What has happened to good BLS?

[firemoose827 324]

Interesting topic, a lot of good points made and a lot that...well...

I have been both EMT-B and EMT-CC and have seen both sides of these arguments. I have walked into a house where BLS providers were already tending to a patient, and doing well, but when they saw me walk in they all backed up from the patient and stopped what they were doing as if expecting me to do everything.

I have been on calls as BLS where other BLS providers moved so slow it made you sick...than want to slap them across the head to get them moving.

I have first responded to a call just recently, a female seizing. I got there to find her actively seizing and loosing her airway quickly. I did what I could with no jump bag, than when the ambulance arrived 2 EMT's and 4 crew walk in and just sit there!!! LITERALLY just sat there and looked at me...I had to start ordering them around telling them to get the suction and get a set of ears out and listen to the lungs. Than it was as if they were just awakened from a dream and they didnt know where they were, one guy just started to brag about how fast he made it to the firehouse to get the rig. ( I dealt with him later on)

Good patient care is both BLS and ALS working together in harmony. All levels of training coming together to do the same job, get the patient to the ER alive, and somewhat better than they were to begin with. Regardless of whether or not you are an EMT or Paramedic, you should both be able to take vitals, start O2, package a pt in an extrication device, splint a wound or whatever is required. Just because the medic has all ALS procedures done does not mean that they cant help with the rest of the care. I for one am tired of seing medics sitting and watching an EMT try to finish another set of vitals instead of picking up a wrist and taking a pulse (without the big fancy machine that does it for you). Conversely Im tired of seing an EMT just sit back and watch a medic try to spike a bag and place electrodes while in a moving ambulance and not offer to help set things up. I do it all the time. I get looks some times but I still offer.

What about working together? Isnt that the best kind of patient care?

[Guest edwardamclean]

Well here is a reply from “the Old Guy”….(this is my first post as well). I passed my first EMT course in 1973..81 hours in NY State. Like many…I spent several years in various private and volunteer situation before joining NYC EMS…(when it was still Health & Hospitals). I found several things over the last 30 years or so…

When I got out of the Academy, I had come fresh from Long Island, as an EMT-B with numerous instructor/trainer credentials,,,,my first day out…I was assigned to a lower Manhattan tactical BLS unit…and as well trained as I was…..I knew nothing.

No level of training will fully prepare anyone for “the Street”. That being said, I was lucky enough to have worked with some of the finest people in the field, BLS..and eventually ALS, and I learned. There are however vast differences between volunteer services, proprietary services, and paid professional services. Those differences continue to define the level of exposure and expertise in EMS services, particularly BLS care, which is the basis for all ALS. Like others have stated much better than I, good BLS is the basis for good ALS intervention. Remember, ALS is an intervention, not an outcome.

I would strongly agree that for the sake of EMS training and professionalism, and most importantly good patient outcomes EMS education would be better served by the Department of Education, not the Department of Health.

I was so well trained, and experienced because I worked in a highly complex, tertiary care EMS system, that in my day averaged 4000 calls a shift citywide. Most non-urban systems don’t drive anywhere near those numbers. It is for that reason….the vast differences in EMS operating environments, that precludes good standardized BLS skills.

We need a better training system, with bi-annual licensure…dependant on CME’s..

BE safe everyone…

[firemoose827 324]

Well here is a reply from “the Old Guy”….(this is my first post as well). I passed my first EMT course in 1973..81 hours in NY State. Like many…I spent several years in various private and volunteer situation before joining NYC EMS…(when it was still Health & Hospitals). I found several things over the last 30 years or so…

When I got out of the Academy, I had come fresh from Long Island, as an EMT-B with numerous instructor/trainer credentials,,,,my first day out…I was assigned to a lower Manhattan tactical BLS unit…and as well trained as I was…..I knew nothing.

No level of training will fully prepare anyone for “the Street”. That being said, I was lucky enough to have worked with some of the finest people in the field, BLS..and eventually ALS, and I learned. There are however vast differences between volunteer services, proprietary services, and paid professional services. Those differences continue to define the level of exposure and expertise in EMS services, particularly BLS care, which is the basis for all ALS. Like others have stated much better than I, good BLS is the basis for good ALS intervention. Remember, ALS is an intervention, not an outcome.

I would strongly agree that for the sake of EMS training and professionalism, and most importantly good patient outcomes EMS education would be better served by the Department of Education, not the Department of Health.

I was so well trained, and experienced because I worked in a highly complex, tertiary care EMS system, that in my day averaged 4000 calls a shift citywide. Most non-urban systems don’t drive anywhere near those numbers. It is for that reason….the vast differences in EMS operating environments, that precludes good standardized BLS skills.

We need a better training system, with bi-annual licensure…dependant on CME’s..

BE safe everyone…

Well put, and welcome to the site. In all honesty though, this is an age old argument that will continue well into the lives of our childrens children. Just like the other well known argument...

Its good to see more experienced EMS people on the site as well, and I look forward to more posts in the future.

[RNEMT26 40]

I live and work in a town here unfortunately there are STILL people who only walk into the house with a clipboard and nothing else. It really grinds my gears and bothers the crap out of me to say the least. Not to mention alot of my fellow EMTs on the rescue squad are "ALS dependent". It's sad honestly. I've witness (and intervened) when a fellow EMT sat there with a PT who was in extremis (resp distress/impending failure) and we heard they were coming from a good distance, after 5 min of everyone standing around with there thumbs up their A**ES, i said I think it's time to get moving and so they did, but of course with moans and groans under their breath. It really seems to me that (and i believe other people have stated the same) that people don't understand the 'why' part of why and how we do things. I've been told by an EMT when I said why are you doing that, their answer was "Because it's protocol" I said just because it's protocol does not mean it is always the right thing to do at that time. It seems to me that they will give any idiot who can pass the class an EMT card (i know you have to pass the test and have some sort of knowledge retention) but really it's a disgrace.

[helicopper 1,050]

Well here is a reply from "the Old Guy"….(this is my first post as well). I passed my first EMT course in 1973..81 hours in NY State. Like many…I spent several years in various private and volunteer situation before joining NYC EMS…(when it was still Health & Hospitals). I found several things over the last 30 years or so…

When I got out of the Academy, I had come fresh from Long Island, as an EMT-B with numerous instructor/trainer credentials,,,,my first day out…I was assigned to a lower Manhattan tactical BLS unit…and as well trained as I was…..I knew nothing.

No level of training will fully prepare anyone for "the Street". That being said, I was lucky enough to have worked with some of the finest people in the field, BLS..and eventually ALS, and I learned. There are however vast differences between volunteer services, proprietary services, and paid professional services. Those differences continue to define the level of exposure and expertise in EMS services, particularly BLS care, which is the basis for all ALS. Like others have stated much better than I, good BLS is the basis for good ALS intervention. Remember, ALS is an intervention, not an outcome.

I would strongly agree that for the sake of EMS training and professionalism, and most importantly good patient outcomes EMS education would be better served by the Department of Education, not the Department of Health.

I was so well trained, and experienced because I worked in a highly complex, tertiary care EMS system, that in my day averaged 4000 calls a shift citywide. Most non-urban systems don't drive anywhere near those numbers. It is for that reason….the vast differences in EMS operating environments, that precludes good standardized BLS skills.

We need a better training system, with bi-annual licensure…dependant on CME's..

BE safe everyone…

Great post. I'll take it one step farther - we need a better operating system, not just training system. Rules, policies, standards vary from town to town, agency to agency, and even crew to crew. It is very hard for anyone new to assimilate to the system because their isn't one. There are no standards or consistency anywhere except perhaps in NYC because they have a much more structured system.

[calhobs 110]

I have bit my tongue long enough. Want to know what has to be done, here it is. Instructors have to stop pushing students through classes, how many people have ever failed EMT class. Instructors have to weed students out before the practical exam, not let the Practical or the State exam weed people out. Passing grade in class should be 80% not 70% this way when it comes time for the State exam you are really ready for it. Think about it how many people who score a 70-75 on the State exam just got damn lucky on the test. I think the practical is a joke the way it is given here in Westchester.

When I first took my EMT class in 1989 I paid for it. We had 32 people in class, do you know how many people actually failed the class…NONE, When I was in TOP for NYCEMS in 1991 we had 44 people in class, by time of our final we had 23 people in class. Then back in 2004 I took the EMT class again due to a lapse in training. 38 people in class and no one failed the class again. What is wrong with this picture?

One of the big differences in TOP and pay for EMT courses are the way the protocols are taught. In pay for courses I was taught just the protocols that where going to be on test or the practical. In TOP we had to know every single protocol in the book. The worse statement I have ever heard from a instructor in pay for course was, “Don’t worry you don’t need to know that for the test”.

I have been told by many people and I do not know for a fact myself, that instructors get paid or a bonus for how many students pass there class. If this is true or not I do not know. I hope instructors are not passing people just for the buck

You want to fix BLS EMS here in Westchester start in the class room, cut the head off of the problem before it gets even worse..

[E-38VMFD 0]

100% agreement. Westchester's 911 system is very ALS dependent, whether its the utilization of ALS because its pretty much always available or if it is poor instruction to begin with

Nothing like a serious call with no ALS available... BLS save!!

[Guest alsfirefighter]

I have bit my tongue long enough. Want to know what has to be done, here it is. Instructors have to stop pushing students through classes, how many people have ever failed EMT class. Instructors have to weed students out before the practical exam, not let the Practical or the State exam weed people out. Passing grade in class should be 80% not 70% this way when it comes time for the State exam you are really ready for it. Think about it how many people who score a 70-75 on the State exam just got damn lucky on the test. I think the practical is a joke the way it is given here in Westchester.

When I first took my EMT class in 1989 I paid for it. We had 32 people in class, do you know how many people actually failed the class…NONE, When I was in TOP for NYCEMS in 1991 we had 44 people in class, by time of our final we had 23 people in class. Then back in 2004 I took the EMT class again due to a lapse in training. 38 people in class and no one failed the class again. What is wrong with this picture?

One of the big differences in TOP and pay for EMT courses are the way the protocols are taught. In pay for courses I was taught just the protocols that where going to be on test or the practical. In TOP we had to know every single protocol in the book. The worse statement I have ever heard from a instructor in pay for course was, “Don’t worry you don’t need to know that for the test”.

I have been told by many people and I do not know for a fact myself, that instructors get paid or a bonus for how many students pass there class. If this is true or not I do not know. I hope instructors are not passing people just for the buck

You want to fix BLS EMS here in Westchester start in the class room, cut the head off of the problem before it gets even worse..

Ok brother...you've been around a long time with me on here and I often agree with much that you have to say...except one small part of your above statement. Its IS NOT the job of any instructor, teacher, proctor, professor etc. to "weed out" students. It is our job as educators to do all we can to facilitate the ability for all students to pass. The students themselves are the ones who "weed out" themselves. I have never been part of any practical test where any lead instructor has asked me or directed me to go soft on students. For one...anyone who knows me..knows that doesn't fly with me...nor fit my educational philosophy overall. If a student fails..it will be on their own accord...and if many fail..then the question of the instructor needs to be raised. I never rate an instructor by how many students pass...but how many fail. I doubt anyone on here would want their kid "weeded out" in any level of education from grade school, to secondary school to college. I mean hell if education is the problem..why isn't the passing grade a 95? Additionally I have never worked with an instructor in any discipline for what I teach who has ever said you don't need to know something for the test. We all in fire and ems education go into greater detail then what the curriculum calls for within reason of content and time...well at least the ones I've taught for.

The bottom line is this..there is no one singular area that you can put your finger down and say that's it. Some are more involved then others yes..but not alone. Even if instructors were pushing students through..the issue still comes down that the individual agency has the final responsibility for the personnel they put on the road. So stop blaming instructors for the BLS provider issues when agencies still pump them out on the streets, know they aren't ready or have issues, but yet let them ride alone often with another weak BLS provider or just a "driver." Even worse I see more and more new providers or those who just haven't gotten to a competent level of street knowledge being mentor by equally or even worse much weaker providers and officers who suck.

So you're right on one thing..lets cut the head off the problem first...and that's the agencies that send people for free on tax payers dime...often knowing they're not going to make it...and then if the person does make it through some form of effort on both student and educators...do nothing to foster their success in the field.

[MoFire390 118]

As an experienced ALS provider and one who saw first hand the decline in BLS skill while still a BLS provider I have several opinions on this. And for the one who said they had "senior EMT's who hated medics," my experience has been they are often the most dangerous and suffer from certification napoleon complexes and are some of the ones I have to keep the closest eye on. But either way...as I often tell people...I'm not here to function so EMT's like me...I'm here for my patients to like me and give good solid patient care. I take being called a "dick" or "intimidating" as a compliment. I'm one of the most demanding medics in my system..and for one purpose..solid patient care. Any instructor and I have heard stories of people teaching..."do this and that and WAIT FOR ALS TO ARRIVE"....WHat!!!???!! Are you kidding me? I have to tell bls crews by radio often to not wait for me if I did a job from far away. Clip boards should be banned from in houses. If you are thrown into the real world..something is wrong...and unfortunately too many agencies push new EMT's into spots they are not ready for. Have required ride time as curriculums do not have enough field rotations in them for EMT-B's. Someone said something about being called old fashioned for taking the time to understanding something instead of throwing on O2 and putting them in semi fowlers and going to the hospital. Yes you are right...but it should take no more then 60 seconds to realize they need oxygen..use the time to get the lifting device you may need or the time transporting to figure it out...on scene time is important and one of the singular most important treatments any EMS provider can perform is transporting your patient.

With that said...

1. The change in curriculum in the late 90's to me was a dumb down of the certification and reduced the background and A & P knowledge us old curriculum EMT's needed to know. The patient assessment in the curriculum is absolutely atrocious and too cookie cutter. I became the medic I am because of strong bls education and street experience...its not there anymore.

2. Lack of training within VAC's. Some things need to be learned on the street..other things need to be learned and practiced as you don't use them often. CME training is often lectures...get them out of their chairs and review equipment and bls skills done in courses and testing.

3. I've worked around and seen some medics who don't step back enough to allow BLS to do their thing when appropriate. I always give them slack...and then take back over if they are lost.

anyone who calls u demanding hasn't worked with you on many calls. ur one of the best medics out there!!!

I recently took the emt class and recived my emt-b. i felt very parpared for the street. the only thing that i wish the class would take more time on is the PCRs. these are the one thing i keep having trouble filling out. im still in the middle of being precited to ride as an emt and i must say its not about the calls for being cleared. it comes down to how i do pt care.

i think a some instrustors beat ALS into some of their students. many of us have dual response with ALS and most of the time ALS gets there before we do and has already made the decsion if the call is ALS or BLS. if its ALS us as emts dont have the time to do their BLS skills and just listen to the medics. to those who have BLS calls we need to focous on the pt and not on the pcr the pcr gets written when we drop the pt off at the ER. it drives me nuts to see that happen. focus on ur pt not that pcr!

[Guest alsfirefighter]

anyone who calls u demanding hasn't worked with you on many calls. ur one of the best medics out there!!!

I recently took the emt class and recived my emt-b. i felt very parpared for the street. the only thing that i wish the class would take more time on is the PCRs. these are the one thing i keep having trouble filling out. im still in the middle of being precited to ride as an emt and i must say its not about the calls for being cleared. it comes down to how i do pt care.

i think a some instrustors beat ALS into some of their students. many of us have dual response with ALS and most of the time ALS gets there before we do and has already made the decsion if the call is ALS or BLS. if its ALS us as emts dont have the time to do their BLS skills and just listen to the medics. to those who have BLS calls we need to focous on the pt and not on the pcr the pcr gets written when we drop the pt off at the ER. it drives me nuts to see that happen. focus on ur pt not that pcr!

Good post Kenny and thanks for the compliment. You've come along very well since you got your cert....even like the time you were turning 3 shades of green standing in the doorway like it had an invisible force field. lol.

Excellent points in your final paragraph.

[MoFire390 118]

Thank you sir. i must say if it wasnt for u and ur knowledge, i wouldnt have become what i am today,

[Guest DaGonz]

What is taught in class and what happens on the street are two entirely different animals.

Part of the problem is also some of the paramedics who feel that because they have the "P" after EMT, those with the "B's" and "I's" don't know anything, so the B's and I's are hesitant to start treatment because those with the "paragod" syndrome will criitcize whatever they do... and sometimes in front of the patient.

By the same token, there are some newly minted "B's" that will criticize anything that an experienced B, I or P will do because we learned our craft "back in the day, that's old school" stuff.

[helicopper 1,050]

Thank you sir. i must say if it wasnt for u and ur knowledge, i wouldnt have become what i am today,

Please stop, it's already hard enough to find helmets that will fit him!!!

What is taught in class and what happens on the street are two entirely different animals.

Part of the problem is also some of the paramedics who feel that because they have the "P" after EMT, those with the "B's" and "I's" don't know anything, so the B's and I's are hesitant to start treatment because those with the "paragod" syndrome will criitcize whatever they do... and sometimes in front of the patient.

By the same token, there are some newly minted "B's" that will criticize anything that an experienced B, I or P will do because we learned our craft "back in the day, that's old school" stuff.

It shouldn't be two different animals. Courses should be practical and useful and not just "teaching to the test". Perhaps if interest groups stopped lobbying against improvements (read additional time) to the curriculum we'd start to see more of what we want.

As for the personalities you describe, this is a system problem. There isn't enough supervision to stop the paragod from alienating the BLS crews and the timid and/or overbearing EMT's (at all levels) who could be coached and/or corrected with supervision and direction. The QA/QI program should speak to this but the reality is that has become just another means to an end that checks a box.

[ckroll 101]

I had an opportunity to be a BLS 'provider' this last week that may be worth sharing. It happened way out of town at the graveside service for the father of a dear friend. As we were leaving the cemetery, an older gentleman walking with me appeared to lose his balance and slide to the ground. After a few tense moments, that included being shoved by a poorly mannered physician who then did nothing, I made patient contact, sat him up in my lap to keep him off the cold ground. I told him who I was, did a quick check of vitals, a stroke test and established he had no significant history, and then we just chatted and tried to stay warm.

By the time an ALS ambulance arrived his color was improved, pulses were strong and he and his family made the decision to refuse immediate care. ALS found nothing wrong with him, we stood him up and he walked back to a waiting car. At the gathering that followed I saw him and his family, and I urged him to tell his physician what had happened when he returned home. He smiled broadly, nodded to his son and said "He knows." The patient, it turns out, also had been a physician and was still teaching at a medical school. After we had a good laugh over the physician who made such a fuss at the cemetery, he hugged me and thanked me for my help. I said, "I didn't actually do anything." To which he replied, "Yes, but you did it well."

The message here is that field work, both ALS and BLS has as much to do with people skills as it does with medicine. Just as ALS has as its foundation good BLS, good BLS is built on providers' ability to connect with the patient, to develop a sense for what is going on and to meet the needs of the patient.

Part of what has happened to EMS, not just BLS, is that we have let clip boards and toughbooks,--even oxygen tanks and blood pressure cuffs--get between us and our patients. This week I had the chance to be nobody doing nothing, and I had forgotten how much fun that was.

[firemoose827 324]

Ok brother...you've been around a long time with me on here and I often agree with much that you have to say...except one small part of your above statement. Its IS NOT the job of any instructor, teacher, proctor, professor etc. to "weed out" students. It is our job as educators to do all we can to facilitate the ability for all students to pass. The students themselves are the ones who "weed out" themselves. I have never been part of any practical test where any lead instructor has asked me or directed me to go soft on students. For one...anyone who knows me..knows that doesn't fly with me...nor fit my educational philosophy overall. If a student fails..it will be on their own accord...and if many fail..then the question of the instructor needs to be raised. I never rate an instructor by how many students pass...but how many fail. I doubt anyone on here would want their kid "weeded out" in any level of education from grade school, to secondary school to college. I mean hell if education is the problem..why isn't the passing grade a 95? Additionally I have never worked with an instructor in any discipline for what I teach who has ever said you don't need to know something for the test. We all in fire and ems education go into greater detail then what the curriculum calls for within reason of content and time...well at least the ones I've taught for.

The bottom line is this..there is no one singular area that you can put your finger down and say that's it. Some are more involved then others yes..but not alone. Even if instructors were pushing students through..the issue still comes down that the individual agency has the final responsibility for the personnel they put on the road. So stop blaming instructors for the BLS provider issues when agencies still pump them out on the streets, know they aren't ready or have issues, but yet let them ride alone often with another weak BLS provider or just a "driver." Even worse I see more and more new providers or those who just haven't gotten to a competent level of street knowledge being mentor by equally or even worse much weaker providers and officers who suck.

So you're right on one thing..lets cut the head off the problem first...and that's the agencies that send people for free on tax payers dime...often knowing they're not going to make it...and then if the person does make it through some form of effort on both student and educators...do nothing to foster their success in the field.

Excellent points. I agree totally about the transition from classroom to field being the failing factor in most EMT's careers. That first few calls and the guidance they receive/do not receive is the critical factor.

I see too many students that get lost, literally in the field. They pass their tests and feel "Comfortable", but than the very first call is usually on their own with no help from EMS officers or senior providers, and its usually the code, or trauma arrest in the 2 car head on collision that they are baptized by fire with. Afterwords is the feeling of inadequacy, and second guessing their treatments, and "what ifs", all because they had no one to guide them successfully into the field. THATS where the problem lies, within the agency and its leadership. Not the instructors.

I had an opportunity to be a BLS 'provider' this last week that may be worth sharing. It happened way out of town at the graveside service for the father of a dear friend. As we were leaving the cemetery, an older gentleman walking with me appeared to lose his balance and slide to the ground. After a few tense moments, that included being shoved by a poorly mannered physician who then did nothing, I made patient contact, sat him up in my lap to keep him off the cold ground. I told him who I was, did a quick check of vitals, a stroke test and established he had no significant history, and then we just chatted and tried to stay warm.

By the time an ALS ambulance arrived his color was improved, pulses were strong and he and his family made the decision to refuse immediate care. ALS found nothing wrong with him, we stood him up and he walked back to a waiting car. At the gathering that followed I saw him and his family, and I urged him to tell his physician what had happened when he returned home. He smiled broadly, nodded to his son and said "He knows." The patient, it turns out, also had been a physician and was still teaching at a medical school. After we had a good laugh over the physician who made such a fuss at the cemetery, he hugged me and thanked me for my help. I said, "I didn't actually do anything." To which he replied, "Yes, but you did it well."

The message here is that field work, both ALS and BLS has as much to do with people skills as it does with medicine. Just as ALS has as its foundation good BLS, good BLS is built on providers' ability to connect with the patient, to develop a sense for what is going on and to meet the needs of the patient.

Part of what has happened to EMS, not just BLS, is that we have let clip boards and toughbooks,--even oxygen tanks and blood pressure cuffs--get between us and our patients. This week I had the chance to be nobody doing nothing, and I had forgotten how much fun that was.

Another excellent point here as well. BEDSIDE MANNER!!! Where did it go? Out the door to make room for the ego trip! People feel important carrying the clipboard and asking questions. I just let them...While myself and other caring EMT's actually take care of the patient and gain their trust and comfort. After all, you do need a secretary to take down all of the info for the PCR later on, so why not just let that person do it? (Unless they are the only provider on scene, than you should slap them across the head and take the clipboard.)

Patients feel so much better when the stranger standing in their home seeing them in an uncomfortable position (pajamas, or in bday suit, somewhat embarrasing) actually has a heart and connects with them, and shows they care about them. Get on the same level, cover them up and show you care, leave the clipboard on the rig, connect with them and things go so much better. I have noticed the decline in respect and bedside manner, and its real disheartning. Good post.

[Guest alsfirefighter]

What is taught in class and what happens on the street are two entirely different animals.

Part of the problem is also some of the paramedics who feel that because they have the "P" after EMT, those with the "B's" and "I's" don't know anything, so the B's and I's are hesitant to start treatment because those with the "paragod" syndrome will criitcize whatever they do... and sometimes in front of the patient.

By the same token, there are some newly minted "B's" that will criticize anything that an experienced B, I or P will do because we learned our craft "back in the day, that's old school" stuff.

I can't say that there aren't those out there that may fit into the syndrome you speak of...but I can also tell you that there are some BLS providers who have extremely thin skin and can't take constructive criticism. I see very few providers in my system that will ever criticize any actions taken by a BLS provider unless it is something that didn't get done that is obvious it should have (bagging a patient who needs it, attempting to cancel ALS on a call that a patient obviously needs help) or the opposite something that was done completely wrong or ill willed (cpr on a patient with pulses/breathing, unwarranted albuterol administration). Bottom line is there are times where being professional means you have to be direct and I'm glad your answering your one or two calls this week but for me its about my 30th so I might not be all chipper and happy go lucky at that point. I have a reputation as being a very tough, staunch ALS provider. I'm fine with that as I don't belittle people, get nasty or treat them in an unprofessional manner. I am demanding...some can't handle that or don't like it...but guess what...I'm demanding because my level of professionalism allows me nothing else for my patient or my professions overall image. There is a time to be friends...and there are times that you have to get down to business. Just being there to "help someone" isn't enough when there they are in critical need for medical intervention.

The final point you bring up is a great one, as I often get complaints or bitching about ALS providers by basics. Any professional paramedic will never ever bad mouth another ALS provider to anyone but their equal colleagues no matter what the situation and approach that provider to talk to them about it. The most often one I hear is "they bls'd that patient and I felt it shouldn't have been." I always reinforce that you have the option of voicing your concern to a provider there...in the end it is their final decision, but you should feel good you voiced your issue/concern. The other thing I often ask them on calls which are often borderline or really didn't warrant ALS intervention is under what protocol should they have taken the call in or why I wouldn't have taken it in either. Again getting thicker skin in some cases just needs to be. The final thing to keep in mind is that we are all human and occassionally don't see things for what they are or make a decision based on that.

[EMSer 15]

IMHO i know "paid" guys aren't always the cream of the crop, but volunteer EMS needs to go ASAP

i have never met a well trained volunteer EMT that wasn't a career EMT. vollies don't care about EMS, they care about their agency's name, their agency's MONEY and their agancy's social cliques. I would be the first person to sign a petition to close down all vollie EMS in the county. With the vollies uniform allowances, their pensions, their $5,000-$10,000 parties and all of the other perks "vollies" get they're no longer actually volunteers!!! They're a form of under qualified cheap labor, I'd rather all that pissed away money go to a WELL TRAINED PAID CREW!

Don't even get me started about vollies response times, it's so disgusting i can't even think about it anymore.

I am a former vollie that no longer participates in any agengy because i can't stand what all VAC's and some vollie FD's have become in recent years

edit...sorry for the rant, it's just tough to see what VAC's have become and it angers me to no end...

Edited April 4, 2011 by EMSer

[ny10570 745]

Wow, thats a pretty broad brush you're painting with. I know many EMT's who have worked no where but their volley corps who are excellent providers. I work with many knuckleheads and idiots in NYC who have received much more training than the vast majority of the volleys out there. Dumb is dumb is dumb. EMS, ALS or BLS is all about being smart. Using intuition, past experience, and training to figure out what is going on. 90% of my calls are just what Ckroll did for her patient and the other 10% the simple stuff is what made all the difference. There are plenty of problems with the volley world however going paid is not the solution to your problem. Where do you think all those new employees are coming from??

[PFDRes47cue 653]

Wow, thats a pretty broad brush you're painting with. I know many EMT's who have worked no where but their volley corps who are excellent providers. I work with many knuckleheads and idiots in NYC who have received much more training than the vast majority of the volleys out there. Dumb is dumb is dumb. EMS, ALS or BLS is all about being smart. Using intuition, past experience, and training to figure out what is going on. 90% of my calls are just what Ckroll did for her patient and the other 10% the simple stuff is what made all the difference. There are plenty of problems with the volley world however going paid is not the solution to your problem. Where do you think all those new employees are coming from??

I would have to agree. I also know a bunch of very competent, respectful, professional and respect BLS providers who have never had a paid EMS gig.

[MoFire390 118]

IMHO i know "paid" guys aren't always the cream of the crop, but volunteer EMS needs to go ASAP

i have never met a well trained volunteer EMT that wasn't a career EMT. vollies don't care about EMS, they care about their agency's name, their agency's MONEY and their agancy's social cliques. I would be the first person to sign a petition to close down all vollie EMS in the county. With the vollies uniform allowances, their pensions, their $5,000-$10,000 parties and all of the other perks "vollies" get they're no longer actually volunteers!!! They're a form of under qualified cheap labor, I'd rather all that pissed away money go to a WELL TRAINED PAID CREW!

Don't even get me started about vollies response times, it's so disgusting i can't even think about it anymore.

I am a former vollie that no longer participates in any agengy because i can't stand what all VAC's and some vollie FD's have become in recent years

edit...sorry for the rant, it's just tough to see what VAC's have become and it angers me to no end...

really!!!!!!! volunteers dont care about ems??? my i ask what u are smoking??? maybe u need to open ur eyes and see that some of us on here are volunteer's. especially me!!! as for being well trained it depends on the emt and how much they want to expand their knowledge. if they dont want to expand their knowledge then thats their problem. we are here for the pts and their families. pt care should be all of our number 1 priorities. and i have no issue telling u that i feel disrepected by u saying that volunteers dont care about ems. i have 15 people here in cortlandt vac that would be pissed off to see u say that.

[PFDRes47cue 653]

A paycheck does not equal competence or a high level of patient care.

[helicopper 1,050]

IMHO i know "paid" guys aren't always the cream of the crop, but volunteer EMS needs to go ASAP

i have never met a well trained volunteer EMT that wasn't a career EMT. vollies don't care about EMS, they care about their agency's name, their agency's MONEY and their agancy's social cliques. I would be the first person to sign a petition to close down all vollie EMS in the county. With the vollies uniform allowances, their pensions, their $5,000-$10,000 parties and all of the other perks "vollies" get they're no longer actually volunteers!!! They're a form of under qualified cheap labor, I'd rather all that pissed away money go to a WELL TRAINED PAID CREW!

Don't even get me started about vollies response times, it's so disgusting i can't even think about it anymore.

I am a former vollie that no longer participates in any agengy because i can't stand what all VAC's and some vollie FD's have become in recent years

edit...sorry for the rant, it's just tough to see what VAC's have become and it angers me to no end...

There doesn't seem to be anything humble about this opinion. You're condemning an entire category of people and using analogies that don't apply to many agencies. I'm not aware of many VAC's throwing extravagant parties, in fact most don't have anywhere near the budgets theys hould.

I've seen incompetent, unprofessional paid providers and I've worked with volly crews more dedicated and skilled than some of the highest paid paid crews. Your blanket statement is just plain wrong.

I can understand the need to vent frustration but I think you've just insulted a great many EMS providers who are professional, receive little or no perks and still do the job.

[GAW6 66]

Well said Helicopper!!!!

[KelliPVAC 32]

EMSer, on Yesterday, 10:26 AM, said:

"IMHO i know "paid" guys aren't always the cream of the crop, but volunteer EMS needs to go ASAP

i have never met a well trained volunteer EMT that wasn't a career EMT. vollies don't care about EMS, they care about their agency's name, their agency's MONEY and their agancy's social cliques. I would be the first person to sign a petition to close down all vollie EMS in the county. With the vollies uniform allowances, their pensions, their $5,000-$10,000 parties and all of the other perks "vollies" get they're no longer actually volunteers!!! They're a form of under qualified cheap labor, I'd rather all that pissed away money go to a WELL TRAINED PAID CREW!

Don't even get me started about vollies response times, it's so disgusting i can't even think about it anymore.

I am a former vollie that no longer participates in any agengy because i can't stand what all VAC's and some vollie FD's have become in recent years

edit...sorry for the rant, it's just tough to see what VAC's have become and it angers me to no end..."

*I agree helicopper!

*For the statement that was made saying vollies don't care about EMS, you are totally wrong! I am a "vollie" and care very much about EMS! Do I care about my agency - ABSOLUTELY!!! Do I care about our budget - YES! With that money we are able to serve our Community, free of charge I may add. Social cliques, yes every department, fire, ems ) paid or "vollie", have there groups of friends. Paid EMTS take the same NYS test as a "vollie". Based on that how many paid EMTS are only doing transports and not using skills? You may think its "cheap labor" to me its dedication!

By the way, this topic was about skills, not bashing volunteers!

Edited April 5, 2011 by KelliPVAC

[firemoose827 324]

There doesn't seem to be anything humble about this opinion. You're condemning an entire category of people and using analogies that don't apply to many agencies. I'm not aware of many VAC's throwing extravagant parties, in fact most don't have anywhere near the budgets theys hould.

I've seen incompetent, unprofessional paid providers and I've worked with volly crews more dedicated and skilled than some of the highest paid paid crews. Your blanket statement is just plain wrong.

I can understand the need to vent frustration but I think you've just insulted a great many EMS providers who are professional, receive little or no perks and still do the job.

Well put. I have been trying to come up with a diplomatic response to that post, but could not due to the anger. Great post.

My VAC can not even buy a decent ambulance to transport patients in, let alone get us a glitzy party with all of the perks you mention. Perks? What the hell are they? The only perks we look forward to are the smiles from patients and the thank you cards we receive in the mail that make us all feel that what we do is appreciated...then we see stuff like what you just posted. You may be angered by the current level of training, or the lack of inexperience, but that is the wrong way to go about venting it. Find a more productive way to vent AND find a solution to the problem.

Stay Safe.

[JJB531 652]

Just wanted to jump in on the discussion for a quick second. Forget about the title of EMT or Paramedic for a minute; speaking solely as a trained and certified practitioner of emergency medicine, nothing frustrates me more than walking into a room full of other trained and certified practitioners of prehospital emergency medicine, asking "What do ya got?" and being met with blank stares. Then asking "What vitals did you get?" and being met with blank stares. Then asking "Can anyone tell me anything about our patient?" only to be handed the clipboard with the patient's name and address written on the PCR, which does me absolutely no good at that given moment.

My point is that an EMT is certified by the State of New York Department of Health to practice prehospital emergency medicine. As basic as some of the skills may be, they are the foundation for every single intervention and treatment the patient is going to receive, at both the BLS and ALS level. Every trained and certified EMT passed the Patient assessment station during their NYS EMT practical skills exam, so when another trained prehospital care provider arrives on the scene where another trained and certified care provider has already initiated patient contact, there is an expectation that certain basic things are completed, time permitting of course, upon the arrival of additional providers (I.e. paramedics). Personally, all I look for is that the chief complaint has been determined, the airway is controlled, oxygen is being administered, ventilations are bein assisted if necessary, serious bleedings being controlled, and a baseline set of vital signs are taken. That's it! It's that whole initial assessment/focused history/vital signs part of the NYS patient assessment station. This is all that most medics are looking for from BLS providers. If you happen to get more, bravo! but I won't be frustrated if you didn't uncover that the patient had foot surgery in 1978 or that you failed to recognize the patient had muffled heart sounds. Why the rant? Because one individual in a previous post brought up the "paragod" complex when referring to Paramedics. Are some medics guilty of this syndrome? Yeah, unfortunately some are. I can tell you with the majority of Paramedics out there, it's not a "paragod" complex, it's an overwhelming sense of frustration that builds up in trained and certified prehospital care providers over time when they witness on a near daily basis the incompetence of some (note I said some, not all) trained and certified BLS providers who can't even handle the simplest of calls. I keep using the phrase "trained and certified" because that's what we all are; trained and certified to practice prehospital emergency medicine. Since we are "trained and certified" we should be held to a standard, not only by the state and other regulatory groups, but by our peers also. As an "EMS peer", I am deeply troubled when I witness other "trained and certified" providers who basically know nothing about the basics of providing prehospital emergency medical care. I have some semblance of patience with new EMT's because we were all new at one point. No one started out as a seasoned veteran. But when a trained and certified has to hold the hand of another trained and certified provider on every single call over the span of months, even years, the frustration starts to set in. This frustration, while it usually ends up being directed at the incompetent provider because they're the easiest target to vent, the overall problem goes well beyond just the provider.

Anyone who's been in the field long enough can tell you that BLS skills have diminished because:

A) A "dumbed down" EMT curriculum that doesn't promote thinking and understanding, it merely promotes recognition. We expect non-trained persons to recognize there's a problem, we should expect "trained and certified" medical professionals to interpret the findings into some form of a presumptive diagnosis to effectively treat the patient.

B. Minimal amount of BLS ambulance rotation hours. 8 or 12 hours of rotations are nowhere near adequate to prepare EMT's for the street.

C) The EMT certification has become more of a joke than anything else. Individuals at job fairs are encouraged to take the EMT class because "after 6 months of training you can make $10 an hour". It's like a bad infomercial. This is not a knock to EMT's, but more so at the means of selecting and recruiting candidates who are being attracted to the field because it's marketed as a quick and easy way to get a certification and start making money; similar to these shady phlebotomy and medical assistant programs you see on TV at 3am.

D) Medic dependency. With the overwhelming number of medics out there, and the fact that they often arrive at scenes first, EMT's are not getting the experience they need to be good providers. One of the problems Paramedics are faced with is walking that fine line of alienating BLS providers on jobs which leads to medic complaints, and then standing back and not getting intimately involved in calls that don't require ALS care, and getting medic complaints for not helping. I don't mind helping out on BLS calls or being a source of guidance, but I shouldn't have to run a BLS call. You're an EMT, you're "trained and certified", you should handle the call.

E) Lack of appropriate field training for new providers and a lack of continuing education for all providers.

Edited April 5, 2011 by JJB531

[EMSer 15]

daaaaaamn, chill out people

usually when someone puts the "sorry for the rant" disclaimer on the post that means they're getting out frustrations

a post that started to be "IMHO" went a little off target helicopter...again, the disclaimer...

yes, my former agency, as MANY OTHER agencies in the surrounding area have EXPENSIVE parties and other PERKS at the expense of the taxpayer! maybe not in your area, but definately in mine! my former agency(s) spend about $10,000 for 2 lavish parties (EDIT: these 2 parties happen each year) and the majority of people think it's ok and those that condemn it still attend it because it's a place to get drunk and eat for free!!

most all of the vollies i know are wonderful and caring people, they just suck at being EMT's (and they know it)

but what can they do?? they have other responsibilities in life, you have the ability to train and retrain PAID EMT's

sorry, there isn't an excuse for being a sucky paid EMT, and i blame the state of NY, REMSCO and the company(s) for allowing EMT-B's and Medics to be subpar. if youre a paid guy and suck, you deserve to be fired, plain and simple

not so easy to do to vollies

Get ready...another disclaimer...YES, i know not everyone sucks at EMS, but we SEEM to agree that EMS personnel are getting worse each year. thats the rant

Edited April 5, 2011 by EMSer

[x129K 1,393]

Quick clipboard story;

About 15 years ago, my department responded to an MVA, occupants were out of the car upon my arrival, but injured, laying on the side of the road...

The ambulance shows up, the EMS Captain walks over to me and hands me the dreaded clipboard...

I look at her, refused the clipboard and said, "I think we need something a little bigger, like a backboard please......"

THAT did NOT go over very well...LOL

[PFDRes47cue 653]

daaaaaamn, chill out people

usually when someone puts the "sorry for the rant" disclaimer on the post that means they're getting out frustrations

a post that started to be "IMHO" went a little off target helicopter...again, the disclaimer...

yes, my former agency, as MANY OTHER agencies in the surrounding area have EXPENSIVE parties and other PERKS at the expense of the taxpayer! maybe not in your area, but definately in mine! my former agency(s) spend about $10,000 for 2 lavish parties (EDIT: these 2 parties happen each year) and the majority of people think it's ok and those that condemn it still attend it because it's a place to get drunk and eat for free!!

most all of the vollies i know are wonderful and caring people, they just suck at being EMT's (and they know it)

but what can they do?? they have other responsibilities in life, you have the ability to train and retrain PAID EMT's

sorry, there isn't an excuse for being a sucky paid EMT, and i blame the state of NY, REMSCO and the company(s) for allowing EMT-B's and Medics to be subpar. if youre a paid guy and suck, you deserve to be fired, plain and simple

not so easy to do to vollies

Get ready...another disclaimer...YES, i know not everyone sucks at EMS, but we SEEM to agree that EMS personnel are getting worse each year. thats the rant

Perhaps there are agencies out there that throw parties for their members. Don't hardworking, dedicated, volunteers deserve a night to celebrate their hard work for the past year? I don't see the money as being wasted but rather spent giving the people who help a stress free and relaxing night one night a year.

Is it possible that these agencies are not using the taxpayers money but rather money the members have earned, collected, and put aside for themselves? sounds quite possible to me.

I understand what you are saying EMSer and this is absolutely not a dig on your or your post. I'm just saying that it is important to keep in mind that agencies do have money that is earned by the members (donations, etc) that the members have every right to use for a "lavish party"

DISCLAIMER: I AM NOT SPEAKING ABOUT SPECIFIC AGENCIES OR AGENCIES THAT I AM PART OF.

Edited April 5, 2011 by PFDRes47cue

[Guest alsfirefighter]

daaaaaamn, chill out people

usually when someone puts the "sorry for the rant" disclaimer on the post that means they're getting out frustrations

a post that started to be "IMHO" went a little off target helicopter...again, the disclaimer...

yes, my former agency, as MANY OTHER agencies in the surrounding area have EXPENSIVE parties and other PERKS at the expense of the taxpayer! maybe not in your area, but definately in mine! my former agency(s) spend about $10,000 for 2 lavish parties (EDIT: these 2 parties happen each year) and the majority of people think it's ok and those that condemn it still attend it because it's a place to get drunk and eat for free!!

most all of the vollies i know are wonderful and caring people, they just suck at being EMT's (and they know it)

but what can they do?? they have other responsibilities in life, you have the ability to train and retrain PAID EMT's

sorry, there isn't an excuse for being a sucky paid EMT, and i blame the state of NY, REMSCO and the company(s) for allowing EMT-B's and Medics to be subpar. if youre a paid guy and suck, you deserve to be fired, plain and simple

not so easy to do to vollies

Get ready...another disclaimer...YES, i know not everyone sucks at EMS, but we SEEM to agree that EMS personnel are getting worse each year. thats the rant

No troubles here brother...I give you kudos for speaking your opinion based on your experiences and to be honest...I don't think they are that far off for many people on here in regards to EMS and fire. So speak your mind..you did it respectfully and with tact, I respect that. It was with a bit of a broad brush as some have said...but while not the broadest of brushes strokes your comments...its pretty darn wide and I welcome anyone on here to try to challenge that argument.

With that said...here is where I differ from you...I'm a professional firefighter/paramedic, I've worked part time for private not for profit 3rd service EMS, I've worked for 3rd service EMS that had "VAC" in their name but have very few of the "V" part of the VAC present in a week, lone less a day. But no matter where I was...I always cared about the patch on both shoulders as a professional I represented both my agency and everyone who did the same profession as me. So even as a professional I cared about my name, my department/agency's name because we all represent each other.

Where the major difference lies is that volunteers will let pride and personal feelings often get in the way of what is obvious in regard to response issues, or how they will treat a professional provider if they come in to "supplement" or even become their service provider or even funnier the career fire service who is really just doing what they need to do to ensure the patient calling for help is getting care and service. Some of you may not like what I'm saying...but where I come from its the truth, and in my experiences in other places...it was the truth. I get tired of the individualism in one aspect, and then the pride over common sense in others that some just can't take the stone cold truth in what is happening as if its the end of the world they might need some assistance to get service where it needs to be...or someone to take it over flat out. And once you start having problems with response times and mutual aid rates...one of the first thing that happens is a drive to get new members, then get them immediately into an EMT course and if they do pass...the rushing of them on the road solo. Getting an ambulance on the road and wanting to help people doesn't translate to good service and quality care. And this unfortunately is becoming the norm..not the exception. Its no surprise that the ones who helped train me as a young EMT in a very busy VAC are the ones I trust the most and have the job done when I get there.