Difficulties with Paramedics as EMT's

[ncmedic309]

WHERE TO START? IN ORDER I GUESS...i DONT KNOW WHERE YOU WORK HAVE WORKED BUT THE ONLY THING THE PARAMEDIC HAS TO "PECK ON" IS THE EMT BECAUSE MOSTLY, WHERE I AM FROM M.D'S PECK ON US. IT IS NOT A GOD COMPLEX BY ANY MEANS WHAT SO EVER. I HATE THAT TERM. THE REASON IT IS THERE IS BECAUSE THE DIFF. BETWEEN AN EMT B AND AN EMT P IS SO BIG.

I AM ALL FOR INCREASING THE AMOUNT OF CLASSROOM TIME FOR EMT B'S AND MAKING IV PLACEMENT WITH NS OR LR A NATIONAL STANDARD AS WELL AS GLUCAGON, NARCAN (ANY ROUTE), CHARCOAL (AFTER ONLINE MEDICAL DIRECTION), ALBUTEROL COMBIVENT VIA NEB, NITRO, AND HOLD ON TO YOUR SEATS.... PR VALIUM GEL FOR PEDS AND ADULTS. THESE MEDS ARE ESSENTIAL AND EASY TO REMEMBER THE INDICATIONS AND CONTRAINDICATIONS FOR...SIMPLY PUT. I THINK THE EMT CAN BE TRAINED VERY EASILY TO HAVE A LARGER SCOPE AND I THINK IT IS VERY POOR THAT THE NATIONAL STANDARD IS SO LOW.

HOWEVER, THERE ARE SO MANY EMT'S WHO DONT CARE AND LEARN THE MINIMUM AND ONLY DO WHAT THEY ARE ASKED AND THE WILL NOT DO AN ASSESMENT PRIOR TO ALS ARRIVAL BUT JUST GET A CC AND A SET OF VITALS. THEY ACCEPT THAT THEY ARE THE LOWEST ON THE CHAIN. B.S. YOU WANT RESPECT FROM A MEDIC, EARN IT. ASK QUESTIONS AND SHOW HIM THAT YOU ARE TRYING TO LEARN ON YOUR OWN OR ARE TAKING ACLS, PALS, PHTLS, AND AMLS,. PROVE TO ME THAT IF I ASK YOU TO DO A TRACTION SPINT YOU CAN DO IT.

AS FAR AS THE 12 LEAD... NO WAY...SORRY MOST MEDICS CANT FULLY READ A 12 LEAD. SIMPLY PUT. I USED TO SEE THIS BLS RIG AT UCLA (WHO WERE EMT D'S) BRING PATIENTS IN ATTACHED TO THE AED BECAUSE IT DISPLAYED THE RHYTHM ON THE AED....CRAZY.

A LOT OF CHEST PAINS ARE BLS, CHEST WALL TENDERNESS IS A MUSCULAR PROBLEM, PNUEMONIA IN A YOUNG ADULT CAN CAUSE IT...THERE ARE A BILLION REASONS WHY CHEST PAIN IS NOT 100% ALS.

COMPLAINING ABOUT A CODE IS A PERSONAL THING, MOST MEDICS USE "CODES" AS PRACTICE OR A TIME TO REALLY SHINE AND REALLY ACTUALLY SAVE A LIFE, SO THAT IS NOT A MEDIC THING, IT IS A PERSONAL THING.

REGARDING THE "OVERSTOCKING OF THE RIG", YOU SAY THAT NOW BUT WHEN AN OLD MAN HITS THE GAS INSTEAD OF THE BRAKES AND PLOWS THROUGH A STREET FULL OF PEOPLE DURING A FARMERS MARKET IN SANTA MONICA AND YOUR UNIT IS STOCKED TO THE BRIM WITH EXTRA SUPPLIES, YOU WILL LOOK DAMN COMPETENT AND NOT INSECURE. STATE STANDARDS ARE B.S. AND ARE THE VERY BOTTOM LIMIT. A GOOD MEDIC WILL HAVE AT LEAST DOUBLE THE AMOUNT BUT HAVE THEM IN SEPERATE PLACES IN CASE YOU LOSE SOMETHING OR FORGET TO RESTOCK OR THERE IS A MCI ETC...

IF IT IS A THUMB LAC ONLY THEN WHY IS THERE AN ASSEMSSMENT BEYOND "WHY DID YOU CAL 911". IF YOU WANT TO DO A FULL ASSESSMENT AND WORK THAT PT UP AND TRANS, GO RIGHT AHEAD.

EMT'S ARE BELOW PARAMEDICS SIMPLE AS THAT. I FIRMLY AGREE THAT THEY SHOLD HAVE A BROADER SCOPE. HOWEVER, AS AN INSTRUCTOR YOU WOULD NOT BELIEVE SOME OF THE INCOMPETENCE I SEE DURING RE-CERTS. SO IF YOU DONT EVEN KNOW YOUR BASIC Ca Ca, HOW ARE YOU GOING TO GET THE RESPECT AND THE ABILITY TO EXPAND YOUR SCOPE?

DONT BLAME THE MEDIC, LOOK AT YOUR SELF. YOU CAN NOT BE A GOOD EMT WITHOUT BEING A GOOD MEDIC.

A GOOD EMT WILL ANTICIPATE THE MEDIC'S NEEDS AND WILL MAKE HISHER LIFE EASIER, AND THUS MAKE BETTER TX FOR THE PT. IT IS THAT SIMPLE.

You're an instructor? Your grammar is horrible, your professionalism and tact is lacking severely, do you want me to continue? You seem to think mighty highly of yourself, but I'm willing to bet most medics and EMTs can probably run circles around you.

[Asysin2leads]

It's LA, man, not exactly the intelligence capital of the United States. These guys voted for the Terminator as governor, remember.

[JPINFV]

It's LA, man, not exactly the intelligence capital of the United States. These guys voted for the Terminator as governor, remember.

In defense of my brothers and sisters out here on the Left Coast, the only other choice was BustaMEChA. He would have turned the state over to Mexico faster then basics are "educated." Grant it, I love living behind the Orange Curtain and what little protection it provides on this insane part of the country.

[Ztenec]

DONT BLAME THE MEDIC, LOOK AT YOUR SELF. YOU CAN NOT BE A GOOD EMT WITHOUT BEING A GOOD MEDIC.

8)

As you also cannot be a good Medic without first being a good EMT. Don't forget all medics were at one time a basic, if for nothing else than having it as a stepping stone to in the education towards medic.

I won't be getting into this rant as I have never had a problem with a Medic looking down on me. I believe the reason I get respect is because I do exactly what is expected of me, but also continue to practice my skills and learn. I almost consider myself as a tool for my partner. By all means use me and my skills to provide faster and better care to the patient. After all that is why I am there.

[Katiebug]

The only problem I have with expanding the scope of practice for EMTB is that most in my B class can barely grasp what we are doing now. I don't believe they belong in the class any more than I belong in an algebra class, yet some of them will pass. I could pass algebra, but I wouldn't be a good mathmatician. Especially if a little calculus was added to it.

This is my niche. I love this field and I will continue on to be a medic. Some of us could handle an expansion of protocol, but I don't think some others should.

There is one fellow in my class, though I like him personally, if he asks, "is that gonna be on the National Registry" one more time I might just punch him in the face. That is a case of just learning enough to pass the test. I hope he doesn't respond to someone in my family. He certainly does not want or need more responsibility.

One thing I agree with the medics on; if you want the responsibility, show that you do and take the class. I wish some colleagues and I could do more, but not at the expense of some others getting the same responsibilities. That could wind up being more cases of EMS looking bad.

I'm sure I'll take a few punches for this post, but I feel it's the reality of it. You can't assume everyone is going to do a good job, regardless of the profession.

[Asysin2leads]

Did being an EMT help be a medic? From my experience as an EMT, I will never forget:

1. The siren has three modes. Slow, fast, and real fast.

2. You have to screw the regulator on real tight or else it goes PSSSSSHHHH very loud.

3. You have to push the button on the side of the radio mic or else no one can hear you.

4. People are heavier than they look.

5. BLEEDING is BAD. Put PRESSURE on the BLEEDING to make it stop.

6. When in doubt, call the medics.

7. BROKEN BONES are also BAD. Keep them from MOVING to prevent the person from being in PAIN.

8. The NRB goes on the FACE.

9. Push fifteen times on the chest, THEN put in twio breaths. Repeat until the medics get there.

10. Put the AED pads on FIRST, then turn the machine ON.

This is just to respond to all of the "Medics were EMT's.... and BLS before ALS" stuff on here. I had to learn to tie my shoes at somepoint before I could even become and EMT, too, but no one seems to harp on that much. You know what's even more important to be a good medic than being a good EMT? Anatomy and Physiology, Pathophysiology, and Pharmacology. They are infinitely more important to the successful treatment of a patient than BLS skills. Yep, you heard me. Good CPR will keep a patient viable, and it is very important to do correctly, and if you can do it well, you will be the vital part of a chain that can save someone's life, but you know what? It won't stop an asthmatic from going into respiratory arrest. It won't reverse a narcotics overdose, it won't stop and anaphylactic reaction from progressing or keep a rapidly slowing down heart from coding.

[nsmedic393]

Actually, god complex boy,...I dont have to prove a damn thing to you. Your stuck with me, so now its a two way street. You want to know where im at, ask. I want to know how you work, ill ask.Im not getting on the truck with you on the first tour to run though skills so you can further feel "god-like". Period.

Side note, if you want that, i want to see you do a stick, a line, tube a airway manekin, tell me the adverse effects of every med you push, while standing on your head and spinning plate on your toe.

EMS reject, rears its incompetent head.

You have questions? Ask. Want to quiz me? Lets do it. I will not go out of my way to prove to you I can do my job. If you expect that, your lucky a few basics havent whooped your as$ and left you on the wrong block in LA.

Thank you for the god complex illustration.

I think dj is spot on here. If I'm working with a new basic or even a basic that I have never met before I NEED to be absolutely sure of where that person stands before we get put into a situation where a patients life could be effected by it. The highest level provider is responsible for AALL patient care regardless if they are in the front or back, attending or not. If something gets missed or a tx is not performed that its going to fall onto the ALS proveder and, "i thought my basic had it covered" is not going to be a good enough excuse.

I NEED to know if the person I am working with is actually someone who will be usefull and know a thing or two about patient care or if they are just a couple hundred pounds to fill a seat for twelve hours. While you are in the middle of a hairy call is not the time to find out that your BLS partner is not capable of performing their BLS skills and I owe it to my patients to make sure they are not put on the recieving end of that particular situation. There is nothing "god like" about any of this in my books.

This is not however a two way street. I have already prooved myself with years experience and my ACP certification and the suggestion of proving I know the adverse effects of every med I push is absurd. 90% or better of all the basics could probably not tell me what I can give for drugs let alone any of the indications, contraindication, adverse effects or dosages.

Any basic that says they can walk onto an ALS truck with a partner they have never met before and have nothing to prove is wrong, or their partner doesn't care enough to investigate. I however care about my livelyhood and my certification and I'm not going to let anybody else ruin that.

As a side note, I'm talking about basics that have completed a year long education with proper hospital and ambulance preceptorship, not the 140hr first aid course that is common in the states. So you can just imagine what I would think if in DJs shoes.

[hfdff422]

If you are satisfied being BLS, then you are not a very good EMT. The one thing I have learned in the last 2 years of emergency services is that I cannot know enough and complacency is the devil. I have learned that being BLS is not worth my time and I strongly feel that any EMS provider that wants to stay at the B level is either lazy or unintelligent. How can you be satisfied not providing the most effective level of service possible. So being and EMT-B is an important first step, but if you are satisfied being at that level long term, don't be suprised if people question your work ethic or competence.

[Dustdevil]

Plus 5 to both of the last two posts. :thumbright:

You're absolutely right, nsmedic393. I am not taking anybody's knowledge and skills for granted just because they have a card in their wallet. That's sheer idiocy. Not only are there a tonne of horrible providers out there at all levels, but there are also some out there who never even finished school that have faked credentials! If you ASSume that every stuffed shirt they stick on an ambo with you knows what he or she is doing, you're a fool, and you deserve the trouble you are going to get for it.

While EVERY partner I get receives the benefit of the doubt and a friendly welcome, they are still going to have to prove to me that they know wtf they are doing before I put my arse on the line for them. That's just common sense.

[PRPGfirerescuetech]

If you are satisfied being BLS, then you are not a very good EMT. The one thing I have learned in the last 2 years of emergency services is that I cannot know enough and complacency is the devil. I have learned that being BLS is not worth my time and I strongly feel that any EMS provider that wants to stay at the B level is either lazy or unintelligent. How can you be satisfied not providing the most effective level of service possible. So being and EMT-B is an important first step, but if you are satisfied being at that level long term, don't be suprised if people question your work ethic or competence.

Your an idiot.

In the interest of fairness, allow me to explain why.

You may believe BLS is not worth your time, and that works for you. There is absolutely no coorelation between remaining a basic and work ethic / intelligence. There are basics on the street that are content that way, but still do everything they can to perform, educate themselves, and perfect their skill and form. Basic is what they do. They do it well, and they are happy being good at that.

Every certification level has an important place within the EMS system. Your failing to recognize that.

PERSONAL RELEVANCE: As a basic, I have spent my career continuing to educate myself, aand learning up to the extent of my scope, and the information behind higher scopes of practice. Where has this got me?

The ability to call myself a damn good basic. Does it make me lazy, or unintelligent? No. It makes me competent.

Side note, is every medic here unintelligent because they didnt progress to nursing, PA, or MD school?

Get a grip.