Are EMT's too Medic dependent?

[ems-buff 81]

Do I agree that, some agencies need to improve EMT medication skills, along with Pt assessment skills? Yes I do, but so does every medical professional here, You can never learn to much, when it comes to EMS. EMT's need to be looked at as the starting point in a career, Not just some one who can carry Medics bags, or turf a Drunk person, who you know is going to Vomit all over you.. ( ) Also EMT need to step up and ask there senior partners or Medic Partners to further there knowledge of EMS.. Like I said before, You can never learn to much about EMS..

[GAW6 66]

No harm no foul brother.....

Also EMT need to step up and ask there senior partners or Medic Partners to further there knowledge of EMS.. Like I said before, You can never learn to much about EMS..

Unfortunately, in the Mt. Pleasant system, EMTs end up driving the Medic's car, therefore they are not getting any "hands-on" experience. This is part of the problem and reason as to why new EMTs are so "medic dependent".

[Goose 188]

Unfortunately, in the Mt. Pleasant system, EMTs end up driving the Medic's car, therefore they are not getting any "hands-on" experience. This is part of the problem and reason as to why new EMTs are so "medic dependent".

Not always the case. I have always worked in a Paramedic system and i am more than confident in my ability to hold my own. In fact, working in a Paramedic system has made me a better EMT. Just because a medic is riding the job in doesn't mean that you can't learn as a new EMT. I learned the basics from a Paramedic when i first fell into EMS - the EMTs didn't want much to do with me, but he took the time and effort to teach me and much of my success is as a direct result of that.

Maybe new EMTs shouldn't be driving the medic truck back? Maybe you should throw them in the back to get their hands dirty?

From my limited experience i have always felt that a lot of that medic dependent stuff is a top down phenomenon. Leadership screaming for a medic on a stubbed toe or being unable to make a decision without a paramedic filters down to the rank and file. I know that being paramedic dependent is not part of the NYS curriculum.

That said, being an EMT is an entry level position. It's a very basic course, granted we can do some cool stuff and occasionally save a life. It's my belief that EMT is too basic in nature - i've always felt that EMT-I should be the B equivalent. It would raise the bar and weed out those who really don't belong.

[ems-buff 81]

That said, being an EMT is an entry level position. It's a very basic course, granted we can do some cool stuff and occasionally save a life. It's my belief that EMT is too basic in nature - i've always felt that EMT-I should be the B equivalent. It would raise the bar and weed out those who really don't belong.

I couldn't agree more... but let's try to keep on topic with the CPAP disscusion. If you want, we can start a new topic on EMT's and how is it a good thing or bad for them to have medic's with them...

[Goose 188]

I couldn't agree more... but let's try to keep on topic with the CPAP disscusion. If you want, we can start a new topic on EMT's and how is it a good thing or bad for them to have medic's with them...

Whatever you want. But i think it is slightly relevant in that fact that there is obviously a disparity amongst the degree of experience, knowledge and comfort amongst EMTs county wide. How can we add a new tool to the tool box if we (we as in a county) have difficulty preforming our initial job description? That's my over arching point. I should have been more clear in my previous post, sorry for the ramble.

[ny10570 745]

Goose, GAW was specifically referring to Mt. Pleasant. On the ambulance you have an EMT, driver, and maybe a Jr member. If the medic rides in, the EMT ends up driving the fly car. Leaving the fly car on scene keeps the medic oos for another 30+ minutes. Another problem is assessment is usually finished and treatment on the way by the time the EMT makes pt contact. Unless the medic makes an effort to get EMT's more involved the EMT has little to no say in what kind of experience they get.

[mwE33 1]

I was taught how to be a good emt by the medics in mt pleasant... even while in jr corps they still taught me. and there have been many occasions where i have been on scene before the medics and i have done my own assesment... also the emt does not have to drive the fly car that is a favor for the medics... i think thats all i gota say so far

[NYMedic37 22]

That said, being an EMT is an entry level position. It's a very basic course, granted we can do some cool stuff and occasionally save a life. It's my belief that EMT is too basic in nature - i've always felt that EMT-I should be the B equivalent. It would raise the bar and weed out those who really don't belong.

I agree with Goose..... EMT Basic is way too basic and bringing the "Basic" up to the "Intermediate" level would be a great thing. Unfortunatly, due to politics, the marginal EMT B's will most likely continue on in EMS. As far as the EMT's relying too much on the Medics, its true. A lot of EMT's will watch the medic and wait for his instruction or do nothing. Also, EMT's should be able to handle critical, unstable or potentially unstable patients if the Medic is not yet on the scene instead of screaming on the radio to expedite the Medic. They should consider transport asap if there is no Medic present.

[Guest]

I would say that, for the most part, yes, Basics are too dependent on medics. However, I think that that is the product of the system they are in, and the people passing down their knowledge and expertise. If we are taught that we can't do anything, and we should always wait, then that's what's gonna happen. But if you get good competent officers, and people who are confident in their abilities, then the system should work as it is intended, where Medics are used for calls where their skills can or will make a difference in patient care, then I would say that Basics can handle most calls. For example, over the last 100 calls I have personally run, the medics have transported with us twice, and that's with about 60 transports overall.

Edited May 13, 2009 by Slayer61

[latemedic39 4]

When you are trained as a emt you are given the cookie cutter responses to all situations, working with seasoned medics and emts can make you a very strong emt, also doing transports to start your ems career you can read the charts of the pts and you get take a set of vitals with your eyes closed ! then aafter a year of transports you can get a 911 shifts so your card is not still wet when the tones drop and nys is always 20 years behind in the field of ems so that will never change unless we want it too

[firefighter36 52]

Goose, couldn't agree more with what you said. I think the one thing that holds back a lot of EMTs are regional protocols. In some regions, EMS in general is too medic dependent, protocols require ALS treatment, and in some cases, ALS providers such as EMT-Is or EMT-CCs are either over or under utilized to carry out such treatments. The system, depending on what region you are located in, and what the local protocols, determines the strength of the EMT-Bs it creates.

The other important thing to remember here is that in a lot of places, regional EMS councils are run or influenced greatly by commercial EMS agencies. Commercial EMS is a business, no matter how you cut it, and their bottom dollar is on the line, and this can greatly affect how protocols are engineered.

On another front, I think that EMT-B should be the minimum qualification to operate on an ambulance, period. I have been to too many places where there were plenty of "drivers" bot not enough people to give definitive pre-hospital care. I have also been to places where a driver and a CFR show up with an EMT-B en route. I think we owe it to our customers/taxpayers, etc. to provide prompt, professional, and qualified care.

A myriad of factors exist, and in a perfect world, cost of equipment, staff, time involved in training, etc. would be of little consequence and our delivery of a high level of care would be paramount. Until EMS is legitimized, i.e. provided as a 3rd municipal service, or by the FD or PD EVERYWHERE, I don't see much changing.

[Guest alsfirefighter]

I'm chiming in a bit late but none the less I'm along the lines of my fellow medic's in some of their thought processes.

In my area I will have to say that the majority of EMT's are medic dependent. Now what does that in itself entirely mean? Every one of us is going to have a different interpretation and thought of what that is. For example...I am in a flycar system where some of the out lying areas take some time to get to. By the time I get there I would expect..and this comes from my own conduct as an EMT...that the BLS crew by the point would at least have a general impression, history of current illness/injury, PMH and a set of vitals and some form of treatment under way. This isn't always happening. The exception was the first couple of months when albuterol was unleashed and then almost every other SOB patient was getting albuterol. Not based on history or lung sounds, but mearly SOB. I can't tell you how many times I removed the neb on a person who was simply hyperventilating. Another constant is patient removal and spinal immobilization of patients who need it. Even after releasing the call to BLS we often have to referee the process to keep it efficient, guide them on how to do it, etc. Everyone has a function and as the Rock says..."know your role." I should not have to direct every single moment from dispatch to either delivery at the ED or have to wait until the patient is loaded to drive off in service.

You will always have your clip board huggers. I have learned to deal with some of them. I have a rep of being prick for some reason when all I demand is professionalism and solid patient care. The one thing I will cut no slack on is sloppy and sometimes down right dangerous skills/work and I certainly do not cut any slack for those who seem as if its a bother to drop the clip board and get the BVM out in a timeframe that should be expedient and proper.

[helicopper 1,050]

Interesting topic. I would have to say that yes, EMT's are generally too medic dependent or rely too heavily on them in their decision making processes.

Before the proliferation of ALS services, EMT's functioned - and functioned well - performing the skills necessary and transporting patients in extremis while providing the best BLS care possible. Today, some EMT's won't even perform an assessment on a patient and wait until the medic gets there to let them do it. Still others won't cancel the medic even on obviously BLS calls.

Some medics don't help the situation by not trusting EMT's to do things and fostering this reliance on them too.

In systems where the medic is dispatched on every call there is also a problem. Systems like that don't enable the EMT to develop their skills and judgment. Relegating the EMT to fly-car driver doesn't help either. There has to be a better way to operate without doing that.

EMT training is also a factor in this. Alot of EMT courses cover the bare minimum just to meet the standard for certification and don't give EMT's a strong foundation to develop their skills and judgment.

[Remember585 815]

I'm chiming in a bit late but none the less I'm along the lines of my fellow medic's in some of their thought processes.

In my area I will have to say that the majority of EMT's are medic dependent. Now what does that in itself entirely mean? Every one of us is going to have a different interpretation and thought of what that is. For example...I am in a flycar system where some of the out lying areas take some time to get to. By the time I get there I would expect..and this comes from my own conduct as an EMT...that the BLS crew by the point would at least have a general impression, history of current illness/injury, PMH and a set of vitals and some form of treatment under way. This isn't always happening.

Yeah, but how often is there actually an ambulance on the scene ahead of the Medics in (y)our area? I would be willing to bet that it's around 50% of the time or less, especially at night and/or on the weekend...

A lot of EMTs are groomed to think that if it's a "minor call" all they have to do is vitals and fill out a PCR. They're also told that if it's really anything serious there will be a Medic on the scene anyway, so don't worry. This "teaching" ruins EMTs before they even leave the classroom. I know this because I have seen it and been told it. If you put it in their heads that an EMT is only there for the B(L)S stuff or to drive a flycar, you'll never get much out of them skills-wise. It's all in the teaching and mentoring of people - if you show them the right way of doing stuff and what is expected of them sans Medic, you'll probably get a good EMT.

PS - what ever happened to Medics taking the time to teach EMTs and guide them? That seems to have died off and I think part of it is burnout of the medics who constantly go to calls and have to wait for Mutual Aid or deal with crappy BLS crews, it's sad and it's one part why EMS is screwed.

[ckroll 101]

PS - what ever happened to Medics taking the time to teach EMTs and guide them? That seems to have died off and I think part of it is burnout of the medics who constantly go to calls and have to wait for Mutual Aid or deal with crappy BLS crews, it's sad and it's one part why EMS is screwed.

'The teachable moment.'... Yes, someone has to be in charge, and if a medic is assigned to the call, then it's the medic. That said, as medics, we work with the same crews over and over. If you teach your crews what to do and why to do it, then they learn and if you can trust them, they can do a lot for you and have a good experience doing it. When I took my state test for paramedic, the first half was BLS and if you didn't pass it you didn't get certified. Good BLS is critical to every call. If a BLS crew is not up to standard, then it is our obligation as care providers, to get them up to standard. Teach the moment, make your crews better. It's good for the patient, good for the medic and good for EMS.

And that said, some days the doors to the ambulance fly open and it's the crew in tights and capes, sometimes its the crew in size 15 shoes, funny hats, and big rubber noses. Either way, there is a job for everyone. EMS is not rocket science. I offer the observation that a medic who needs a great crew may be EMT dependent?

Take what you get, make the best of it, and make them better.

[Goose 188]

Yeah, but how often is there actually an ambulance on the scene ahead of the Medics in (y)our area? I would be willing to bet that it's around 50% of the time or less, especially at night and/or on the weekend...

A lot of EMTs are groomed to think that if it's a "minor call" all they have to do is vitals and fill out a PCR. They're also told that if it's really anything serious there will be a Medic on the scene anyway, so don't worry. This "teaching" ruins EMTs before they even leave the classroom. I know this because I have seen it and been told it. If you put it in their heads that an EMT is only there for the B(L)S stuff or to drive a flycar, you'll never get much out of them skills-wise. It's all in the teaching and mentoring of people - if you show them the right way of doing stuff and what is expected of them sans Medic, you'll probably get a good EMT.

PS - what ever happened to Medics taking the time to teach EMTs and guide them? That seems to have died off and I think part of it is burnout of the medics who constantly go to calls and have to wait for Mutual Aid or deal with crappy BLS crews, it's sad and it's one part why EMS is screwed.

I see your point but how many EMTs go into EMT class with volunteer time under their belt? Lots. Not a bad thing, don't get me wrong. But many these days have already picked up the bad habits and formed the preconceived notions well before they step into the class room. That is beyond difficult to teach away (for lack of a better term). Try to teach them that they should be able to handle A,B and C alone they will tell you "oh well, where i volunteer the medic will be there." You can't force someone to stop thinking that way.

[NWFDMedic 58]

Do I agree that, some agencies need to improve EMT medication skills, along with Pt assessment skills? Yes I do, but so does every medical professional here, You can never learn to much, when it comes to EMS. EMT's need to be looked at as the starting point in a career, Not just some one who can carry Medics bags, or turf a Drunk person, who you know is going to Vomit all over you.. ( ) Also EMT need to step up and ask there senior partners or Medic Partners to further there knowledge of EMS.. Like I said before, You can never learn to much about EMS..

There are so many different variables to this question, from the volunteer, to the career EMT, to the (for lack of a better term) kid EMT working through college, to the EMT with aspirations to become a medic. There are also a number of different response systems here in the Hudson Valley. I've seen good and bad EMT's in every one of these areas.

As a medic for a commercial service, I work with four very competent EMT partners (yes, I got lucky with this schedule). For the most part, I allow them to go into pretty much every situation where we operate independently first and let them do the assessment/interview. With a good partner, I can get the answers to the questions I need and do the things I need to do while he/she is asking questions and doing basics. Some of this didn't come easy because not all medics expect so much from their partners. There have been plenty of times where I've stopped at the front door and pushed my partner in first.

When I end up dealing with BLS agencies on meets, I find the entire spectrum from great to not so good at all. I like to let the volunteers do what they are getting out of bed to do for free because I respect that. Some want to do everything, some want to do nothing, and some are afraid they will do something wrong. I try to work with the ones that want to learn and take whatever I can get from those that have no interest in learning. Everything they can do independently is one less thing I have to do, which is both good for the patient and good for me.

[DDixie 12]

We've all been doing this a long time. I see EMTs all the time who have the greatest of intentions, but get tunnel-vision when in front of a patient. As the Medic, I usually walk in and standback to get a general impression and feel for the scene - especially if the EMTs are huddled around the patient, taking vitals, info,etc. Now, if there is distress or an obvious intervention then I'm a bit more forward. But EMTs need to look at the big picture, and so many of them around here are so zoned-in on what the "dispatch chief complaint" was that they do not take the time to do a full patient assessment and investigate what is going on. Prime example: dispatch for "dislocated finger" at an office building. Woman sitting at a desk. EMTs checking out her finger. They ask how it happened. Woman replies, "I fell." EMTs still completely absorbed and in awe of her finger. I finally step in because no one else is asking and ask, "Where did you fall? How far? Oh, down a flight of stairs... Oh, concrete stairs in an industrial office building...What did you land on because I know your finger wasn't the only thing that you must have hurt....Oh, look at that (yes, take off jacket, expose patient - her upper arm/shoulder, swelling, tenderness...)

I'm MORE than willing to give EMTs the lead on calls - I'm more than willing to teach on calls - but when the basic BASIC skills and scene assessments aren't being done, I get frustrated. Perhaps it is tunnel vision of the EMTs. Perhaps it's because they don't know What or How to ask the questions. But, we need to stop giving them more toys and medications. They need the basic tools, a PAD OF PAPER to take information, and forget the damn PCR/clipboard until we all get to the hospital.

[GAW6 66]

Well said CKroll!

[ny10570 745]

ckroll, I take serious offense to your last post. I am not nor have I ever been a clown. Just because I have size 16 shoes has absolutely no bearing on my ability as a provider. Other wise, great post.

[ONEEYEDMIC 68]

When I worked on an AMB as a MEDIC, I was very, very fortunate to always have great EMT partners. Most of the time we didn't even have to talk to each other. We just did out own business and for the most part everything turned out OK. Then I went onto working FLYCARS all over this COUNTY. I have seen great skills and I have seen some pretty horrible skills.

I think dealing with a fly car and vollies it is hard to judge what you are going to get with the vollies and maybe they think what they are going to get with the MEDICS. Most of the time, the MEDICS are on scene first. They do their assessment and determine ALS or BLS. When the AMB gets there, I don't see why they have to come in and do another assessment epecially if the call is BLS. The MEDIC should be able to give the EMT and entire run down of what is going on and the PT should be packaged and taken to the AMB where, the EMT can do vitals and their own assessment. If it is ALS, then hopefully ALS skills have been done and then the PT is packaged. If the AMB is there before the FLYCAR, then I would hope that an assessment has been done for the MEDIC. But, the MEDIC is probably going to do their own because maybe they don't know the EMT's skills.

I would also like to see THAT STUPID CLIPBOARD left in the AMB. There is no need to have it in the house. You can do paperwork in the back of the AMB and/or in the ER. If you really want to learn from the MEDICS, then watch what HE/SHE is doing. Ask questions. Maybe get together with the MEDICS in your system so you can learn what HE/SHE wants from you on a call and what you want from them. I always like the EMT to help out. If you show interest in Purging a Line then be my guest. That is one last thing that I have to do and more time goes to PT care. Just make sure you know what you are doing.

[ex-commish 490]

I feel an emt should treat the patient per BLS protocols untill the medic arrives and says otherwise. I will begin to do my initial assesment, obtain vitals, etc. and continue to do whatever is needed untill the medic needs me to do something else. To do nothing untill the medic gets there is not good patient care.