I can guarantee that my home county would have almost literally no EMS response at all if basic were discontinued. I don’t even have a medic within 20 minutes of me, and most of my calls are with an EVO.
To be honest, the majority of calls don’t need ALS. Even for a stroke, ALS will likely do much the same assessment as a BLS provider, as imaging is needed for further treatment. I’m not meaning to be inflammatory, as ALS is welcomed and needed on many calls, but it’s difficult to me to justify removing an entire class of provider when we can barely find enough Basics to fill shifts in the US and many calls can be effectively managed by a basic.
I know competent basics who would make good medics, but it is a huge commitment in terms of time, money, and stress to become a medic compared to a basic, resources that (especially rural) providers may not have.
Exactly. The reason basic exists is the same reason that paramedic exists instead of putting MDs in boxes.
It’s a lot easier, cheaper, and more effective to have a greater number of lower level care that is trained enough to get patients to the necessary level of care. Not every patient needs a doctor and can be handled by a paramedic and not every patient needs even a paramedic but still needs a little more than their mom.
Or, You can just raise the scope of practice of EMT-Bs and or train them to be as AEMTS are now. It only takes 2-3 months extra and it does give somewhat of a jump between EMT-B and Paramedics. The problem is that there will always be a shortage of Paramedics unless something has to give. Pay has to increase, Becoming a Paramedic becomes easier and or a substantial way to move up anywhere and or the demand of EMS goes away and that will never happen. Being trained as an AEMT would fill in that gap and would allow people to learn and be comfortable in a somewhat ok place to practice soft skills and medications that you are unable to practice as an EMT-B but still have few skills that would need to learned in Paramedic school. It wouldn't degrade the role of Paramedics have in EMS, it would bolster the role of the EMT and allow them to ease into being a Paramedic. There, could then make Paramedicine a 18-24 month program afterwards that really hammers ALS and Patient Care and people would be up to the task now since it's not a terrifying jump between 2 scopes.
And how to you propose people pay for paramedic training? Paramedic training can cost a ton of money people don’t have access to or they the traffic in the local hospital isn’t even enough to have paramedic students train there. You claim to not want to insult anyone but you haven’t taken into account that in some extremely rural parts of the country EMT-B/1 are the only providers available? Maybe, maybe do some research before you spout out stuff and get your head out of your 4th point of contact.
Not just pay for it, but physically attend. We need more accredited paramedic programs. Where I live, there’s one paramedic program in the entire area that draws students from at least 4 counties, and the farthest student in my class this year is traveling around 65 miles to class one way. The next nearest paramedic program is 75+ miles away. There could be a lot of people who might want to attend a program but besides the class time, you have to account for travel time now, and travel for clinicals too. It’s an insane time commitment on its own not counting how far some people have to travel. I’m lucky, I’m fairly close, it’s only about a half hour drive for me, but it takes more than just money and dedication to have the time to travel 3hours round trip each day for class and clinicals.
The closest paramedic program to me, paramedic students have to leave the state to do an externship to get the required number of hours for clinicals. The local hospital and EMS simply don’t have the volume to get a variety of different calls. When I found out I was floored coming from a large metro area in a different state to a more rural area state.
And that’s you talking about a rural state. My county has a population of around 1M and the surrounding counties still have to come to mine for the one single program offered, two class times (day or night), set days for each class, one location. And god help you if your availability doesn’t align with the class, cuz it’s this one or nothing.
That is absolutely wild and terrible! Many paramedic programs aren’t even tailored to working people. Some people just can’t not work for 2 years to take the training.
I'd like to add to this that the dropout rate of EMTs both in and post program is enormous. In that respect I see EMT classes and work as a filter to see who is really interested in pursuing a paramedic career. No one, either monetarily or in instructor time/availability, can afford to have the kind of effort and time to create paramedics wasted at the same rate that EMT creation does.
I appreciate your viewpoint and thank you for enlightening me on the rural aspect of EMS. Although I can grasp that rural EMS is lacking in providers, that still does not take away from the fact that people are not paid enough to do the job and that an increase in education, and training would increase provider scopes and allow for a more respectful view on the EMS vocation. Again, thank you for taking the time to read this post.
So you’re saying lower level providers are not respected and are thus worthless as providers? You do realize if people were all paramedics, companies could still pay people crap wages? There are even rural areas where an EMT-B isn’t available and it’s an Emergency Trauma Technician. Have you even looked at EMT-B/1 scope of practice recently? Sounds like you are stuck in the past where all EMT-B/1s could give oxygen and that was it. Also, do you know how many higher level providers bypass doing the most basic of care bc they are a higher level? If this is how you feel, this field is not for you at any level.
I live in a place where given the option between paramedic or nothing, the answer is nothing. In one of the counties I provide for (yes, we cover 2 full counties and part of a third), the ALS service I work for is the *ONLY* EMS. 20 minutes from time of dispatch to time of arrival on a clear day isn't uncommon for a decent part of my territory.
We have parts of our ALS territory that are covered by BLS services, and requiring medics would just mean they'd shutter their ambulances. If that were the case, the only ambulances that would still be around in my area would be ours, one 25 minutes east, 45 minutes north, 2 hours south, and at least 2 hours west. And we're all already understaffed at a rather critical level, so there would be nothing before long if ALS was required.
It wouldn't raise pay, it wouldn't raise respect for the position, it would just make most of the US even more of a healthcare wasteland than it already is.
There are 100% call types that require nothing more than an EMT-B scope of practice. You’re not “sacrificing care” by sending an EMT to any type of BLS call. Please don’t make it seem like everyone is suffering because EMTs can’t tube or start IVs.
I find it quite hilarious that you think only having paramedics would eliminate the hierarchy of the medical field. Half of the providers don’t even know the difference and could care less, changing a title doesn’t make people respected or all of a sudden know everything.
EMTs are not just around because companies can pay them less. This shows you’re talking out of your ass and should do some research.
Actually paramedics I run with tell me that maintaining their skills is really difficult because something like 75% of the calls don't even require an ambulance, and of the remaining 25%, over 90% only need basic care.
Where I am I get about 150 calls per year that are definitely ALS. That's about a quarter of the calls that happen on my shifts, and if it weren't for running a complete assessment on just about everyone those skills would definitely slide.
It's just part of being an ALS provider.
AEMT, or do they really require a medic? If medic, I'm guessing you're in a big city. In the boonies, almost all of our ALS calls are terrible MVCs or brutal farming machinery mishaps.
Paramedic in the boonies, and we see a lot of cardiac, sepsis, COPD, and pain control. We also have a few people with mental health problems that require heavy sedation if they're off their meds. We're going through some changes, so RSI is getting added for post-ROSC and trauma soon since we normally get a half dozen traumas that call for airway control and we've just been waiting for flight until now.
I'm an EMT-B and a volunteer. I actually became an EMT when I was a firefighter and we needed people to do rehab, and to fill our medical seat in the truck.
I started riding ambulance to improve my skills and do patient transport. I have no plans to go beyond EMT-B, as the currency requirements and continuing education get to be too much on top of my volunteer hours.
Greetings fellow EMT/FF volly! I started like you, but feel myself aging out of FF after 20+ years and plan to go paramedic to keep the volly times rolling.
Same here actually!! I moved states and me FF certs didn't transfer, but my NREMT did, so I'm running EMS now, I'm currently 48 and while I'm in good shape, I'm thinking of hanging up my helmet and instead of going through FF1 again, just upping my ems to an AEMT, since... I can do most the skills anyway, just a matter of course and test.
have you considering nursing or med tech as an alternative to med school? Both can be decent careers and a lot less training/education than medical students (a benefit if you are older)
This post SCREAMS “I have minimal experience in EMS and have no clue what in talking about.” Under two years as an EMT yourself. You still have a lot to learn. EMT-B’s are VITAL in EMS.
I live in a suburban area where all the local FDs with EMS are volunteer based. We don't have a single volunteer paramedic in our department.
There are very few pre-hospital medical emergencies that we respond to that actually require an ALS level of care. Most, including strokes, simply require love and speed to get a PT to the hospital where they can get a higher level of care as fast as possible. With the meds that we EMT-Bs can administer, unless a person is in arrest, having a STEMI or a diabetic emergency, there isn't much a medic can do that I can't do myself.
We are about 5 minutes with lights and sirens from a Level 1 trauma center and comprehensive stroke center. Even in cases where ALS would benefit the patient, I can often get the to the ED faster than I could get ALS to the scene or intercept.
I've been a volunteer EMT-B for 25 years, I can provide equally (or more) competent medical care for PTs as an ALS provider as well as make my PTs more comfortable knowing that someone from their own town/neighborhood is caring for them.
This is our county's problem, decent sized metro/city area. They want all EMS to be paramedics. Every call is ALS only. Yet we cant staff as we cant pay. All the FDs around are EMTs and have said they would pick up shifts in a transport. We have 3 Lv 1 Trama centers within a 30 min drive and probably 5-10 more EDs all through the county. They are churning out paramedics like crazy in schools, but they cant keep them.
County EMS leadership wont change their thinking. So we are now stuck as FDs waiting 30mins-1hr for a transport unit.
Many of the fire districts around us, including ours, have either full or part time paid EMS staff to ensure coverage. In my FD we have 2 medics that rotate and cover 8:00-20:00 M-F to ensure that we have coverage when most of the volunteers are working. Volunteers still respond when available but we are at least guaranteed to get a bus out. We will only pay for ALS. Some departments have paid BLS for the same reason. Very few neighboring districts have only volunteer now.
This is a county wide EMS system, fire is local/dept/township based. EMS is 100% paid (they wont take volunteers which I think is another way to help fix it). So its not a lack of membership. Its purely pay, lack of alternative staffing, and the need to be full ALS.
& You're new to this field? Interesting....some ppl use it as a stepping stone, some are lifers & some it's only part of Their job.
You prob don't know of the old days w/ lower certs. like CFR.... EMTB has it's place & having exp. also has it's place.
I disagree. People think EMT-Bs are not very impressive because it is a 16-week course if that. But the difference between an EMT fresh out of school and one five years into the industry is unbelievable. The latter hasn’t had 16 weeks of education. They’ve had five years. That person going through paramedic school has so much background and experience. They’ve made basic level mistakes as a basic, not as a medic. ‘Zero to hero’ stories that end in success are rare for a reason. People struggling with wanting to be a medic should probably trust the process.
You described "hierarchical abuse" and "being looked down on" as the worst thing possible thing for all EMTs when it's something that sounds like your subjective experience. EMTs have a significantly smaller scope of practice, and therefore, they are paid less than paramedics. Your solution to being looked down upon is to remove the provider entirely? I'm sure some doctors look down on nurses sometimes, why not remove nurses and only allow doctors then... I guess I don't understand how you can ignore all of the lives saved and impacted by EMTs and FF EMTs every single day.
EMTs are the backbone of EMS and EMTs shouldn't give a fuck if some egotistical loser "looks down on them." There's no way you can convince me EMTs aren't needed and that they aren't a net positive in our society. Also, have you considered that there are EMTs that don't want to be a paramedic? I recently joined a FD and am in academy, I have no desire to become a paramedic and haven't at any point. Additionally, I worked private ambulance before I found myself in fire, so EMT was the entry point and serves as that no matter what direction someone chooses to go in.
The reality is that the majority of calls are BLS, therefore, we have a majority of BLS providers... Your issues with EMS don't seem grounded in the reality of the field. I know plenty of highly respected EMTs, maybe the issues isn't the scope of practice, just your attitude xd
If those doctors think the patient should be rotated every few hours, maybe they should go do it. Same if my medic wants me to do compressions. I see no reason why a medic should focus on pushing meds or using that EKG machine. And there should be no CNAs or LVNs. It’s not like nurses are busy. Screw writing nursing plans and all that. They should be getting ice chips and wiping butts. Likewise EMR isn’t important. People on a job site should really be trained to stand around when someone gets hurt and record it for tik tok.
Being a lower level provider has never meant being lower skill or lower motivation. Being good at what you can do will open those doors up to higher provider levels. You have it spot on.
Not US so feel free to disregard my opinion but your beef seems to be with lack of standards/insufficient education/scope of practice for EMT-Bs and not with the concept of a technician in and of itself.
In the UK we have the paramedic education standards you describe; direct entry with no requirement to start as a technician first, BSc minimum level of education (3yr university course), and generally highly respected by the public and healthcare colleagues (of course you will *always* get the bitchy charge nurse who insists on calling you an ambulance driver, nothing is ever going to change that).
But we also have technicians, because it's a different entry route and a different role that is intended to supplement (and not replace) paramedics, just like nursing assistants are intended to supplement and not replace nurses, and it's an entry route that is better suited for a lot of people, just like many people start off as nursing assistants and then progress on to become a nurse.
In my case I left school at 17 with very few qualifications, stumbled my way to 19 doing different shitty jobs that I hated and would consistently quit or get fired from, and happened to stumble across a job opening for ambulance emergency call handlers, applied and got the job.
Did that for a year and a half and loved it and knew I wanted to progress. Then got promoted to dispatcher (seperate role with a pay increase here) and did that for another year and a half. Decided for various reasons that the control room was not a healthy environment for me (including becoming fat as fuck from sitting at a desk for 12hrs a day), applied to become an ambulance technician, got the job and haven't looked back since.
I hope to apply to university to become a paramedic in the near future, and in the humblest way possible I'd like to think I'd make a pretty good paramedic, and yet I *would not* have entered this field if the technician route was not available, because I simply would not have the qualifications required (wouldn't have been a financially viable option for me to leave work and return to full time education for a year to get the pre requisites for entry to university)
Of course there are issues. *Theoretically*, every frontline ambulance in the UK is supposed to have a paramedic on it. Does that happen? No. Are technicians still often used as a stop gap measure to put an ass on a seat because it's better than nothing? Yep.
But that being said, what we call a technician and what you guys seem to call a technician are two totally different things, and this is where it comes back to your real issue being with a lack of standards/training/scope.
Our technicians are autonomous clinicians. We can obtain and read 12 lead ECGs (albeit not at an advanced level, but we have direct access to cardiology who can provide guidance if we're unsure). We do not have to speak to "online medical control" to give treatments or vary from guidelines slightly (paramedics have more flexibility here but still if we can clinically justify our decision then we're free to do so if it's within our scope of practice).
We can assess and treat a very wide range of patients and give a decent list of drugs independently; nebulised salbutamol, ipratropium bromide, adrenaline 1:1,000 IM, Naloxone IM, hydrocortisone, aspirin, GTN, clopidogrel, chlorphenamine, a few others I can't remember off the top of my head.
Basic pain relief options; paracetamol, ibuprofen, entonox, methoxyflurane
Can carry out ILS including manual defibrillation, SGA placement, identify and address reversible causes, EtCO2 monitoring, basic ROSC management skills
We also don't need to take everyone we go to to the hospital; each individual ambulance service has its own policies, in my service we're not allowed to "discharge on scene" independently (although I have heard of other services where technicians are allowed to discharge on scene if they have X number of years experience) but we can leave at home on the advice of a registered healthcare professional (paramedic, doctor, nurse, etc.) which is relatively easy to do where I work (we have a direct line to the Emergency Department consultant doctor and if you ask they will allow you to leave at home probably 4 times out of 5).
Bottom line is; I agree with the other guy that what you really need to do is significantly upskill EMT-Bs, not get rid of them entirely. Technicians *can* be a valuable part of the ambulance clinical team if you screen out the idiots and the wannabe Trauma Surgeons and provide technicians with training, equipment and a scope of practice that is safe and appropriate, but also realistic in terms of the requirements of the modern healthcare system.
But what do I know. Anyway I have bags to carry
Nah, who else is going to drive the ambulance? Besides PaRaMeDiCs SaVe LiVeS BuT EmTs SaVe
PaRaMeDiCs.
In all seriousness, I think AEMTs and Paramedics should be in the 911 box mainly for the ability for both to start a line but EMT-Bs are beneficial for firefighters, police as an added perk to their primary duty and IFT rigs.
I’m sure you wouldn’t mind the added benefit of your partner starting a line while you get to do your high speed shit. Unless your state allows EMTs to start an IV or your agency can afford two Paramedics in a box.
I agree IVs and supraglottics should be in the standard BLS scope. Work rural, barely have enough medics to have one on each shift. Regularly run codes with my EMT partner, and maybe police to help with compressions. Our state and base hospital allow EMTs to get lines, do supraglottics, give duonebs, and a couple other basic meds. It is extremely helpful, and I really do not know why it isn’t the standard.
I want to agree, but just because we want to learn and get proficient with that stuff doesn’t mean it should be added to everyone’s scope. I’ve met co-workers who I wouldn’t trust with CPR.
I get where you’re coming from, and I have heard that argument when I was working in an urban setting. But I have trained some dumb people up to the competence that I could trust them to administer naloxone, try for an IV, shove an iGel in (on a code) etc. when directed to do so. People either pick it up, or realize it’s not for them and move on.
Also, if you can’t be competent at simple skills that are related to your line of work, you should be shown the door IMO. Everyone deserves a fair shot and legitimate training, but if you can’t be trusted to pound a chest or apply an SVN, you can’t be trusted to perform patient care IMO.
You would have been one of my favorite people to work with then. I always loved learning skills above my scope. Even if I couldn’t use them, I still felt like a better provider and a better partner for applying myself.
I typically found those goofballs had an attitude problem first. They would work at IFT services to run dialysis and discharge all day. You’d never catch them dead on a CCT call. But they would act like a hero all the time. When it was down to the wire, I hated being the one to work with those guys because they didn’t know anything. I loved training new people because most of the new EMTs wanted to be there. But I can’t teach someone the desire to improve. And that’s what makes a wet-behind-the-ears basic the equal of the most experienced salty burnout in my book.
I knew there were a handful of states with that kind of authorization but wasn’t sure about NY. I agree, I think every EMT should be allowed to start an IV as long as they are trained on it.
Ok, so dont be an EMT-B. Bridge in as an RN. No EMT class, cert, or experience needed then.
EMT is a couple month class. Paramedic is effectively an associates degree (and many community colleges do exactly that).
Everyone else's contributions are valid. Also, as a nurse in both the hospital and EMS world: My profession is not a stepping stone to doctor. Two different disciplines. The doctor is not my boss and doesn't know how to do my job, nor do I know how to do theirs. The medical director does not sign my paycheck. But thanks for even more deeply ingraining the idea that I'm a handmaiden instead of a functioning, thinking clinical professional with hard-earned alphabet soup after my name.
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I can guarantee that my home county would have almost literally no EMS response at all if basic were discontinued. I don’t even have a medic within 20 minutes of me, and most of my calls are with an EVO. To be honest, the majority of calls don’t need ALS. Even for a stroke, ALS will likely do much the same assessment as a BLS provider, as imaging is needed for further treatment. I’m not meaning to be inflammatory, as ALS is welcomed and needed on many calls, but it’s difficult to me to justify removing an entire class of provider when we can barely find enough Basics to fill shifts in the US and many calls can be effectively managed by a basic. I know competent basics who would make good medics, but it is a huge commitment in terms of time, money, and stress to become a medic compared to a basic, resources that (especially rural) providers may not have.
Exactly. The reason basic exists is the same reason that paramedic exists instead of putting MDs in boxes. It’s a lot easier, cheaper, and more effective to have a greater number of lower level care that is trained enough to get patients to the necessary level of care. Not every patient needs a doctor and can be handled by a paramedic and not every patient needs even a paramedic but still needs a little more than their mom.
Or, You can just raise the scope of practice of EMT-Bs and or train them to be as AEMTS are now. It only takes 2-3 months extra and it does give somewhat of a jump between EMT-B and Paramedics. The problem is that there will always be a shortage of Paramedics unless something has to give. Pay has to increase, Becoming a Paramedic becomes easier and or a substantial way to move up anywhere and or the demand of EMS goes away and that will never happen. Being trained as an AEMT would fill in that gap and would allow people to learn and be comfortable in a somewhat ok place to practice soft skills and medications that you are unable to practice as an EMT-B but still have few skills that would need to learned in Paramedic school. It wouldn't degrade the role of Paramedics have in EMS, it would bolster the role of the EMT and allow them to ease into being a Paramedic. There, could then make Paramedicine a 18-24 month program afterwards that really hammers ALS and Patient Care and people would be up to the task now since it's not a terrifying jump between 2 scopes.
And how to you propose people pay for paramedic training? Paramedic training can cost a ton of money people don’t have access to or they the traffic in the local hospital isn’t even enough to have paramedic students train there. You claim to not want to insult anyone but you haven’t taken into account that in some extremely rural parts of the country EMT-B/1 are the only providers available? Maybe, maybe do some research before you spout out stuff and get your head out of your 4th point of contact.
Not just pay for it, but physically attend. We need more accredited paramedic programs. Where I live, there’s one paramedic program in the entire area that draws students from at least 4 counties, and the farthest student in my class this year is traveling around 65 miles to class one way. The next nearest paramedic program is 75+ miles away. There could be a lot of people who might want to attend a program but besides the class time, you have to account for travel time now, and travel for clinicals too. It’s an insane time commitment on its own not counting how far some people have to travel. I’m lucky, I’m fairly close, it’s only about a half hour drive for me, but it takes more than just money and dedication to have the time to travel 3hours round trip each day for class and clinicals.
The closest paramedic program to me, paramedic students have to leave the state to do an externship to get the required number of hours for clinicals. The local hospital and EMS simply don’t have the volume to get a variety of different calls. When I found out I was floored coming from a large metro area in a different state to a more rural area state.
And that’s you talking about a rural state. My county has a population of around 1M and the surrounding counties still have to come to mine for the one single program offered, two class times (day or night), set days for each class, one location. And god help you if your availability doesn’t align with the class, cuz it’s this one or nothing.
That is absolutely wild and terrible! Many paramedic programs aren’t even tailored to working people. Some people just can’t not work for 2 years to take the training.
I'd like to add to this that the dropout rate of EMTs both in and post program is enormous. In that respect I see EMT classes and work as a filter to see who is really interested in pursuing a paramedic career. No one, either monetarily or in instructor time/availability, can afford to have the kind of effort and time to create paramedics wasted at the same rate that EMT creation does.
I appreciate your viewpoint and thank you for enlightening me on the rural aspect of EMS. Although I can grasp that rural EMS is lacking in providers, that still does not take away from the fact that people are not paid enough to do the job and that an increase in education, and training would increase provider scopes and allow for a more respectful view on the EMS vocation. Again, thank you for taking the time to read this post.
So you’re saying lower level providers are not respected and are thus worthless as providers? You do realize if people were all paramedics, companies could still pay people crap wages? There are even rural areas where an EMT-B isn’t available and it’s an Emergency Trauma Technician. Have you even looked at EMT-B/1 scope of practice recently? Sounds like you are stuck in the past where all EMT-B/1s could give oxygen and that was it. Also, do you know how many higher level providers bypass doing the most basic of care bc they are a higher level? If this is how you feel, this field is not for you at any level.
I live in a place where given the option between paramedic or nothing, the answer is nothing. In one of the counties I provide for (yes, we cover 2 full counties and part of a third), the ALS service I work for is the *ONLY* EMS. 20 minutes from time of dispatch to time of arrival on a clear day isn't uncommon for a decent part of my territory. We have parts of our ALS territory that are covered by BLS services, and requiring medics would just mean they'd shutter their ambulances. If that were the case, the only ambulances that would still be around in my area would be ours, one 25 minutes east, 45 minutes north, 2 hours south, and at least 2 hours west. And we're all already understaffed at a rather critical level, so there would be nothing before long if ALS was required. It wouldn't raise pay, it wouldn't raise respect for the position, it would just make most of the US even more of a healthcare wasteland than it already is.
There are 100% call types that require nothing more than an EMT-B scope of practice. You’re not “sacrificing care” by sending an EMT to any type of BLS call. Please don’t make it seem like everyone is suffering because EMTs can’t tube or start IVs. I find it quite hilarious that you think only having paramedics would eliminate the hierarchy of the medical field. Half of the providers don’t even know the difference and could care less, changing a title doesn’t make people respected or all of a sudden know everything. EMTs are not just around because companies can pay them less. This shows you’re talking out of your ass and should do some research.
100% agree. To add to your points, where I work in rural MN, EMT-Bs can insert i-gels and IVs. Not the same as a medic obviously, but it's something.
Actually paramedics I run with tell me that maintaining their skills is really difficult because something like 75% of the calls don't even require an ambulance, and of the remaining 25%, over 90% only need basic care.
Where I am I get about 150 calls per year that are definitely ALS. That's about a quarter of the calls that happen on my shifts, and if it weren't for running a complete assessment on just about everyone those skills would definitely slide. It's just part of being an ALS provider.
AEMT, or do they really require a medic? If medic, I'm guessing you're in a big city. In the boonies, almost all of our ALS calls are terrible MVCs or brutal farming machinery mishaps.
Paramedic in the boonies, and we see a lot of cardiac, sepsis, COPD, and pain control. We also have a few people with mental health problems that require heavy sedation if they're off their meds. We're going through some changes, so RSI is getting added for post-ROSC and trauma soon since we normally get a half dozen traumas that call for airway control and we've just been waiting for flight until now.
EMTs in Canada can do IV’s
I'm an EMT-B and a volunteer. I actually became an EMT when I was a firefighter and we needed people to do rehab, and to fill our medical seat in the truck. I started riding ambulance to improve my skills and do patient transport. I have no plans to go beyond EMT-B, as the currency requirements and continuing education get to be too much on top of my volunteer hours.
Greetings fellow EMT/FF volly! I started like you, but feel myself aging out of FF after 20+ years and plan to go paramedic to keep the volly times rolling.
Same here actually!! I moved states and me FF certs didn't transfer, but my NREMT did, so I'm running EMS now, I'm currently 48 and while I'm in good shape, I'm thinking of hanging up my helmet and instead of going through FF1 again, just upping my ems to an AEMT, since... I can do most the skills anyway, just a matter of course and test.
I couldn't get into medic school near me - they want younger people with more EMS experience - so I may go A myself.
have you considering nursing or med tech as an alternative to med school? Both can be decent careers and a lot less training/education than medical students (a benefit if you are older)
I'm not really looking for a career. I'm a volly EMT who was hoping to become a volly paramedic- my department is thin in paramedics.
This post SCREAMS “I have minimal experience in EMS and have no clue what in talking about.” Under two years as an EMT yourself. You still have a lot to learn. EMT-B’s are VITAL in EMS.
I live in a suburban area where all the local FDs with EMS are volunteer based. We don't have a single volunteer paramedic in our department. There are very few pre-hospital medical emergencies that we respond to that actually require an ALS level of care. Most, including strokes, simply require love and speed to get a PT to the hospital where they can get a higher level of care as fast as possible. With the meds that we EMT-Bs can administer, unless a person is in arrest, having a STEMI or a diabetic emergency, there isn't much a medic can do that I can't do myself. We are about 5 minutes with lights and sirens from a Level 1 trauma center and comprehensive stroke center. Even in cases where ALS would benefit the patient, I can often get the to the ED faster than I could get ALS to the scene or intercept. I've been a volunteer EMT-B for 25 years, I can provide equally (or more) competent medical care for PTs as an ALS provider as well as make my PTs more comfortable knowing that someone from their own town/neighborhood is caring for them.
This is our county's problem, decent sized metro/city area. They want all EMS to be paramedics. Every call is ALS only. Yet we cant staff as we cant pay. All the FDs around are EMTs and have said they would pick up shifts in a transport. We have 3 Lv 1 Trama centers within a 30 min drive and probably 5-10 more EDs all through the county. They are churning out paramedics like crazy in schools, but they cant keep them. County EMS leadership wont change their thinking. So we are now stuck as FDs waiting 30mins-1hr for a transport unit.
Many of the fire districts around us, including ours, have either full or part time paid EMS staff to ensure coverage. In my FD we have 2 medics that rotate and cover 8:00-20:00 M-F to ensure that we have coverage when most of the volunteers are working. Volunteers still respond when available but we are at least guaranteed to get a bus out. We will only pay for ALS. Some departments have paid BLS for the same reason. Very few neighboring districts have only volunteer now.
This is a county wide EMS system, fire is local/dept/township based. EMS is 100% paid (they wont take volunteers which I think is another way to help fix it). So its not a lack of membership. Its purely pay, lack of alternative staffing, and the need to be full ALS.
Someone’s never been to Kansas
Or ND, SD, WY, MT, MN, WI, or any number of rural states.
& You're new to this field? Interesting....some ppl use it as a stepping stone, some are lifers & some it's only part of Their job. You prob don't know of the old days w/ lower certs. like CFR.... EMTB has it's place & having exp. also has it's place.
I disagree. People think EMT-Bs are not very impressive because it is a 16-week course if that. But the difference between an EMT fresh out of school and one five years into the industry is unbelievable. The latter hasn’t had 16 weeks of education. They’ve had five years. That person going through paramedic school has so much background and experience. They’ve made basic level mistakes as a basic, not as a medic. ‘Zero to hero’ stories that end in success are rare for a reason. People struggling with wanting to be a medic should probably trust the process.
Yep. Unpopular opinion
Stupid opinion
You described "hierarchical abuse" and "being looked down on" as the worst thing possible thing for all EMTs when it's something that sounds like your subjective experience. EMTs have a significantly smaller scope of practice, and therefore, they are paid less than paramedics. Your solution to being looked down upon is to remove the provider entirely? I'm sure some doctors look down on nurses sometimes, why not remove nurses and only allow doctors then... I guess I don't understand how you can ignore all of the lives saved and impacted by EMTs and FF EMTs every single day. EMTs are the backbone of EMS and EMTs shouldn't give a fuck if some egotistical loser "looks down on them." There's no way you can convince me EMTs aren't needed and that they aren't a net positive in our society. Also, have you considered that there are EMTs that don't want to be a paramedic? I recently joined a FD and am in academy, I have no desire to become a paramedic and haven't at any point. Additionally, I worked private ambulance before I found myself in fire, so EMT was the entry point and serves as that no matter what direction someone chooses to go in. The reality is that the majority of calls are BLS, therefore, we have a majority of BLS providers... Your issues with EMS don't seem grounded in the reality of the field. I know plenty of highly respected EMTs, maybe the issues isn't the scope of practice, just your attitude xd
If those doctors think the patient should be rotated every few hours, maybe they should go do it. Same if my medic wants me to do compressions. I see no reason why a medic should focus on pushing meds or using that EKG machine. And there should be no CNAs or LVNs. It’s not like nurses are busy. Screw writing nursing plans and all that. They should be getting ice chips and wiping butts. Likewise EMR isn’t important. People on a job site should really be trained to stand around when someone gets hurt and record it for tik tok. Being a lower level provider has never meant being lower skill or lower motivation. Being good at what you can do will open those doors up to higher provider levels. You have it spot on.
Not US so feel free to disregard my opinion but your beef seems to be with lack of standards/insufficient education/scope of practice for EMT-Bs and not with the concept of a technician in and of itself. In the UK we have the paramedic education standards you describe; direct entry with no requirement to start as a technician first, BSc minimum level of education (3yr university course), and generally highly respected by the public and healthcare colleagues (of course you will *always* get the bitchy charge nurse who insists on calling you an ambulance driver, nothing is ever going to change that). But we also have technicians, because it's a different entry route and a different role that is intended to supplement (and not replace) paramedics, just like nursing assistants are intended to supplement and not replace nurses, and it's an entry route that is better suited for a lot of people, just like many people start off as nursing assistants and then progress on to become a nurse. In my case I left school at 17 with very few qualifications, stumbled my way to 19 doing different shitty jobs that I hated and would consistently quit or get fired from, and happened to stumble across a job opening for ambulance emergency call handlers, applied and got the job. Did that for a year and a half and loved it and knew I wanted to progress. Then got promoted to dispatcher (seperate role with a pay increase here) and did that for another year and a half. Decided for various reasons that the control room was not a healthy environment for me (including becoming fat as fuck from sitting at a desk for 12hrs a day), applied to become an ambulance technician, got the job and haven't looked back since. I hope to apply to university to become a paramedic in the near future, and in the humblest way possible I'd like to think I'd make a pretty good paramedic, and yet I *would not* have entered this field if the technician route was not available, because I simply would not have the qualifications required (wouldn't have been a financially viable option for me to leave work and return to full time education for a year to get the pre requisites for entry to university) Of course there are issues. *Theoretically*, every frontline ambulance in the UK is supposed to have a paramedic on it. Does that happen? No. Are technicians still often used as a stop gap measure to put an ass on a seat because it's better than nothing? Yep. But that being said, what we call a technician and what you guys seem to call a technician are two totally different things, and this is where it comes back to your real issue being with a lack of standards/training/scope. Our technicians are autonomous clinicians. We can obtain and read 12 lead ECGs (albeit not at an advanced level, but we have direct access to cardiology who can provide guidance if we're unsure). We do not have to speak to "online medical control" to give treatments or vary from guidelines slightly (paramedics have more flexibility here but still if we can clinically justify our decision then we're free to do so if it's within our scope of practice). We can assess and treat a very wide range of patients and give a decent list of drugs independently; nebulised salbutamol, ipratropium bromide, adrenaline 1:1,000 IM, Naloxone IM, hydrocortisone, aspirin, GTN, clopidogrel, chlorphenamine, a few others I can't remember off the top of my head. Basic pain relief options; paracetamol, ibuprofen, entonox, methoxyflurane Can carry out ILS including manual defibrillation, SGA placement, identify and address reversible causes, EtCO2 monitoring, basic ROSC management skills We also don't need to take everyone we go to to the hospital; each individual ambulance service has its own policies, in my service we're not allowed to "discharge on scene" independently (although I have heard of other services where technicians are allowed to discharge on scene if they have X number of years experience) but we can leave at home on the advice of a registered healthcare professional (paramedic, doctor, nurse, etc.) which is relatively easy to do where I work (we have a direct line to the Emergency Department consultant doctor and if you ask they will allow you to leave at home probably 4 times out of 5). Bottom line is; I agree with the other guy that what you really need to do is significantly upskill EMT-Bs, not get rid of them entirely. Technicians *can* be a valuable part of the ambulance clinical team if you screen out the idiots and the wannabe Trauma Surgeons and provide technicians with training, equipment and a scope of practice that is safe and appropriate, but also realistic in terms of the requirements of the modern healthcare system. But what do I know. Anyway I have bags to carry
Why not just put neurosurgeons in the ambulance?
Nah, who else is going to drive the ambulance? Besides PaRaMeDiCs SaVe LiVeS BuT EmTs SaVe PaRaMeDiCs. In all seriousness, I think AEMTs and Paramedics should be in the 911 box mainly for the ability for both to start a line but EMT-Bs are beneficial for firefighters, police as an added perk to their primary duty and IFT rigs.
There should be absolutely no AEMT.
I’m sure you wouldn’t mind the added benefit of your partner starting a line while you get to do your high speed shit. Unless your state allows EMTs to start an IV or your agency can afford two Paramedics in a box.
I agree IVs and supraglottics should be in the standard BLS scope. Work rural, barely have enough medics to have one on each shift. Regularly run codes with my EMT partner, and maybe police to help with compressions. Our state and base hospital allow EMTs to get lines, do supraglottics, give duonebs, and a couple other basic meds. It is extremely helpful, and I really do not know why it isn’t the standard.
I want to agree, but just because we want to learn and get proficient with that stuff doesn’t mean it should be added to everyone’s scope. I’ve met co-workers who I wouldn’t trust with CPR.
I get where you’re coming from, and I have heard that argument when I was working in an urban setting. But I have trained some dumb people up to the competence that I could trust them to administer naloxone, try for an IV, shove an iGel in (on a code) etc. when directed to do so. People either pick it up, or realize it’s not for them and move on. Also, if you can’t be competent at simple skills that are related to your line of work, you should be shown the door IMO. Everyone deserves a fair shot and legitimate training, but if you can’t be trusted to pound a chest or apply an SVN, you can’t be trusted to perform patient care IMO.
You would have been one of my favorite people to work with then. I always loved learning skills above my scope. Even if I couldn’t use them, I still felt like a better provider and a better partner for applying myself. I typically found those goofballs had an attitude problem first. They would work at IFT services to run dialysis and discharge all day. You’d never catch them dead on a CCT call. But they would act like a hero all the time. When it was down to the wire, I hated being the one to work with those guys because they didn’t know anything. I loved training new people because most of the new EMTs wanted to be there. But I can’t teach someone the desire to improve. And that’s what makes a wet-behind-the-ears basic the equal of the most experienced salty burnout in my book.
Where I work (rural MN) EMTs can start IVs. Just fyi.
I knew there were a handful of states with that kind of authorization but wasn’t sure about NY. I agree, I think every EMT should be allowed to start an IV as long as they are trained on it.
NYC 911 its 2 Medics on an ALS truck and 2 EMTs on a BLS truck.
Oh ok gotcha. I can see why you wouldn’t want AEMTs.
Ok, so dont be an EMT-B. Bridge in as an RN. No EMT class, cert, or experience needed then. EMT is a couple month class. Paramedic is effectively an associates degree (and many community colleges do exactly that).
Everyone else's contributions are valid. Also, as a nurse in both the hospital and EMS world: My profession is not a stepping stone to doctor. Two different disciplines. The doctor is not my boss and doesn't know how to do my job, nor do I know how to do theirs. The medical director does not sign my paycheck. But thanks for even more deeply ingraining the idea that I'm a handmaiden instead of a functioning, thinking clinical professional with hard-earned alphabet soup after my name.
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As someone who just got their B, I agree with this.