And the patient runs screaming from the truck…

"I've got a real problem here one that only a real paramedic can handle and these bums show up and now I'm running wild through the streets of providence looking for the real thing while my heart is racing at 200 beats a minute and I can't slow it down on my own and those EMT things don't know nuthin bout no SVT who the hell do they think they are stickin needles in my arm and telling me to bear down dumb asses probably can't even splint a broken arm which is what I'm gonna have if i don't stop runnin around looking for a paramedic…"

Can't say that's ever happened to me, I've never had a patient ask for credentials, inquire about my training or skill level, or licensure. But I have been questioned once or twice about such things by Paramedics-never in real life mind you- where the medics I run with are top notch, but in this weird place we call cyberspace, well, that's another story.

My alter-ego, The Director of THE EMS hires only Paramedics, but keep in mind that the director of THE EMS also does not tolerate any nonsense from the populace, and when a Paramedic responds to an emergency, a real emergency had best be awaiting him/her or the repercussions for the perpetrator who called are severe.

If that we only responded only to Paramedic level emergencies then all of this hee-ha I'm a medic and you're a wannabe might make sense, but we don't, we respond to emergencies, perceived emergencies, non-emergencies and even emergencies that have yet to happen.

Staffing every ambulance or even every 911 EMS response vehicle with paramedics is nuts. Its overkill. Its like sending a surgeon into the ER on a Friday night.

Basics do a great job most times, here in Rhode Island we have EMT-Cardiac, which is a lot like an EMT-I, I think, I really don't know. I do know that I've done a lot of things in the field that have saved some lives, and only a small percentage of those things needed the EMT C level training. Mind you that there is  hospital on every corner here in the Capitol City, and rapid transport to an emergency room-cath lab-surgery suite-stroke center is most often the most prudent course of action.

That being said, if ever I'm attacked by a bear, or fall off a cliff, or cut off my dick with a chain saw, or run myself over with a tractor, or crash my car on some desolate stretch of highway, send the Paramedics!

Anyway, we are what we are, and if we all do the best job we can at the level we are trained at I think we can all get along, save some lives and act like professionals.


  • B says:

    My problem with the Cardiac level (and I say this as one) is because it was born of an attitude of "just enough to get them to the hospital" and created a culture of mediocrity in RI EMS that persists to this day.  "Eh, good enough."  No.  Not good enough.  People shouldn't be falling off backboards, getting albuterol for every respiratory complaint, or being handed 4 baby asprins and a nitro without a 12-lead, or being expected to "suck it up" and deal with excruciating pain because "Eh, we'll be there in a couple minutes."  
    85% of a paramedic's scope of practice with 15% of the education to back it up.  Does that seem safe?  If it's such a great idea why hasn't any other state done it?  Why has every state that DID do it get rid of it?  
    I got my C because I couldn't afford medic school on Basic pay.  Then life happened, and I'm still here, with a mortgage, a family, and no time, kicking myself every time I run into a situation, a 12-lead, a patient presentation that I know I should know more about, but I don't.  Because I went with "good enough."  
    There are fantastic cardiacs out there saving lives all the time based on what we were trained to do.  There's also a few murderers out there that got away with it because nobody's paying attention from the top on down, and every day there are people not getting the assessment and care they deserve because they were unlucky  enough to become ill or injured in RI instead of another state.  

  • Mr618 says:

    There are two reasons I let folks know I'm "only" a basic: first and foremost, I want them to understand I cannot do all the Johnny-and-Roy magic that the TV machine has led them to expect, and second, to defuse the occiasional paramedic who thinks of himself as God, and believes that basics identify themselves as medics for the glory attached thereunto. Here in Maine, we basics identify ourselves as EMTs, while the medics trumpet their exaulted status from the hilltops. The Intermediates… well, I don't know how they identify themselves, since they only hang around with medics and won't talk to us lowly basics.
    Just remember, though: lots of studies say BLS skills — especially good chest compressions and early AED use — save more lives than ALS skills.

    • Michael Morse says:

      we all have a part, Mr. 618, some people are miscast, not their fault, the system is in need of an overhaul, but how? That is the million dollar question I wish I had an answer to.

    • Nick says:

      You’re absolutely right. “BLS skills” save more lives than “ALS skills.”

      Just a shame the job has very little to do, anymore, with “saving lives,” it has to do with providing health care to a person requiring, or requesting such…

  • T.C.S says:

    While there are different levels of training in germany, we usually don't comunicate this to the public. The medic or doctor leading the call does the introductions -usually along the lines "XY County EMS, I'm Mr. Smith and this is my colleague Mr. Miller"
    If a patient asks who the dorctor is and no such demigod is present we tell them, the same if they inquire about our training which they usually don't.

  • Michael Morse says:

    Thanks for that T.C.S, I always find the European model fascinating, I used to follow mark from Medic999 but his blog is gone, the NHS system is similar to ours with all of the nuttiness the crews are sent to. I heard that in France a MD is part of all EMS calls.

  • Glenn says:

    I'm a FF/EMT from California, and I have yet to see the establishment of a "EMS caste system", if you will.  Down here, regardless of the medical care (from the EMT-B who routinely deals with thw Airway, breathing and Circulation, the AEMT (formerly the EMT-I) who handles limited narcotic and mainly cardiac care interventions while still maintaing significantly excellent BLS skills, to the Paramedic, the all rounder). The moment in which we have the "well, piss on you, I'm better becaue I have the A.S in Emergency Medicine" attitude occurring, the offending paramedic needs to realize that He/She was once an EMT-B/AEMT once…We should all be in this for the "help all, and harm none" principles..I know the oath I took to "do no harm" means something to me.

  • G Jeff says:

    I've never heard a patient complain about level of license, well other than the ones who complain about the moon being too bright and such. Personally, I've come around to a way of thinking that would involve a lot more basics and strategically placed fly-cars. Those flycars would be staffed by your medics, maybe a trauma nurse, maybe in rare cases a doc. Especially if we could get an emergency medicine resident ride along program going. Basics are awesome, they do great work. Unfortunatley what I've seen is that EMS medical directors aren't letting the basics do even a quarter of what they can do. So therfore, my Paramedic butt gets stuck in the back on all 911 calls and my partner gets relegated to professional delivery driver.

  • Butch M says:

    We all started out at the lower level, some of us chose to advance up the ladder until we got to where we feel comfortable, but still challenged, We must remember at all times to control the scene,not let the scene control you.And with the system I work in we are all a part of the complete team. I as a Paramedic can not do the best for my patient without my partner (Basic or CPR Driver) Put Patient care first above all else and the rest will take care of itself.

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