For a long time now I have been a big proponent of EMT’s fulfilling their role and riding with patients in the back of the ambulance on BLS calls. All the while, most of the dissention has been among those who do not care for EMS and say that the EMT-I’s and Paramedics get paid to ride in the back. I have had long discussions with numerous EMT’s, Medics, and Officers to try and pinpoint what exactly the extra pay that ALS providers receive is for. Some say it is for the certification, others say it is to ride the ambulance. I do not think it benefits anyone to have a Firefighter/Medic ride the ambulance all of the time, and most end up riding the Engine at least 1 day a cycle. Of course if we had an abundance of ALS providers it wouldn’t be a big deal.

In talking with the EMT’s, most will state that they are ambulance drivers. Like I have said before, I have never seen it this way. If you ask many ALS providers they will tell you that the EMT’s should take BLS calls. Other ALS providers seem to be content with taking all the patients.

It seems as though the hospitals demands of nearly all patients having I.V.’s obtained pre-hospital and sometimes even the blood samples drawn makes almost every call an ALS call. The exception being most nonsense “BS” calls we run.

Therefore the system we use has created mostly ALS calls across the board, leaving only the nonsense calls for the EMT’s to ride in with. That is if the EMT knows what they are doing.

I will admit it, I had more experience as an EMT than a Firefighter when I came to Roanoke. I had volunteered as a firefighter for about 5 years, yet worked as a paid EMT in Richmond. Even though I only worked in Richmond a year, which was plenty, I have yet to experience many calls which I ran there on a weekly basis. Yet in Richmond I was an ambulance driver. Yes, I helped with pt. care, and there was a lot more on scene pre-hospital care given than Roanoke. We usually sat on scene for a while taking care of the basics on ALS calls before leaving the scene, whereas in Roanoke the medics usually take care of things en route to the hospital.

So I got experience with being an EMT. When I came to Roanoke, I was stationed at #9. I rode the medic truck a day and a half a cycle, basically every other day unless the other EMT was off and then I rode every day. I took patients in the back whenever possible and I knew what I was doing. If I didn’t I asked the medic, and if I didn’t feel comfortable with the illness/injury, the medic took the call.

The point I am getting to is that it seems as though we are not training EMT’s in Roanoke. It seems as though we are certifying EMT’s and teaching them to drive an ambulance. Then we are expecting them to become ALS providers. It just doesn’t work.

Ask any ALS provider and they will tell you if all else fails when attempting ALS skills to revert to BLS skills. For example if you can’t get the pt. intubated then bag them.

Over time, I have heard nearly every argument on both sides of the fence. I enjoy learning what others opinions are on the subject. I have come to the realization that the Roanoke Fire-EMS Department puts a lot of stock in its ALS providers. That is understandable. However, the emphasis that should be placed on learning the basics as an EMT is nonexistent.

It seems as though the $4000 carrot being waived in the face of these new guys isn’t working either. This blows my mind. I can tell you that if I had it to do over again, I would have gotten my ALS certification. Just think of the money I would be making right now. I have thought for a while that these guys are stupid for not getting it. In my mind there should be a line at the door. Sure there is a downside, having to ride the ambulance more. Unfortunately there is a cap on how many ALS providers we can have. However, I have come to realize that most of these new guys are in over their heads as EMT’s. Many see these ALS providers’ skills, knowledge, and experience and find it overwhelming. They cannot comprehend how they know all the stuff they are required to know. It is because the EMT’s are rushed through EMT class and taught to drive the ambulance. Sure they go to Continuing Education and might further their knowledge, but they aren’t really EMT’s. They are more like first responders, which I believe was a very short and basic class.

I know as I write this that many of you might not agree. Some things going through your head might be that you are a strong EMT, or that you know a Medic that is dumb as hell. I am sure that what I write about true about everyone. We have plenty of competent EMT’s. But how many would be comfortable on a BLS ambulance. That is what I thought. Oops, did I say that. Hang on; I am not advocating BLS ambulances. I think that every ambulance should be ALS. However, that is a good judge of comfort – that EMT’s should be comfortable taking patients in the back of the ambulance on a BLS truck.

Before all of the guys who were blue patches start hollering, you guys should know what I think about that by now.

There are so many other tangents to explore on this situation, some that I have hit on in the past and others I might get to in the future.

I guess my main point is that over the years I have thought that the EMT’s were somewhat at fault for not embracing EMS. That is the case with some who remain somewhat anti-EMS. However, it seems as though the system we have in place has set a precedence which has created EMT drivers.

My last thought is that maybe this is exactly what is wanted “EMT Ambulance Drivers”. If so, then why in the world would we want to take an ambulance driver and turn them into an EMT-I? The phrase that comes to mind is having the cart before the horse. You cannot become a skilled EMT-I if you are not a skilled EMT.