emt-i

[primemedic01]

Ok, I think we can all agree that the EMT-I is the most unorganized pre hosptial provider level in the United States. With the Basic, there is basically one curriculum throughout the country, that almost every state follows. Same with the medic. Then, with the EMT-I, there are over 300 separate curriculum's that are utilized by all 50 states. The I-85 course is generally the basis of the original pre hospital provider, the paramedic, which was then built upon to what we know as the medic today. Then the Basic, which was created to allow services to hire people that could handle the "basics" of trauma and medical emergencies, and save communities time and money.

As we all know in 1985 the DOT created the middle level, the intermediate, hence I-85, which was the EMT-B with IV therapy and slightly more advanced assessment. No meds, no EKGs, no defib, no ET, etc. In theory this is a 64 hour course. In 1999, with a growing demand for more advanced pre hospital care, the DOT decided to revise this level with the I-99. This went ahead to include 10 Meds, interpreting rhythms, defib, ET tubing etc, with a standard course being approx 400 hours, which was the same course length as the original "paramedic". The problem today, is that there are so many variations of both these I-85 and I-99 curriculum's, that it has become a complete fuster cluck. I believe that the only two states to utilize the complete I-99 are Maine and Colorado. Some don't use any, some use the standard I-85, and like NH, some have courses that use the I-85 as a basis, and have built upon it to include 10 Meds, Rhythms, Defib, ET etc. The NH curriculum is approx 200 hrs plus clinical time. The problem though, with taking it in NH, is that unless you are going to work in NH, you are kind of screwed. In Mass, it is generally the same course, except, you need to have 10 ET tubes in the OR in order to get your license. In NH this is not needed. Which means you need to accomplish this on your on time, which can be extremely difficult to do in Mass with the number of people that are trying to get it done. If you go to Maine, you don't have sufficient training because they utilize the full I-99. There is also a reason that makes it difficult to use NH training in VT, but I can't recall exactly what it is off the top of my head, so I'm not even going to try.

So basically the EMT-I has become the bastard child of EMS. It definitely depends on where you live and where you work as to whether or not it is even worth it for you to waste your time. It is definitely a waste of time in Mass because there is such a high concentration of medics, that finding a job is damn near impossible. In NH it makes a little more sense because the job opportunities are definitely there. I still agree with most though in saying that you should go big or go home. And I'm saying this even while I am right now in an EMT-I class. I am taking for the fact that, I don't have a very big background in A&P and Pathophysiology, so I'd like to do this, strengthen by basic skills more, and also start the process of learning all I can in advanced medicine. I absolutely plan on starting my education in paramedicine by next fall, and I think I will be able to learn a lot more and a lot easier (not saying that by taking the intermediate I will blow through the medic course, I know this is absolutely not the case), but I definitely have a better understanding for what is being thrown at me than someone who is fresh out of a basic class. And hey, I have the time and money to blow. If you're still with me after that long drawn out rant, thanks for listening.

In addition to that I remembered another silly fact about the NH Intermediate.

Regardless of how the curriculum has been built upon the I-85, the NR tests the actual I-85 curriculum. So you would think that because the education has more skills and is more in depth than the original I-85, that it would actually make the NR test easier. The problem is that you actually have to downplay your knowledge, because taking the test is like pretending it's 1985 again. For example, you are dispatched to an unconscious person and find a patient unresponsive, apneic and pulse-less. You could have the answers A.) Pronounce DOA. B.) Ventilate, Begin CPR, Start IV C.) Ventilate, Begin CPR, Defib D.) Detailed Physical Assessment and obtain Sample History. Now according to the actual course (and common sense) the answer would be C. But because in 1985 I's didn't defib, you actually have to choose B.

Not to big of a deal, and I don't think it will really be problem for me, but I can see where a lot of people will choose the obvious answer, not thinking that they actually have to pretend its the year of the Ox.

Finished ranting.

Time for night night.

[emschick323]

Just a few tid-bits of info. I took an EMT-I(99) class that lasted 6 months, although I have to agree with you that they really are the bastard children of Ems in some systems they are highly relied upon. The service I worked for at the time was very rural.We were a small hospital based service in a poor community that couldn't afford to employ the number of Medic required to make the county function.So the intermediates served a vital purpose. As for preparing you for medic class IT WILL it made everything easier to understand and concepts were easier to grasp. Meanwhile working at the ALS level during medic class gave me the confidence I needed when I finally became a medic. Yes it was the long way to get there but i think it made me more efficient in the end.

Good luck with class.

[primemedic01]

Just a few tid-bits of info. I took an EMT-I(99) class that lasted 6 months, although I have to agree with you that they really are the bastard children of Ems in some systems they are highly relied upon. The service I worked for at the time was very rural.We were a small hospital based service in a poor community that couldn't afford to employ the number of Medic required to make the county function.So the intermediates served a vital purpose. As for preparing you for medic class IT WILL it made everything easier to understand and concepts were easier to grasp. Meanwhile working at the ALS level during medic class gave me the confidence I needed when I finally became a medic. Yes it was the long way to get there but i think it made me more efficient in the end.

I definitely agree that in some areas the Intermediates are absolutely vital to the operation of an EMS system. And I think I may have described the NH system in a way that made it come across as if I thought that Intermediates are mundane and not needed/used. My criticism was directed more towards the curriculum and the process to become certified, rather than that actual role of the intermediate. I don't think the actual education is bad, depending on what program you attend. The intermediate certainly plays a large role in areas of NH. Especially in the smaller volly departments where they A.) can't budget medics and B.) Most who get any type of EMS cert (FR, Basic) and work for a volly fire department aren't really interested in the medical aspect of the job (Please notice that I have said MOST, and not all. This is how it is in my area, and I'm not meaning to offend anyone who works for a volly department), and have only gone through those programs because they were required too. In my Basic class, I was the ONLY one in there who A.) Had an interest in medical care, and B.) Had the intention of furthering my knowledge as a pre hospital provider. EVERYONE else in the class was from one of the small volly departments from around my area that had no interest in the class, and didn't really pay attention or care about really understanding the information being given to them.

I guess what I'm getting at is that Intermediates definitely serve a purpose in those small towns that don't have medics and need more people other than those who are Basics just to be Basics.

Intermediates also help the larger communities provide 100% ALS coverage. Where I live the Fire Dept has 80 Full time firefighters, with much more than half being medics. The rest are mostly intermediates (with the exception of a few officers who are basics, and have been there since before they started only hiring medics). The dept is set up so that no matter which piece of apparatus roles out of the bay, there will be a medic on it. The normal man power on an engine is an operator, an officer, a medic, and an intermediate. The normal staffing of a medic unit is either a medic and an intermediate, or medic and a medic. This system has worked out very well for them, with my community having some of the most highly respected medics in the region, and being one of only seven fire dept based ambulance services (and one of two ambulance services in all of New England) to achieve national accreditation (caas).

Good luck with class.

Thanks!

[itku2er]

UMM .............WELLLLLLLLLLLL...........I can say that after reading this thread I am totally insulted by people in my profession, I have been called a bastard chlid of EMS and a Basic with Skills....... :roll: :roll: :roll: :roll:

and yes I live in a "small backwoods town" but hey we do have running water and electricity and get this we even have PARAMEDICS here.....I do plan on going on to paramedic but when I do and when I become one I pray to God that I dont become like some of you guys.....meaning I DONT WANT TO BE A PARAGOD :!: :!: :!: :!: :!:

there is a right way and a wrong way to talk to people and insulting them and their intelligence isnt the right way to do it

some of you guys really need to go back to school and learn TACT gezz.....but i will leave you with this one thought before i go

dont judge people before you walk a mile in their shoes and see life from thier eyes not your judgemental ones

that is my $0.02 worth

Terri :wink:

[primemedic01]

UMM .............WELLLLLLLLLLLL...........I can say that after reading this thread I am totally insulted by people in my profession, I have been called a bastard chlid of EMS and a Basic with Skills....... :roll: :roll: :roll: :roll:

When I referred to the "Bastard child of EMS", it was in regards to the education and certification process and organization, not the actual Intermediates themselves. Also, if you want to be completely technical, the Intermediate is a Basic with more advanced skills. So is the Paramedic. Remember, the Basic is the BASE of all advanced levels of pre hospital care.

and yes I live in a "small backwoods town" but hey we do have running water and electricity and get this we even have PARAMEDICS here.....I do plan on going on to paramedic but when I do and when I become one I pray to God that I dont become like some of you guys.....meaning I DONT WANT TO BE A PARAGOD :!: :!: :!: :!: :!:

I don't recall anyone insulting smaller communities. I do however recall a point being made more than once that Intermediates play a vital role in EMS in a lot of smaller communities. Also, I don't believe anybody said smaller towns don't have Paramedics. It was stated that smaller towns don't have as many, nor do they have as much money to budget them. This is a fact that you are just going to have to live with. Please take into consideration that in most of these posts (and I even clarified this in mine) people are stating their opinions on the use of the Intermediate in their areas. Don't take it as a personal attack against you or your service. It's childish.

I'm also curious as to who all of these paragods you are referring to are. There is really only one medic on here who I could see you taking his post as insulting. He does however make legitimate points to back up his opinion. All others were either Intermediates, Basics/Students, or Medics who agreed that the Intermediate is an important level of EMS.

there is a right way and a wrong way to talk to people and insulting them and their intelligence isnt the right way to do it

some of you guys really need to go back to school and learn TACT gezz.....

No one insulted your intelligence, let alone all Intermediates as a whole. So I'm not really sure as to where you are coming from with this. There were some questions raised upon one of the posters, but that was between him and another respective poster. I'm sure he doesn't need you to defend him, he did pretty well on his own.

Your level of training wouldn't make me question your intelligence. I know Basics that are smarter than some medics

This post does however make me question your reading and comprehension skills. On the first day of my Intermediate class, my teacher stressed that when writing reports and communicating with people in general, you should always be as grammatically proper as possible. When your writing is sloppy, people will assume you are sloppy. You WILL be judged on how well you present information. If you want people here to respect you and your intelligence, this post probably wasn't the best thing to boost your credibility in that department.

but i will leave you with this one thought before i go

dont judge people before you walk a mile in their shoes and see life from thier eyes not your judgemental ones

Was this a quote that you just decided we needed to see, because I don't see it's relevance with this topic. More than 90% of the posters on this thread, that you were probably offended by, were either intermediates, intermediates at one point, or in school to be an intermediate, like myself. I'm fairly certain that this gives them the right to their own opinion regarding something they are directly involved in, and it also means that they have walked a mile in the aforementioned shoes.

No one on this thread was judgmental, just opinionated. If you have a hard time dealing with opinions, then a message forum certainly isn't the place for you. So my advice would be to get off here and pull up the google webpage (www.google.com). Then search statistics and more information regarding the EMT-INTERMEDIATE in the United States, and you might find that things in other places of the country might be a little different than they are in your small backwoods town.

Nighty Night all.

[Medic26]

Are EMT-I's vital in EMS.....In my opinion yes if they are used correctly. Of course a national standard making them the same in all 50 states would be helpful. I work in Rural PA where as we speak the state lawmakers are deciding whether or not to implement an EMT-I's scope of practice, as it stands now we have basics, paramedics and pre-hospital RN's (healthcare professionals as the state calls them). I do believe that this would be very beneficial for both rural and urban services if utilized correctly. The current proposal as I understand it is only the addition of IV's and an airway device like the combitube, as little as this is it may be a big help. Not to mention the addiotnal assessment skills that these providers may have from additional class time.

Personally I would love to have an EMT-I as a partner, especially on those pucker factor calls at 3 am when its just me and my partner. I do work part time at a service that runs dual medics and what a difference it can be when time is critical, but not all communities can afford this kind of coverage.

[AZCEP]

The additions of IVs and combitubes has already been done in many places to the BLS level. Creating an entire level with these skills does not create more capable providers. Plenty of discussions have already been done on this very topic.

If we want pseudo-ALS providers, then why not add to the basic without creating an intermediate? The very idea that a partial upgrade is acceptable should be appalling to all ALS providers. Whenever you compromise with the educational standards, who gets the short end of the situation? By it's very nature compromise will create band-aid solutions. The intermediate level should not be viewed as adequate, because it isn't. Allowing jurisdictions to decide what level of patient care they will provide only worsens the situation.

If you want EMT's with some extra skill sets, then allow that. If you want full paramedic capability, then support the move to this level. If you want a little of both, you are missing the bigger picture.

[nsmedic393]

Our intermediate level was instituted after the province took over ambulance services from private/funeral homes. At the time they had a mixed bunch of medics working under many different skill sets. Creating the I level allowed medic with skils above the BLS provider to have a level to fit into without loosing those skills. It also gave the province the ability to get ALS onto the ambulances quickly.

That was 10 years ago. Five years ago the Province stopped training or accepting ICP providers. Those that worked here previously as intermediates are allowed to practice at that level still however now if you want to go beyond the PCP level you have to go ACP.

[Medic26]

If you want EMT's with some extra skill sets, then allow that. If you want full paramedic capability, then support the move to this level. If you want a little of both, you are missing the bigger picture.

Never did say it was an "acceptable" replacement for ALS, it is someone who can do more that is closer until a paramedic arrives. NOTHING MORE, AND NOTHING LESS. In this area BLS units can wait for up to 30-60 minutes until they interface with ALS, it would be nice if they could do more!!

And just for the record, an EMT-I is not ALS in my book, just an advanced form of EMT-Basic. ALS = Paramedic.

[Dustdevil]

As for preparing you for medic class IT WILL it made everything easier to understand and concepts were easier to grasp.

Definitely. But that is definitely not a positive argument for the Intermediate level. It makes grasping paramedic school a little easier because you have already done it once. That's like saying repeating the grade 9 makes it easier the second time. Sure, but I don't think anybody would recommend that we take the grade 9 twice just so the second time is easier.