I suppose I should preface this post with a few things before diving into the meat of it. As someone who was away from EMS for almost 20 years the changes in focus and scope of practice have been glaringly obvious. I suppose you could compare my perspective to that of the grandmother who only sees your kids once a year. She raves about how they’ve grown since she last saw them, while you silently wonder if it’s time to take granny to the “wrinkle ranch” as she has surely lost her ability to reason; the kids look exactly the same to you as they always have. Sadly, much like that grandmother also sees how values aren’t what they once were, I too wonder if we haven’t “evolved” in our role so much that we forgot what it means to be an EMS provider.
Because I try to always find the bright side in everything, I’ll start with how much EMS has grown. I work in Colorado which is a pretty progressive state in terms of EMS, from my understanding the scope for a basic here far exceeds what is allowed in other states, I point that out because my scope may be different then that of a basic working somewhere else. Having gone through EMT school twice (damn I never should have let that cert expire) it became clear to me that the “focus” of a basic’s education has shifted from trauma to medical which is a great thing… trauma is easy, medical requires some investigation. The days of “stay and play” at least to the extent they used to be emphasized are long gone – replaced with the correct assumption that the most important thing we can do as pre-hospital providers is deliver our patients to definitive care – preferably with a pulse.
AED’s were bursting onto the scene when I got my first cert, and required a separate 24 hour-long class, AND a separate cert. after successful completion you were an EMT-D. The difference between professional rescuer CPR and lay person was the professional was also taught two person and pediatric/infant CPR. MAST pants are no longer a required skills basics are tested on, replaced by a tool that is more useful to us a glucometer. On my first go round, basics could give O2, ipecac, activated charcoal and oral glucose – period. Ipecac has been removed (as has activated charcoal from our system though still taught). Basic’s can now give aspirin, assist with Nitro, assist with MDI’s, and epi-pens. In Colorado with an IV cert basic’s can also administer D-50 and naloxone, our protocols even allow basic’s to administer albuterol nebs (as a call in). In Colorado basic’s can also take an EKG class, and become certified in EKG, (a useless skill for us other than knowing how to place leads for our paramedic partners (but that’s another story as well) Oxygen delivery has been simplified – we had the nasal cannula, simple mask, partial rebreather and non rebreather to remember flow rates for as well as oxygen percentage delivered by each, these days it’s the nasal cannula, and non rebreather, and if you can remember hi flow O’s for everybody you can pass the test (pointing out how it is not how it should be…. so don’t shoot the messenger)
Oxygen tanks were steel, and the stretcher had to be lowered all the way to ground before you and you partner lifted it from the ground to the back of the rig.
Speaking of partners when I took my very first EMT job doing IFT’s in NY – my partner was a driver, no not a pointed stab at the first responder, he was literally a driver, he didn’t even have a CPR card. In fact, I remember coming up on a MVC and sending him back to the bus for 4X4’s and he asked what those were. :O. While I could be mistaken, I don’t think this occurs anymore, I know here in Colorado it is prohibited by Rule 500.
Getting that first job required no more than a valid certificate, a CPR card and a pulse. Once I got that job, it was there’s your shirt, there’s your driver and your bus, go to work. These days testing – both written and skill – are conducted prior to hiring, then there’s the interview process, followed by an academy, and then a field internship where you are again tested on your specific knowledge of the system you are working in.
For a profession in its infancy I’d say that’s pretty significant change over 20 years… Most of those things can be viewed in a positive light by most providers, although there are folks out there who will dispute basic’s administering fluids, starting IV’s and “interpreting” strips, and some of their arguments are more than just medics being pissed we are playing with their toys.
Sadly, all of the changes haven’t been quite so positive… that’s tomorrow’s post.