driver who has First Aid/CPR. If I need an extra pair of hands, I commandeer a CFR. Up until last year when a law was passed LIMITING CFR training to a maximum of 51 hours, NYSDOH CFR's were still being trained as if they were staffing ambulances. Given a choice, I'd much rather have a CFR trained partner than FA/CPR, but that's just not the way the world works here.

On a side note, I find it hard to believe that any service would pay for two medics and an EMT to ride one bus, but I guess you can always dream...

[JakeEMTP]

On a side note, I find it hard to believe that any service would pay for two medics and an EMT to ride one bus, but I guess you can always dream...

No dreaming here Buddha. All the City of Greenville ambo's are staffed with two medics and a Basic. As well, all the fire apparatus hav at least one Medic on board.

[UMSTUDENT]

In an ideal world I think EMT should be increased to about 200 hours of acctual classroom time with another 100 hours or so of minimum clinical time with a certain number of skill proficiency's required. The problem with more education is that it isn't really needed when it comes to the scope of practice of what a first responder or EMT is doing.

An intelligent person can absorb all the information in an EMT class in 120 hours. Monkeys could seriously learn most of the skills. I can say that EMT class required little or no effort on my part, nor does it for many people. The people who seem to have the most problems with EMT are a) The untraditional student whose been out of school for years and extremely intelligent people. The first group is just not use to learning and the second group often will find holes in the procedures or overthink what they're doing.

Paramedic on the other hand should be a minimum of 1-2 years of acctual paramedic instruction. Atleast 1-2 years should be had obtaining basic college prerequisites Obviously, someone with a B.S. in Biology whose taken A&P probably doesn't need to do another year or prerequisites depending on the amount of time they've been out of school. Each paramedic program should require a type of internship similar to those done by physicians. Atleast 2000 hours of clinical rotations on the road and in several speciality centers.

People, especially those people in the field already, tend to scrutinize the value of a higher education. Many of them fail to see the benefit of a sociology course, or language, etc. It's self-explanatory for most of the professional world, but apparently not us.