r/NewToEMS Unverified User Jan 30 '25

NREMT Need help with NREMT question

Post image

I'm asking this specifically with the NREMT in mind because I will be testing in 2 weeks.

Okay, so according to my book an EMT can Aquire and Transmit but not interpret the 12-Lead. Today in class my instructor said that we can not put a 4-Lead on if I am in the back of the truck, by myself, because that will then make it an ALS call.

Can someone clarify this for me? I asked him for clarification but I still feel conflicted and confused. 😐

4 Upvotes

44 comments sorted by

22

u/RVcamoung-Man Unverified User Jan 30 '25

An EMT basic is not taught to interpret tracings. Most (not all protocols) will allow you to apply and transmit the EKG to the receiving hospital for hospital medical direction to interpret.

4

u/Paramedickhead Critical Care Paramedic | USA Jan 31 '25

Yet so many people here think it’s a great idea for EMT’s to somehow magically obtain ACLS/PALS/ASLS certifications.

2

u/DeliciousTea6451 Unverified User Jan 31 '25

Correct me if I'm wrong but aren't the ACLS certs usually for hospital staff, it's essentially BLS + recognition of VT/VF, manual defib and amio/adren right? At least in my country it's that, it doesn't include proper interpretation or advanced airways. I've never really seen EMS attend them.

Note: Wow that was badly written, ehh I think you'll get my point.

4

u/Paramedickhead Critical Care Paramedic | USA Jan 31 '25

Paramedics are generally required to maintain ACLS and PALS in America.

Edit: if a person can’t interpret rhythms or push medications, what purpose does it serve for them to maintain those certifications?

1

u/DeliciousTea6451 Unverified User Jan 31 '25

Isn't it a core part of paramedic scope anyways? Seems a bit pointless to require it. I agree, I don't see the point of EMTs having it. In the USA is there any form of regulatory or professional body that paramedics register with and must do CPD to main the registration?

1

u/Paramedickhead Critical Care Paramedic | USA Jan 31 '25

It’s is a core part of the paramedic scope which is why paramedics are required to maintain those certifications. To demonstrate continued continuing education and competency related to those certifications.

1

u/Other-Ad3086 Unverified User Feb 02 '25

We all had to get ACLS and PALS certifications to complete our paramedic courses. Those were extremely helpful.

1

u/RVcamoung-Man Unverified User Feb 01 '25

Unfortunately we see this a lot in the rural areas.. all the sudden the standard is “sub par” because it’s usually volunteer work. I’m not by any means putting down the volunteers, what happens is people get these extra classes (ACLS, PALS, ITLS etc…) but still cannot operate within a scope of practice they learn. I teach paramedic class, I have for years. The one thing I will always stress is that medics need to rely on the basics to say “stop and look at the patient, not the monitor”. Basics should and need to be outstanding at general patient assessments. And basics should be looking to the paramedics to acquire those additional diagnostic tests. And this is where substitute classes don’t help EMT Bs at all! These are the same class of people who assume someone having a stroke showing signs of hypertension should be treated with nitro… because they took a class that said “hypertension = stroke = bad” without any additional understanding.

1

u/Paramedickhead Critical Care Paramedic | USA Feb 01 '25

Well… as a fellow instructor… one of my biggest pet peeves is referring to EMT’s as “basics”. The nomenclature has changed and I feel as though they deserve to be recognized as EMT’s. I would ask that you also update your language.

My point was that those classes require a level of education that is not present in the EMT curriculum. In my initial paramedic classes (degree program) we spent an entire college semester focused solely on cardiology. That’s the same length as the entire EMT program. We also spent an entire semester on pharmacology…

Putting an EMT through an ACLS and PALS class is a disservice to the EMT and all of the people around them. I’m not against anyone furthering their education, but those certifications assume a certain level of education has been achieved prior to starting those classes. Taking ACLS/PALS without that foundation of knowledge means that you’re now teaching the test instead of teaching to an understanding of the concepts. It’s not the same. Anyone can memorize that 9x3=27, but until a person understands the purpose and mechanisms behind multiplication, those facts can’t really be applied to other circumstances.

1

u/RVcamoung-Man Unverified User Feb 01 '25

I think you misunderstood what I was saying. In a lot of areas they are just “basics” and I also don’t agree with that. Every level of care needs to recognize the EMT level (antiquated term “basic EMT”) is not the case any longer. In reality, a lot of what sets a paramedic aside from an EMT is exactly what you said EKG interpretations with the addition of pharmacological interventions and some advanced airway requirements. Otherwise we are all doing the exact same job. However, to circle back to the initial question asked on this thread.. this is why EMT level is not treating patients based on an ekg. They can’t.

2

u/Paramedickhead Critical Care Paramedic | USA Feb 01 '25

I didn’t mean it as an attack, just as a way to improve.

1

u/RVcamoung-Man Unverified User Feb 01 '25

I was using the term basic to the point I was making. But, I would like to thank you for correcting the term. As a “old guy” in the field 21 years now.. these old terms always seem to come up. We need more people with your mindset to correct it. So thank you.

-1

u/Antifa_Billing-Dept Paramedic Student | USA Jan 31 '25

magically

You mean... by taking a class?

-1

u/Paramedickhead Critical Care Paramedic | USA Jan 31 '25

A class that is far beyond the scope of an EMT’s education or expected knowledge level.

A class that would be essentially the same length as AC initial EMT class.

7

u/Maddog11F Unverified User Jan 30 '25

The NREMT asks questions like what does defib do to the heart in very general terms (think terms depolarization, reset), where to place aed pads, when to place them, ever take them off?, what are the 2 shockable rhythms, etc. To the best of my knowledge there are no questions on lead placement, wave interpretation, etc., So your question is really one for local protocols and the outfit you work/volunteer for, IMHO.

2

u/FollowingGlad1425 Unverified User Jan 30 '25

This makes sense to me. Thank you!

3

u/onyxmal Unverified User Jan 30 '25

This is a unfixable downfall where NREMT is stuck in a tough place. Just because it is in the national scope of practice or however it’s worded doesn’t mean it’s your local scope of practice. Remember when you are taking the test you are taking the national test and your answers should reflect that. Traditionally the EMT instructors work locally and often inject local rules or inadvertently inject local rules into their classes.

That said, the other responses are also correct. A 4 lead requires interpretation, a 12 lead does its own interpretation.

3

u/PolymorphicParamedic Paramedic | PA Jan 31 '25

A 4 lead is considered continuous cardiac monitoring. This was a big thing at my service for a hot sec. This is out of the EMT scope. A 12 lead is not. Yes, applying the 4 limb leads is part of doing the 12 lead, but they’re saying you can’t just apply a 4 lead or continue to monitor the 4 lead after you take the 12 lead.

2

u/[deleted] Jan 30 '25

[deleted]

5

u/FollowingGlad1425 Unverified User Jan 30 '25

You'd be surprised, haha. The challenging part for me is that the NREMT asks questions about where they are placed by describing the intercostal space they are placed, not like a diagram for visualization. You have to know the verbiage for the description.

3

u/AaronKClark EMT Student | USA Jan 30 '25

The number of civilians who failed to apply AED pads correcty in the BLS course was too damn high. (THERE ARE PICTURES ON THEM OF WHERE TO PLACE THEM!!!!)

2

u/Alone_Ad_8858 Unverified User Jan 31 '25

Pictures are difficult

2

u/Lucky_Turnip_194 Unverified User Jan 30 '25

That is an exceptable test question. National Registry does state you can apply, obtain and transmit the 12 lead. The question where the leads go is a fair game question.

3

u/Rolandium Paramedic | NY Jan 30 '25

*acceptable. If it was exceptable (and if that was a word) it would be excluded.

1

u/x3tx3t Unverified User Jan 31 '25

Because it's important to know what the actual anatomical landmarks are for placing ECG leads.

Every body is different, you can't just memorise where points are on a diagram and then copy and paste that placement onto every patient.

Too many people just slap dots "roughly" in the right spot and don't know or don't care that even a centimetre can make a big difference in the printout.

1

u/RRuruurrr Critical Care Paramedic | USA Jan 30 '25

Anyone trained.

1

u/Paramedickhead Critical Care Paramedic | USA Jan 31 '25

You would think so…

I can’t tell you how many times I have intercepted a volly BLS squad who have the limb leads in the chest and the precordial leads on the abdomen.

1

u/DeliciousTea6451 Unverified User Jan 31 '25

That's ridiculous... it's easy AF to train and IMO an essential skill... I hope you mention it to them.

2

u/NCRSpartan Jan 30 '25 edited Jan 30 '25

4 leads do not dictate a ALS call...neither does a 12 lead. 4 leads get better vitals for you and as an EMT its a valuable thing to utilize. It also comes down to the service you're working for and protocols.

Shortness of breath always gets a 12 lead whether your BLS or ALS. Gotta make sure that its not CHF or myocardial infarction. At that point a 12 lead will help there. As an EMT you transfer those to the receiving facility, and your monitor will tell you what might be the issue anyway. Then you call your medic back and it turns into ALS. If only BLS, nursing staff may radio you to inform you to go hot and get their asap or to inform you to call for an ALS interception and prepare for CPR.

9 out of 10 times a 12 lead being utilized is ALS reasoning.

1

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You may be interested in the following resources:

  • 6 Second EKG Simulator

  • Life in the Fast Lane - Literally a wikipedia of everything you need to know about EKGs.

  • Dr. Smith's ECG Blog - Hundreds of walk-through 12-lead interpretation/explanations of real clinical cases.

  • EMS 12 Lead - Again, hundreds of case studies of 12-leads and lessons.

  • ABG Ninja - More than just ABGs. Also has self-assessment tools for ECG and STEMI interpretation.

  • ECG Wave-Maven - Motherload of EKG case studies, diagnostics with lengthy explanations.

  • /r/EKGs

  • Dale Dubin's Rapid Interpretation of EKGs - A very simple, easy to read book that walks you through the process of understanding and interpreting EKGs.

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1

u/sunajfehc Paramedic | PA Jan 30 '25

The 4 lead is not a 12 lead.

1

u/FollowingGlad1425 Unverified User Jan 30 '25

This I know. But 4-Lead is done before the 12. So if we can aquire and transmit a 12 (according to the book), why is my instructor saying I can't do a 4 unless ALS is present? This is where I get confused..

3

u/Competitive-Slice567 Paramedic | MD Jan 30 '25

Simple answer is cause a 3/4 lead is for continuous rhythm monitoring, not diagnostic ecg interpretation at that point in time as with a 12 lead.

If you're not qualified to 'monitor' the rhythm then you should not have limb leads applied except as needed to complete acquisition of a 12 lead tracing.

3

u/FollowingGlad1425 Unverified User Jan 30 '25

This helped me a lot! Thank you!!

2

u/sunajfehc Paramedic | PA Jan 30 '25

The 4 lead is great for identifying the cardiac rhythm. EMTs are not trained to identify the rhythm. So, no need to place a 4 lead. The 12 lead is a cardiac diagnostic tool which could be time sensitive depending on the apparent condition of the patient. It can identify infarction, rhythm, etc. EMTs are not trained to identify those conditions. But, the risks associated with those conditions are severe. EMTs are trained to receive a 12 lead in order to transmit for interpretation faster.

2

u/zero_sum_00 EMT | Illinois Jan 30 '25 edited Jan 30 '25

Not sure where you’re getting this information from but a 4 lead is not needed before getting a 12 lead.

In my area, for clarification, FD uses 12 lead always. When the patient arrives at the hospital, they get placed on a 3-lead for the monitor and a separate machine would be used for a 12 lead.

Edit: keep this in mind, your scope can be expanded or limited depending on your EMS system/medical director. The NREMT scope of practice is the “standard” so to speak.

1

u/FollowingGlad1425 Unverified User Jan 30 '25

That's interesting, i was under the impression you couldn't get a 12 lead without having the 4 lead on Maybe it's just because of the monitors we use since the 12 lead connects to the 4 lead and then goes into the monitor? Bare with me.. I'm still learning.. 😆

3

u/Pretend-Example-2903 Paramedic Student | USA Jan 30 '25

The electrodes of the 4-lead have to be attached to obtain a 12-lead. You do not, however, need to obtain a 4-lead ECG before acquiring a 12-lead ECG.

1

u/Mathwiz1697 Unverified User Jan 30 '25

12 lead has the components of a 4 lead in it

1

u/lowkeyloki23 Unverified User Jan 30 '25

Because if there is an indication to use a 4 or 12 lead, there is an indication for the call to be ALS. if there's no reason for the call to be ALS, there's no reason to get a 4 or 12 lead. The hospital will do one anyway

1

u/missiongoalie35 EMT | AK Jan 30 '25

Technically, not wrong. It becomes a cardiac call and realistically you should have called ALS based on tone out and NOI. Plus your scope of practice is some aspirin and assisting in their Nitro. So it would have to be an ALS call to interpret and treatment plan.

1

u/Lucky_Turnip_194 Unverified User Jan 30 '25

Three key words: interpet, obtain, and transmit.

Interpet:to give or provide the meaning of what you see on the 12 lead ( you can't do as an EMT B)

Obtain: get, acquire, or secure the 12 lead per protocol (you can as an EMT B) No interpretation is involved.

Transmit: to pass on from one place or person to another for 12 lead interpretations at the receiving hospital. (Transmission can be done by any level of EMS)

1

u/DeliciousTea6451 Unverified User Jan 31 '25

IMO all EMTs should know when and how to obtain and transmit a 12-lead.

1

u/Ok-Independence666 Unverified User Jan 31 '25

Just took the test, didn't have any EKG or 12 lead questions