Edited Version of July 12, 2000 Transcript
EIIP Virtual Forum Presentation

"Emergency Medical Services: EMT 101"

Warren J. Vaughn
Deputy Director
Dickson County Tennessee EMA

Moderator: Libbi Rucker-Reed
Tennessee Emergency Management Association

The original unedited transcript of the July 12, 2000 online Virtual Library presentation is available in the EIIP Virtual Library Archives (http://www.emforum.org/vlibrary/livechat.htm). The following version of the transcript has been edited for easier reading and comprehension. Typos were corrected, date/time/names attributed by the software to each input were deleted but the content of questions and responses are as stated by each participant. Answers to participants’ questions are grouped beneath the appropriate question to facilitate meaning.


Libbi Rucker-Reed: Welcome to the EIIP Virtual Library!

For the benefit of any first-timers, when you see a blue web address, you can click on it and the referenced Web page should appear in a browser window.

We will start with a presentation, and then follow with a Q&A session for your questions and comments. Right before we begin the Q&A portion we will review the procedure.

Please do NOT send direct messages to the speaker or moderator as it makes it difficult for us to follow the discussion.

Our session today is titled "EMT 101". Background information for today's session may be found at <http://www.emforum.org/vlibrary/000712.htm>.

I am Libbi Rucker-Reed and will be acting as the moderator for today's session. We are very pleased to present Warren J. Vaughn, Deputy Director Dickson Co. EMA and shift supervisor for Dickson Co. EMS who is today's speaker. Warren, please begin.


Warren Vaughn: Thank you. I want to welcome you today to a basic overview of EMT and EMS services.

EMS training in Tennessee consists of four levels: First Responder, EMT Basic, EMT IV and Paramedic. While Tennessee is currently training under the DOT national registry standards in EMT basic and Paramedic it has yet to officially adopt the EMT Intermediate level. A State EMS board member advises that Tennessee is focusing more on Paramedic training rather than the EMT Intermediate level.

First Responders are trained in basic life saving including CPR, bleeding control and basic bandaging. EMT Basic level adds more advanced procedures and splinting, oxygen administration, setting up IV fluids for administration. EMT IV level adds starting an IV and administering IV fluids. Paramedic level adds advanced life saving techniques to include administering various medications and performing invasive therapies necessary for life support.

In Tennessee all training except the First Responder is handled through the two- and four-year colleges, although most are coordinated primarily through the Junior College system. When I started back in the "dark ages", EMT and Paramedic courses were taught through the Vocational System and the only cost was your books (back then about $30.00). The current EMT Basic course is one semester in length. Advancing to the EMT IV level adds another semester to it.

The Paramedic level is in the process of changing from a certificate to a full two year degreed program. Prior to this, depending upon the school where you were enrolled, the certificate path only took one to one and one half years; but the Paramedic student had the option of going on to a degree if he or she wanted to.

EMS students are also taught scene safety, personal safety and blood borne pathogen precautions. Very little time is spent on basic hazardous materials training, although some are shown a DOT Emergency Response Guidebook and some are trained in Haz Mat to at least the awareness level. Hazardous materials are involved in so many incidents now, and with the increased awareness in domestic terrorism not to mention the upsurge of violent acts in general, I feel it is time for EMS and Emergency Management to become better acquainted and begin more cross training.

In Tennessee, primary EMS services are organized into four levels of Certification: A, B, C, and D. An EMS service capable of providing ALS on 95 % of all emergency calls is classified as an A. An EMS service providing only a driver and an EMT Basic for response is classified as a D. Tennessee is in the process of requiring the last few D providers to upgrade. Some services are part of a city or county Fire Department. Some counties contract with privately owned services for emergency response, and some counties have third service providers.

Third service providers are county or city EMS services that are stand-alone - not associated with a fire department at all. The service that I work for is a third service. Although some states may have volunteer agencies that provide primary EMS services, I am not aware of any in Tennessee that do so.

Some local Rescue Squads provide a transport type service such as for doctor appointments and body removal, and some do First Responder community standbys at ball games, races or other local events. Depending on how the local EMS system is structured, some provide extrication, high angle or other rescue, water/dive rescue or recovery, tactical medics, and other specialized capabilities. Libbi's home service in Rutherford County provides pedal medics on bicycles for local events.

Coordination between EMS and other local emergency response agencies is often disappointing. It has been my experience and observation that unless you have Department heads that agree to coordinate and interact together at all times, the EMS provider (EMTs and Paramedics) is left out a lot in training and planning and this is an area where EMS services should aggressively pursue participation.

One thing to remember is Emergency Management/Civil Defense has been around since the 1940's; the fire service since Ben Franklin and law enforcement goes a long way back. EMS, as we know it today, only dates back to the early to mid-1970's - less than two generations! I can still remember the local funeral homes fighting over which one got the next call. In some areas, EMS is still thought of as primarily a pick 'em up and get 'em to the hospital provider. While this is not true in all areas, the feeling does exist in a lot of places. I am still asked by family members (older ones) if someone is going to be in the back with the patient!

I have noticed during exercises that EMS is often relegated to being patient "toters" rather than partners in response, and a lot of EMS services that work as part of the fire service are glossed over when it comes to public awareness or budget concerns - buy a new fire truck but not another ambulance. This attitude can only be changed by education. One mechanism to aid in this understanding is for EMS to be more proactive in presenting what we refer to as "Show and Tells" to schools, civic groups, county commissions and the community. Telling them what EMS is and what EMT/Paramedics can do. The fire service has public education officers, as do a lot of Police Departments. There are only a few EMS providers that do this, but educating the public can go a long way in positive exposure for EMS and EMT/Paramedics.

Finally, I would like to say that I am delighted to have participated in today's program and appreciate your interest by being here today. After Libbi explains the Q&A process, I will be happy to answer your questions. Libbi?

[Audience Questions /Answers]

Libbi Rucker-Reed: Audience, please enter a question mark (?) to indicate you wish to be recognized, go ahead and compose your comment or question, but wait for recognition before hitting the enter key or clicking on Send. Remember, it will take a few moments for the speaker to compose his answer to your question. We now invite your questions/comments.


Ray Pena: Most of our EMS services here in Dane County Wisconsin are volunteer, and retention is sometimes difficult. How about there?

Warren Vaughn: We are pretty much all paid in Tennessee now. Except for the few instances I mentioned above, EMS is not that bad off for help.


Darla Chafin: Do you deal with many severe MR/MH types? With de-institutionalization in ME that's becoming more frequent & I must say the EMTs have been excellent in their approach.

Warren Vaughn: MH we are seeing more of as the state reduces the places where they can stay. MR is not that big of a problem yet.

Darla Chafin: It saves lives but must increase stress on your costs/time.

Warren Vaughn: We have a lot more of them on the streets.


John H.: EMS provider pay is low in California. Do you think that increased educational requirements will result in an EMS provider shortage?

Warren Vaughn: It does. The main problem is where to carry them. We are starting to see that in Tennessee also and we are waiting to see how that plays out. For myself, I see the coming of a shortage in people the next couple of years.


Ray Pena: Did you recently move from a volunteer EMS to paid EMS system? If yes, how was it (the cost) handled politically?

Warren Vaughn: My county has been career since the early 70's. For the areas that have moved from volunteer to paid. It was an uphill fight politically because of the tax hikes involved.


Libbi Rucker-Reed: Given the current national focus on NBC and Terrorism by various agencies, what additional training is needed by EMS/EMT's to be adequately prepared for incidents and where can this training be obtained?

Warren Vaughn: The primary training is in Hazardous Materials. The line folks need that as a good base to build on before they get into the Terrorism classes. Where the training is found? Local Fire Departments, local EMAs and through FEMA's Independent Study Classes.


Ray Pena: Libbi, our office just held a week's worth of Domestic Preparedness Train the Trainer workshops. Some EMTs attended, but not as many as we would have liked, since they are mostly volunteer! All sponsored by DOD (Madison is one of the original 120 cities).

Warren Vaughn: Ray the answer to that is night and weekend classes. I do very little training during the work week here.

Libbi RuckerReed: Ray, I am sure that is the case in many areas where EMS is mostly volunteer.

Ray Pena: For these we had to work with DOD's schedule, daytime, please! Sometimes, it's hard to coordinate!

Libbi Rucker-Reed: Ray, you are right, and that is an issue everywhere when volunteers are involved.

Warren Vaughn: I know. But now you have the people trained to send out to do the local training.

Ray Pena: Warren, Absolutely! And we will.

Cristina Mooney: I took a first responder WMD NBC from our OES and CSTI.

Warren Vaughn: CSTI?


Warren Vaughn: Folks remember that EMS in a lot of areas is still thought of after the fact. You have to remember to include them in your training, planning and what ever else you have going on.

Gary McGinnis: Do the colleges give a break on the cost of their EMT programs? In MD the training is provided free by MFRI.

Warren Vaughn: Not here. It cost the same per semester hour as a regular class does.

That is going to impact our training numbers also.

Gary McGinnis: Very much so.


David Crews: Either presenter: Do you actively participate in the Local EOP ( e.g. writing, review, revisions.?)

Warren Vaughn: I do. I am multi hatted. I work for EMS and EMA. I wrote the last plan we are using.


Vel Stafford: Red Cross used to provide free First Responder training. Is this still the case?

Warren Vaughn: Nothing in Red Cross is free anymore. At least in Tennessee they charge for everything.


Jaroslav Pejcoch: Do you use some Internet-based training or education or certification or do you know about such and activities going on at your sites?

Warren Vaughn: The only Internet training I know of right now is FEMA's and EMI's Independent Study Courses that you can get off their web site.


Gary McGinnis: What are the FEMA/ EMI courses ? Are they EMS or disaster planning?

Warren Vaughn: If you go to <http://www.fema.gov> and look under Mitigation, I think, you will find a link to Independent Study Courses. Disaster mainly. There are a couple of EMS related ones.

[Note: See also http://www.usfa.fema.gov/about/ems.htm and http://www.naemt.org/edu/ for further information regarding USFA and NAEMT EMS-related courses.]

David Crews: <http://www.fema.gov/fema>. Look under Independent Studies


Isabel McCurdy: Warren, what is your active involvement in Tennessee's Emergency Management Association? Are EMS personnel involved or just emergency management people?

Warren Vaughn: I am past president and I have held several committee chairs. There are several EMS directors that are members also.

Final Question:

Dee Beaugez: I am the Project Impact Coordinator in Sparks, NV. We have used part of our grant funds to the Red Cross to offer free training for seniors and other special needs groups. <http://www.disasterplans.com>

Warren Vaughn: That's a great idea, Dee. I didn't know you could use the funds that way.

Dee Beaugez: We set up our MOU to include special needs training to be determined by the committee members.


Libbi Rucker-Reed: It is time we wrapped up for today. Warren, thank you very much for your informative presentation. And thanks to all our participants in today's session

Next week, you are invited to participate in the EIIP Virtual Forum on Wednesday July 19, 12:00 Noon EDT. The topic will be "What Does the Public Need to Know about Drought?" Our speaker will be Dr. Frances Winslow, CEM, Director, San Jose Office of Emergency Services. Please make plans to join us then.

We will adjourn the session for now, but you are welcome to remain for open discussion. You no longer need to use question marks. I hope everyone has a wonderful day!