NO EMT's In The Back

[firemedic302]

I have worked for a small service ever since I passed my NREMT test. Up until 6 months ago EMT's were allowed to tech on BLS calls and Transfers that did not require ALS skills. Now for some unknow reason EMT's are no longer good enough to work in the back, were basickly Ambulance Drivers....I went to school for a year and a half to be able to preform Emergency Medical Treatments not drive a truck for a living. I know that a lot of the bigger services have this same rule, but 98% of our calls are non-emergency transfers to 1 of th 10 diffrent nursing homes in our area. I think this is a complete waste of time not to mention the fact that some of our new EMT-P are scared to death because they have never had any experience in the back of a truck with a patient. What are some of your thoughts on this subject?????????????????? :confused:

[ALSfirefighter]

I'd look at it almost as a blessing if I were an EMT. Not have to be stuck in the back. Especially with some of the ripe ones. Yes it is a waste, and really makes no sense to me why you would put a medic in the back for a BLS transport interfacility. Unless your agency is billing for ALS transports across the board.

Secondly, if you have medics who can't deal with an interfacility transport, especially when its BLS, they've got problems. I certainly wouldn't want to see them on a 911 job. In fact that is the easiest way to hone and keep sharp some of your BLS skills is during transports like that. Also, you have a QA/QI problem if your throwing medics on buses without any additional ride time with another medic.

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The above is my opinion only and doesn't reflect that of any dept/agency I work for, deal with, or am a member of. :D

[911WACKER]

Sounds like two things have slipped there in that service:

1.Medics got big "god sydrome"

2.Techs have declined in pt care skills??

I know how you feel Ihave seen it at one of the services I work at part-time. Its a direct result of a few medics thinking they are the only ones who know how to do good pt. care. The "god syndrome", also it could be a direct result of the decline in some of your bls staff pt care skills, afew ruined it for the many here. Fortunate for me, i work with the same two medics usually and i get to do the basic stuff regardless if its BLS it gets a basic. Besides if anything happens and it turns als you pull over and switch with the medic, although ive only heard of someone having to do that once.

[Paramenace]

Hey WACKER

I gotta stand up for the Medic side of the house here.. I also worked for a service that required the medic to tech all calls. The reason I was given was that the service had a contract to provide ALS level service to the city.. I risked my job many times by asking my EMT/I partner if he wanted the call... How can we expect an EMT to get the experience they need to be a good tech at 2am on a 4 car MVA and only one truck for 10 minutes..... I think the rule stinks and the only way to change it is to take the bull by the horns and make management aware that there are some great BLS people on the street to.....

[chief4102]

FF/EMT302;
I understand your position on this issue. The SOP's in my service do allow for EMTs or EMT-Is to be in the back on transports that are taking patients to a facility with a lower level of care. e.g. hospital to nursing home. The medics pushed for this with a former PMD and finally got it through. The EMTs were getting VERY frustrated. We also have them help us in the back with serious/double patients and have a qualified MFR from the rescues drive. Maybe something along these lines would work for your system? Good luck; and hang in there. :)

[ 08-14-2001: Message edited by: chief4102 ]

[efdtower1dr]

Maybe I don't fully understand your situation. The service that I work part-time for now (I worked there full-time as a medic prior to being hired full-time by the EFD) allows EMT's to ride with BLS patients.
There are many days where we have anywhere from 2 to 5 ambulances staffed with TWO EMT's (out of a 13 ambulances). These crews do many of the nursing home and interfacility BLS trips, thus allowing the ALS ambulances to go on the 911 calls.
Sometimes an ambulance with an EMT and a medic will get a BLS transport and the EMT's are "jumping" to ride in the back. This not only allows them to get from behind the wheel, do patient care and give their medic partner a break (the medics can get backed up with 3 to 4 patient care reports before getting a chance to write them. The EMT's will also treat BLS patients from motor vehicle accidents, minor injuries and illnesses.
If all ALS crews are out on calls and another 911 call is received, a BLS ambulance is dispatched along with a paramedic supervisor--these BLS crews love going on calls like this. They could respond on anything from a shooting, stabbing, MVA, drowning or even a structure fire with entrapment. This allows them to work "the big call" and get some glory (maybe even a commendation in their personnel file--these are great boosts for evaluation time).
Not all patients need a medic in the back of the ambulance--that is why there is a difference in the levels of certification.
I know in one area where I grew up, medics did so much of the patient care, many EMT's could not keep up with their skills or decided to let the medics do all the care. Allowing the medics to ride to the hospital with all patients (especially when it is a BLS call) is a poor example of paramedic utilization. There have been times when a medic is needed elsewhere and none were available (they were transporting a BLS patient to the hospital).
I also believe that how personnel are taught in an EMT class has alot to do with how they will act in the field. If the students are not challenged in the classroom scenarios, they will only wish to be ambulance drivers. The EFD EMT instructors are teaching personnel in a challenging environment even though we have a non-transport EMS system (a privately owned ambulance service does the ALS/BLS transport).
Anyways, only about 25 to 30% of all EMS calls need a medic. So why do we waste the additional money on wages for a medic when EMT's can lower expenses and save wear and tear (and decrease burnout) on our good medics.
I hope this has been a great help. Just remember--It's better to talk to you than talk about you. :)

[NFfireman23]

I volunteer for a private EMS, I am also in school for EMT-B for the same service. The squads go out on transport calls with 1 EMT-P and 1 EMT-B or EMT-I. The EMT-P runs the calls and the EMT-B or I drives. Thats is the minimum staffing for a squad. Every run has a paramedic on board.

[BlackJackCo]

I guess we are just spoiled with manpower here. Our ambulance runs 2 man, both EMT-B - IV's. If it is an ALS call our Rescue Engine assists. (4 man unit, myself (Engineer), Captain, and 2 FF/Paramedics.) For ALS Transport both of our medics and one of the EMT-B's ride the back of the rig, the other EMT-B drives and we follow in the engine. If it is really hairy the other EMT-B will also assist in the back and our Captain will drive the ambulance. On average we have 6 guys on every ALS Call.

[firefighter064]

OK....After reading this I assume that rules and regs are different from state to state. In my state, an ambulace is "licensed". It can be licensed for a BLS,INTERMEDIATE, or ALS unit. Now, if a call comes in it is an emergency and the ambulance has a Medic and a basic or 2 Medics...MINIMUM! If you get on scene and it ends up being a BLS call when you get there then the Medic stays with the pt. REASON....the ambulance is licensed as an ALS unit which means that the pt can expect ALS treatment at ANY time during transport. If the pt is misdiagnosed on scene and becomes critical during transport, what are you going to do? Pull over and let the Medic get in the back? Thats B.S. for pt. care!! If you are advertising ALS service then thats what you need to give! If you community runs 98% BLS facility to facility then maybe its not cost effective to run an ALS serice. Basics drive. Noway can a 1st responder even DRIVE an ambulace UNLESS it is a major call. If you want to do pt. care you have to goto Medic school...PERIOD.

[emt824]

i'm an EMT who works for an ALS ambulance company that covers 1200 square miles in one county and is the only transporting agentency in the county. We run at least one emt and one paramedic on an ambulance. Most FD's are also ALS and we run a two tier system with all. We run emergency, nonemergency and interfacility calls. When we run any kind of call the paramedic does a primary survey and if it doesn't meet ALS critera than it is a BLS transport and the EMT rides in the back. I don't know if the state allows this or if it is a county thing that our medical director allows, but i do know that in another county, right next to ours, all FD's do ALS emergency calls and the EMT's can ride in the back but don't choose to so the paramedic has to attend the BLS call.

[Big T]

Hello FF/EMT302
A few question just to clear things up. One What are your SOP on EMT'S in the back ?? How is your rig Licensed ALS or BLS ??? And do you bill a BLS run or ALS if the medic where to drive ???
Were I run the highest trained is in charge of the run.. When the medic shows up if they get in the squad they are in the back no matter what. And the P/T gets billed for a medic run no matter if they just did BLS service..
And one other comment if your company advertizes ALS care they must provide it or it's a legal issue. And every one knows how sue happy people are now a days

[FF/emt weidman]

Here in pa. we run emt-b's and medics on most trucks if the pt. is bls the basic rides if it's als the medic takes it . We bill for how we treat. medic bills als basic bills bls. we are licensed by padoh the only difference is a bls only unit cannot have als equipment on board. :p

[FLASHOVER00]

Well I'm also going to stand up for the Medics here. I was a basic for several years. And now being a Medic I understand the overall picture alot better. Now for the part where I'm going to become unpopular. If you are not happy performing as an EMT-B, get another job. If 98% of your calls are Non-Emergency and the "NEW MEDICS" are scared to death, they need to join you in getting a new job. I find it really hard to believe that out of ten nursing homes (in your area) that 98% of your calls are Non-Emergency transfers. From someone that has been doing this job for a litle while, I think that either your numbers are ALOT OFF or your just completely NUTZ. Good luck in the future. It sounds like to me that it doesn't need to be in EMS though.

[medic37sup]

well folks in the company i work for we have both ALS and BLS ambulances and ALS chase cars in our company. Our BLS medics can medic any BLS call including the ones with a Paramedic or CC tech on board. in the event that our BLS crews run into something they can not handle they call for a chase car to meet them at the scene or enroute to the hospital. Most of the volunteer agencies in the county as well as the surrounding counties only run a full BLS ambulance no matter what the call is and then wait to dispatch ALS once they arrive on scene and find they need us, this is partly because with the exception of Monroe County the other area do not have a inhanced 911 center including EMD. there has been several times where a full BLS crew has handle the most serious call on there own because there was not enough ALS to go around. I guess it just all depends on what state and area you happen to be practicing.... I hope this helps ...please keep all our fallen brothers and sisters in NYC close in your heart. :rolleyes:

[RyanEMVFD]

The service i work for allows EMT-B's to handle BLS calls. The medics usually rotate BLS calls with the EMT-B's. This allows medics to have all the ALS calls and the EMT-B's take care of the paperwork for the no transports. The service I use to work for didn't let the EMT-B's do patient care except for stuff done on scene.

[brianshep]

Here in New Jersey all ambulances are for the most part are BLS. On all 911 calls if ALS is needed there are sent from the MICP hospital that is assigned the particular area the incident is located in. ALS for all 911 calls comes in the form of a chase truck along the lines of a tahoe to a utility body type custom als unit. If ALS is not needed or if it is an ALS workup and you can get to the hospital before there arrival BlS can cancel ALS if the EMT's see fit. As for billing. the pt in NJ if it is an ALS workup gets billed by both the BLS and ALS providers. The only ALS "buses" in NJ that are licessed are used by some private companies for interfacility transfers.

[ 10-08-2001: Message edited by: New Jersey EMT6738 ]