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

[vs-eh?]

vs - Stop going off half-cocked. If you have a tackle box or a Pelican case or a soft bag filled with medications, you can pull out each box and read the label or you can KNOW what color some of the medications are. If you are working a code, I would like my EMT partner to know the epinephrine boxes are grey so that when I need an epi, he or she does not have to pull out each drug to find one.

How can anyone logically argue that BLS is NOT the majority of what EMS does? For every serious ALS call EMS agencies run 20 or 30 BLS "emergencies". It's all about economics. I live in a community (island, more or less) of 30,000 people. We have zero cardiologists and zero neurologists. If you need sophisticated medical care you fly for nearly three hours. Would it be acceptable for a Cinncinati or a Tucson or a Savannah to not have at least one hospital with a neurologist and a cardiologist on call? No way. Would it be acceptable for those municipalities to have single medic ambulances? Not in my opinion. When you have agencies with call volumes in the double-digits, however, I think a BLS partner is justifiable.

Silly me....That whole 6 R's thing. Come on. Honestly, you are using recognition of colours as a strong attribute in a good BLS partner?

Nobody will argue that the majority of EMS calls require only "BLS". However...

If placing leads, setting up a bag, driving safely (seriously), or knowing that epinephrine box is grey (or brown or whatever) is seen as a sticking point for a good BLS partner, how can I expect them to know how to auscultate a BP properly or ventilate someone properly? The answer is, I can't...

PS - I don't work in the USA. Here, at my place of work with the majority of paramedics (PCP, ACP) these are moot points. Of course this might have to do with (amoung other things) 2 years college education for BLS, 800+ hours didactic, 500+ hours on ambulance prior to working, etc...

[brentoli]

My question to you Vs, if you don't know what it is like to work with an American BLS partner how can you judge them? You havent experienced it yourself.

I know basics can be replaced by medics easliy and they are a resource better used for first response and not primary care. However, I don't see where you can say a EMT that learns the needs of his medic partner is inferior and can not be trusted?

[vs-eh?]

My question to you Vs, if you don't know what it is like to work with an American BLS partner how can you judge them? You havent experienced it yourself.

I know basics can be replaced by medics easliy and they are a resource better used for first response and not primary care. However, I don't see where you can say a EMT that learns the needs of his medic partner is inferior and can not be trusted?

People, people...

Again, you are advocating RECOGNITION OF COLOURS, sticking dots on people, and sticking a thing in a thing and running a bit of fluid (setting up a line) as POSITIVES you WANT in a bls partner!

I could show john q. nobody on the street that in less than an hour and then get them to run a dynamic arrest with me. John pass me the brown box, ok, pass me that vile...

Honestly, that is a joke. And people are like WOW, Steve can stick 3 leads on that guys chest or know what colour purple is! WOW....Sign that man up....EMT-B of the YEAR!

[pyroknight]

In a perfect world, I would LOVE to see two paramedics on every ambulance, a Volvo in every driveway, and fire sprinklers in every home. The world we live in, however, is somewhat less than perfect.

It's not just being able to apply the stickers or "stick the thing in the thing", it's about knowing when to do it and doing it without me having to tell you to. I believe being able to coolly assist when someone's life is on the line is a skill. I believe being able to keep your adrenaline in check and provide a smooth ride for the attendant is a skill. I do not believe you can teach any monkey how to perform these skills in an hour or two. I believe that a competent EMT-Basic partner who can think on their own enough to anticipate what I will be asking for next is far superior to an incompetent or inexperienced EMT-P partner who would rather second-guess or question my care than do something helpful.

[Michael]

The following is a sincere, not rhetorical, defensive, or argumentative question:

Given the litigious nature of contemporary America, if inadequate care by EMT-B's is common, why have there not been many, many, many lawsuits filed and won against providers (= the medical directors) of such services? And why is there not a consequent universal reluctance of MDs to remain medical directors of such services, of insurers to sell them insurance, and so on down the line? It has been suggested in similar threads that requirements will upgrade as soon as the mayor's daughter (or the equivalent in fame, power, and/or money) receives such substandard care. Surely that must have happened somewhere by now.

When I lived in NYC I served on a jury for a slip-and-fall case at Macy's. If I recall correctly, I was told that Macy's retains attorneys to defend one to two new cases of that kind daily. Lawyers don't usually overlook opportunities, so why aren't they planted at more 911 calls? I am thinking of what the anti-B contingent finds the worst-case scenario, namely a pair of EMT-B's not supervised on-site, who with necessarily inadequate qualifications erroneously determine that a patient does not need ALS, and the patient suffers or dies needlessly.

I don't pretend to know enough about law or insurance to ask this in a nuanced way, just common-sensically. And again, it's not an argument, but rather an inquiry to those more experienced.

[emtannie]

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.......

And, to remain on topic here, I did research more on EMT-B's as we do not have them where I work either. I tried to find statistics on BLS vs ALS calls (which was amazingly difficult – does no one keep those stats?); one site dated May 2005 states that in Philly, 75% of calls are non-life-threatening. (http://forums.firehouse.com/showthread.php?t=69986 )

An interesting comment I did find was “there is a great deal of controversy surrounding the benefits of ALS over BLS. ALS interventions, except in specific clinical situations, are not well proven as beneficial. “ (http://www.emsresponder.com/print/Emergency--Medical-Services/Youve-Got-Questions-Research-Has-the-Answers/1$1859). I am not saying I agree with this comment, just that it is interesting...

Part of the American way has always been to put the making of money at the top of the priority list. This is part of what makes basics useful. They provide a service that medics could also provide, but at a much lesser cost to the system. Making all EMS workers paramedics would be wonderful, but the health system in the US wouldn’t be able to withstand the cost pressures. Basics are cheaper to educate, and cheaper to replace.

[Janmarie3]

There is a law in physics that states: for every action there is an equal and opposite reaction. In other words, what we resist, persists. Judging, berating, criticizing, and complaining are all forms of resisting. And it sticks like crazy glue. Basically nothing will ever change or get better if all we do is resist reality. What I can say about this subject, what ever you are, an ambulance driver, life guard, first responder all the way up to the very top of your game.....do your job with EXCELLENCE, live in the moment and never lose yourself.

Never losing yourself is the most important above all, especially if you are a woman but it also includes men in this profession as well. Something happens to all of us when we choose to live this life. With all the better then thou attitudes and constant complaining about one thing or another.....we forget who we were when we started.

As a women our greatest power lies not in competing with or trying to be like men, but embracing our natural and womanly strengths of compassion, enchantment and tenderness. We are intuitive healers among a lot of other things, we are remarkable beings in many aspects, not just on the battlefield.

I was at the top of my game in the agency I came from and I realized how much it had changed me as the person that I was when I started. I took a step out of it and away from it to be able to bring myself back to me. And in doing this I realized that we are all okay. Underneath all the illusions of worry, anxiety and the belittling of our own selves and others are all mental constrictions called up by our minds to distract us from the terrifying truth that underneath it all . we're just fine.

Relax, embrace your own okay-ness and your dreams will surge back into your hearts and your spirits are free to soar once again. Without so much of your energy tied up in imagined neuroses, we have the time and energy to re-engage with our purpose and once again make a difference in our world.

The world needs us no matter what level we are at. We have a purpose and hiding behind a fictional story that you are broken or not good enough or incomplete because someone else said so...is not it. The world needs that very special something you knew you had when you first started.

Balancing yourself out is the key to unlocking your full potential as a human being. Follow as much as you lead, comfort as much as you command and never forget who you are.

[whit72]

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.

[pyroknight]

As a women our greatest power lies not in competing with or trying to be like men, but embracing our natural and womanly strengths of compassion, enchantment and tenderness.

Warning, the N.O.W. troops have arrived!

[Scaramedic]

Warning, the N.O.W. troops have arrived!

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

Enchantment!! :roll:

Peace my Wiccan unshorn sisters,

Marty