EMT-Intermediate Training and Use in NY

[SRS131EMTFF 471]

im gonna use myself as an example becuase i agree with what u are sayin. and i think u are bringing up a good point. ive been in EMS for about 8 years now. 5 of which i was an attendent for an ambulance corp. and had NO drive what so ever to take the EMT class. It wasnt until 2 years ago when my wonderful cousin asked me how come i didnt want to take the class. i explained to him my situation and he said grow up and get over it. (thanks pat) now here i am a newly certified EMT and have been taking a ton of classes on how to make myself a better.

as for the question at hand. yes a VAC officer (line officer) should be an EMT or an EMT-I or even a Paramedic.

It really amazes me how down in Westchester we completely ignore the EMT-I training and protocols. Where I am in VT, almost everyone here is an EMT-I. The EMT-I course up here is nothing more time wise than another EMT class (i.e. you meet for about 4-6 hours a week for about 3-4 months). In this time you learn IVs, some interventional med. administration, ECGs, and other advanced techniques. I guess since we staff our volly and career rigs 24/7/365 with EMT-Is minimum paramedics are not very common. Almost every rescue squad in the state is volunteer but staffed 24/7/365 with EMT-Is, additionally we always have EMT-Bs and EMT-Is "jump" the calls, get on scene before us and start treatment. Often if an EMT-I has responded and an IV is required, the IV is started and flowing before we even get there.

I know WPs high angle team and YVAC have EMT-Is, anyone else in West. Co. use EMT-Is, I would imagine in areas where the VACs actually get out and paramedics are far away, having EMT-Is on the rig would be very beneficial.

[Goose 188]

It really amazes me how down in Westchester we completely ignore the EMT-I training and protocols. Where I am in VT, almost everyone here is an EMT-I. The EMT-I course up here is nothing more time wise than another EMT class (i.e. you meet for about 4-6 hours a week for about 3-4 months). In this time you learn IVs, some interventional med. administration, ECGs, and other advanced techniques. I guess since we staff our volly and career rigs 24/7/365 with EMT-Is minimum paramedics are not very common. Almost every rescue squad in the state is volunteer but staffed 24/7/365 with EMT-Is, additionally we always have EMT-Bs and EMT-Is "jump" the calls, get on scene before us and start treatment. Often if an EMT-I has responded and an IV is required, the IV is started and flowing before we even get there.

I know WPs high angle team and YVAC have EMT-Is, anyone else in West. Co. use EMT-Is, I would imagine in areas where the VACs actually get out and paramedics are far away, having EMT-Is on the rig would be very beneficial.

I have a feeling that more than 90% of the time paramedics either beat VACs or are only a few minutes behind them in westchester. I just don't really see the point here, especially when the scope of practice is so limited.

[PFDRes47cue 653]

It really amazes me how down in Westchester we completely ignore the EMT-I training and protocols. Where I am in VT, almost everyone here is an EMT-I. The EMT-I course up here is nothing more time wise than another EMT class (i.e. you meet for about 4-6 hours a week for about 3-4 months). In this time you learn IVs, some interventional med. administration, ECGs, and other advanced techniques. I guess since we staff our volly and career rigs 24/7/365 with EMT-Is minimum paramedics are not very common. Almost every rescue squad in the state is volunteer but staffed 24/7/365 with EMT-Is, additionally we always have EMT-Bs and EMT-Is "jump" the calls, get on scene before us and start treatment. Often if an EMT-I has responded and an IV is required, the IV is started and flowing before we even get there.

I know WPs high angle team and YVAC have EMT-Is, anyone else in West. Co. use EMT-Is, I would imagine in areas where the VACs actually get out and paramedics are far away, having EMT-Is on the rig would be very beneficial.

EMT-I is a fairly common thing to be in St. Lawrence County (NY) as well.

[PEMO3 523]

I have a feeling that more than 90% of the time paramedics either beat VACs or are only a few minutes behind them in westchester. I just don't really see the point here, especially when the scope of practice is so limited.

Goose, I know we have gone off topic but an EMT-I would be of benefit. You are correct about ALS/BLS arrival times. But, many true ALS calls hear the call for a second medic to respond. If that BLS unit was EMT-I staffed that EMT-I would probably be enough to suffice as the second set of hands.

[Goose 188]

Goose, I know we have gone off topic but an EMT-I would be of benefit. You are correct about ALS/BLS arrival times. But, many true ALS calls hear the call for a second medic to respond. If that BLS unit was EMT-I staffed that EMT-I would probably be enough to suffice as the second set of hands.

Not going to disagree with you thats its nice to have a second set of advanced hands. But again - at least here - the "I" scope of practice is limited and courses are not readily available. Likewise, they are operating in a system heavily saturated with paramedics - the opportunities for them to maintain proficiency in IV, IO, Intubation, etc i would persume would be somewhat limited. In areas where paramedics are more of a regional resource (as appose to local one, as we are fortunate to have in westchester) i think they bridge a gap. I work fine alongside EMT-Bs now with no issue, so like i said before...not sure how applicable it is for westchester.

In sake of relevance, i also agree that leadership positions should require at least the EMT-B level of certification.

Edited February 25, 2011 by Goose

[SRS131EMTFF 471]

Goose, I know we have gone off topic but an EMT-I would be of benefit. You are correct about ALS/BLS arrival times. But, many true ALS calls hear the call for a second medic to respond. If that BLS unit was EMT-I staffed that EMT-I would probably be enough to suffice as the second set of hands.

Additionally, someone trained in ECGs, IVs, Med admin etc could if nothing else assist the medic in these things. So long as the Paramedic oked and observed everything the medic might not even have to touch the patient to give drugs and take an ECG and let the EMT-I do everything.

Edited February 25, 2011 by bvfdjc316

[Goose 188]

Additionally, someone trained in ECGs, IVs, Med admin etc could if nothing else assist the medic in these things. So long as the Paramedic oked and observed everything the medic might not even have to touch the patient to give drugs and take an ECG and let the EMT-I do everything.

The regional protocols only allow you to obtain IV/IO access and perform intubation. Besides, i know i wouldn't be comfortable allowing any of that, especially if it involved a pharmacological intervention. We should probably create a new topic to discuss this further.

Edited February 25, 2011 by Goose

[GAW6 66]

Likewise, they are operating in a system heavily saturated with paramedics - the opportunities for them to maintain proficiency in IV, IO, Intubation, etc i would persume would be somewhat limited.

Very true! I gave up my EMT-I certification (after 9 years) and went back to Basic for the reason stated above. Never got the opportunity to use the skills. Glad I did get the certification for the added knowledge, but wasn't worth going through the skills test with no practice/experience.

[helicopper 1,050]

I'm sure I will draw the ire of some with these comments but having experienced some of these things first-hand, I have some strong feelings on the subject.

The need for a second medic should be a rare call because a paramedic should be competent and able to handle a single patient without a second paramedic. That said, there are always those calls where IV access or intubation is challenging and the condition of the patient warrants the expeditious handling that two medics may be able to provide.

In cases where an intubation is difficult or suitable IV access can't be obtained, the benefit of an EMT-Intermediate on scene will be limited. As was pointed out, in this area EMT-I's don't get a lot of opportunity to hone their skills and they would not be my first choice to back me up if I couldn't get a tube or line in someone. This is not to say that an EMT-I is not valuable or their skills useful in some areas (St. Lawrence County probably has more EMT-I's than P's but Westchester is the opposite).

I suspect that the EMT-I program never really caught because we have people who are resistant to the length of the EMT-B course so taking another course of nearly the same length with no prospects for employment or skills practice had no appeal. Another big problem is that there are some skills that paramedics don't get to practice often enough to maintain their own proficiency so they're not going to let the EMT-I perform them.

As for people being able to assist the medic with EKG's, setting up meds or IV's, or other stuff, there was a time that we called those indispensible assistants EMT's. You don't need to be an EMT-I to put electrodes on a patient and set up the monitor while the medic does other things. EMT's routinely used to do most of the things that are being discussed here and I've never understood why that skill set diminished as much as it did. I guess turnover, apathy, delayed response times, and other things all contributed to what I'll call the demise of these kinds of EMT's and that's a shame. I worked with EMT's who were able to do almost everything I could do as the medic right up to the venipuncture or intubation or other invasive skills. They were crackerjack EMT's and truly a pleasure to work with.

Unfortunately we have EMT's out there now (and I'm confident that they're still the minority) who are barely competent in their basic skills so helping a medic is stretch.

Good topic!

[ny10570 745]

^^ What he said

[ex-commish 490]

I am a former EMT-I. With the excpection of a few sticks I hardly used the skills I was taught. The majority of the calls were BLS. I won't go as far as saying that taking the class was a waste of time as I learned alot from some excellent instructors.

[firefighter36 52]

I am an EMT-I, and I can concur with everyone that it is tough to use the skills you are taught, mainly due to regional protocols and the system we all seem to work in. We are fortunate to be in relatively close proximity to definative care, and we are able to get a patient to the hospital in a prompt fashion. EMT-I skills can be of great use in remote areas with longer access and transport times.

The training I received was invaluable, and was an excellent learning opportunity, better than any EMT-B recert or some CMEs, in my humble opinion. I would reccommend the class to anyone who feels they want to do more or learn more, but cannot make the commitment to be a paramedic.

[Eagle24 2]

I think you guys all got the right idea. The value of an EMT-I in this part of New York is, thankfully, not that high because of the proximity of most medic units. However, as an EMT-I myself, I think the course is very valuable for any EMT that is going to be riding calls simply for your own benefit of knowledge and experience(rotations during the course).

Having said that, you will only get to practice your skills on a small amount of calls (if you get to at all). I've found that if you work with the same medic "group" long enough, and they know that you are a COMPETENT EMT-I(and are MAC'd), they do not have a problem with you practicing your skills when appropriate(under their supervision). Do I ask to start every IV line? No. But if there is an arrest and everything else is taken care of except for intubation and IV access, then yes I might ask to do whatever the medic isn't working on (assuming BLS care is being taken care of by other EMT-B's on the crew).

If you have the time, just go for the medic course. But if you can't manage that into your schedule, then an EMT-I course might be a good way to get a good foundation in emergency care.

[50-65 205]

In NYS, the EMT-I curriculum follows the 1985 standard whereas most other states follow the 1999 standard. A big difference. Here in the Hudson Valley, the regional protocols require simutaneous dispatch of a medic to any ALS call. At least in Westchester, there is the option for a two-tiered response. In many upstate regions, the EMT-I is the main provider of pre-hospital care. I think this is due to the lack of paramedics and the longer transport times to definitive care.

I wouldn't consider my time spent in the "I" class a waste, however, opportunities to utilize my skills are very limited. Additionally, because of the regional protocols requiring the simutaneous dispatch of a medic, I don't know of any paying EMS agency that will pay more for an EMT-I.

I doubt I will renew my "I" when it expires next year.

[NWFDMedic 58]

I'm sure I will draw the ire of some with these comments but having experienced some of these things first-hand, I have some strong feelings on the subject.

The need for a second medic should be a rare call because a paramedic should be competent and able to handle a single patient without a second paramedic. That said, there are always those calls where IV access or intubation is challenging and the condition of the patient warrants the expeditious handling that two medics may be able to provide.

In cases where an intubation is difficult or suitable IV access can't be obtained, the benefit of an EMT-Intermediate on scene will be limited. As was pointed out, in this area EMT-I's don't get a lot of opportunity to hone their skills and they would not be my first choice to back me up if I couldn't get a tube or line in someone. This is not to say that an EMT-I is not valuable or their skills useful in some areas (St. Lawrence County probably has more EMT-I's than P's but Westchester is the opposite).

I suspect that the EMT-I program never really caught because we have people who are resistant to the length of the EMT-B course so taking another course of nearly the same length with no prospects for employment or skills practice had no appeal. Another big problem is that there are some skills that paramedics don't get to practice often enough to maintain their own proficiency so they're not going to let the EMT-I perform them.

As for people being able to assist the medic with EKG's, setting up meds or IV's, or other stuff, there was a time that we called those indispensible assistants EMT's. You don't need to be an EMT-I to put electrodes on a patient and set up the monitor while the medic does other things. EMT's routinely used to do most of the things that are being discussed here and I've never understood why that skill set diminished as much as it did. I guess turnover, apathy, delayed response times, and other things all contributed to what I'll call the demise of these kinds of EMT's and that's a shame. I worked with EMT's who were able to do almost everything I could do as the medic right up to the venipuncture or intubation or other invasive skills. They were crackerjack EMT's and truly a pleasure to work with.

Unfortunately we have EMT's out there now (and I'm confident that they're still the minority) who are barely competent in their basic skills so helping a medic is stretch.

Good topic!

Great post. In our area, the only reason why a "second medic" is usually called is for a second set of hands for a 2-person crew. There have been many times that I have called for a backup unit and utilized the second crew's EMT as it is a good training opportunity for the EMT. If a medic is calling for a second medic in a single patient situation on a regular basis for reasons other than the need for hands, I would question their level of competence. There are rare cases where a second medic is warranted, and a few by protocol (i.e. in the Hudson Valley region, a patient requiring RSI needs a credentialed paramedic).

As far as the EMT-I program is concerned, I took it in 1997 before I decided to go to medic school. I didn't get a lot out of the increased skills available. What I did get, and maybe it was a function of how my class was taught, was a feel for WHY we do a lot of what we do on the BLS level. The EMT program basically teaches you to ask a bunch of questions to gather information and if you "find this" then "do that". My EMT-I program taught a lot more about systems and how to do a more advanced patient assessment which could lead to a better field diagnosis. For a while, I volunteered with an EMT-I agency and I actually found the skills part of the EMT-I function to do more harm than good. Providers that weren't getting regular experience doing ETTs and IVs were wasting a good amount of time on the scene trying to perform those skills instead of getting the patient to the EMT-P unit or the hospital.

I've also had the pleasure of volunteering in St. Lawrence County and you are correct, it is a different world. Their program relies on EMT-CC providers, mostly from the larger volunteer agencies, to provide mutual aid to the outlying agencies. There are places in the county where the closest CC unit is almost 40 miles away and given the general condition of St. Lawrence County roads in the winter, that could mean your closest ALS resource is well over an hour away. The EMT-I could prove to be an invaluable resource in these situations. They also teach the EMT-B class differently up there. Due to the limited ALS resources, their EMT-B class teaches their EMTs to exercise much more clinical judgment than we do down here. The volunteer EMTs were very mindful of the fact that they were waking up a volunteer from an agency an hour away and taking away their scant resources if they called for EMT-CC mutual aid. The patients that we ALS for "precaution" are generally brought in BLS up there and I must say, the BLS providers up there are really good. This may be different now, as my experience up there was almost 20 years ago.