The end of the EMT-Basic?

I have always hated 2 terms in EMS but until I can get everyone to agree on just calling us “Paramedics” and assigning skills and licensing on a National level, I’m kind of stuck.

At a recent class a colleague mentioned how he hated the term “EMT-Basic” because it sounded too much like “EMT-Minimum.”  This is the absolute minimum set of skills we think you need to be able to identify a life threatening emergency, intervene as indicated and arrange for a more educated assessment and treatment.

 

Another term that always dig sunder my skin is when we slap the word “Advanced” on the side of our ambulances.  Advanced compared to what?  To the basic?  To the minimum?  Current Paramedics are the advanced version of the minimum required.  Well, 3 is more advanced than 2, but it will never be a 10.

 

So how do we achieve the pinnacle of Professionalism with these outdated inaccurate terms chained to our ankles?

How is it that someone can be content with a certificate or license that uses the term basic?

Imagine you have a plumbing problem in your home and call the plumber.  The person arrives identifies themselves as a Plumber-Basic.  Perhaps they are trained and experienced to handle the problem, but what is our confidence level in that person?  Low, right?  Now what if he arrives and says “I’m an advanced plumber”?  We feel better, sure, but what if he simply arrived and said, “I’m a plumber, what’s the trouble?”

 

As an EMT-Basic I hated having to rely on someone else to come help me with my patients, yet I refuse to seek out additional education above the level of Paramedic because I like where I am.  I get that not everyone wants to raise to the next level, I’m one of those folks, but I wonder if we’re setting ourselves up for most of the problems we’re experiencing.

 

EMT-Minimum and EMT-More than Minimum.

 

We need to get one name and stick with it guys, or this stratification will never end.  Paramedic – Level 1?

But Level 1 is basic, no?  Meets only the minimum.

How about EMT and Paramedic for now and we’ll work on the details later.  The National Registry introduced the non EMT Paramedic requirements, that’s a good first step.  Can we do the same for EMT-Basic? Just drop the basic part?  Can we at least do that?  I don’t like the term technician, but in looking at the standards for EMT-Basic in this country, the term is accurate.

 

What do you think?

-HM

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19 thoughts on “The end of the EMT-Basic?”

  1. Actually Happy, they’re doing just that. In the new curriculum roll-out they’re changing EMT-Basic to “EMT”, EMT-I to Advanced EMT or “AEMT,” and EMT-P to “Paramedic.” Is it perfect? No… but it’s some of the change you’re advocating

    1. However, until that standard is Nationwide and required, we’re stuck hoping folks take it upon themselves to join the Registry.

      1. I wish the Registry would make it easier to update training records. Not all of us work for services who want to affiliate with NREMT. My service just plain doesn’t have the money, and our director doesn’t have the interest. Ergo, no NREMT affiliation, and no way for me to update training to avoid having to take the whole damned test process again.

        1. What do you mean by affiliation with the NREMT? My fire department doesn’t pay any money to the NREMT, but I’m certified through them. I do my state refresher, I accumulate my 48 hours of CEUs and every two years I keep my NREMT patch. The only money paid is the renewal fee, which isn’t much.

  2. It will be years before states agree on a standard terminology despite what the “new curriculum” gang does, but whatever.

    How about a single standard? If you’re going to have plumbers, let’s have a single standard – somebody who can go on a 911 call and handle everything they run in to with state-of-the-art, evidence-based medicine.

    Why do we in the US have the lowest standards of any first-world, English speaking nations? Because we, alone amongst those nations, allow the volunteers to dictate the minimum standard, rather than allowing the profession to set the standard and allowing the volunteers to meet them if they wish.

    I would submit that what we call a paramedic should be the entry level professional standard for those who would provide EMERGENCY medical services (meaning, respond to 911 emergency medical calls as the primary, transport capable responder). Call it something else for non-emergency medical transportation, inter-facility or discharge (non-critical care) transportation, etc.

    1. Skip, I don’t know where you live and work, but up here in Maine, if volunteers were to be locked out of the system, the entire thing would grind to a halt. And before you say you’re not getting rid of volunteers or basics, expecting everyone — volunteers and paid — to meet the same requirements — which would be medic-level, I’m sure — would in fact drive out the volunteers. I, for one, do not have the resources to devote the time to becoming a medic. Nor, for the most part, do the calls in my area require a medic: they’re mostly minor stuff, but still emergencies (as our local PHTLS instructor said last week, BLS saves more lives than ALS). And, just to make matters even more challenging, the communities here in Maine don’t have the resources to support an all-medic system either. If we here in Maine had to meet the same training standards set by folks in DC, NYC or Frisco, we’d be screwed… we just cannot do it. You know, kinda like if we volunteers in Maine got to set national standards: lots of training in hypothermia and frostbite (which would be useful in Phoenix, right?), driving the ambulance through blinding snowstorms, how to determine if a fallow field is suitable for a helicopter landing zone, the morons that clear the lawn mower discharge without shutting off the motor, all that stuff that *we* deal with that you don’t have to worry about in the big city.

      1. I agree with mr618 that there are areas where volunteers are the only viable option and that the system would shut down without them. However, Skip, you’re right that we need to become a profession and set the bar higher. Perhaps the best option is to have the minimum level for professionals be somewhere higher than EMT-B (probably like what Canada has), and then keep EMT as something for volunteers, people who work with EMS but are primarily drivers, firefighters that don’t have medical calls as their primary responsibility but want some training, and police that want additional medical training. Kind of like what CFR is supposed to be, but at a slightly higher level.

  3. What does Licensed Practical Nurse mean or Registered Nurse for that matter? These terms mean nothing unto themselves, but the word ‘nurse’ is clearly understood by the public and politicians. This is a public relations battle more than anything.

    We are paramedics in Canada: Primary Care Paramedic, Advanced Care Paramedic and Critical Care Paramedic. It’s ego that keeps the word ‘paramedic’ as the exclusive property of the holy and enlightened EMT-P’s.

    One thing is for sure: we need to own this. If we want to continue to be treated like the illegitimate child of healthcare or the ugly stepsister of emergency services… just keep on doing what we’re doing.

  4. I believe there are three levels of plumber – apprentice, journeymen, and master. When I call the plumber the call taker assesses the problem with a triage system and then sends the appropriately trained personnel and crew size to my problem. When necessary the plumber can call for additional resources.

  5. Here in Toronto, Canada, as soon as you’re entry level you’re rise through the ranks from Paramedic Level I to Level III. It sounds as simple as that. The only physical difference is the number of bars on your epaulettes, however the knowledge base is substantially greater for Level III. I like this system because Level I’s get the same respect from a panicked casualty at an emergency but can also be differentiated from Level III’s by colleagues in the field. Patients recognize a ‘paramedic’ as a ‘paramedic’. no ‘basic’ bs

  6. I am one of the “Advance-basic’s” they call here in alabam, To me, it don’t make a difference. Most people around here refer to you as a EMT or a Medic. The only thing I like as a Advance is I am able to do a couple more things, But that brings more responsibility. But I reckon’ its good for a newbie like me.

  7. One other problem that will rear its ugly head, regardless of what terminology we choose: educating the public. Currently, a lot of the public refers to EMS personnel collectively as “medics” which is fine by me. BUT, as an EMT-Basic, I have to make sure my patients know that I am not a paramedic, because I don’t want them expecting a level of service or care that I am not licensed to provide (obviously, if the patient needs that level, I’m going to be on the radio asking for a medic response). If we are going to settle on one term, whether medic, paramedic, emergency medical technician, paragod, or veeblefetzer, we’re going to have to figure out some way of differentiating certification levels, unless everyone — nationally — is licensed at the same level (which, as has been pointed out, is not feasible yet).

    1. The public is already set into their terminology, therefore we are the ones that need to be educated, not them. They call us the “medics” yet still have no idea what elvel of service you can provide, not should they need to worry about it. I have never once wondered what the pump rating is on the fire engine nearest my home is, or the clip capacity of the nearest police officer, only that if I need them, they’ll come make things better.
      Now all we need to do is move away from the fee for transport only model and embrace our role as primary care giver to most of America.
      Thanks for reading.

      1. True, but paramedics — in the mind of the public — can do all the Johnny and Roy magic; I want them to know that *I* can’t. Whether it’s right or wrong, the public seems to think that all EMS personnel are paramedics. I’m not sure your analogy using fire pumps is accurate, though… perhaps more along the lines of “do I need a dentist, an endodontist, or an oral surgeon for my mouth problems?”
        Of course, the bit about the police would fit here in Maine: only the State Police and the city cops in the three largest cities are allowed to investigate homicides, and some town PDs are required to turn felony investigations over to the state or to the local sheriff. You would expect the first police officers on the scene to be able to help you, but if they had to wait for felony investigators to show up, you’d be a bit annoyed, right?
        I’m not sure I’m making myself clear, but I hope you get the idea… the public has a fixed image of our abilities, based on the highest rank, which not all of us have achieved.

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