I work in a system that runs an EMT-enhanced and a Paramedic on the truck. We do not switch out on calls. The EMT-E does not run any calls in. They do not practice to their level. I am not saying that they are not an asset because they are without a doubt. I am saying that they have been given knowledge and then restricted in their ability to care for patients. This has given them no responsibility. Everything is put off on the paramedic. This feeling of no responsibility has given a few of the people I work with the feeling that they can speak to the family and say whatever they choose. They seem to forget that they make no decisions regarding patient care. I believe that this is the problem with giving people more knowledge and then restricting their exposure and decision making skills. They are exposed to the patients that we see but they do not develop any kind of assessment skill. So when I hear them saying things like "oh this person isn't really hurt." When the patient has an obvious orbit fracture or telling the parents of a kid that got hurt playing football that he can go to his doctor and is fine when I want to board and collar the kid makes the Enhanced look bad and makes us as a whole look like we don't have our act together. Plus it breeds discontent between the medics and enhanced guys when we have to correct them or contradict them. Unfortuantely it happens in front of people because they are talking to our patients or their families.
The only way I can think of to curb this is to give them the responsibility of being AIC. Make them decision makers and make their jobs depend on it like ours do. Allow them to practice at their level. If we can't do that then we don't need Enhanced providers. I can start my own IV's and give my own meds. Let them be EMT-B's and they can function as they do know minus the IV/med administration skills.