EMT upgrade question

[Activatedcharcoal]

Hello everyone. it's my first post in this forum,and I hope Im in the right forum. My question is the following. I want to become an EMT and work in ER,now, I hear EMTs can't do too much when your a basic,how can one get to intermediate level?,can I take a medical assistant course,or phlebotomy alone or EKG courses and also can I use these skills while in the ambulance. I know,I'm not an EMT yet,but I just want to be informed,what other skills I can add to EMT,thank you all for your help.

[flightnurse2b, LPN]

if you are already an EMT basic, you should go to the bridge program to become a paramedic. you already have the basic technical and critical thinking skills and you will be able to learn and do so much more!

[Sandy_dfw]

I would suggest as soon as you get your EMT's to keep going and get

your paramedics.

Good Luck

Sandy

[EricJRN, MSN, RN]

You should check with the EMS governing body (often the state health department) in the state where you live to determine whether additional skills would impact your scope of practice as an EMT.

In my state (Texas), there are specific skills that are associated with each level of EMS certification. For example, EMT students learn to bandage, splint, take vital signs and provide an array of basic life support care. EMT-Intermediate students learn about phlebotomy, IV therapy, and advanced airway techniques like intubation. Paramedic students spend much of the time on cardiology, learning about cardiac rhythms and cardiovascular drugs. BUT...

Once you graduate and get a job (at least in TX), the division of responsibilities is not as clear. Each EMS medical director has the authority to establish treatment protocols and the skills that he or she allows at each skill level. One service's medical director may decide that intraosseous infusion is fine for EMT-I's, while another service may restrict that to paramedics. In any case, they usually don't factor a medic's non-EMS training into these decisions, simply because it is impractical.

Essentially, if your state works like mine, additional allied health education won't give you a broader EMS skills set. I'm an EMT-Intermediate and I follow the same protocols as non-nurse EMT-I's. It would kill too many trees for my medical director to write protocols for "plain EMT-I's" and another set for EMT-I/RN's. It's probably the same in your situation if you pursued medical assisting. You would acquire some knowledge, but I doubt it would translate to performing more skills on the ambulance.

Once you begin your hospital and field experiences, I think you'll begin to develop some ideas about exactly where you want your career to go. That will help you to focus on the education and training that will be most relevant to your future practice in healthcare.

[craigd30]

Really all you'll be able to add to your job is a better assessment. You will be limited in what you can "do" for interventions. In WI I think EMT-B's can only give 9 meds, and do a few extra interventions. Any extra knowledge you have is great, but any extra skills or interventions you have are going to be limited by what your license says you can do. Your medical director is the one who says what EMT-B's can do, and it's general categories of who can do what, not specified for specific people in the system. I'm currently a paramedic going through an ADN program, and I've found that nursing is vastly different than EMS, but I (and I'm really biased on this) think that being a paramedic (or even an EMT-I) first gives you a great background, great knowledge base, and great experience when going through a nursing program. Having extra skills, teaching, experience, or whatever, won't help you in the field/ED as an EMT-B though. You will still be limited to practicing within your scope of practice and using what you know. As an example: I'm currently a first sem. nursing student. We haven't covered IV's yet in class, yet In my job in the ED as an EMT-P, I learned from my ED director (who is big - and I am talking BIG - into portable diagnostic ultrasound) how to start ultrasound guided IV's in those patients who are really, really, hard starts. I don't want to brag, but I'm going to (brace yourselves). I have gotten really good at them. I get called to the ICU and Med/Surg floors every now and then to start them, and I'm usually pretty lucky identifying the vessels and watching my cath go in. When I'm doing my nursing clinicals (at the same facility where I work in the ED, and get called to do these advanced IV starts) I am not allowed to touch an IV, because it's a skill we haven't covered yet, and as such isn't in my scope of practice when I'm there as a nursing student. I can still try to help by talking one of the nurses through it, but can't physically have anything to do with it. This is a hard thing to justify, but is needed in our field. We can only do what we are legaly there to do. If you are there and punched in as an MA, you can only do MA stuff. If you are there and punched in as an EMT-B, you can only do EMT-B stuff. No matter what your training. Despite that, you can always use your knowledge, just not your physical skills. I hope that makes sense. Also, in WI I think they are phasing out the EMT-I's and just going with paramedics, although when I took the paramedic program they still offered the EMT-I option. You only had to show up at certain classes and test out on certain skills, although I would just recommend going through with the whole EMT-P program. If you want to work in your local ED stop in and talk to them. They will be able to give you better advice than anyone else. If you can, meet their director and see what they think. They should be all about public relations enough for you to get 10 min of their time. Good luck, and don't be afraid to stop in and ask. It may provide you with a future job lead.

[GilaRRT]

Do not waste your time on Intermediate. Educational standards and SOP vary significantly from state to state. Even Among cities or counties in the same state. Go to PM school if you are serious about EMS. If you fancy working within the hospital, why not nursing school?

[Thornbird]

For info on EMS careers and certifications check www.nremt.org . Most states now use national education and testing standards set by National Registry. From there scope of practice varies widely by state, region and even hospital. EMS follows its own set of standards and practices which are not the same as nursing and not really geared to in-hospital care although clinical training is done partially in-hospital.

Who is allowed to do what in an ED is largely up to the hospital. Most ED's use PCT's or ED Techs, many of whom have EMT certifications. In some states paramedics can work in the ED, in others, like mine, EMS is limited to out of hospital work. MA's rarely are employed in ED's as anything other than clerks.

Try checking with community colleges. That is generally where you can find EMT or Paramedic training, as well as Nursing and Medical Assisting. You should be able to get career counseling and more info on what program to take to be able to do what you want with your career. You may have to check with more than one Community College as in any given area each one may not offer all the programs.

[Medic09, BSN, RN, EMT-P]

Everyone pretty well covered it. I'll only add that the requirements for paramedic school vary among the states. NM, for instance, requires that you work your way through the whole ladder from basic to intermediate to paramedic. Some states (Mass. comes to mind) will allow a Basic to go straight to Paramedic school. You'll have to find out what your state requires.

As far as working in the hospital goes, each hospital determines what their EMTs or Paramedics may do, within the limits of the state's EMS Act. The way around that is to simply title them 'techs', and then establish in-house training and scope. Like Gila said, if you see your future in the hospital then think about nursing. No matter where you work in-house, a paramedic won't be allowed as broad a scope of practice as an RN.

[classicdame, MSN, EdD]

depending on the state laws, even a paramedic might be restricted in the hospital environment. So if you want to work in the ER you ought to consider nursing school while you continue to get that valuable EMT experience. If you want to advance as EMT then the paramedic route is the way to go. I applaud your goals!

[GilaRRT]

Medic09, who told you you had to go through B & I education prior to entering paramedic school? This may be a service or perhaps a specific program requirement; however, I have never know this be a state requirement. In fact, I know of at least one college in NM that does not require EMT-I. The consistent requirement is EMT-B or EMT-I credentials. However, both are not required. An EMT-B can go straight into a PM program in NM.

[algebra_demystified]

I worked as an EMT while I went to nursing school, and I don't think I wasted my time. Paramedic school would have been too much of a sidetrack, and the ambulance companies accommodated my schedule pretty well.

Nobody's keeping you out of the library in the meantime, so go read up on anything related to vital signs and patient assessment. Widening and narrowing blood pressures, how diabetics have decreased cap refill, etc. Make that time your own, learn something every day. Don't just sell your life for ten bucks an hour, use every minute as a learning opportunity.

When you pick up a patient, do the cranial nerve checks on top of everything else. Read any textbook you can get your hands on. Pick up the Paramedic textbook and read that, too.

Good luck,

[Medic09, BSN, RN, EMT-P]

Looks like I stand corrected about NM state requirements. I didn't go to P school here. When I was training officer at PVAS, our paramedic students were all going through UNM. I guess the B to I to P requirement was UNM's, not the state board's.

In any case, the requirements will vary by locale. Some places will take paramedic students with no EMS background, though I personally don't recommend it for the civilian sector.

I think EMS experience is invaluable. If you're a Basic you'll have more opportunity to grow and develop skills in a small, preferably rural service. That's the environment where they rely on the Basics to really perform. Same if you have opportunity to do wilderness search and rescue. So, if you go to work or volunteer somewhere as a Basic, ask what the Basics can do. If you have a choice, go where the Basics are most heavily utilized.