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

[batjka104]

We are in agreement in a way.

I don't think two years of college are needed to bring EMT-B's to the level you are talking about. That would put a huge strain onto the whole EMS system in the United States. I think that one full college-level semester (4 days a week) would be able to cover a great amount of relevant material. As I understand, you are advocating having better educated people in EMS in general. Not because an Associate Degree is really required for their job, but because it would bring better human material into the profession.

To be a good EMT one does not need 2 semesters of physics and English. Anatomy, however, is a must.

Current EMT-B certification, of which I am in possession, is good enough for first responder level. And it does help save lives.

But to be efficient, as I said, EMT-B's scope of practice should be expanded to at least Combat Life Saver level, and should include the skills listed above (glucose injections, IV saline or Ringers, needle decompression and ETT or Combitube).

My 200-hour course was decent, but I wish it had ran longer and required more ER experience.

[vs-eh?]

I do believe the EMT needs more education. A&P, chemistry, biology, psychology amongst others. Two semesters would be sufficient, ER rotations and ride time. I had pre-reqs to apply to my EMT class. Why shouldn't they now? We are not educating doctors here, we are educating pre-hospital providers. Recognition is our most important trait. Not how many meds I can push, or tubes I can put in you.

See but that's the problem whit. It would be the teeny tiny minority that would do what you are suggesting. I had to do 2 years education for BLS prior to ALS - psychology, writing techniques, all the sciences, etc... But as a PCP my scope of practice is very similar (with regard to actual skills) to the EMT-B. "LUDACRIS!", they'd cry. Why should I have to do all that for BLS? You would do it, or had to, others would not.

People don't do ER rotations or ride out time for EMT-B? Maybe sticking dots in the right places is a plus then...

[vs-eh?]

But to be efficient, as I said, EMT-B's scope of practice should be expanded to at least Combat Life Saver level, and should include the skills listed above (glucose injections, IV saline or Ringers, needle decompression and ETT or Combitube).

Advocating intubation at the BLS level is a losing argument, period.

Intubation does not save lives. Proper BLS airway management with good BVM skills will manage 99% of airways prehospital. You need/should have a dedicated airway course will ER/OR rotations with an anesthetist. Not simply placing a tube in a mannequin. Even if you are saying you will intubate only dead people, reading the new ACLS you will see that intubation is deferred and (in the end) isn't necessarily needed. CT is the same argument.

Needle decompression? Maybe in Combat lifesaver (I'm not familiar) where I assume you see a tonne of trauma/chest wall injuries. Decompressing a potential pneumothorax is a lifesaving procedure, however...Generally speaking this is going to be quite rare for a normal EMS provider. You are probably going to see as many medical pneumo's (asthmatic, barotruma with PPV, etc) as traumatic ones, and these aren't exactly easy to recognize with 200 hours of education under your belt.

IV's? Again don't save lives, especially if you aren't giving IV meds. Again in this "combat lifesaver" roll where you are seeing a lot of trauma and hypovolemic shock it may have its place. Normal EMS work for BLS? Probably not.

Glucose injections? Like what glucagon or are you saying giving D50 (pretty vague)? Again, do you have a reasonable amount of pharmacology within that 200 hours? Meh, I think not...

[Dustdevil]

See but that's the problem whit. It would be the teeny tiny minority that would do what you are suggesting

Exactly. I have worked with excellent EMT-Bs. They are out there. But they are damn few and far between. I bet you probably are one of the better ones, Whit. I think I was one of them. But that is the problem. They all think they are among the best, usually about three months into their first transfer jockey job, after finally passing NR by one question on the third try. You have to judge the usefulness of the genre (which is again the point of this topic) by the norm, not by the anomaly. Therefore, EMT-Bs don't all totally suck. And neither are they all useful or even competent. And I am pretty sure that if you averaged the two, the useless ones would come out on top by a big percentage. Is that a reflection on you personally? Nope. And I don't mean it to be. This topic isn't about you. It's about the vast majority of the hundreds of thousands of EMT-Bs in the U.S. And even considering the very best of them, there is nothing they have to offer me that a paramedic partner could not also offer me plus a lot more. And that is the bottom line. EMT-Bs bring nothing uniquely useful to the table, and they bring a lot less than another paramedic, causing me more work. Why would I want that? The only medic who wants that is a wanker paragod who wants to feel superior to his partner. Personally, I want somebody who is on equal footing with me so that power dynamic never comes into play.

[batjka104]

When talking about IV, I mean starting the line so that it can be utilized by appropriate personnel in the ER. If a patient loses a lot of blood, it is difficult to put in the line.

Glucagon IM should definitely be an option for EMT-B's. It's easy to administer and has a great effect. D-50 also should not be a problem, given that an EMT can gain IV access. A lot of medical calls are hypoglycemia related, so why wait for an ALS rig to show up to administer?

Chest decompression? You have a point there. Maybe in some area it's not as needed. But still, a simple skill that can save a life. And pneumothorax is already explained in the BTLS course in detail.

Intubation is needed for unconscious situations. Gaining a definite airway improves survival chances. And combitube is simple enough to install (even though I've never done it).

But that's all off-topic. The point is, we started discussing why EMT-B's are needed, and it turned into discussing why they make bad ALS partners. BLS should be able to be dispatched on its own. And with some expanded scope and better learning it should be able to pull its own weight.

[Dustdevil]

A lot of medical calls are hypoglycemia related, so why wait for an ALS rig to show up to administer?

Uhhh... you kinda just answered your own question. BECAUSE THEY ARE ALS AND A BASIC IS NOT! Why is this such a difficult concept for somebody who thinks he understands pharmacology and emergency surgery?

Chest decompression? You have a point there. Maybe in some area it's not as needed. But still, a simple skill that can save a life. And pneumothorax is already explained in the BTLS course in detail.

You're kidding, right? Obviously you've never done it. And having it "explained in detail" isn't exactly real education or experience. You're living in the theoretical dream world. Even CLS out here don't do that but once in a very blue moon. Show me a system in the U.S. that needs basics decompressing chests, and I'll show you a system that needs paramedics.

Intubation is needed for unconscious situations. Gaining a definite airway improves survival chances. And combitube is simple enough to install (even though I've never done it).

Again, it is very obvious that you've never done any of this. If fact, it is painfully obvious that you've never even been competently educated or trained on any of this, or you'd know how silly you sound right now.

But that's all off-topic.

How convenient for you to finally admit that -- after being told several posts ago -- when you hit the bottom of the hole you have dug here.

The point is, we started discussing why EMT-B's are needed, and it turned into discussing why they make bad ALS partners. BLS should be able to be dispatched on its own. And with some expanded scope and better learning it should be able to pull its own weight.

You just killed your own argument. Again! You just said what we have been saying all along. EMT-Bs as they CURRENTLY EXIST (as opposed to how wonderful they are in your crack induced pipe dream), are not useful as a crewmember of an emergency ambulance. To be useful, they would require a great deal more education and training. You just said so yourself.

What is with you people anyhow? You're certainly not helping the cause of "defending" EMT-Bs with this idiocy. Isn't anybody here going to say something that actually makes a valid case for their usefulness? Are you going to let me win this easily? I mean, be my guest if you want to just keep taking the discussion off topic in an effort to obfuscate the issue in hopes that we won't notice. Everybody has a right to make an arse of themselves if they so desire. But again, this nonsense isn't helping basics. It's just making them look worse.

[JakeEMTP]

Yes, a needle decompression is an relatively easy skill. However, without proper education in A & P, what's under the skin where you want a EMT-B to stick a 14g needle in me? I'll pass.

Glucagon has a 15-20 min delayed onset action. I would hope the medics would be there by then. Even if there not, unless you're more than that from the ED, just load and go.

If you're going to start an IV already, administer the D50. Oh, don't forget the Thiamine IM while your at it.

ETT, no, never. EMT-B should insert OPA or NPA and BVM only.

I see where you want to progress the education and I applaud that. But the amount you're asking for isn't hardly enough. Why do people always want more skills without the proper education? This isn't rocket science, I know. But 1 semester isn't anywhere near adequate.

I have to agree with others that medic/medic is the way to go. A equal level of provider.That is why I am working feverishly to complete my classes. 1 semester left

Now, I have to go find my Basic partner. They forgot to clean the windows on the Ambulance. J/K

[batjka104]

Thank you very much, Your Highness. You are so extremely polite and kind, I am very impressed!

Anyway, maybe my intubation argument was not great. I admit it. When I have more time, I will back it up.

Basics in their current state are useful on their own as they take the patients to the hospital in expedient manner while stabilizing them to the best of their training and education, as described by Medical Director.

I, however, advocate expanding the education and training of EMT-B's to make them better providers. I think that CE classes should be put in place (or the original course expanded) to allow Basics to perform limited ALS skills that would benefit trauma patients. Medical stuff will still be ALS's domain, as it requires a great amount of education and time. And understanding.

As far as hypoglycemia goes, I would hope that a EMT-B can recognize it and treat accordingly. And if the patient is unconscious, be able to intervene with glucagon or D50.

[medicmole]

Once again, vs-eh, you disappoint me. I have seen you bring legitimate points to a conversation, and I have seen you provide quality input to discussions, but those tend to be few and far between.

You purposely comment in an argumentative manner. As I don't live in Ontario, I looked up the Ontario PCP guidelines. A quote directly from the Ontario Paramedic Association website ( http://www.ontarioparamedic.ca/faqs.html) indicates: "The Primary Care Paramedic (PCP) is a graduate of a Ministry of Health approved college Paramedic Program, has obtained A-EMCA certification, and is employed in an emergency medical service. The function of a PCP is to provide emergency patient care, cardiopulmonary resuscitation (CPR), patient immobilization, oxygen therapy, basic trauma life support, blood glucose testing, and non-emergency patient care and transportation. "

That appears to sound very similar to EMT-B... but, I will research further.......

Yes this is off subject but here is some information for emtannie.

This link shows the comparisons between EMR (which I believe is close to your EMT-, PCP, and ACP. Hope it helps.

Competencies

[paramedicmike]

Anyway, maybe my intubation argument was not great. I admit it. When I have more time, I will back it up.

You think? Maybe?

Basics in their current state are useful on their own as they take the patients to the hospital in expedient manner while stabilizing them to the best of their training and education, as described by Medical Director.

You've yet to say how. And the only reason I'm posting here is simply because I am asking you to think for once and come up with something original.

I, however, advocate expanding the education and training of EMT-B's to make them better providers. I think that CE classes should be put in place (or the original course expanded) to allow Basics to perform limited ALS skills that would benefit trauma patients.

This statement is further evidence that you don't know what you're talking about. Besides, if you start allowing basics to perform ALS level interventions, they're not BLS providers anymore, are they? How many times has this point been made? I lost count.

Medical stuff will still be ALS's domain, as it requires a great amount of education and time. And understanding.

This statement implies that you do, in fact, understand that BLS providers are inadequately prepared to do anything in an EMS environment. So why are you continuing to argue contradictory points?

As far as hypoglycemia goes, I would hope that a EMT-B can recognize it and treat accordingly. And if the patient is unconscious, be able to intervene with glucagon or D50.

But you just said that medical stuff is the domain of ALS. Which is it?

Please please PLEASE quit while you're ahead. You have dug yourself a hole from which you cannot get out. Just stop and save us, and yourself, from further headache.

-be safe