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

[frontcrawl]

Now, I'm new around here but I get the impression that you folks just don't get it. It's not about BLS vs ALS, it's not about "skills", it's about why in the hell a 120-hour puffed up advanced first aid class qualifies anyone to staff an emergency freakin ambulance.

"Oh, but my state has higher standards, our EMT class is 160 hours!"

:roll:

[ccmedoc]

...dual-medic ambulances are completely justified. I would even argue they are the standard of care.

I fail to see why two medics are justified as "standard of care". Why do you "need" two medics on an ambulance.? I can't see how quality of care goes up the more medics you have. :?:

Also, two paramedics can act as a safety check for each other, if one has hit a mental bump in the road ("Sam, do we use Narcan or Nitro in this type case, I seem to have forgotten").

I think this is a rather weak argument, although I hear it often.

If a paramedic has to "bounce" treatment options off of their partner, then said medic needs a fair amount of remediation and additional education, IMHO :roll:

[Janmarie3]

No I think that is a quote from "Charmed." Sounds like something Piper would say!

Enchantment!! :roll:

Peace my Wiccan unshorn sisters,

Marty

"Unshorn" doesn't that mean "Unshaven?" Hmmmm well that counts me out of the unshorn enchanted ones :-)

[Janmarie3]

I fail to see why two medics are justified as "standard of care". Why do you "need" two medics on an ambulance.? I can't see how quality of care goes up the more medics you have. :?:

I think this is a rather weak argument, although I hear it often.

If a paramedic has to "bounce" treatment options off of their partner, then said medic needs a fair amount of remediation and additional education, IMHO :roll:

The only time I have ever seen two medics on an ambulance together is when one is being trained and trying to get all his requirements met and then is shortly released on his own with his own medic rig. Course that was backwoods country style, perhaps in the cities there is a need for two ALS providers on an Ambulance.

[JPINFV]

I think this is a rather weak argument, although I hear it often.

If a paramedic has to "bounce" treatment options off of their partner, then said medic needs a fair amount of remediation and additional education, IMHO :roll:

Would you say that 2 doctors of the same specialty bouncing treatment plans off of each other also qualify as needing remediation or would you just chalk that up as a consult?

I think the big problem is that people don't look to see where EMS is going and are only seeing where it is. I honestly believe that if EMS is going to stay relevent that paramedics are going to have to become essentially prehospital PA/NPs that will not transport every patient to the hospital (treat and release on scene, or maybe transport to an urgent care clinic, as well as more preventative medicine). That is simply not possible given the current system. Furthermore, the problem isn't the 'paramedic helped' basics that would never truely have to make patient care decisions, but the 'basic with basic partner' that has to decide when a patient is serious to require rapid intervention.

[CBEMT]

Furthermore, the problem isn't the 'paramedic helped' basics that would never truely have to make patient care decisions, but the 'basic with basic partner' that has to decide when a patient is serious to require rapid intervention.

Which happens thousands of times a day all over the country, and as Michael pointed out, there's nobody suing over it.

Given that American file lawsuits because their coffee is hot, I'm not seeing the big problem here.

[Dustdevil]

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.

Seems like all the defenders started out on the wrong foot, by not bothering to fully read the original post. Typical of Basics to run off half-cocked and jump into interventions without fully understanding the rationale of the intervention or the pathophys of that which they are intervening in.

So far, nobody has even come close to satisfactorily answering the above question. The best that I've heard so far are merely contentions that most patients only need a taxi driver/attendant to begin with, so that's okay. While that may be a valid point in many cases, it is totally irrelevant to the question which was asked.

So again, for the hard of hearing, what makes a Basic more than a taxi driver/attendant? What makes you more useful to me than the average Joe? Why would I want you as my helper when I could have a Paramedic as a true partner instead? And why, as a citizen, would I want you coming to my home to evaluate and treat my illness -- or the illness of my loved one -- instead of a Paramedic?

You simply can't do it. It cannot be done. Without talking about how much cheaper they are, there simply is no rational justification for the existence of EMT-Bs as primary crewmembers on an emergency ambulance.

Whit... two words. Spell check. It's hard enough to take you serious as it is.

[PRPGfirerescuetech]

in my opinion...

YOUR ALL WRONG![/font:5249314c47]

Now, heres the thing. When it comes to EMT's vs. Paramedics, the sad truth is that no one on here has enough education to be an adequate EMS provider. Period.

That being said...

EMT-Basic level providers have an ABSOLUTE use in the field. They might be a useful level, when their level of education, professionalism, and scope are expanded as they need to be. When the "special" folks among our ranks are weeded out, and have moved on to jobs at BK asking about "fries with that" and all that jazz, then, and only then, will their usefulness being as it needs to be.

EMT-Paramedic level practioner education is a complete joke as well, but their level would be useful when we can raise the level of education, professionalism, and scope are expanded as they need to be. When the "special" folks among our ranks are weeded out, and have moved on to jobs at BK asking about "fries with that" and all that jazz, then, and only then, will their usefulness being as it needs to be.

Now...

The discussion on the usefullness of a tiered system, or a limited MICU/Mensa medic system is a completely different discussion, meant for a different thread.

Sorry for the reality check kids, but above is the harsh reality of the topic. The only reason we argue about who is better than who is because were all inadequate, due to our level of education, and the standards established by our forefathers. You want my respect? Get a real education, not 18 months of trade school making you an overpaid skills monkey.

Discuss.

[akflightmedic]

OK, I have some free time and will weigh in a little bit on this topic.

First off, I am not an English teacher, however grammatical errors always tend to sway my opinion when people are trying to convince me how important they are. It is just a personal pet peeve I thought I would share and yes I do make them occassionally but I do try to double check and spell check before hitting final submit.

Anyways, I think this is a great topic as long as people don't get too offended and try to respond in a logical manner, but as always I see people getting upset and responding more emotionally than intelligently or scientifically.

Now for the topic at hand...Yes EMT-Basics are needed, Yes the IDEAL system would be to increase education standards and have medics everywhere for optimal care. However this is just not a reality and can not be possible in many areas of this country. I have worked in some very remote areas (the arctic), and if it were not for basics, there would be NO pre hospital care. Up in that region, medic students have to LEAVE the state to finish schooling due to the fact that the call volume is not there to allow these students to complete the requirements. So it would seem that being so remote, medics would be ideal; however, it is not possible. I will point out the fact that the EMTBs in that area had at best a 6th grade education, which was the requirement, and they successfully completed the course and were able to do the skills after passing NATIONAL REGISTRY, so if they do it, any Lower 48 high school graduate should have no problem.

When I first started in this business, I came from EMT/Medic truck system. It was the only system I knew about and I could not have imagined it any other way. I asked a ton of questions and I did learn a little from the medics that were kind enough to share knowledge. I quickly realized there was more to every patient than my skills or knowledge provided and this frustrated me greatly. Therefore, I became a medic and opened my eyes to an entirely different approach to patient care and ASSESSMENT. The skills of a medic are irrelevant, as any monkey can do them, so I never wish to hear the only difference between this level and that is they can do IVs and intubate or something ridiculous like that. As I said, anyone can do skills. My first intubations were as an EMT basic as that was when they rolled out the new course that allowed us to do so and my state approved it at that time. It boils down to knowledge and I know that may sound pompous but it is true. As you learn more, you quickly realize how little you truly knew beforehand. It is those that choose to remain ignorant that never become aware of this concept and continue to spew forth mindless mantras and catchy t-shirt phrases.

As for dual medic trucks, they are the best! When I moved to Florida, this was my first exposure to the concept. At first I was a little leery, but it did not take long for me to adjust and enjoy this concept. It is nice to know every other call is yours. It prevents burnout and report overload. The majority of our patients are ALS there, not critical, but ALS yes. It is just the nature of the beast in that area. It is nice to know on calls, you do not have to worry about asking for anything or hoping your EMT is good enough to anticipate your needs and set things up for your ease. It is done because the other person is educated to the same level as you are. On multiple patient incidents, which are common with our interstates, turnpikes and clustered roads, it is nice to know when you split up to go assess patients in different cars, it is an assessment you can trust from an ALS perspective. I am not saying Basics are mindless idiots, but it is possible for them not to see the big picture or recognize something for what it is. Yes, this can happen to medics as well (been there, done that) however it is less likely so.

Dang it, I was going somewhere with all of this and got distracted by something else. I will extrapolate further when I remember where I was headed.

Anyways, it all boils down to the fact that yes, Basics are needed in some areas, however the ideal situation would be increased education and more medics.

From the posts I have been reading, I see people having a hard time justifying the basic's position as this was the original topic at hand. Many have strayed onto different tangents and I fear this is due in part that the question can not be answered. Yes, our system is flawed and needs a major overhaul, but it is going to take all of us to correct it. But again, this is not going to happen anytime soon cause there are too many people that are content in their current position and think they know all they need to know.

Yes, we should do the best we can in our current position but why can we not strive for higher excellence? I would love to hear basics championing for higher levels of care and education, demanding it be done. But a majority do not because they know if they do this, eventually they will have to comply themselves or find another job or hobby. No one wants to better the system if it is going to one day force a change upon their current lifestyle which they enjoy.

Ok, I will leave it alone for a few hours, see what new responses come about and then respond if needed.

[akflightmedic]

I also meant to comment on the lawsuit topic.

Lawsuits do happen everyday, they just do not make the headlines unless they are high profile cases.

Many county, city and other govermental agencies are exempt from lawsuits as well per state law. This does not mean the individual can not be sued, but the agency itself can not.

In addition, many services are self insured which means they are content to hand out settlements to avoid a courtroom and headlines. This happens more frequently than one would think.

A year or two ago, I posted about a lawsuit I was personally named in, it was frivolous but I was named regardless. My service chose to pay the small settlement rather than going to court and involving whatever else may accompany that ordeal. These little deals go on all the time. Many moons ago, I worked as Loss Prevention in a major retail store. Part of our job was assessing and watching for the slip and falls, boxes on head etc by customers. Whenever this happend, we were authorized in conjunction with the store manager approval to offer and secure on the spot settlements up to 20K dollars. These events will never be logged or tracked statistically by an outside agency, therefore they do not exist. Same thing happens in EMS land, just because it isn't on the news or some website, does not mean it is not occurring.

I think the entire "no lawsuit, therefore it doesnt happen" tangent is a moot point and irrelevant to this discussion.