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EMT to EMT-Ambulance to EMT-Basic. The course has also grown to about 150 hours in length, however, EMTs still seem to get taught really handy stuff to manage a medical emergency.
What amazes The Skeptic is how we have taken these really handy folks and turned them literally back into ambulance drivers. Apparently these days no community is properly protected from trauma, disease and pestilence unless you have advanced life support. Of course, most patients, sometimes up to 90- 95% of them, generally don’t need ALS anything, Let this be no obstacle though, because The Skeptic can take you to systems where every ambulance must have 2 paramedics, and every fire truck must have at least one more. Of course a few EMTs show up as well, but they mostly get to carry stuff. What is even more amazing is that some systems run ambulances with an EMT and a Paramedic on the crew and the rule is, yes you guessed it, the EMT can NEVER attend the patient! The Skeptic also hears that there are some rural communities that will guilt an EMT- I or Paramedic to be on-call for weeks on end because “our community deserves ALS.”
Frankly, The Skeptic thinks its time to throw the penalty flag because there was a time a decade or two ago when ALS was rare, and BLS care got the job done just fine. There was also a day when a seasoned EMT partner was the best thing a paramedic could ask for. There are even, tucked away in communities around the state, EMTs that run ambulance calls on a regular basis that actually do a great job! The Skeptic thinks it’s high time we stop wasting ALS care on people who don’t need it, and stop burning out medics while simultaneously rusting out our EMTs. While The Skeptic loves going on ambulance calls with 3 paramedics doing the work, and a few more providing a play-by-play, the economics of this are pretty dumb. Of course it’s good to have ALS around just in case, much like I sometimes wear a helmet around the house just in case gravity suddenly fails.
Of course, it’s also no great surprise in today’s environment that paramedics are doing fewer and fewer high acuity procedures. Luckily, they are spending plenty of time thinking about the cool stuff they aren’t doing while they forget to put oxygen on the patient. This is even more comforting when you consider the EMT along to help may not ever get do any critical interventions on sick patients. Of course, the EMT can just go to paramedic school to learn how to look down on EMTs while criticizing their driving. I guess there just aren’t enough of us left who started our careers as EMTs who were told, “Don’t call for ALS unit unless you need it.”
The Skeptic concludes that EMS leaders should get over this ALS everywhere, every time nonsense, they should start believing in their EMTs again, and build systems that properly develop and capitalize on the strengths of well-trained and well-utilized EMTs that deliver great BLS care. Sure paramedics save lives, but remember, EMTs save paramedics!
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Communication 