Difficulties with Paramedics as EMT's

[PRPGfirerescuetech]

In kind to another post, i'd like to get an idea of the issues EMT's are having with their upper level partners. Lets keep it professional, and possibly come up with several productive ideas to improve the limited MICU kumbyyah. Keep the mudslinging to yourself, lets try to generate a few ideas here.

PRPG

[Ridryder 911]

Thanks.. I was going to do that as well... but got busy...

R/r 911

[JakeEMTP]

In the very foreseeable future, EMT-B's will be able to start 12 leads as well as nasal Narcan in NC. My medic partner ( who is very cool btw) was a little miffed when she got the news. After I explained to her that as Basics we were not going to be interpreting said 12 leads, she conceded that it was a good idea. Placing the leads isn't the hard part, the interpretation is. That's why I'm in medic school. :wink:

[AZCEP]

Anyone that wants to reduce the amount of work that I have to do is welcome.

That said, if you want to start IV's, place advanced airways, push medications, or use a manual defibrillator/monitor, I only ask that you receive enough education to justify your being allowed to do so. Four to eight hours in a classroom just does not translate to the field to well.

If you have a question, ask us. We may not be able to answer immediately, but we will when we can. If you don't like the answer you get, ask someone else as well. Taking the responsibility to increase your education on your own speaks volumes about your mindset.

[medic001918]

In the very foreseeable future, EMT-B's will be able to start 12 leads as well as nasal Narcan in NC. My medic partner ( who is very cool btw) was a little miffed when she got the news. After I explained to her that as Basics we were not going to be interrupting said 12 leads, she conceded that it was a good idea. Placing the leads isn't the hard part, the interpretation is. That's why I'm in medic school. :wink:

I have to agree with your partner. If an EMT-B is going to perform a 12-lead but not be able to read it, what's the point? This also opens the door for an EMT-B to make a decision based on what they percieve from a 12-lead. This happened here in Connecticut and they found that BLS providers would obtain an EKG and rule out the need for an ALS intercept based on what they saw. If a basic can't read it, it probably shouldn't be done by them. It doesn't take that long for a paramedic to obtain a 12-lead.

Shane

NREMT-P

[Ridryder 911]

Attaching electrodes , etc. is not a big deal, as long as it is placed properly, in which I have seen many Paramedics even place wrong. We have ER & EKG techs that do it all day, and never had pre-formal training.

Spiking a bag, setting up an IV as well is not a compicated procedure.. actually all of these should be taught in the basic EMT level. Does this mean you can perform the procedure itself or interpert the readings ...of course not. But, medicine has always had assistants to prepare and assist in tests, & procedures.

R/r 911

[medic001918]

A good point rid about having assistants. My concern, and maybe it's jus because it has already happened here, is that people will try to "read" the EKG and make a decision based on what they see on it with minimal training. At least in hospital, they have the doc there to run the EKG right over to. I don't have a problem with it, as long as they are not making decisions based on it.

Shane

NREMT-P

[PRPGfirerescuetech]

A good point rid about having assistants. My concern, and maybe it's jus because it has already happened here, is that people will try to "read" the EKG and make a decision based on what they see on it with minimal training. At least in hospital, they have the doc there to run the EKG right over to. I don't have a problem with it, as long as they are not making decisions based on it.

Shane

NREMT-P

What decision is there to make. If a EMT is setting up a 3, 4, or 12 lead EKG, there is a ALS provider on location, or soon to be there.

If not, the bigger problem stands as why would they be setting that up in the first place. sounds like a few basics with scope of practice confusion.

PRPG

[medic001918]

You're right on as far as the scope of practice confusion. It happened here on multiple occassions. They would put the patient on the monitor and not see anything so they would either not call or cancel the medic. If this were to be allowed, the protocol should probably state that if you're going to put the patient on any kind of cardiac monitor, ALS is to be requested or not cancelled. This would aid to avoid that issue altogether.

Shane

NREMT-P

[nsmedic393]

I have to agree with your partner. If an EMT-B is going to perform a 12-lead but not be able to read it, what's the point? This also opens the door for an EMT-B to make a decision based on what they percieve from a 12-lead. This happened here in Connecticut and they found that BLS providers would obtain an EKG and rule out the need for an ALS intercept based on what they saw. If a basic can't read it, it probably shouldn't be done by them. It doesn't take that long for a paramedic to obtain a 12-lead.

Shane I'm going to disagree with you slightly here. We are just now implementing 12 leads for all levels. For the ACPs that will eventually mean pre-hospital thrombolytics. For the PCP or BLS the reason it is being given to them is to decrease the Door to drug time for patients axperience an acute STEMI. The 12 leads will be taken in the field by the BLS providers, they will continue with their BLS protocols for the call, the 12 lead will be faxed to the recieving facility via cell phone or land line depending on the location and the patient will recieve the thrombolitics faster.

On annother note, I'm not against BLS providers having more skills. We recently had a debate here about PCPs starting IVs. A stand alone protocol for BLS starting IVs is a bad Idea in my mind because there is literally no reason for them to do it, however if the PCP has an ALS partner and they can help speed things up by starting the IV I am all for it. Its a simple skill really, just like administering most drugs and taking an EKG for example. My point is that the BLS provider is not deciding to do the skill on their own, its not for their own use and they are under direct supervision the whole time.

The skills are easy, its making the decisions of when and why that are difficult and if it speeds up patient care and the BLS provider does not have to make those decisions themselves, I am all for it.