I am currently working in a TCU and managed to send out two people within 30mins of each other last night. While giving report to the medics I found myself wondering if it was too much or not enough and what exactly they learn in training.
When I give report I find myself talking to the medic like I would another nurse or MD. Situation, variations in vitals, most recent labs, and diagnosis.
I am curious though when I tell a medic that I guiaced the patients vomit and it was positive and the hgb drawn today was 8.2 and their UA/UC was clean... if they know what the heck I am talking about.
Could some of the people here who are paramedics give me a heads up on what kind of report you need and what kind of training you have regarding diagnosis and labs are?
Quick mention... even though the EMT has less training than a paramedic, they deserve a good report. They are still responsible for that patient during transport and need to know whats going on. Just like a paramedic (where you don't know their background), the EMT may be in nursing or medic school. When I was an EMT, one of my partners (an EMT) was a Physician Assistant as well.
Soo.. my point being.. EMTs are still part of the health care team and deserve some respect.
the paramedic curriculum was based on the RN curriculum,
The Paramedic curriculum was and is based on the DOT standards. The curriculums are very different in their educational base. In California it may only take 6 months to be a Paramedic. AMR has its own school which only requires a week of anatomy.
also read the patch on the shoulder and please know the difference between "EMT" and "PARAMEDIC". if all else fails think EMT=CNA, paramedic=RN. hope that helped, if not ask the next medic you give report to.
The patches are changing and California is one state which also varies from county to county in its scope of practice. The state has gone through EMT-B, EMT-1 and now AEMT along with just EMT. We rarely if ever see a Paramedic a CCT team. It is usually an RN and two EMTs with whatever other letter following or preceding EMT. Some EMTs (A, B or 1) have advanced skills and some have on the job knowledge which is impressive so it is easy to think they are at a higher level and many will participate in report with the RNs.
Other states I believe have even more levels. Hawaii calls their equivalent of the Paramedic the MICT which I would never have known what they were if someone hadn't enlightened me. Some states also have EMT-I which is not to be confused with California's EMT-1 but is more like what California's EMT II was. An EMT-I or EMT II is not a Paramedic but if they are on an ambulance, it can still be called ALS. Or, it can also be called BLS depending where you are. If you go to Canada the term Paramedic is included in all levels. It is actually very interesting, and confusing, to take notice of other states (or counties) and their EMS when traveling. So for these reasons I don't assume anything when giving report and will ask if the patient they are about to accept is within their comfort level and abilities regardless of what the patch says just as the expectation is for other professionals.
The Paramedic curriculum was and is based on the DOT standards. The curriculums are very different in their educational base. In California it may only take 6 months to be a Paramedic. AMR has its own school which only requires a week of anatomy.
The patches are changing and California is one state which also varies from county to county in its scope of practice. The state has gone through EMT-B, EMT-1 and now AEMT along with just EMT. We rarely if ever see a Paramedic a CCT team. It is usually an RN and two EMTs with whatever other letter following or preceding EMT. Some EMTs (A, B or 1) have advanced skills and some have on the job knowledge which is impressive so it is easy to think they are at a higher level and many will participate in report with the RNs.
Other states I believe have even more levels. Hawaii calls their equivalent of the Paramedic the MICT which I would never have known what they were if someone hadn't enlightened me. Some states also have EMT-I which is not to be confused with California's EMT-1 but is more like what California's EMT II was. An EMT-I or EMT II is not a Paramedic but if they are on an ambulance, it can still be called ALS. Or, it can also be called BLS depending where you are. If you go to Canada the term Paramedic is included in all levels. It is actually very interesting, and confusing, to take notice of other states (or counties) and their EMS when traveling. So for these reasons I don't assume anything when giving report and will ask if the patient they are about to accept is within their comfort level and abilities regardless of what the patch says just as the expectation is for other professionals.
Yes, California's EMT patches are changing. The EMT-I has been the designation for an EMT-Basic for at least 10 years, probably more like 15 or more. It's now known as simply "EMT." The EMT-II is now known as "AEMT" for "Advanced EMT" and is essentially the same as an NREMT-I99, if you're familiar with that standard. EMT-P became simply "Paramedic" towards the beginning of this decade... In any event, you likely won't see many AEMT personnel as most counties have just 2 levels of providers authorized. A CCT-P is a Paramedic that's locally authorized to do some procedures, monitor some meds, and the like that's outside the scope of the typical Paramedic.
Outside of California, there may be several different designations. Oregon has 3 levels of Paramedic and used to have something like 6. Just get to know what your local system calls the individual providers.
While it is possible in California to become a Paramedic in just 6 months, remember that a Paramedic gets about 600 hours of classroom instruction, 160 hours of a clinical internship, and 480 (or more) hours of field internship. That's quite a bit to squeeze into 6 months. Most training programs that I'm familiar with take a year or two. Community College programs may have a full year of A&P required as well, if not additional prereqs that mirror RN prerequisites.
When giving report, you may find that a Paramedic or an EMT may have a far greater understanding of what you're saying than you might realize. If you know you're dealing with a Paramedic, give report like you're giving report to another RN. Chances are good they'll at least understand the significance of things. Some Paramedics are either quite sharp, had an extensive education, or they're going through RN/PA/MD school themselves and will understand and remember the labs and what they mean. Those that don't quite understand will probably ask you for clarification. Regardless of what the patch says, ask them if they're comfortable with the patient or if the patient is in their scope of practice. The IV fluid that's running may very well determine the provider that can transport the patient. Don't be surprised if transport asks you to change to a different fluid for the trip...
Paramedic gets about 600 hours of classroom instruction, 160 hours of a clinical internship, and 480 (or more) hours of field internship. ...
According to the state website they haven't raised the hours yet. The classroom is still only 450 hours.
Some do vary but the college degree is not required and almost all the colleges offer the shorter certificate option.
No CCT-Ps in my local counties.
I have noted a few counties now adding the AEMT certfication at least for those who already have the EMT.
As far as patches, almost all the Paramedics here wear FD T-shirts so we can assume they are Paramedics since most FFs are in this area.
Different areas of expertise. Even if someone is in PA or RN school, they are still in training and you should not assume they will function at that level. I can not assume they are higher than the level for which they are licensed or certified for although they have expanded their knowledge base. Even the new doctors that just appeared this July are not experts in critical care medicine.
Edit:
I was just advised Contra Costa has a CCT-P policy but RNs are still used due to the limited scope.
I know I have not given report to a Paramedic on a CCT unit in over 20 years that I can recall. But, I do give report to EMTs and RNs. For BLS, it is primarily EMTs or a few Paramedics working BLS units. It is just rare to see a Paramedic doing IFT. Those I see are with the Fire Departments doing 911 calls.
Specializes in Trauma Surgery, Nursing Management.
This.
Keep it on target with what is needed to get from point A to point B and not to overwhelm with a lot of information which might bury the important need to knows.
One more thing to address is vascular access. Not all Paramedics are allowed to access central lines including PICCs and various other long term indwelling catheters. Some of the terms for these devices might be unfamiliar with them until they see it. One Paramedic knew he could not access any port on a Swan Ganz but was sure a PA catheter would be okay. If they are allowed, it may have been awhile and it doesn't hurt to do a quick review which isn't insulting to them about access and compatibility. Making them aware of shunts, grafts or flaps and other vascular situations which might prevent establishing another line or is made known to whoever is drawing labs or doing BPs at the other facility is an important but often overlooked piece of information.
Funny story...My DH is an excellent Paramedic,cabable of running circles around many nurses. He was transferring an ER patient from the hospital that I worked in, and was attempting to receive report from the snotty nurse that was going to be riding along (required additional support in back of ambulance due to instability). She told him that he didn't need to know any information when he asked what the infusion rate was on the patients multiple IV lines. He informed her that if something happened and power was lost,he needed to be able to run those IV. She also had issues obtaining a manual blood pressure reading while bouncing around back in the ambulance, and required the paramedic to get it. But the funniest part of the entire situation was when they arrived at Charity Hospital's ER, and the receiving nurse asked for report from the paramedic...who deferred to RN that rode along since she wouldn't give report to them...receiving RN had a field day.
I usually give a report on why I am sending them out, what thier baseline normally is, VS & if they are A&O or not. I usually send the last labs done on the patient so the hospital has an idea of what to test for and are not repeating tests unless needed. I also call the hospital and report who I am sending, why and what I am sending with them. My BF is a retired EMT/Firefighter, I know he has alot more experience than I do so I treat all EMT/Paramedics as if they are equal or more experienced to me.
some of my responses in red, in-line to better respond to you.
according to the state website they haven't raised the hours yet. the classroom is still only 450 hours. the state minimum is 450 hours didactic but most of the programs will exceed that by a good margin. why? there's a lot more they're throwing at paramedics these days than when that standard was set. quite frankly, i'd like to see didactic time nearly double in hours, or require the usual healthcare field prerequisites prior to entry.
some do vary but the college degree is not required and almost all the colleges offer the shorter certificate option.
a degree is required in oregon. personally, i like that requirement. too bad it's not required in california.
no cct-ps in my local counties. cct-p is used in some ca ems systems or their paramedics are provided an expanded scope of practice beyond what's typical for the state. a good training program should provide an education to be able to function at the full scope of a typical (non-cct-p) paramedic for any ca county.
i have noted a few counties now adding the aemt certfication at least for those who already have the emt. aemt is simply the old emt-ii. as of 2007, there were 5 local ems agencies that used emt-ii. which ones have adopted the aemt besides those 5?
as far as patches, almost all the paramedics here wear fd t-shirts so we can assume they are paramedics since most ffs are in this area. throughout the state, don't assume that a ff is a paramedic or that a paramedic is a firefighter.
different areas of expertise. even if someone is in pa or rn school, they are still in training and you should not assume they will function at that level. i can not assume they are higher than the level for which they are licensed or certified for although they have expanded their knowledge base. even the new doctors that just appeared this july are not experts in critical care medicine.
also, don't assume that someone who is just a basic emt doesn't possess a very strong education in healthcare and has completed their education in another area of medicine. that person may simply be limited in their scope because of the job they're doing at the moment.
edit:
i was just advised contra costa has a cct-p policy but rns are still used due to the limited scope.
santa clara county has a cct-p policy also, and they are used.
i know i have not given report to a paramedic on a cct unit in over 20 years that i can recall. but, i do give report to emts and rns. for bls, it is primarily emts or a few paramedics working bls units. it is just rare to see a paramedic doing ift. those i see are with the fire departments doing 911 calls. given your experience with firefighters being paramedics, and fire normally doesn't do ift work, that's not surprising at all. those counties that allow paramedics to function in non-911 roles will usually have them also doing ift. some counties only authorize paramedics to work 911 units.
something to also remember is that paramedics do have what's known as an "undefined scope of practice." if it's not in the basic scope of practice, and a local ems agency wants their paramedics to do it, if the state ems agency agrees, then after an appropriate education, the local paramedics can do it. while the basic scope of practice is quite limited, the mechanisms are already in place to allow for a massive expansion of the scope of practice should the state decide it's warranted. i do not foresee that happening any time soon because of both political and educational reasons.
Anyway, here's a link to a good pdf spreadsheet about what California has for their basic scope of practice for all current providers.
Red = not authorized
Yellow = authorized through a trial program or only specific EMS agencies allow it
Green = authorized
In any event, I still say to give report as if you were giving report to another RN who will be taking over care from you. Worst case, you can say that you gave a thorough report to transport personnel. What (I think I read earlier) might be a good idea is why not set a monthly meeting with your transport providers to hash out what is expected of them and of you for each unit both in hospital and transport. That should reduce friction that always occurs.
also, don't assume that someone who is just a basic emt doesn't possess a very strong education in healthcare and has completed their education in another area of medicine. that person may simply be limited in their scope because of the job they're doing at the moment.
i think you have misunderstood what i stated. i prefer not make assumptions when giving report to someone especially to another professional whose knowledge and skills i do not know firsthand when it comes to patient care. i can not assume an emt is in med school any more than i can assume another nurse on a transport team has the exact same critical care knowledge as i do. speaking in highly technical terms with the assumption that they may also be a surgical pa or np with a cardiac specialty with them not understanding a word but with too much pride to say otherwise will not benefit anyone especially the patient. i want my report to be clear and understood. this should not be about whether we offend but because we know they are functioning at an emt level even if they are in med school. it should be about providing clear information to which both emts on an ambulance will have an understanding about the patient and not just the one who is almost a doctor.
i hope that doesn't sound offensive to you but i prefer not to base releasing my patient on assumptions of what i do not know and go with what is appropriate for the expected level of care and explain terms to procedures and medications which i know an emt or paramedic would not normally encounter rather than make the assumption they should understand everything i say but have too much pride to ask questions or say otherwise. i do find those who may have more knowledge will ask questions and not just assume they know everything. those who are studying for a higher level also like clear explanations because they now know what all they don't know and that each patient can be a little unique. there is absolutely nothing wrong with gearing your report towards the appropriate level of provider to make it clearer and to get the important points across without confusing with too much info which may get lost in the translation with important points missed.
i make the same adjustments in my report when it is to different transport rns or to those in different units. the rns that work at a local hospital based flight team or who are with a specialty team will demonstrate their knowledge by taking the lead on most of the questions. those who work for the local private ambulance service may have primarily ed experience and not much in all the critical care specialties. that report will be different with more explanations which may be at a simpler and more educational manner to ensure a safe understanding of the patient, medications and equipment. but, that is based off of interaction and not assumptions.
I make the same adjustments in my report when it is to different transport RNs or to those in different units. The RNs that work at a local hospital based flight team or who are with a specialty team will demonstrate their knowledge by taking the lead on most of the questions. Those who work for the local private ambulance service may have primarily ED experience and not much in all the critical care specialties. That report will be different with more explanations which may be at a simpler and more educational manner to ensure a safe understanding of the patient, medications and equipment. But, that is based off of interaction and NOT assumptions.
this is dangerous. I understand altering your report when they ask you questions, but you should always give the same report to make sure nothing is skipped. I always listen first then ask questions. IE, get full report then questions about vent settings, drips, sats, ins and outs...
as to the post about CA training, yes the state minimum is still 450 but that is not acceptable for NREMT testing so that is a null and void point. as for AMRs school, NCTI, I went there and it was 690 hours classroom and the process was well over a year from start to finish, please verify your information before posting or we may start to think you are TRAUMASURFER in disguise. your area may not have paramedic CCTs, if so where are your geting your information/experience with us... in states other than California, such as the last state I worked in, i could transport almost any medication that had been previously started on the patient, the only med i needed DC'd was crofab. in a physician delegation state a paramedic can do anything the physician orders, ie RSI, pressers, inotropes, chronotropes, nitrates, antibiotics...the list goes on. your local paramedics will gladly take you on a ridealong and answer all your questions about local scope if you would like.
back to the OP, if you call for a BLS amblam basic reports are best, "where their going, what there DX is, what TX has been done, last VS and trends" for ALS give the same, just more in depth. they will clarify if needed, most medics aren't shy.
raskol
53 Posts
Quick mention... even though the EMT has less training than a paramedic, they deserve a good report. They are still responsible for that patient during transport and need to know whats going on. Just like a paramedic (where you don't know their background), the EMT may be in nursing or medic school. When I was an EMT, one of my partners (an EMT) was a Physician Assistant as well.
Soo.. my point being.. EMTs are still part of the health care team and deserve some respect.