Let me set the tone: I've been a basic EMT for 15 years by choice. It's not that I haven't wanted to pursue the "bigger and better" world of wearing a Paramedic patch, and I haven't completely written it off. It's just that I've seen the merit of having well-trained, experienced EMTs complementing the strong ALS system we have in place in our region.
That being said, I'm tired of the "just a basic " mantra that's haunting our EMS systems. At least in New York State, with very few exceptions, all advanced providers must spend some time learning the ropes before earning a Paramedic credential. What bothers me the most, though, is that this is often used as an excuse by EMTs for not knowing or understanding things that purportedly fall out of the scope of their foundational knowledge. For example: when preparing to teach a transition class on cardiology, I was questioned by a few colleagues as to why I was preparing slides with various EKG rhythm strips. I replied that, in my opinion, EMTs should know the difference between a normal sinus rhythm, asystole, coarse and fine ventricular fibrillation, ventricular tachycardia, and pulseless electrical activity (among others). Their reply: "Basics don't need to know that." I asked them to back up their position; they replied that "we're just basics, we're not responsible for interpreting EKGs."
The argument was factually correct, but is this information going to hurt? Is learning something that might be new harmful? Some would say that it sets up unreasonable expectations and that EMTs need to "focus on the basics." In my experience, mixing things up a bit and throwing in some new material is a way to get EMTs more involved and enthusiastic about learning. I also find contradiction in the "basics don't need to know that" routine when the material is being provided by an advanced practitioner, nurse, or physician. In those circumstances, apparently it's okay but not when an EMT wants to teach colleagues the same topic.
The other part of this mantra is "we only really get to work the priority four [strictly BLS] calls alone. Everything else is handled by ALS, so we don't get the experience we need to be better providers." Here, again, I say stop: this is absolutely the best opportunity to gain experience. Truthfully, are we going to "save a life" when transporting a patient BLS? In the physical sense, probably not. But this is where EMTs have the opportunity to hone their interview, assessment, and BLS intervention skills. These are patients who we should be performing detailed assessments on, listening to lung sounds in multiple fields, listening to bowel tones, fine-tuning our blood pressure evaluation skills and learning as much about the human body as we can.
Don't use the "it's only a nausea/vomiting/diarrhea patient" excuse to ignore your patient during transport. Get your BSI on, get your hands on the patient and assess him. You might find that what is causing the patient's bodily dysfunction is completely unrelated to what the patient ate last night. Or in the event of the "simple fall," find during an interview that the patient has been falling more frequently and may be in need of a social intervention to rectify the situation. In these cases, you can certainly "save a life" by taking the short time you have to learn as much as you can about the patient and his or her condition then sharing it with others who have other specialized resources at their dispersal.
Don't think of yourself as being "just a basic." Take the time to invest in your education, attend continuing education, and dedicate yourself to being a clinician instead of a technician. In doing this, you may find greater satisfaction in your position and understand that you are a bigger part of the system than you originally thought.
