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

[James_ffemt]

Wow... I go to work for 24 hours, make an unscheduled trip to the Cape to visit some family... and look what happens! Everyone has either lost their mind, or completely lost the point.

I knew what I was doing when I made this thread, and I'm relatively sure that Dust knew what he was doing when he suggested it. Dust is a very thoughtful individual who is looking for a reason to advance EMS and improve the standards. I do not begrudge him this want, and frankly encourage any and all to sidle up beside him and help further the cause. Unfortunately he and others have made it clear that in their desire to re-vamp EMS, it is going to require the destruction and disbandment of the single largest group of EMS providers.

They have all made it clear that they think the majority of BLS providers are bad. You know what? I agree. I think the majority of BLS providers are either in it for the wrong reasons... i.e. Fire Monkey add-on, or lack the in-depth knowledge and social skills (Dust: It IS about the Skills, just not the ones you mean) to perform at a high level. Most EMS personnel in general are people with very little accessory knowledge about life, classical regular educations, business, culture, literature, or even simple life skills like balancing a check-book or holding down a regular job. This is cumbersome for all of us who look to further the abilities of the industry and our systems.

What I keep reading here is that even a good basic is more useless than a paramedic, to another paramedic. I believe this statement implies that all paramedics are adequate. I think the issues regarding why EMT-B's are useless applies even more dramatically to the paramedics. Bad Basics make bad paramedics. Regardless of where you started, if you don't have it in you to be a good basic, you cannot be a good paramedic. Most paramedics are just as woeful and sub-standard as all the Basics that run about. The problem here is that we are judging people based on the number of hours in a course. It's not about the course... it's not about the school... it is about the PERSON. The individual makes a good EMT or Paramedic. The schools and the hours and the education is ancillary in nature. If the quality of material being molded is deficient, so will be the final product.

So, to answer my own question. A good EMT is similar to a good pharmacist, or a good construction worker, or a good engineer, or a good fighter pilot, or a good WHATEVER PROFESSION YOU CHOOSE. It is someone who tries hard, and thinks harder. Someone who is not satisfied with the education he received in class and didactic, and has taken it into their own hands to learn from their peers (the good and the bad... you can learn something from everyone). A good EMT has good peripheral vision, so that they can constantly watch their partners' back. A good EMT questions orders when appropriate to do so, and has a warning bell always ready to go off in his head when things are about to go wrong on a call. A good EMT knows every application of every piece of equipment in his truck. A good EMT know how to do exactly what his partner is not doing so that you can move with greater efficiency toward the ultimate goal... definitive care. A good EMT knows when his/her partner needs help before the partner needs help. A good EMT knows how to evaluate a patient in a controlled and detailed manner and know not only your own plan of care, but understand your higher level of care partners' plan of care. A good EMT knows how to organize a scene and knows how to utilize every person on that scene to make things run smoothly and efficiently. A good EMT knows how to communicate to a variety of people in a variety of circumstances in an intelligent and focused manner. A good EMT must give respect.. or expect none in return.

The answer to everything is education (and the abolition of whackerism). But education alone is not sufficient if the beings getting the education are not capable of absorbing it. The one thing that is always overlooked on these forums is the QUALITY of the person doing the job. We are quick to nay-say the level of certification and all that hold it, but not break it down into fair and appropriate aggregates. One should not say that basics suck, they should say, "Hey! That basic sucks!" - or - "That paramedic sucks!" Because by classifying all basics or all medics together we verge on a new form of bigotry... One of which I will dub... EMS Apartheid.

I could go on and on if I chose. But I got to go back to work. I believe I have gotten my point across, if not... then I will just tell everyone that what ever level of provider you are, that you suck.

Cheers & Jeers

Josh

HMMMMMMMM!!!!!! Seem like that is allot of what I said.....

[Richard B the EMT]

Can we all agree, no matter what the level of training, that the patients benefit from some kind of skilled patient handlers, so injuries are made so that there's less, or no, pain on motion, some care, even if not really definitive, is started?

Thank the (insert name of deity) that we are now far removed from just throwing a patient into the back, and lighting the afterburner to jet to the ED.

[Richard B the EMT]

Oops, almost forgot...The Calvin and Hobbs picture used as an avatar? Not a cat, but a tiger (said the guy with the Picachu Pokemon as his own avatar)!

[mediccjh]

Here is an article.

http://pdm.medicine.wisc.edu/20-4%20PDFs/Isenberg.pdf

The benefits of ALS in certain situations is immeasurable. I have been witness to these on a daily basis. However the thought that the EMT has out lived his welcome is asinine. Studies have proven time and time again the small percentage of pts that benefit from pre-hospital ALS. There is no reason to have a ALS provider on every ambulance. If you have paramedics available when they are needed that is sufficient.

Who do you believe to be the more capable ALS provider:

The paramedic that responds to 20 calls a day, 5 maybe which are true ALS where an intervention is warranted.

The paramedic that responds to 20 calls a day, All which require an ALS intervention.

There is a place in EMS for both the paramedic and the EMT.

Exactly!

A two-tiered system is the best. Oversaturation of paramedics does lead to increased mortalities, as well as provider burnout. Look at Philadelphia.

There is NO reason a Paramedic needs to be on a stubbed toe, or an arm pain, a toothache, or a leg pain. Even if the leg pain ends up being a DVT, the Saline Lock of Life isn't going to make a difference. This is where the EMT-B comes in.

Hospital discharges do not require Paramedics, unless it is an Inter-Hospital ALS Transfer. This is where the EMT-B comes in.

Everything boils down to EDUCATION. Increase the EMT-B class hours, instead of the current ARC Emergency Responder on Steroids it is.

As someone who has had both EMT-B partners and Paramedic partners, I'd rather have another Paramedic. When I hit a mental block, they are there for me. When I miss an IV, they get it for me. And vice-versa.

You can form an EMT-B partner to help you the way you can on an ALS bus; however, that EMT-B still can't intubate or start an IV when it needs to get done and you have a hard time, whether it be poor veins or difficult airway.

[emtkat]

Well I have waited awhile to respond to this topic so that I could think about it. And I have come up with this reply.

I think that having emt-b's is a good thing, for this reason. The world is full of different places and each place needs different things. Where I live we have a 2- tiered system. A BLS/ILS unit gets dispatched while at the same time the county ALS unit gets dispatched. Some places this would work and other places it wouldn't. But if we got rid of emt-b for good what would happen to the more distant small towns? Example below:

My town is a half hour away from ALS and the Hospitals. But is too small to staff a paramedic due to limited calls (we only have MAYBE 1 call a day). The local emt-b and emt-I's respond and asses if the patient needs advanced care, if so we package up the patient, keep them stable to the best of our ability and training and meet ALS in route (since they where already automatically dispatched). If the patient didn't need advanced care and emt-b's can handle the call then the Paramedics will be available for the rest of the county (that has about 10 other small city's). In this way patients get the kind of care they need faster. 8) If it there was no BLS, patients would wait close to an hour before getting to the hospital (half hour for ALS to drive out to the patient and half hour for them to transfer the patient to the hospital)! So in this case EMT-B's are very important to our community! But I can see how emt-b's would not be as vital in large towns.

One thing to keep in mind though is that training is Very important for emt-b's! My agency meets 1-2 times a week for OTEP (continuing education) training. We have a High turn over rate here due to people wanting to learn more and become paramedics (A good thing)! I have valued the time as an emt-b and I think it is a very valuable step to becoming a Paramedic ( I will be taking the paramedic program in a year or so ). Most of the time we meet ALS, they let us jump in their rig with them and learn from them (great opportunity)!

ok I have said my peace and hope I gave another angle or perspective to the topic.

~EmtKat~

[AnthonyM83]

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.

Even though I'd much prefer to have only medics answering calls, I'll play devil's advocate on this one. Why isn't financial reasons enough of a justification? I imagine there are a number of jobs in society that could be done with people of a higher level of training, but they delegate it to people with lower training because they can get buy doing the basics themselves, then having the higher trained person jump in where/when needed. Allowing the higher trained person to help in several projects and have more projects accomplished.

Parallel this to the system where every area has an EMTB crew readily available pretty much all of the time, within 2-4 minutes of dispatch. Then the medic squads can be there usually within 2-6, usually. Why do you need the EMTs at all then, if medics will be there in 2 - 6? For the few times when they might actually be truly useful...mainly cardiac and respiratory arrests, among others AND so medics can send the BS, I mean BLS, call to hospital by medics and not have to wait hours in the hospital for a bed, so they can answer more calls.

I think financial reasons are actually a good reason...if we had no EMTs, I think LA would have much longer response times.

[Dustdevil]

A two-tiered system is the best. Oversaturation of paramedics does lead to increased mortalities, as well as provider burnout. Look at Philadelphia.

That's not an oversaturation thing. That is simply an urban thing. Dual medics actually help lessen burnout because no one medic is stuck with all the patients or all the responsibility.

There is NO reason a Paramedic needs to be on a stubbed toe, or an arm pain, a toothache, or a leg pain. Even if the leg pain ends up being a DVT, the Saline Lock of Life isn't going to make a difference. This is where the EMT-B comes in.

What if the toothache or arm pain turns out to be an AMI? You are correct in theory. Those simple ailments do not require a paramedic. The problem is, you don't know that ailment is until you make the scene and evaluate the patient. Consequently, they do all need a Paramedic.

Hospital discharges do not require Paramedics, unless it is an Inter-Hospital ALS Transfer. This is where the EMT-B comes in.

Exactly. Hospital discharges are not an EMS function. That is horizontal taxi service. And yes, that is where the EMT-B comes in.

Everything boils down to EDUCATION. Increase the EMT-B class hours, instead of the current ARC Emergency Responder on Steroids it is.

Agreed. The problem is, most people only want to increase EMT-B skills without the requisite education. I maintain that the overwhelming outcry for more "skills" for the EMT-B is in and of itself proof that the EMT-B is currently inadequate for EMS practice.

[katbemeEMT-B]

Let me start by saying this has been one long thread to read. It has taken me all day. Of course I did take some time to go on a run and attend my son's baseball game.

Anyway, I agree with what Josh says makes a good EMT-B so I am not going to rehash what he has already stated. I think that it can really be summed up in a few words:

Education: Never stop learning. Take the continuing ed classes (even if they are for medics or nurses), classes at a local college, attend conferences. Do research and read books. Learn what things are, why they happen, and what can be done for them.

Experience: Gain as much on-the-job experience as possible. Learn from every call. Knowing every aspect of your job is of the utmost importance. It also helps to know something about your partners job.

Stewardship: Know how to use every piece of equipment on your truck whether you are allowed to use it or not. Know the ins and outs of the truck itself. Keep everything clean and in working order. Avoid wasting supplies. Take pride in your truck and what you carry in it including yourself.

Respect: Respect your patients, co-workers, and most importantly yourself. Be courteous, kind, and considerate. Value each others opinions, values, and morals.

Communication: Keep the lines of communication open between you and your co-workers. Don't get involved in petty arguments that sometimes happen. You have to be able to listen just as well as you have to be able to express yourself clearly to other.

Competence: Be confident in your abilities and strive to be the best at everything. Continue to improve your skills and understanding of those skills. Perform these skills and other duties safely, with good judgment, and with the expertise that your education has supplied.

Integrity: Be honest, ethical, and fair to yourself, your partner, and your patients

Cooperation: Work together to provide the best care for your patients.

You are only as good as what you put into it. If you are satisfied with your education and feel you know all there is to know, then you have failed at your job (regardless of whether it is EMT or Paramedic). A good EMT-B goes through their little class and learns their basic skills. They then get a job and continue to learn while working. This is done not only by gaining more experience, this is also accomplished by asking your partner questions (at appropriate times). Do what you do because you want to be excellent at it not just because it's a job.

[whit72]

Dust wrote:

What if the toothache or arm pain turns out to be an AMI?

And how many ALS providers, would treat this as a cardiac complaint?

No wonder medicare is broke. A two-thousand dollar ambulance ride for a toothache.

If it walks like a duck and quacks like a duck. Usually it is a duck.

Through assesment I could narrow it down and if I believe its cardiac related. You will get a call.

[katbemeEMT-B]

Ummm...a monitor along with a good assessment might tell the medic it is a cardiac issue. Although, if an EMT-B is well educated they should also be able to recognize the fact that this patient is having a possible MI and therefore would request ALS.