Difficulties with EMT's as a Paramedic

[Ridryder 911]

The debate and heated topics have been flying (must be the spring weather!).. but, we Paramedics realize not ALL levels of EMT's perform badly. In fact most perform an very outstanding job and yes work as a team with us (not saved us ).

But, there are some that do not meet the par .. I know it is none that ever post here :wink:

Okay Paramedics (please) what are some problems you have with your lower level partners, were you able to correct it, deal with it. How does it affect you running on calls, patient care, crew, system etc. Suggestion to others to make it better. (Preceptorship, more/less responsibility, eliminate the level?)

Although this open to anyone, trying to prefer Paramedics viewpoints. This is not just unique in EMS, actually received the idea from allnurse.com; with RN vs. LPN.. so it is a common problem and with some unique suggestions.. not trying get into mud slinging.. let's be professional and come up with some problems, ideas and hopefully good suggestions maybe to correct the difficulties.

R/r 911

[PRPGfirerescuetech]

My god, a thread showing an issue in a positive light, with ideas to correct it.

I shall post the reverse.

PRPG

[1EMT-P]

I have experienced problems in the past with newer EMT's who didn't know how to assist or do certain procedures, but those problems were corrected with better communication, planning and practice.

[RegularEMT]

Would love to hear some responses on this to help me better myself as an EMT-B working with medics.

[Ridryder 911]

The problem I see is at first. We do not have proper screening or basic education level for EMT applicants. Why is so difficult for EMT's to understand studying skills, reading habits. and writing assignments ?.. Other health professions do!

On other thread many started discussing that many "over step" their boundary, i.e. EKG interpretation. Well partly it is our fault.. we encourage other to learn all the time, however; we hardly ever discuss the restrictions of it as well.

For as basic learning more advanced skills... I totally opposed. Here is why.. If they learn advanced skills, then they are no longer a basic.. short & simple. They should be expected to know the same as an advanced level, perform as well and be paid as one too. There is only 2 reasons to establish IV's in the field ... fluid administration and route for IV medications, neither in which the Basic EMT should be doing. For patients that need this, should be referred to an ALS personnel. Skills, can be performed by anyone, yes including some animals, but again the rationale, the knowledge of adverse effects and the ability to obtain a clinical impression with the appropriate treatments is at the advanced level.

Does this mean we treat as subordinates..NO! But, at the same time be sure all procedures are warranted and have a person who can control the situation if there is adverse effects.

R/r 911

[Dustdevil]

There is a theory in the martial arts about students learning just enough to be dangerous. Mostly to themselves. This theory very much applies to EMT school. As our new friend from WV has told us, most are interested only in learning hands-on skills, and simply don't think that the scientific foundation that comes from all that "book learnin'" is really important. And yes, EMT schools tend to perpetuate that fallacy by teaching under the same theory. Consequently, the great majority of EMT's in the US come out of school with just enough knowledge to be dangerous. They are taught all sorts of skills that, if inappropriately applied, can cause harm or death. And yet, the knowledge base they are given with which to make their clinical decisions is horrible, even in the very best schools who provide double the minimum required hours of instruction. Examples?

• EMT argues with paramedic who chooses a scoop stretcher to move a patient instead of a long board.

EMT argues with medic who places a nasal cannula on a mouth breathing patient.

EMT argues with medic who places high flow oxygen on a distressed COPD patient.

EMT argues with medic who places oxygen on a baby.

EMT argues with medic who gives only D50 to the unconscious diabetic instead of the whole "coma cocktail."

EMT argues with medic who intubates a patient who is not in full arrest.

EMT argues with medic who runs a non-rebreather at 12 lpm instead of 15 lpm.

EMT argues with medic who does not run a strip on an obviously dead body.

EMT argues with medic who doesn't let him drive hot to the hospital with non-critical patients.

EMT argues with medic who refuses to stay and play with critical trauma patients.

EMT argues with medic who stays and plays with critical medical patients.

• And those are just the medically related things I have had EMT's argue with me about. I won't even get into all the operational issues from when to refuel to what siren tones to use. Need I say anymore? Obviously, the problem is huge.

As has been universally agreed to by the respected professionals here, EDUCATION is the definitive answer to each and every problem in EMS. Period. Not only do we have to change what we are teaching in EMT school, we have to change what we are NOT teaching in EMT school. We have to stop feeding the monster. We have to stop blowing so much rah-rah smoke up newbies arses and convincing them that they are something special. They come into school with that attitude, and schools only make it worse with all their "public safety" uniforms and bloused boots and the superiour attitudes of the instructors. Funny, I never had an instructor in nursing or respiratory therapy school who copped that sort of attitude. The change in both the attitude and the curriculum of EMT school would go a very long way towards shaping a new breed of provider that eliminated a lot of the current lunacy.

Eliminating the basic level from 911 ambulance EMS would be a very, very good step in the right direction. The current level of training is wholly inappropriate for somebody who has ultimate transporting responsibility for emergency patients. It's just first aid. It's appropriate for first responders, and that's it.

Contrary to popular and idiotic belief, simply elevating the skillset for the EMT-B (as Tennessee appears to be doing) is certainly not the answer, or even a sane option. Again, the problem is not skills. The problem is education. The problem is that too many in EMS do not receive adequate medical education to have the knowledge base necessary to make clinical diagnoses and treatment decisions, regardless of the monkey skills they learned. Consequently, simply eliminating EMT-B's is not in itself an answer either, because EMT-I's are just as poorly educated as EMT-B's.

So, again it brings us back to education. Prepare people from the very beginning with adequate education to function safely and independently, and assure with a lengthy internship that they are capable of doing so, before they ever receive a patch. That means a significant increase in school time for ALL levels of providers. And, it probably means that the absolute lowest entry level for a 911 ambulance EMS provider should be no lower than the current paramedic level of education, then work our way up from there until it becomes a medical profession instead of a job.

And of course, changes in education have to affect ALL levels of personnel involved in EMS. Instructors need to be real teachers, with formal education in the educational process, taught by education professionals. We don't need more burnouts with no formal education who thought teaching would be fun and never had any training beyond a 16 hour course in instructional techniques. Supervisors have to be more than simple senior medics. They need EDUCATION in supervision, management, and human relations. Remember some of the absolutely horrible responses we got in the topic a few weeks ago about "punishing" the medic who forgot to report defective equipment for a few hours? That's all the proof we need that the deficiencies of EMS are much deeper than inadequate field practitioners. And if our instructors and supervisors were themselves adequately educated, it would be a lot easier to shape and train our newbies.

That's it, folks. Education. Education. Education. There is no other solution. There is no other answer. In fact, there is no other problem.

[Spock]

I'm all in favor of GOOD education and increasing educational requirements. That can only lead to fewer volunteers, more jobs and higher pay. I don't think I would eliminate the EMT altogether but I would require experience as an EMT prior to entering the medic class. Here in Pittsburgh you can start the medic class the day after you pass the EMT exam. I had to have at least one year of critical care nursing experience prior to entering anesthesia so I don't see why EMS should be different.

I will say the best partner I ever had was an EMT. He was fully capable of assessing a patient and if the call was BLS he insisted on taking the call. He could check a blood sugar (EMT's in PA aren't allowed to do that) and knew enough about EKG strips that he could recognize a lethal or life threatening arrhythmia. Unfortunately cancer got him and he passed away. EMS hasn't been the same without him.

Live long and prosper.

Spock

[medic001918]

There is a theory in the martial arts about students learning just enough to be dangerous. Mostly to themselves. This theory very much applies to EMT school. As our new friend from WV has told us, most are interested only in learning hands-on skills, and simply don't think that the scientific foundation that comes from all that "book learnin'" is really important. And yes, EMT schools tend to perpetuate that fallacy by teaching under the same theory. Consequently, the great majority of EMT's in the US come out of school with just enough knowledge to be dangerous. They are taught all sorts of skills that, if inappropriately applied, can cause harm or death. And yet, the knowledge base they are given with which to make their clinical decisions is horrible, even in the very best schools who provide double the minimum required hours of instruction. Examples?

• EMT argues with paramedic who chooses a scoop stretcher to move a patient instead of a long board.

EMT argues with medic who places a nasal cannula on a mouth breathing patient.

EMT argues with medic who places high flow oxygen on a distressed COPD patient.

EMT argues with medic who places oxygen on a baby.

EMT argues with medic who gives only D50 to the unconscious diabetic instead of the whole "coma cocktail."

EMT argues with medic who intubates a patient who is not in full arrest.

EMT argues with medic who runs a non-rebreather at 12 lpm instead of 15 lpm.

EMT argues with medic who does not run a strip on an obviously dead body.

EMT argues with medic who doesn't let him drive hot to the hospital with non-critical patients.

EMT argues with medic who refuses to stay and play with critical trauma patients.

EMT argues with medic who stays and plays with critical medical patients.

• And those are just the medically related things I have had EMT's argue with me about. I won't even get into all the operational issues from when to refuel to what siren tones to use. Need I say anymore? Obviously, the problem is huge.

As has been universally agreed to by the respected professionals here, EDUCATION is the definitive answer to each and every problem in EMS. Period. Not only do we have to change what we are teaching in EMT school, we have to change what we are NOT teaching in EMT school. We have to stop feeding the monster. We have to stop blowing so much rah-rah smoke up newbies arses and convincing them that they are something special. They come into school with that attitude, and schools only make it worse with all their "public safety" uniforms and bloused boots and the superiour attitudes of the instructors. Funny, I never had an instructor in nursing or respiratory therapy school who copped that sort of attitude. The change in both the attitude and the curriculum of EMT school would go a very long way towards shaping a new breed of provider that eliminated a lot of the current lunacy.

Eliminating the basic level from 911 ambulance EMS would be a very, very good step in the right direction. The current level of training is wholly inappropriate for somebody who has ultimate transporting responsibility for emergency patients. It's just first aid. It's appropriate for first responders, and that's it.

Contrary to popular and idiotic belief, simply elevating the skillset for the EMT-B (as Tennessee appears to be doing) is certainly not the answer, or even a sane option. Again, the problem is not skills. The problem is education. The problem is that too many in EMS do not receive adequate medical education to have the knowledge base necessary to make clinical diagnoses and treatment decisions, regardless of the monkey skills they learned. Consequently, simply eliminating EMT-B's is not in itself an answer either, because EMT-I's are just as poorly educated as EMT-B's.

So, again it brings us back to education. Prepare people from the very beginning with adequate education to function safely and independently, and assure with a lengthy internship that they are capable of doing so, before they ever receive a patch. That means a significant increase in school time for ALL levels of providers. And, it probably means that the absolute lowest entry level for a 911 ambulance EMS provider should be no lower than the current paramedic level of education, then work our way up from there until it becomes a medical profession instead of a job.

And of course, changes in education have to affect ALL levels of personnel involved in EMS. Instructors need to be real teachers, with formal education in the educational process, taught by education professionals. We don't need more burnouts with no formal education who thought teaching would be fun and never had any training beyond a 16 hour course in instructional techniques. Supervisors have to be more than simple senior medics. They need EDUCATION in supervision, management, and human relations. Remember some of the absolutely horrible responses we got in the topic a few weeks ago about "punishing" the medic who forgot to report defective equipment for a few hours? That's all the proof we need that the deficiencies of EMS are much deeper than inadequate field practitioners. And if our instructors and supervisors were themselves adequately educated, it would be a lot easier to shape and train our newbies.

That's it, folks. Education. Education. Education. There is no other solution. There is no other answer. In fact, there is no other problem.

+1. A great post. Education really is the answer to furthering out profession and the key to solid clinical decision making.

Shane

NREMT-P

[ncmedic309]

Eliminating the basic level from 911 ambulance EMS would be a very, very good step in the right direction. The current level of training is wholly inappropriate for somebody who has ultimate transporting responsibility for emergency patients. It's just first aid. It's appropriate for first responders, and that's it.

I actually tend to agree with most of your comments except this one in particular. There are way to many areas of the country that depend on basic EMTs for EMS services in general. There are some areas of the US that you'll be lucky to have anybody skilled pass the EMT level attend to you if you need emergency services. Just take a look at the comparison chart from the JEMS website that somebody posted in the other thread, the comparison of EMTs to advanced prehospital providers. In a perfect world, nothing but ALS ambulances would be ideal, but it will never happen. Instead of eliminating the basic level from 911 ambulances, which would wipe out a lot of fleets, we need to focus on much better education for those EMTs. Let's make them better at the jobs they are supposed to do so they can be utilized more efficiently. That's the answer to our problems unless you can turn all those EMTs into paramedics, that would be a even better solution.

[AZCEP]

I will go ahead and agree with most of what Dust wrote. I will also disagree with eliminating EMT-B's entirely. I want my EMT partners to feel that they can ask any question, and get a reasonable answer. My issue is their timing of the question.

Don't argue with me. If you ask, I will be glad to explain the why's and how's of what I am doing. If you present your question so it sounds argumentative, we are done.

How do we fix the problem? Yes, education would help immensely, but where do we put it? More before people are allowed into a program, ala "pre-med" style, or do we simply make the current standard longer? Until there is a standard that everyone must be held to, it will be a tough sell convincing the bean counters to pay for more.

I would welcome an entrance requirement of, at minimum, an Associate's degree prior to moving into an ALS level course. This way the BLS provider would have a broader view of education than is currently in place, and be able to ask better questions when they get into the field.

Also, eliminate the "grandfathering" that is so common now. When the standards are raised, everyone needs to be held to the same one. Allowing some to continue with the "old" ways only cheapens the efforts of those that try to increase what is needed.