A call to arms! EMT-B's defend yourself!

[JPINFV]

At the behest of the revered Devil of EMT-city, I am going to give all EMT-B's a chance to let Dust know what a good BLS provider should know. Any and all users of this site have probably run into the attitude that Basics are sub-standard on some (if not all levels) of EMS. There have been multiple threads and comments on this very site that advocate the need for medics on every truck.

My challenge to the perusers and users of this fine internet establishment is to quantitatively and qualitatively list what you think makes a good basic. Explain to the masses why Basics are not useless, and are more than drivers/taxi attendants.

If you are to take part in this challenge... I implore you, think it through and try and post reasonable, intelligent responses. Also I think it might be useful to know from the advanced providers on this board to explain what they like to see in their basic partners (and no... a paramedic license is not an appropriate answer for this discussion).

In the meantime, I will reflect and postulate my answers to this question and will not get another chance to respond for another 30-42 hours from now (duty as an under appreciated BLS provider calls). Happy posting, and I await the answers with unrepentant anticipation.

In the immortal words of Rob & Big... time to do work.

First, I believe that EMT-Basics are important for the system indirectly. One of the major reasons that patients are held in the ER is because of the lack of bed space in the hospital. For that very reason, EMT-Baiscs are important for the system essentally as a taxi driver. That said, at most the lights on a van staffed only by basics should be amber. They should not be involved with transfering a patient to an ER except in rare cases (BLS transfers from hospital to hospital, for example. These should be set up by physicians knowledgeable about what basics know). Any ambulance should be staffed, at a minimum, by an EMT-intermediate. Intermediates in this case should not be viewed as "limited advanced life support" or a substitute for paramedics, but as a BLS provider. It is essentially the same thought process of not every patient needs a MD/DO, but can just as safely be seen by a PA/NP.

This is not to say that EMT-B personal should not be allowed on an emergency ambulance, but they should not be the highest level of care. From my experiences volunteering at a busy non-trauma center (tons of medical patients, though. The hospital has some of the highest number of paramedic runs and lowest divert times in the county), the initial stabilization of patients involves lots of things that can only be described as "skills." Skills such as hooking a patient up to a monitor, establishing IV access, preparing medications, documentating, etc allows treatment to run more smoothly, yet not everyone needs to know everything. Yes, it is true that a paramedic can do all the skills needed where a basic is limited, but couldn't the same argument be laid against any level below a physician (assuming an unlimited supply of physicians)?

[Dustdevil]

Yes, it is true that a paramedic can do all the skills needed where a basic is limited, but couldn't the same argument be laid against any level below a physician (assuming an unlimited supply of physicians)?

Dude, you are about the last Basic here that I would have expected to say what you just said.

I am going to give you a chance to re-read that and redeem your reputation by correcting it without me pointing it out. :?

[brentoli]

Well, A basic compared to a medic partner, there is no justification. If a medic wanted a basic for a partner and not a medic he A)is stupid or B)thinks he is god which leads back to A.

Basic in general however there is reasoning for this.

Law Enforcement officers, security guards, firefighters, and other public service occupations it makes sense to have people certified in this.

That is a big difference from EMS however, as that is training and not education based. I don't expect my sheriff deputy on the scene of my accident to know the physiology behind why I am bleeding everywhere. I expect him to know to put a dressing on it and secure it to slow and stop the bleeding.

I think maybe Dust, this is getting in to your thoughts on a new system. EMT-B is just a first aid course. I agree. It is nothing to get a woody for.

We go in to the ER expecting quality care from a physician, not from the ER tech who takes our temperature. Why would the ambulance be different.

EMT is a certification, it is a tool to help you. But the points are valid, a medic partner beats an EMT any day. I'm not being wishy-washy here. I am rebutting to Dust's point he made, and I think I am starting to understand what he means by a "new" system.

[JPINFV]

Dude, you are about the last Basic here that I would have expected to say what you just said.

I am going to give you a chance to re-read that and redeem your reputation by correcting it without me pointing it out. :?

Durrr, me tired. The "why should I have a partner that can't do the same as I" argument only really works when personal is in limited supply [i.e. ambulances staffed by 2 people]. If a MD/DO has a problem with an intubation, there will probably be another doc or RT able to give it a go, providing that the patient is stable enough to not force more drastic measures (For example, in one of the intubation threads one of the docs stated that while he has limited intubations due to working at a hospital with a residency program, the intubations he performs are selected for being the difficulty). Hospitals have the staffing levels to justify an ER tech, whereas ambulances generally don't.

If you are talking about the skills v education debate. I will submit that the only education that truly matters are the ones who are allowed/able to work autonomously on the patient [i.e. RNs, MD/DOs, PA/NPs, etc. See Harbor/King/Drew botched triage story for a perfect example]. An ER tech or lab tech are able to contribute to stabilizing a critical ER patient not because of their education level, but because of their skills. Being able to give the person making the decisions (physicians in time sensitive cases) information and treatment options [i.e. assisting with the monitor, providing IV access, obtaining blood samples for the lab], or freeing up other personal for more delicate procedures [essentially the same examples to help an RN with managing multiple patients that have orders that need to be fulfilled].

[Dustdevil]

If you are talking about the skills v education debate. I will submit that the only education that truly matters are the ones who are allowed/able to work autonomously on the patient

EMTs working a basic unit ARE working autonomously. There is nobody there looking over their shoulder to evaluate that patient before they start pushing drugs or tubes. The existence of protocols notwithstanding, they are still functioning independently when it comes to patient evaluation. So no, skills are not okay if you do not have the educational foundation to back them up.

The point you missed ---> IT ISN'T ABOUT SKILLS!

Minus 10.

[JPINFV]

Except in my first post in this thread I specifically stated that Basics should not be on an emergency ambulance alone [with the definition of an emergency transport basically being anything going to an emergency room], but were imporant for things like discharges. I also stated that things like discharges don't need red lights or sirens, just a van with shiny amber lights.

[scott33]

Well, I have tried, but I really can't answer the original question, as to be honest many EMT-basics are no more of use than the average police officer on scene. I don't mean that to offend, as one is only as capable as ones training or education, which in some places isn't much.

I think the mindset has to change however. Not enough basics see his / her position as a stepping-stone to a higher-level EMS qualifications. Too many people just want to run about in ambulances, making as much of a spectacle as they can, then do very little in the way of a good assessment and treatment when they reach the patient. I know the level of training is pitiful, but it's a starting point, and should be all the more reason to want to go onto bigger and better things. It is too easy just to stay a basic and do your two-week, once every three years, refresher.

Just to go off on a slight tangent, perhaps a small part of the problem is the historic (and can I say outdated) affiliation many systems have with the Fire Dept. Good for the FD as it's a clever way to quickly quadruple their call out figures. The problem arises with those who see their EMT-B as a mere adjunct course to being a FF. How many FF / EMTs can you think of, who see themselves as primarily an EMT, then a FF, in spite of what most of their calls will relate to?

Then there are the volunteer systems which have many of its members "unable to put in the time for a Paramedic class due to work / financial commitments" (deliberate quotes as I have heard this many times). Again, if you are serious about EMS, this should not be an issue. How many of us work full-time and still manage to put ourselves through...nursing school for example?

It baffles me why someone would not wish to go further with their EMS training / education if they were really taking it seriously, not just seeing it as a little hobby. It's like someone who wants to train to be an airline pilot, but just wants to taxi around the airport...not actually fly. All the glory, without the responsibility. Not that it ever happens in EMS :roll:

A little extreme perhaps, but maybe there should be a cap on how long someone should be permitted to be a basic for, before being encouraged to move up a rung or two on the ladder. The powers that be should at least pitch this idea at an entry-level interview, or to a fresh out of school probie.

It would be to everyone's advantage to have more advanced providers out there, if only, at the very least, to become more capable "basic" providers.

[Dustdevil]

Except in my first post in this thread I specifically stated that Basics should not be on an emergency ambulance alone [with the definition of an emergency transport basically being anything going to an emergency room], but were imporant for things like discharges. I also stated that things like discharges don't need red lights or sirens, just a van with shiny amber lights.

Ah, I have a clearer understanding of what you meant in your final paragraph after re-reading it.

Sorry bout that. :wink:

[whit72]

Just for shits and giggles if I had to defend myself or my position on a 911 BLS truck it would go something like this:

My co workers and I are completely capable, more then competent enought to respond to, treat, recognize the need for a higher level of care, maintain that pt till they arrive and help in the effort to care for and transport that patient.

We dont have to justify or defend ourselves to anyone. If you dont think are training or education is sufficient, write a congressman or somthing I dont have to sit here and whine about how I am not respected or included in the real EMS world because I am not a medic, or what I can do to make my medic co-workers more confident in my abilities, my job is not to impress, seek your approval or justify my existence to you. I know the responsabilities, capabilities and limitations of my proffesion. If the pt requires an ALS intercept just make sure you know the responsabilities, capabilities and limitations of yours. If you want to spend our time together evaluating what I have done thats fine. I dont want a crash course in the metabolic process of CHF on the cellular level, or negative effects of high flow oxygen on the copd pt that resides above seal level. Neither does the pt. that cant breath. If I have a question about somthing I will ask you. I dont want to hear why you wish you had this drug or that drug or CPAP or BIPAP or RSI. I wish I had a million dollars. I dont so lets just move on with what we do have.

My actions speak loud enough. If we were not competent enought to tend to our duties we would be removed, by our medical director the one with the MD on his coat. The decision to run BLS units was not a financial one. We could be replaced by ALS units tomorrow. However I am sure if you would like to contact them and voice your opinions on what you believe with your vast knowledge and education would be a better way to run the system across the country I am sure they could use a good chuckle.

If not concentrate on being the best provider you can be at the level of your choice, find you niche, and do your part at making this proffesion a little better then you found it.

Stop bellyaching about what you wish it could be and concern yourselves with making the one we have as capable and efficient as possible.

By the way, when you guys do achieve the elite nationwide paramedic only standard, dont forget to inform me so I dont have to set my alarm.

[dropdeded]

Whit72, good post.

Im am good at my job, and I enjoy my job.

ed