The role of the EMT-B in EMS Misunderstood!

[downsouthlaff, LPN]

Hello again, I have been through so many threads reading about tension between Nurses and EMS Practicioners. I have noticed that the vast majority of EMS vs Nursing comes from tension between the Long Term Care LPN/LVN and the EMT-B. It appears that EMT-Bs think that long term care nurses are careless and incompetent when it comes to resident care. It appears that LTC LPNs/LVNs view the EMT-B as the CNA type role of EMS, because of shorter education 3-7 months (in most places) that EMT-Bs are not prepared or competent

to handle medical care of a patient. Well to bust all myths of course either of these is true.

As a former CNA in Long Term Care, its clear to see that the LPN/LVN is very competent in this enviroment. In fact one could say that it is really the LPN/LVNs area of expertise. LPN/LVNs are given the authority to work independently alot of times with nothing but RN telephone availabilty on Nights and weekends. And its almost impossible for a lay person to find differences between the RN and LPN in long term care. So far closed minded EMTs and Paramedics Myth Busted.

As an EMT-B, despite what "Some LTC Nurses think", i will tell you that there is a whole lot more to being an EMT-B than going to a class for a short period of time just to learn some cookbook fix her up medical skills. And EMT-B despite often being portrayed as it is, is not the entry level position into the EMS field. this a model U.S. EMS professional rank.

Licensed Emergency Medicine Physician/ Medical Director

EMT-Paramedic

EMT-A/IV/I/CC/I85/I99 or simply A-EMT (this level is being used less and less)

EMT-B or wich is commonly reffered to as simpy the EMT

State Certified Emergency Medical/First Responders

EMDs (Emergency Medical Dispatchers)

CNA and Nurse is not a good comparison to EMT-Bs and Paramedics at all. A CNA is a an Assistant and a Nurse is a Nurse. Just like an LPN and RN are both Nurses, EMT-Bs and Paramedic or EMT-Ps are both EMTs. Just at different levels of education and training much like RNs and LPNs. I dont know who started the myth that EMS is ALL ABOUT SKILL, pshhhhhh couldnt be further from the truth. 50 percent of an EMT-B class is on Critical thinking, Patient Assessment, Anatomy, physiology, pathophysiology. Unlike a CNA or LPN for that matter, an EMT-B can function as an indepependent practicioner of EMS, with a medical director. Paramedic supervision/delegation is NEVER required, However when a Paramedic and EMT work on the same unit as partners the EMT is still an independent practicioner of BLS EMS, but they are now an Assistant to ALS and must be supervised by the paramedic when assisting with ALS for ex (spiking an IV bag, setting up for intubation etc.) So no, CNA is not a good comparison to EMT-B at all.Its not about how long you go to school, but about what you learn and the scope/responsibility given. For example (most LPN/LVN programs last between 12 and 15 months give or take. Most medical assistant programs run about 12 months, but they are not qualified to carry the responsibilty that the Licensed Nurse is. Some surgical tech programs can last as long as 2 years, and they are considered Unlicnesed Assistive Personell and carry zero liabilty.

So for all you LTC Nurses who think we are not competent and are less educated, Thats simply not the truth. As an EMT-B, i can Administer oxygen via NRB at 15 lpm, nasal cannula at 6 lpm, with Docs order i can Administer aspirin, epinephrine, glucose, Nitro, MDIs, Nebulizer Treatments, Charcoal, I can check a patients blood glucose level, dress wounds, insert an OPA or NPA, apply slings and traction splints, apply suction, perform detailed assement and exams, plus I have to be aware of Scene Hazrds, a good Traffic Direcor, and a Professional Driver, plus treat a patient trying to think critically after 27 hours on the road without sleep, or on the side of the road in below freezing weater, freezing pouring rain, a lightning storm, flooded roads, 100 degree weather, or at the scene of a violent crime, in a violent neighborhood.

Unlike Nursing, EMS is a building block profession. RNs, dont have to be LPNs first and LPNs dont have to be Nursing Aides first. You cant just become an EMT-I. The EMT-I class is not going to waste time going back over the foundations for assessment and EMT skills and all that. The EMT-I class is gonna go straight into starting IVs, and how to push certain IV meds, and new focused assesment and critical thinking for these skills, just like the Paramedic course wont teach those basic skills of an EMT either, they go straight into advanced skill and new focused assesment skills.

So despite the closed minded view of some nurses that the EMT-B backboards, takes blood pressure, and drives, "Or an ambulance driver is trying to go way overboard and assess my patient, so i need to intervene and put him in his place" says some nurses wich the actual quote ive heard before in a nursing home after a resident is having trouble breathig and a pulse of 32, I know its annoying when we have to perform an assessment and you might feel like we are undermining your Nursing Assessment skills, but thats not it, our protocol requires assessments on every patient every time, and these findings must be documented in a run report. I think it all boils down to as LPNs and EMTs we are not at the top of our respected professions, and our knowledge and skill is questioned, we become frustrated because our superiors can be Jack****, we pin the steroe types on each other to make ourselves feel better and it turns into a big war in front of a resident who is in need of Emergency medical transport care, rather than long term nursing care, at the moment. Sure as an LPN, you can sit there all day in the nursing home hooking up the resident to oxygen, ausculating lung and heart sounds, monitoring and assessing the patients condition, but the difference is as an EMT i can do all that, but what makes us better for the resident is that every minute we are doing exactly what you would be doing, we get a mile closer to higher Medical Care in wich physicians can work there magic. As an EMT coming to the nursing home to bring a patient to the doctor or dialysis, or to ER, is probably the least desirable of our tasks and is not the reason we became EMTs. Bu we do it for a pay check and we do get a kick out of hearing dementia paw paw say the darnest things on the ride to Doctor Jones office for his checkup, just like most LPNs probably didnt choose to work in a Nursing Home to run emergency codes, or break up fecal impactions, but you do it to get paid and support yorself, having to start chest compressions on your close friend resident is not something you like doing as an LTC Nurse, but it does kinda give you and adrenaline rush that you might like, just like as an EMT visting with Paw Paw in the back makes us laugh, and makes us stop for awhile and realize how good we have it, and realized we enjoyed his company.

Bottom line is we should quit this Nursing Home vs EMS crudd, and get along and coencide for the better of the resident/patient. I rarely hear of this problem occuring between a Paramedic and RN. We need to just stop trying to compare the scopes and education differences. So yes, LPNs/LVNs as an EMT even a Paramedic for that matter, Medication Administration is very limited. But EMS is not about passing meds, its Not about "Ok Maw Maw heres your blood pressure pill, drink your water, or Hello Doctor Jones Paw Paws not tolerating his new meds well, and it appears that has condition is worsening, or hello Maw Maw im gonna flush your peg tube alright" EMS is about " Lets get a C Collar on him immediately, get him on the backboard, get an OPA in start cest compressions, start PPV with the bag attached to high concentration O2 at 15 lpm, and get him hooked up to a defribilator, or Hi Ms.Jones since yoyr feeling weak and dizzy and with chest pain, Im gonna listen to your lungs to see if your breathing adequately, assess your vital signs, hook you up to o2, and perform an exam, and identify a possible cause of whats going on by an exam, v/s assessment, and pertinent history, and relieve some symptoms and prolong your stable condition until the doctor can run tests figure out whats exactly going on. Two completely different Medical Roles. No interchangeble and one cannot assume authority over the other.

[downsouthlaff, LPN]

And P.S., This is not a post that I write to attack Nurses. I just feel its important to improve the relations between EMS Professionals and Nurses especially those in long term care, because as the future of long term care population is expected to skyrocket, so will the demand for Ambulance Transports in nursing homes, wich already is the revenue that keeps Private EMS going. It was alos to clarfy the scope of an EMT-B wich is sometime seen by nurses who are unfamiliar withe the EMS field as that Ambulance driver orderly, who takes blood pressures, puts the patient on a backboard, helps the Medic throw him in the back and then drives.But I also know that EMS has a part to blame in this too. They can soetimes be arrogant, and try to purposely act like a jerk and try to make the nurse look bad in front of a residents family, becuase they didnt want to leave a fast food joint or wake up from a nap, its a two way street!