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Old May 12, 2019, 06:08 PM   #36
Senior Member
Join Date: November 18, 2017
Location: Madison WI
Posts: 164
davidsog, I am happy to hear that your buddy survived and that the high initial and continued level of care necessary for his survival was available, but in most cases, that level of care will not be available for most people.

Since I was an EMT (up to intermediate level and was in paramedic training when a family problem interrupted), I can fill you in on that side of it.

First of all, most people are not cut out for emergency medical training of any sort. They don't/can't bring themselves to be near people who are in pain, bleeding or have open wounds etc.. There is also the money and time involved in being trained and the continuing education required after the initial training. In some states, you need to belong to an ambulance service in order to qualify for EMT training. A large amount of money and time is involved as well.

Even trained, certified EMS people have their problems. I had a trained, licensed EMT freeze up when he saw a pool of blood by a patient who had been shot. When I was a crew chief, I had an EMT on my crew tell me that she would not be able to help on a SIDS call (sudden infant death syndrome) because she had had a baby die that way. The first person I never trusted after that, but the second I thanked for telling me beforehand so I wouldn't put her in a situation which would put her in a highly stressful position.

There are many different levels of EMS:

There is first responder level of trained people (Red Cross, Boy Scouts, etc.) who are trained in just the basics of emergency treatment, or the basic ABCs (airway, breathing, circulation). They can clear an airway by pulling the tongue or a foreign object out of the area of the mouth or perform the Heimlich maneuver. They can control bleeding to a certain extent and they can perform CPR (oops, it's now CCR I guess).

Here are the levels of emergency medical responder training levels of various states around the country:

Emergency Medical Responder*
Community Paramedic
Registered Nurse-EMT
Registered Physician Assistant-EMT

Emergency Medical Responder (EMR)
Emergency Medical Technician (EMT)
Advanced EMT (AEMT)
Prehospital Registered Nurse (PHRN)
Prehospital Physician Extender (PHPE)
Prehospital Physician

Emergency Care Attendant
Advanced EMT (formerly EMT-Intermediate)
Licensed Paramedic (paramedic with a college degree)

EMR (Emergency Medical Responder)
EMT (Emergency Medical Technician)
AEMT (Advanced Emergency Medical Technician)
EMT-Intermediate (Emergency Medical Technicial Intermediate)
Critical Care Paramedic Endorsement
TEMS (Tactical Emergency Medical Service Endorsement) Primarily for SWAT teams

As you can see, there are quite a variety of levels of treatment available. In most cases, the needed level of training to keep one of your 7 people alive until they could reach a level 1 trauma center would be probably an EMT Intermediate or above (ALS). I say that because the victim is going to need an IV started at a minimum to stay viable.

In most rural areas, the highest level of training that you are going to find on an ambulance crew will be a basic EMT. The reason is that it costs money to train these people and it costs time and money to keep up their skills. The higher the training, the more money and time involved. Most rural EMS ambulance services can't afford that kind of money. If these services need advanced care, they will ask for a perimedic service to meet them at scene/during transport or, if available, a medical helicopter.

In my earlier post, I mentioned that my service (basic EMT at the time) had a gunshot patient who wasn't seen until the building was cleared and we were called in, which took some time. Even though we had a level 1 trauma hospital within 15 minutes of where we were, and two level 3 hospitals within 5 minutes, the crew chief called in a paramedic unit because of the time situation involved.

I remember reading somewhere/sometime that medics and corpsmen weren't recognized by some states as legal emergency medical providers, even though their training was at a paramedic level or above!

I will continue to say that the 7 victims are not likely to receive the necessary initial treatment they need, nor is there likely to be a level 1 trauma center available to continue the level of treatment needed within the necessary time frame. I know that my remark about the rope breaking could offend some people, but I wanted to make the point that in most instances, those seven people were more likely to die without extraordinary means available, which isn't likely to happen in most areas of the US.

By the way, while I was an EMT, I was able to talk to some ER and ICU nurses. Most of the ones that I talked to said that they would never work on an ambulance! I thought that was pretty interesting.

Again, I am thankful that your buddy was able to get the level of care he needed to survive.
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Last edited by blackwidowp61; May 12, 2019 at 06:15 PM.
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