Young ride alongs and EMT's

[Ace844]

Imagine,

The analogy isn't all that much of a long shot. Because just the risks can be just as life threatening, or changin as maybe the case in either instance..

[medic001918]

We have had EMTs who kept rooky medics from making a mistake several times (like giving atrovent to a CHF patient).

This kind of prompted a question for me, as while atrovent is not a front line CHF medication, it's also not absolutely contraindicated. In fact, from my reading it seems that it's something to be considered for CHF treatment. My usual choice of neb for CHF is albuterol, but the anticholinergic property of atrovent isn't totally harmful in pulmonary edema. A pneumonia case is where I would be more considered with drying out the hypersecretion than that of pulmonary edema and CHF. I even found protocols online here that call for atrovent (in the form of a duoneb/combivent) in CHF/Pulmonary Edema. Please explain how this EMT did the rookie medic a huge favor? Unless the medic meant to simply give albuterol and was going to give straight atrovent accidentally? This isn't meant as a chance to beat up on you or your system, but a chance for me to learn in case I missed something along the way...

Shane

NREMT-P

[GreenHat]

I myself am an EMT-B in the great state of Oregon, and we require both a 12 hour ride along and 12 hour clinical rotation (still wildly insufficient, but they do exist) for EMT-Bs and a basic can do quite a bit on a scene. we are trained in paramedic assist protocols ie spiking bags, combi tubes, drawing drugs, etc. and within our scope are able to assist in interventions, but the paramedic supplies the knowledge and expertise for patient care, then we transport (and yes, I do drive most of the time). However, many many patients are only BLS patients even on 911 calls, so I do take patient care. I have found this extremely helpful as I am a paramedic student (in one of the few degree paramedic states) and I have learned much from my paramedic partners. Also, you only learn about half of what is necessary to be a good paramedic in class, the rest comes in the field and I have been afforded the opportunity to jump start that training before I finish my paramedic. I am very much aware of my narrow scope of practice, but it is a necessary to maintain in order to take the paramedic exam... all in all, it is a good position for somebody entering EMS to get their feet wet in patient care and get a job with a company where they can continue their education.

[Imagine89]

Imagine,

The analogy isn't all that much of a long shot. Because just the risks can be just as life threatening, or changin as maybe the case in either instance..

I agree Ace, that the things EMTs do absolutely have the ability to change lives, for better or worse. My point was that during surgery, you're inside someone's body, perhaps looking for something very small, trying to make a very percise cut, and that's why it would be important to have a fully developed brain. You could be the most mature 16 year old in the world, and I'd rather have it done by an adult whose hand-eye coordination is superior. If the teenager was properly educated, I would trust his judgement calls, but not his hands. Being a basic is a lot more about making proper judgement calls (does this pt need ALS? O2? etc). The drugs and interventions a basic performs are simple to carry out, not so much in surgery.

[whit72]

Its odd how every discussion on this forum ends up going down the same road?

Who's better then who?

[AZCEP]

And every couple of months, the same discussions are revisited.

I'm beginning to think that some law of physics is being applied to the information as well.

Bonus points to the one that can name which law it is.

Except you Ace, you know too much as it is.

[Timmy]

Im going to explain everything for the last time as I cant be bothered wasting anymore time arguing with people. I was only contributing to the forum and everyone starts to make a big deal out of it! As I said from the start Im a volunteer with Australians largest EVENT FIRST AID SERVICE were not paramedics and we don’t transport patient to hospital! We call in the professional paramedics give a hand over then they go to hospital. In Australia they wouldn’t let you touch an ambulance unless you have been to university. For the guy who brang that stuff up about the Cspine a motocross, although I cant give fluids or provide ASL I can still collar them strap them to a spine board and take them back to the first aid post. And you also stated that first aid cant cure a Cspine fracture well either can anything a paramedic can do... Also to give examples of the life treating situation I was placed in with no adult... On duty at a rave party 7000 people with only 10 adult first aid staff and 1 doctor and 2 cadets. Most people stoned out of the brains. In the 8hrs we work we treated 70 patients with 23 of those requiring emergency care the only reason a cadet team responded was there were no adults available. The patient had OD and was in arrest. I was put in a difficult position, either take the other cadet and go save her or let some security guy stand there and watch her die. Thankfully we saved her with defib and 02 resus gear. As for the trauma centre our nearest one is about a 3 hour drive or 1 1/2 hour fly and the paramedics probly no more than what some doctors do around here. As for the gentleman were stated that he would rather die that have a bunch of kids work on him... I think that’s sad there’s nothing wrong with the skills of the cadets I work with...

Im not saying I work all the time without adult supervision just sometime. I am quiet surprised at the response I have got normally people think its great that kids are getting out there and helping the community. Oh and I don’t think Im better than everyone else, as most people in this forum probly know more about paramedics than what I do. Im just trying to get some experience and this is the best way I can do it.

[NREMT-Basic]

In the time I have been a member of this site, I have seen so many valid discussions which turn into spitting matches of EMTs vs. Paramedics. One of the things that it seems might help is to remember the EMS concept that a Basic is an EMT, an Intermediate is an EMT and, though they are often want to admit it, a Paramedic is an EMT...I can just see medics all over the world having small MIs when they read that.

First of all, we simply must stop comparing the training of EMTs of any level in the US to that of our brothers and sisters in Canada, Australia and elsewhere. The training and scopes of practice are simply not the same. An EMT here is not the same as an EMT in Canada.

Secondly, I disagree with the fact that the training of EMTs (as one author noted, particularly basics) is insufficient. In my experience both as someone who has spent a year in medical school and is now a National Registry EMT-B/D, when people start complaining about training being insufficient, it is most often not the fault of the training, but the fault of the one being trained. Maybe people should start asking themselves, did I LEARN material and interventions or did I memorize it long enough to get through an exam. I think often, especially with students at the basic level, the latter is the case. As far as clinicals go, my training program required 20 hours of clinical time divided between ambulance and hospital. I completed almost 3 times that many hours, including 24 hour shifts in Level I trauma centers, where I assisted physicians and nurses, administered treatments to patients whose care was placed in my hands and regularly performed neuro exams on patients. Perhaps the best question to ask is not whether the training is sufficient, but whether you took full advantage of the opportunities for training and learning made available to you. I have seen students in clinical settings, both Basic and Paramedic, sitting in lounges drinking coffee waiting for the next "interesting case." When we begin to argue about who is well trained and who is not, perhaps we should be intelligently discussing who took advantage of the opportunities made available to them and who sat around on their thumbs until their shift was over so the nurse manager could sign off on a "clinical rotation."

As for BLS vs ALS, this question doesnt even exist in my area. Every single crew has a BLS Basic and an ALS paramedic. There is never any need to see what a patient needs and then call for an ALS intercept. ALS providers are already on scene ON EVERY CALL. In fact, several of our private agencies have three person crews consisting of a Basic and two Paramedics.

Whether you are training to become a Basic, a Paramedic, a CCP or a Basic or Medic specialist, the question is not how good was the training, but rather how well did you train. Yes, I plan to move on to Paramedic level. But I am also proud to be an EMT-Basic. I worked very hard during my 176 hours of training (not 120) and came away feeling that I had mastered the skills of assessment, splinting, patient stablization, bleeding control, labor and delivery, wound care, breathing treatments, scene size up and the 100 other things that we were trained to do.

If you are an EMT and feel that your training was insufficient, then by all means have the good sense to get out of the ambulance and back into the classroom. If you are a Paramedic who feels that the Basics with whom you work are ambulance drivers, why dont you let them participate in the patient care they were trained to give. Basics and Paramedics should work together, hand and glove, not servant and master.

[GAmedic1506]

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[JPINFV]

When your scope of practice for a medical patient can be summed up in sugar, air, and kingsford in most places and one of the biggest mantras in training is, "You don't diagnose," then there is a problem. Unfortunately, the 120 hours does not mean that most basic providers know how their kingsford, air, sugar affects the body, so the end up giving things not because the patient needs it, but because "protocol tells me too." I don't believe it would take much to make basics competent in knowing what they are currently doing. Unfortunately, that scope, and therefore the affect on the patient, will still be limited in comparison to any other level of EMS.