Roles

In one of the comments for a previous post, I was asked about paramedics who can arrange drugs. As I thought about answering why paramedics are really not equipped to do this, I realised that for a lot of people there is still some confusion about the ambulance personnel job titles and roles.
I then found out that my job title is no longer EMT, but is now EMT-3, which is a nice Christmas present… So here is a quick rundown of some of the job titles for those of us working on the road.

Note, this may be wrong, and I accept feedback – it's just how I see things, and the roles seem to be changing every day

EMT-1 – Trainee Emergency Medical Technicians, basically while you are still in training school doing your 20 weeks of classroom learning you are an EMT-1. In London they wear attractive blue boiler suits, which make them look like Kwik-fit fitters. They aren't allowed to even touch a patient without an EMT-3 or higher standing behind them.

EMT-2 – '80 percenters', when you come out of training school and go on the road for the first time you used to be known as an 80 percenter, this is because you only get paid 80% of your proper wage – suposedly to pay the firm back for the cost of your training. You are expected to do the same role as an EMT-3, but for this first year on the road you aren't allowed to crew up with another EMT-2, you also can't go on the rapid response car, attend football matches or do any of the juicy training courses like the Decon team. Other than that you are fulfilling the same job role.

EMT-3 – Yours truly. After a year of being an EMT-2, you sit an exam (the 'Millers' exam), and run through a few more assessments – if you pass then you become a fully fledged EMT-3. The biggest change is that you suddenly get a pay rise of 20%. This is really nice. You also then start getting crewed up with EMT-2s who you are supposed to supervise.

EMT-2/EMT-3 have a number of drugs that we can give, these include Aspirin, Salbutamol, Epinephrine (for allergic reactions and severe asthma), Oxygen, Hypo-stop, Glucagon, Paracetamol, Entonox and GTN. Some of these are prescription only drugs, that we give according to our guidelines training. We are also trained to defibulate people in cardiac arrest, perform CPR with adjuncts and mop up vomit from the back of the ambulance. We will also be giving Narcan soon, as soon as we get certified for it.

Paramedic – Paramedics are EMT-3s who have an extra year of experience, then go on a course that is hideously oversubscribed. the course is residential and lasts (I think) 10 weeks. At the end of the course they can cannulate, and intubate people who have no gag reflex (in practice, this means dead people), but they cannot induce unconsciousness to intubate someone (RSI). They have all of the EMT-3 drugs at their disposal and a few extra ones like Narcan, Atropine, Epinephrine (for cardiac arrests), Benzylpenicillin, Diazepam and Tramadol (for pain relief, they used to use Nubain). They can also infuse a limited number of substances like Ringers lactate and Glucose 5%. For this they get paid around an extra £40 a week. One of the better things that they can do is halt a resuscitation attempt, something that EMT-3's can't do.

Paramedic Practitioner – This is a new role that will see highly trained paramedics covering 'green calls' – they will be trained to do such things as stitch wounds, stop ambulances from coming to people who don't need them, arrange social services/district nurses and arrange GPs prescriptions. The training goes on for ages and there are only a few of these service wide at the moment. They have been created so that we can provide cover now that GP's no longer have to attend patients 'out of hours'. They are going to get paid a lot of money when our new pay deal goes through. They work on their own.

Rapid Response Unit – EMT-3s and Paramedics can drive one of these accident magnets – the idea is to get to a patient within 8 minutes, realise that the job is complete crap and then hold the patient's hand until the ambulance gets there. If the job is genuine, then they can start basic treatment early and then wait for the ambulance to turn up. They are brave souls who race around the streets of London alone, in the dark… Or have a sleep on the sofa on station because their dispatch desk has forgotten about them.

Intermediate Tier – These are people who have had some basic first aid training, so that they can do the 'green' calls that some EMT's and above think are beneath them. these would include taking Doris into hospital for her appointment and GP urgent calls. Considering that it is a common occurrence that I end up 'blueing' in a GP 'urgent' case – I feel sorry for these folks. they also get paid a lot less than the rest of us.

HEMS Paramedic – The Helicopter Emergency Service has a Doctor and a Paramedic assistant. The paramedic carries the bag with all the emergency kit in it.

We then go onto management – but to be honest I have no idea what any of them do, and the job titles seem to change every six months – so the less said about them, the better. There are also the support roles, like the blokes who keep the ambulances on the road, admin staff, training staff, etc… And that is without counting the lovely people from Control who send us on jobs, and always seem apologetic when they know a job is a load of crap.

15 thoughts on “Roles”

  1. Very interesting. You guys have added an extra level to the three basic levels we have here – EMT-3. Our basic recognized levels are EMT-Basic, EMT-Intermediate, and EMT-Paramedic.Basic = EMT-1

    Intermediate=EMT-2 with the addition of D50 and Patient assisted MEdications (ie the pt's own NTG and ASA). The also get Cardiology and defibrillation.

    Paramedic – You EMT-P as well. All the drugs, offline protocols, etc.

    The roles here are also being changed currently. Within a few years there will be a recognized Advanced Practice Paramedic who basically does what your PP's do now.

    On a side notw, currently I actually fill that role offshore, but since it's not an actual nationally recognized “level” yet I am titled a Paramedic with Advanced Clinical Practice – ie I took an extra course to do what I do. Oh, and those skills are only recognized by my offshore service. I can't use them anywhere else.

  2. “We are also trained to defibulate people in cardiac arrest.'Won't they need their fibulas when they're discharged from the coronary-care unit?

    Part of me thinks I shouldn't be sarcastic in my first comment about your fascinating blog, but another part of me whispers `You're a sarcastic git – why fight it?'

    Seriously, I found your pages when considering working for my local Trust (Westcountry), and you haven't put me off yet. Thanks, and keep writing.

  3. Reading between the lines, there will be less need for EMT's as NHS has found a way to be efficient and realized they can save mucho dinero by turning over ambulances quickly.”..Ninety-six per cent of patients are seen within four hours in accident and emergency departments and 99 per cent are offered an appointment with a GP within two days………that no patient should wait more than six months for hospital treatment by December 2005 – which was once dismissed by critics as a pipe dream..”

    http://news.independent.co.uk/uk/health_medical/story.jsp?story=589602

    no more excuses 3 patients a shift?

  4. Just out of interest, whats the approx ratio of paras to techs in LAS? How many of your front line motors are usually para and tech crewed (as opposed to double tech) and how may of your frvs are paras?Up our way all the cars are para's (bar one tech) but probably about 80%+ of our motors are double tech crews.

  5. Could I ask, what is Epinephrine?, is it what I know as Adrenaline?Also, whatever happened to Aminophyline for asthma.

    I realise I am well out of date, so please humour(or should that read humor) me.

  6. Hi,Thats usefull information for those of us on the other side of the pond. I've met a few people from that side through BUNAC and i can practically here the London accent. Anywho, you'll be blogrolled in the real near future when i get around to an update. I'm located over at http://www.iwt.blogspot.com. And the writer for somethingpositive lives just a few miles from me.

    Take care.

  7. It's interesting, that while I could do certain things in the hospital as a nurse (simple stuff as well like cannulation) I can't do it 'out on the oad' – yet I can prescribe drugs that I couldn't do as nurse.It's fun having two roles jostling in my head – and it surprises some nurses when I know more about a bit of kit, or a disease than they do – because I'm 'only' an ambulance driver.

  8. I would say (and I have no official figures here) that it is about 40% paramedic to 60% EMT's. That's just on the sector that I work on, it may be wildly different elsewhere.

  9. E.U. directive four-nine-teakettle-niner made us change the names of various drugs that we use, adrenaline becoming epinephrine, frusemide becoming ferusimide, lignocaine becoming lidocaine. and various others.It's purely optional to say them with an American accent like on 'E.R'.

  10. The real news in the story is that GP referrals are still rising, by 1.7 per cent last year, which represents the increase in the need for hospital healthcare. Without an increase in units and beds the system will collapse, one of the reasons why long term care in the community is so popular with the government at the moment.But… as I mention in the posts around this one – the quality of care in the community is of varying standards…

  11. Aminophylline treatment for asthma (in the emergency sense, restricted to IV administration) is something purely for the A&E because of the risk of cardiac arrythmias, or at least that is the thinking over here.Generally we can keep people alive using Salbutamol nebulisers and if serious enough, with a shot of epinephrine. Anyone that is having a serious asthma attack needs to be in hospital rather than sitting in an ambulance while you try to start an IV line and mix up the drug. One of the bonuses of working in London is that we are normally very close to a hospital. (5 minutes by blue-light).

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