EMT-B, opinions, advice?

[davemata]

As part of my desire to be more survival situation ready I'm registering for an EMT-B course. I'm planning on doing this, then the Wilderness First Responder course. Does anyone have any comments on the value of the EMT-B, or any suggestions for learning material? I've taken an anatomy class but that was geared towards art, and was 5 years ago at this point, so I'm pretty much a newbie.

Thanks.

 

[FSTC]

I think its a good start. Look up Professional EMS in Cambridge, I think they run a B program

 

[coastie]

I think it all depends on where you take it. I took mine in Boston in 01-02. Basically they taught us to stabilize someone, get them in the truck and get to a hospital. I was disappointed. I would have liked more on caring for the patient and addressing injuries. I imagine if I were to take it in a more rural area than I would get more of that as they would be further from a hospital. I got my ticket and didnt do anything with it so it expired. I am taking the Wilderness FA course in March. I am looking forward to it.

 

[Knuckle Dragger]

Boston EMS runs a very excellent EMT-B course once or twice a year. It's also very affordable.

First Response out of Norwood or Stoughton also does a good job I've heard.

 

[SSW]

I think its a good start. Look up Professional EMS in Cambridge, I think they run a B program

They did in the past, but stopped. PCFM teaches only the Paramedic program.

 

[BradM]

EMT-B is a good class, but pretty basic. Lots of good common sense reminders though.

 

[davemata]

I need to start somewhere Brad.

From the EMT-B though, if I didn't want to go with paramedic related knowledge, but something more appropriate to rural/ search and rescue skills would there be a step prior to WFR?

coastie - do you think what you learned would be helpful for you if you were basically unsupported and needed to stabilize someone or even perform basic "field care"?

 

[SSW]

It all starts with great Basic skills, whether you never use them or move on to be a Paramedic, Nurse or Physician.

The skills of the EMT-Basic can be succesfully applied with what ever you may have at hand and yes these skills can and will, stabelize a patient, prevent worsening of an injury and in fact save lives.

Paramedics, Nurses and Physicians rely on technology, pharmacology and yes basic skills to do our job.

Because of thier dependance on technology and lack of prehospital "survival skills" the worst place for a Nurse or Physician is commonly (not exclusively) out in the field. This is in no way a negative statement about RNs and MDs, we all have our place in the continum of care.

So IMHO if you are looking to be prepared for the worse case scenerio, where all you will have are your wits and the debris that surrounds you. The skills of the EMT-Basic are best tools you can have.

My .02


Everything in medicine, EVERYTHING relies on strong Basic skills. So again IMHO getting your EMT-B whether you earn a living with it or not this knowledge will do well by you at some point.

Sorry if this sounds preachy, I would love to see the EMT-B program offered in high schools, at a minimum CPR should be mandatory core content.

 

[Mass-diver]

Because of thier dependance on technology and lack of prehospital "survival skills" the worst place for a Nurse or Physician is commonly (not exclusively) out in the field. This is in no way a negative statement about RNs and MDs, we all have our place in the continum of care.

Everything in medicine, EVERYTHING relies on strong Basic skills. .

Excellent post. Very true IMO. I'm just curious, at what level do you guys learn IV skills? I think everyone should know CPR - but if we are talking about treating serious injuries in the middle of nowhere, being able to start an IV is pretty darn important.

In terms of a reliance on technology, speaking for myself, I get nervous intubating people outside the OR ( like in the ICU or on the floors), never mind out in the woods somewhere, so I think there is some truth to your statement there as well.

 

[SSW]

snip I'm just curious, at what level do you guys learn IV skills? I think everyone should know CPR - but if we are talking about treating serious injuries in the middle of nowhere, being able to start an IV is pretty darn important.

In terms of a reliance on technology, speaking for myself, I get nervous intubating people outside the OR ( like in the ICU or on the floors), never mind out in the woods somewhere, so I think there is some truth to your statement there as well.

IV's in Massacusetts are taught at the Intermediate and Paramedic Level. The Intermediate level may or may not be morphed into the Basic. I think it should be, but that is just me. I know the Nationa Registry is redefining the EMT Levels and IIRC Intermediate is gone. But check on that.

As far as Endotracheal Intubation, in some cases Intermediates in Massachusetts can perform this skill. ETT placement is a fundamental skill for Paramedics. With technology we have real-time waveform capnography to confirm ET placement along with the more conventional means. So an ET can be placed without a lot of technology, but in this case I think the more the better. A goose tube does not bode well for anyone

 

[Mass-diver]

With technology we have real-time waveform capnography to confirm ET placement along with the more conventional means. So an ET can be placed without a lot of technology, but in this case I think the more the better. A goose tube does not bode well for anyone

I assume it's cost prohibitive for you guys to have video scopes? I probably use the glidescope once or twice a week. With some models having a very long battery times - it would be an awesome tool for you guys to have in the field.

Lots of the CRNAs I work with have pre-hosptial backgrounds and I'm always asking them about their (airway) war stories: bloody blind nasal intubations, needle crics, retrograde wire intubations etc - very cool stuff.


As I always post in these threads (and I mean it very sincerely) God bless all you EMTs and paramedics - you guys are doing a very tough job that very few people could do...Keep up the good work!

 

[SSW]

I assume it's cost prohibitive for you guys to have video scopes? I probably use the glidescope once or twice a week. With some models having a very long battery times - it would be an awesome tool for you guys to have in the field.

Lots of the CRNAs I work with have pre-hosptial backgrounds and I'm always asking them about their (airway) war stories: bloody blind nasal intubations, needle crics, retrograde wire intubations etc - very cool stuff.


As I always post in these threads (and I mean it very sincerely) God bless all you EMTs and paramedics - you guys are doing a very tough job that very few people could do...Keep up the good work!

Your right the Glide Scopes are pretty much $$$ wise out of the question, but a good alternative is an Airtraq it is a prism based system with a fiberoptic light at the distal end that reflects back through the prisms to an eye piece. Kind of like a periscope.

You clamps a 7.0-7.5 ETT in the slot visual ise the cords and pass it. Any debris becomes an issue, but over all at $67.00 each not bad for difficult airways. In our district we still do nasal tubes as well.

I am guessing you must work in anesthesia in the OR, critical care or the ER???

 

[Chris]

The WFR course is good. The most important part is the "it might be hours before you get to civilization"

For example, my local EMS is prohibited to treat burns. Seems some idiots began putting on cream before they stopped the internal burning and basically insulated the furnace. So, because of that, they leave the damaged skin open to infection, or pad and strap it. Guess how much damage you do removing gauze from a burn wound after an hour....

You'll also learn about Quick Clot (also not allowed by my local EMS)

Spenco Second Skin? Local EMS - NO, WFR - Great stuff!

But a lot of the class is understanding how systems work and what you need to do to stabilize and keep a person alive for a long extraction, or until the body can begin to heal itself. So much of the extended care is simply not addressed in any standard class.

The downside is the recert. I managed to keep mine current for 8 years and then I just could not make one of the full weekend courses. Now I'd have to go for the full week course again. I have two young kids - guess what the chance of doing that is now...

But, you know what? In a real emergency, will the person worry if your papers are in order? There are some very good wilderness medicine books out there. While it should be handy for reference, you HAVE to read it. You have to become familiar with the basics and learn what to look for when things are not 'simple'.

The hardest part is getting scripts for even basic items. Add to this the fact that I would prefer 'pure' drugs rather than mixes makes it even worse. I prefer Oxycodone without the tylenol in it. Why? Because I'd try the tylenol first and don't need to OD anyone when it isn't enough and have to reach for the more powerful stuff. I want Codeine Sulfate instead of a cough medicine with codeine. Why? Nobody makes a sugar free cough medicine with codeine and the last thing you want to do to a diabetic when they are sick is spike their blood sugar.

Z-Pacs are expensive compared to more generic selections, but the easy doses make it much simpler to use. The expiration seems to be longer too. (but keep some more generics on hand because you can't use them for kids)

Anyway, regardless on what course you take (and do take some basics so you can get some hands on instruction - quite a few things do not translate well to print) get a good wilderness medical manual and READ it.

I don't recommend you go practice medicine based on just book learning, but when things are "not normal", your prep can literally be the difference between life and death.

 

[Mass-diver]

Your right the Glide Scopes are pretty much $$$ wise out of the question, but a good alternative is an Airtraq it is a prism based system with a fiberoptic light at the distal end that reflects back through the prisms to an eye piece. Kind of like a periscope.

You clamps a 7.0-7.5 ETT in the slot visual ise the cords and pass it. Any debris becomes an issue, but over all at $67.00 each not bad for difficult airways. In our district we still do nasal tubes as well.

I am guessing you must work in anesthesia in the OR, critical care or the ER???

I've used airtraqs - they work OK IMHO. I'm spoiled in the OR as the glidescope is pretty much always available. Sometimes I look with a different blade or use a bougie, but most of the time I have a low threshold for just using the glidescope.

I mostly do elective cases at a couple of hospitals around the Boston area. Once in a while I end up going to a code in the ICU or on floor and tubing someone. While I had did some trauma as an RN, and a good deal while I was in nurse anesthesia school, these days I see very little, but I still try to stay current.

 

[OCB]

I was in a similar situation to the OP. I wanted to have the skills in case I ever needed them, not necessarily because I was going to work in the field. A lot of the information you get in the Basic class is valuable and definitely worth knowing. One of the things that I've done in the process of meeting my continuing education hours over the years is to seek out classes like wilderness first aid and other classes that are more advanced that what I'm technically allowed to do as a Basic (such as advanced airways). I won't be legally allowed to use these skills if I were working, but if the SHTF, I'm glad I know how to place an ETT, combi-tube, king airway, etc.

 

[OB1Kenobi]

CPR, 1st responder, first aid or EMT is a great skill to have IMO.

The only issue would be the upkeep of your credentials via continuing Ed if you choose to maintain it.


If you have friends in EMS / Fire, you might get a heads up on free classes. Patient assessment and trauma are my personal favorites... Vs. ass aches. .

Good EMT's and medics develop a sixth sense. It's a great skill to have.

 

[KMM696]

One of my brothers got started with a Wilderness EMT-B course (IIRC, somewhere in NH). Covered EMT-B and wilderness medical, and taught out in the woods, too. I can't remember the specifics, but if anyone wants me to ask him where he got the course let me know. Might take a bit, he's a paramedic in Denver now and works some goofy shifts.

 

[davemata]

Good EMT's and medics develop a sixth sense. It's a great skill to have.

If it's anything like a nurse's, it's a scary skill to have. My mom can know a lot of things about a person's health and can anticipate what they are going to do within moments of meeting them. Saved her ass in a couple situations, and helped her save more than a few lives.

KMM696- that would be great to find out if your buddy would be willing to share a program name.

 

[KMM696]

If it's anything like a nurse's, it's a scary skill to have. My mom can know a lot of things about a person's health and can anticipate what they are going to do within moments of meeting them. Saved her ass in a couple situations, and helped her save more than a few lives.

KMM696- that would be great to find out if your buddy would be willing to share a program name.

Finally heard from him:

http://soloschools.com/

Solo in conway nh. Intensive emt program. 5-6 days a week. Awesome instructors. They do a wilderness extension if a evening part time regular emt class makes more sense.