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

[Dustdevil]

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.

I agree. Financial concerns are indeed valid justification. However, that is not really relevant to the original question which was asked. That's why I excluded it from consideration in this instance.

[mediccjh]

Dusty, while I usually agree with you on most things, there are things I'm gonna disagree with you here:

mediccjh wrote:

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.

You are correct; however, if those 2 medics are doing 20 BLS jobs in a shift every night, while ALS jobs are holding, they tend to get burnt out quick. Yes, there is the "luck of the draw" of the EMS Gods, but it does happen and human nature shows that people get pissed when they don't get to use your skills. I, like most medics here, have no problem running non-stop if at least 50% are actual ALS jobs. I do get frustrated when I'm working in my two-tiered system, and I'm getting stuck on nothing but BLS assignments. Trust me, we're trying to fix it.

Quote:

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.

If my patient is an old diabetic woman c/o of a toothache, then maybe I'll consider doing a 12-lead. Not everybody can catch everything. The 99% of idiots who call 911 for a toothache only need a ride to the hospital. Until the time we are all allowed to tell people that they don't need to go to the hospital, they get a ride, and that's where the EMT-B comes in.

For the most part, most EMT-Bs can tell when a person needs Paramedic intervention, like the person who is puffing away at 40 times a minute. The GREAT EMT-Bs can tell when that borderline patient requires Paramedic intevention.

Quote:

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.

Quote:

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.

Agreed.

See, I can disagree with someone I respect and not get nasty. Why can't most others?

[Scaramedic]

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.

What about hiccups Whit?

Peace,

Marty

[Dustdevil]

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

Any ALS provider with half a brain and a decent education (yes, I know that excludes about half of them), would do a thorough assessment to determine that this is indeed an isolated dental event before ASSuming it is just a toothache. An EMT-B lacks the educational foundation or equipment to do that exam, therefore useless.

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

No wonder so many people die of MIs. Not only are they in denial, so are their EMT-B rescuers.

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

Actually, no. We're not talking about zebras here. We're talking about the number one killer of adults. Thousands a day. And anybody who keeps up with the current literature knows what a large percentage of MIs present atypically. They also know how often these people are undertreated because of their atypical presentation. If you routinely blow these people off because you don't want to admit that they need more than an EMT-B can provide them, then you are the problem.

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

I've been involved with a lot of EMT-B courses over the last thirty years. I have yet to see one that gave its students the education needed to perform a thorough assessment. EMT-B courses simply do not give you the theoretical foundation necessary to translate your silly little "SAMPLE DCAP BTLS" history and exam into an intelligent medical assessment. Consequently, your beliefs about whether it is cardiac related or not are worthless. Just like EMT-Bs in general.

[Inf]

Ok Dust, you seem to have gained a momentum with your rambling.

I thought of a few angles how to present an argument for Basics, but I think its easier to simply try to explain why there wont be much change. The public in general is not punished for dialing 911 for bullshit. Yes, the fucking welfare recipients who want a refill for their hydrocodone dont call a taxi, they call 911 and complain of abdominal pain, get a free ride to the hospital, get their refill and then one of the privates even transports them back home.

Until those pieces of shits who abuse the 911 system are met with a hardcore legislation which would fine and even imprison those who call 911 for nonemergency purposes, there isnt a need for change. The Basics will continue transporting the 85% of patients which are sheer bullshit, and the Medics will wait for their difficulty breathers, their drunks passed out on corners, and their cardiac arrests.

So before you blame the Basics, consider yourself being on a 2 medic truck running the bullshit calls - put yourself in the tech's position that transports a "patient" who just wants a refill for his meds and calls you an ambulance driver -- because you can take out the Basics, but you cant take out those who call 911.

[batjka104]

I tend to agree with Dusty that volunteer EMS brings about a lesser standard in patient care. However, it will be in place in the foreseeable future until EMT-B requirements are raised. In that case it's going to be extremely difficult for a person with a full-time job to acquire the necessary certification, and they are not going to be able to volunteer. If one day Surgeon General issues a decree that all EMS are to be brought up to a new level, and federal funds are allocated to provide communities with necessary financing, that will be the end of EMT-B's and the volunteers.

But US should consider itself lucky compared to some other places like Israel, where I had an opportunity to volunteer. The whole countrywide EMS system there is volunteer-based. And, it gets no funding from the government or municipalities. At the beginning of the Second Lebanon War MADA was $10 million in the hole and considered shutting down. In the whole country!!! In the middle of a war!!! That's what I call stupidity in action. So we in the US are not so bad after all.

Anyway, the change to the system should come from above, not from the ranks. The ranks are simply too inert to do anything, and the municipalities are unwilling to take up extra costs of hiring professionals. So, if you want to bring about a real change, lobby your congressmen and other politicians. Just my two cents

[scratrat]

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.

I have to agree and disagree with you on this one Dust.

First, I came from a two tier system. The most frustrating part was going on calls that BLS could not figure out that we were not needed. The upside was, in general, we saw only sick people who those who required ALS intervention. Burn out did happen a lot in this system because most of the medics were tired of dealing with idiots. Every call was BS until proven otherwise.

Now I am in an all ALS system where I work with an EMT or a paramedic. So now, I have to go on every call just like before, only now I get the drunks, the toothaches, the "I've been sick for 3 weeks and at 3am I think it's an emergency", etc.

Both systems have pros and cons. But I liked the two tier system better. I got more experience there in one week than I have for the past 6 months here!!!

[whit72]

Dust, I think your toothache argument is a stretch, but I get your drift. I would hope most providers BLS or ALS would be able to determine the probability of this being a cardiac event.

A toothache alone does not constitue an ALS call. A toothache with other findings of your ASSESSMENT might determine it to be. An ache here or there, nausea, vomiting diaphoresis a cardiac history.

Listen I stated many times the benefit of ALS providers. I am not questioning that fact. What I am arguing is the use of them for every call under the sun. Is useless and can be detrimental to the outcome of the pt. that truly needs their services. I will take two competent basics for a sick family member, then two overworked,underpaid, medics that have been up all night rounding up nonsense and frankly don't give a shit at this point and don't tell me it dosent happen often.

So both play a role in EMS you can argue all day whos is more important. A competent educated and experienced EMT may not have all the bells and whistles you have, however don't underestimate their ability to do their job in a professional manner.

[katbemeEMT-B]

It seems as with almost every thread this one has turned from what makes a good EMT-B to the continual argument of EMT-B-vs-Medic and BLS-vs-ALS.

Let's look at it this way, in a perfect EMS system, it would be better for all communities to be serviced by ALS. Unfortunately, that does not happen. I would like to see us all strive to help that happen. One comment made is that "the ranks can not due this". Well, I disagree. Our service, which was started in 1974 was strictly volunteer BLS. No schedules, no pay. Whoever showed up went. It has taken time but we are slowly evolving. We are now scheduled three to a 12 hour shift and get paid $2.00/hour to wear our pagers. We are paid $12.00/hour for run time. Along with this has also come an increase in education requirements beyond what is required to maintain National Registry. As members of the service, we are striving to move away from the volunteer stigma and closer to a professional paid service. It may be one baby step at a time but we are getting closer each year.

We are city owned and governed. Money is a factor as our community has a population of only 2,531 at the last census. We have a call volume on average of about 205 calls per year. Pretty low! We can not do any type of fund raising as the State of Minnesota doesn't allow it for city owned entities. But this doesn't deter us from moving forward. A few of us will be starting our medic schooling either in the fall or in January. In two years we will have achieved another step in showing our community that we want to be professional. We continue to push and they must give or they risk losing us as a service. They don't want that, so they give in one baby step at a time. As our city continues to grow the need for a better service will be inevitable and we intend to be the ones to provide it.

So instead of fighting over EMTs-vs-Medics and BLS-vs-ALS how about discussing what it is going to take to make your service a better one. If you are a basic or BLS service start pushing to improve your service and becoming a more professional service. Further your education and prove to your employer that you are serious about your job. Even if there is no chance that your BLS service will become ALS, go for your Medic degree as it will only improve your patient care. You will be given more information to better assess your patients even if you don't have the equipment to treat them. Remember that your assessment is crucial in proper patient care. The better you are at assessing a patient the better care that patient will receive whether it is from you or an intersecting ALS truck.

I think the answer is to work together to make both EMTs and Medics more proficient at their jobs and education is the key.

[Dustdevil]

Dust, I think your toothache argument is a stretch, but I get your drift. I would hope most providers BLS or ALS would be able to determine the probability of this being a cardiac event.

I would also hope so, but the sad fact is that most can't. Seriously dude, you read the horror stories on this board. A horrifying number of providers can't even figure out the obvious ones. You really think the average 120 hour EMT-B out there is going to know how to recognise the tough ones? Without significant ALS experience, are they going to have the knowledge necessary to develop that sixth sense and high index of suspicion? Not a chance. You may be in a Phi Beta Kappa system where the few people you work with actually are relatively competent, but I doubt it. And if so, that is the exception to the rule.

A toothache alone does not constitue an ALS call. A toothache with other findings of your ASSESSMENT might determine it to be. An ache here or there, nausea, vomiting diaphoresis a cardiac history.

And you don't know any of that until you have made the scene and assessed the patient, which an EMT-B is not educated to do.

What I am arguing is the use of them for every call under the sun. Is useless and can be detrimental to the outcome of the pt. that truly needs their services.

Check your math, bro. It's not adding up. So... Basics are useful because they can take the BLS runs? Well, so can medics. Basics don't put more trucks on the streets. They only bring some of those trucks down to the basic level. If all of those trucks were staffed by medics to begin with, the system would function just as quickly, more efficiently, and every patient would be afforded an advanced assessment. Nobody would be stuck waiting for an "intercept," or worse yet, stuck with an inappropriate level of care during a medical emergency.

I will take two competent basics for a sick family member, then two overworked,underpaid, medics that have been up all night rounding up nonsense and frankly don't give a shit at this point and don't tell me it dosent happen often.

Funny how it always comes back to the invalid comparisons when there are no valid justifications left. If the medics in your system are up all night and burned out, so are the basics, genius. Compare apples to apples if you want any credibility. Medics in LA don't ride an ambulance, and don't make BLS runs at all, yet ask Anthony and JPINFV about how burned out LA medics are. So there you go, your theory about basics preventing medics from burning out fails.

So both play a role in EMS you can argue all day whos is more important. A competent educated and experienced EMT may not have all the bells and whistles you have, however don't underestimate their ability to do their job in a professional manner.

Again, you are trying to make this about individual people, and it is not. It is about a level of training. And no matter how smart that individual basic may be, or how great of a basic he is, he is still inadequate to perform primary EMS without those bells and whistles.

And, as usual, you're back to focusing on the bells and whistles, when any intelligent practitioner of EMS knows that they are not what it's all about.