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EMT-B, EMT-A and Paramedic what's the difference?

Discussion in 'First Aid Station' started by smellypaddler, Nov 14, 2010.

  1. medic2807

    medic2807 Loaded Pockets

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    If you have insurance, they usually pay if they cover ambulance. If you have medicare (old people) or medicaid (poor people) they will pay. In a motor vehicle accident, the auto insurance pays. If you are in a car accident that is not your fault or if you are hit by a car, the other person's insurance is supposed to pay. If you don't have insurance the ambulance service will try and collect the money somehow-either have you on a payment plan or put the bill into collections. Many ambulance services eat a ton of cost on transports. Hospitals do, too. Our 25 bed hospital does 5 million dollars in charity care per year. Many volunteer ambulance services (basic life support) will just take what they can get. We have a disproportionate number of patients who qualify for medicaid but don't put in the time to get on the system, for whatever reason.
    And some ambulance services transport for free. An example would be Maryland State Police air ambulance. They don't charge for transport and are taxpayer funded. They are one of the best flight services in the country, so if you are gonna wrap your car around a tree, do it in Maryland.
     
  2. Flight-ER-Doc

    Flight-ER-Doc Loaded Pockets

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    Why would he want to reduce torts? His largest groups of supporters are trial lawyers and those on welfare.
     
  3. smellypaddler

    smellypaddler Loaded Pockets

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    Thanks guys, it's good to know how other systems work. It obviously gets a bit complicated with a country the size of the USA and the different states and counties having different rules. Australia is a large country and although hospital care is uniform throughout the ambulance services differ between states and territories. The difference is that we only have 8 different states and territories. The state I live in has an ambulance insurance membership scheme running where you pay your $60 per annum and you are covered for any ambulance care. If you don't have ambulance membership they will try and charge the patient directly. Queensland has a completely different scheme where there is a surcharge on your electricity bill that is used to pay for the ambulance service.
     
  4. Buckaroomedic

    Buckaroomedic Loaded Pockets

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    smellypaddler,

    You're right, it is a very complicated system in the US because there is no nation-wide standard system. EMS is different in every state, and sometimes very different within states, from county to county and city to city. Texas, and a couple of other states, now have "licensed" paramedics. This licensure requires a two year degree in EMS/paramedic, or a four year degree in anything else plus the state approved paramedic course. Although the licensed paramedics don't make anymore money than certified paramedics, I do see this as a positive trend in American EMS. With degrees backing-up paramedics, we will eventually become more accepted by other degreed, medical professionals.

    Not to "toot my own horn", but I wrote a couple of articles on becoming an American EMT for another web site. Here's a link: http://www.deathvalleymag.com/2010/06/05/medical-medic-101-how-to-become-a-medic/

    And: http://www.deathvalleymag.com/2010/06/16/medical-medic-201-how-to-advance-my-training/

    Hope this helps.

    Take care,
     
  5. ObiHann

    ObiHann Loaded Pockets

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    In Canada we have First Responders (St John Ambulance, Fire, etc), then Primary Care paramedics (first level of a paramedic), an Advanced Care Paramedic (cardiac drugs and lots of fun stuff) than one more level I can not think of at this time (CCP - critical care paramedic maybe?) which would be part of groups like a helicopter paramedic group.
     
  6. stevem174

    stevem174 Loaded Pockets

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    Hey Doc, this might be a State to State term issue but......

    In 1988 when I first got into EMS in IL, there were EMT- A (Ambulance) EMT-I (intermediate) EMT-P (Paramedic)

    There are now EMT- B (basic) EMT-I and EMT-P.
     
  7. Flight-ER-Doc

    Flight-ER-Doc Loaded Pockets

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    Trying to standardize the terms....

    California, for instance, had more than a half-dozen different kinds of EMT - EMT (Ambulance), EMT (Fire), EMT (Lifeguard), EMT (cop, but they called it something else), an EMT that was the same as ambulance but no ride-along training, etc.

    Now its just EMT(basic)
     
  8. Rich

    Rich Loaded Pockets

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    This is what's on the horizon, for those who really care and want an inane level of detail: National EMS Scope of Practice Model. This is a NHTSA (US DOT) publication posted on the NREMT website.

    EMT-B, EMT-A, and Paramedic, the National EMS Scope of Practice Model likes to call these: EMT, Advanced EMT and Paramedic. A basic synopsis of what this skill levels are is as follows:
    EMT - basic level skills/interventions
    Advanced EMT - all of those above plus high frequency/low risk advanced skills (IV, esophogeal airway device, BG chem reading/D50 administration, SpO2/med-neb, nitoglycerin and aspirin, etc)
    Paramedic - all of those above plus higher risk/liabilty skills (ET intubation, cardiac rhythm interpretation and treatment/cardiotonic medications, needle thoracostomy, needle cricothyroidotomy, etc)
    Now California has basically adopted these skill sets.

    On a slight tangent:

    Page 14 of this PDF has an overly detailed description of the "relationship among education, certification, licensure, and credentialing". Basically the main point here is that to practice as an EMT or a Paramedic one should be educated, certified, licensed and credentialed. This means you took an EMT class or went to paramedic school (education), then you took the national registry exam or another exam to prove your competence (certification), and your state gave you the legal ability to stick needles into people, or at least drop an OPA (licensure); these acts would otherwise be quite questionable when inflicted on an unconscious person in the back of a van. Credentialling could be as simple as a handshake with your new medical director/the head of your EMS agency, or could include a period of review/evaluation post-licensure.

    And it isn't just EMTs/medics most healthcare providers need to have completed all of these requirements, for example, I would bet that Flight-ER-Doc went to medical school (education), applied to the state for a license (licensure), and has a bunch of fancy letters like FACEP or FACS after the MD in his name (board certification), finally I'm betting that he has what are called "privileges" at the hospital he works in (credentialed). Confused yet? Good! Because even if a state calls licensure a certification, it is still licensure.
     
  9. flymd

    flymd Empty Pockets

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    Come on guys - look at the data. CBO estimates that limiting malpractice liability would save 1/2% of total health expenditure. And several other studies have suggested that there is no significant difference in spending between states with and without tort limits.
     
  10. filjos

    filjos Loaded Pockets

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    To add to the confusion, the NREMT is no longer referring to the level below EMT-B as "First Responder", and now calls them EMRs, or Emergency Medical Responders". So we have EMR, EMT-B, EMT-I85, EMT-I99, and EMT-P. But my state doesn't recognize EMT-Is of any kind, so instead we have EMT-B's that get varianced to do IV's and other advance care, and the ambulance services refer to them as EMT-I, even though the state board won't.
     
  11. don Roberto

    don Roberto Loaded Pockets

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    Citation needed.

    Look, I have buckets of respect for your professional skills, but this kind of claim needs a lot of support. I realize I'm reviving an old thread by referring to a tangential subject, but I find this kind of claim highly implausible, barely relevant, and mildly offensive.

    Full disclosure: I voted for Obama twice, once because of what he said, and the second time because (although I was a lot more skeptical) the other guy was worse. I'm the first to admit that Obama has been an utter train wreck on civil liberties, for all the good he's done elsewhere, but Romney would have been a train wreck on just about everything. If people want to see better presidents, the Republicans need to start fielding better candidates. If they don't, then the Democrats don't need to field a better candidate than Obama, so they won't.
     
    Last edited by don Roberto, Jan 27, 2013
  12. ShadowE

    ShadowE Loaded Pockets

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    :eek:

    Sent from my Mobile Command Center via Tapatalk II
     
  13. don Roberto

    don Roberto Loaded Pockets

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    I just logged on hoping no one had replied, and I could just delete my post, but apparently ShadowE went and got all efficient and stuff. So now instead of deleting, I'm going to apologize for threadjacking and an unnecessarily political post. I should not have let myself go off on a SIWOTI tangent. Conversations like that rarely end well.
     
  14. Medic715

    Medic715 Loaded Pockets

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    It all depends on where you're from. An EMT-B (Basic) will have a greater scope of practice in NH as opposed to PA due to the vast rural communities. In PA, the EMT-B is really basically trained in splinting, bandaging, spinal immobilization, basic first aid care, and recognizing the need for further ALS (Advanced Life Support) interventions and assisting a Medic in such ALS skills.

    Paramedics in PA have skills including:
    • IV's
    • IO's (Gaining venous access through the marrow cavity in the bone via a drill-type tool)
    • The ability to interpret EKG's
    • Electric therapy (Defib, synchronized cardioversion, and cardiac pacing)
    • Administration of nearly 30 different meds (most of which have standing orders and no need for orders from a doc)
    • Intubation
    • Placing surgical airways
    • Needle decompression of tension pneumothorax
    As of right now, we don't have an EMT-A (Advanced) or EMT-I (Intermediate, same as Advanced). But legislation was passed several years ago to develop those programs. They will have some of the skills as a medic but not all. I'm not 100% sure, but I believe their scope of practice will be limited to IV's, first line drugs, and advanced airway adjuncts such as a King LT or CombiTube.