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.