# ALS Sleepover



## alphatrauma (Jun 28, 2009)

This verbiage seems to get tossed around whenever the "accelerated program" or "medic mill" threads pop up... I'm just curious as to what exactly  an ALS sleepover is, and why the negative connotation is justified.


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## medic417 (Jun 28, 2009)

It means you are just doing hours not doing patient care so clinicals benefit you 0%.


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## VentMedic (Jun 28, 2009)

I use the term because some medic mills hook up with FDs to get more of their students pushed through their programs quickly. Some will use ALS engines and allow them to do a full 24 hour shift. At a slow suburban station, that is a "sleepover" but the number of hours still count toward the completion of the program. 

Another term often used is "coffee clinicals". The hours are being accrued while sitting around the coffee pot.

Florida has had to emphasize that an engine is NOT an ambulance. 
http://www.fl-ems.com/July2008Newsletter.pdf

As a response to several inquiries
made by educators regarding
paramedic field internships on
Advanced Life Support (ALS)
engines, please refer to the following
information:
Section 401.2701(b)2, Florida
Statute, requires the field internship
experience be aboard advanced
life support permitted
ambulances. The statute reads as
follows:​ 

_*Paramedic*_ 
_*programs must provide a*_ 
_*field internship experience*_
_*aboard an advanced life support*_
_*permitted ambulance.*_​

_Section 401.23 Definitions:_​

_(5)"Ambulance" or "emergency_
_medical services vehicle" means_
_any privately or publicly owned_ 
_land or water vehicle that is designed,_
_constructed, reconstructed,_ 
_maintained, equipped,_ 
_or operated for, and is used for,_ 
_or intended to be used for, land_ 
_or water transportation of sick or_

_injured persons requiring or_
_likely to require medical attention_
_during transport._​​


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## alphatrauma (Jun 28, 2009)

Ahhh... so in essence, FDs can use the "star of life" (slapped on an engine) in order to circumvent/facilitate meeting required field hours. Interesting


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## VentMedic (Jun 28, 2009)

alphatrauma said:


> Ahhh... so in essence, EDs can use the "star of life" (slapped on an engine) in order to circumvent/facilitate meeting required field hours. Interesting


 

ALS engines are very common first responders in many parts of the country. However, they do not transport and those Paramedics will often return to service when Rescue or an ambulance with Paramedics arrive. However, there are situations where the transport is a BLS ambulance and the Paramedic from the engine will have to ride in to the ED on the ambulance. That may take the engine out of service as well as the ambulance.

The best clinical experience it the one that allows for the most patient contact be it "BLS or ALS".


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## Sasha (Jun 28, 2009)

Sleep overs aren't necessarily bad. If you have are suburban stations you never know when calls will come in and being at the station all day iNcreases the chane of patient contact


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## Ridryder911 (Jun 28, 2009)

So let me see if this is correct. Students get to sleep on their clinicals?


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## medic417 (Jun 28, 2009)

Ridryder911 said:


> So let me see if this is correct. Students get to sleep on their clinicals?



All quality programs that I am aware of fail you immediately and remove you from the program with no refund if caught sleeping during internship.  If it gets slow you should be studying if all station chores are complete.


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## Sasha (Jun 28, 2009)

medic417 said:


> All quality programs that I am aware of fail you immediately and remove you from the program with no refund if caught sleeping during internship.  If it gets slow you should be studying if all station chores are complete.



Seriously, you can only study for so long, and if you're there for 24 hours you are expected not to sleep? Wow, talk about a dangerous drive home.


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## daedalus (Jun 28, 2009)

medic417 said:


> All quality programs that I am aware of fail you immediately and remove you from the program with no refund if caught sleeping during internship.  If it gets slow you should be studying if all station chores are complete.



I would certainly hope not! 
Sleeping is a natural and needed body function and those who do 12 and 24 hour shifts with their preceptor certainly are going to fall asleep many times during their internship. Like sasha has said, one can only study for so long, and plus, I am not paying for school to clean someone else's station beyond the messes I create and to help out with some daily cleaning.


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## Ridryder911 (Jun 28, 2009)

Sasha said:


> Seriously, you can only study for so long, and if you're there for 24 hours you are expected not to sleep? Wow, talk about a dangerous drive home.



Hence, why you should not be doing more than 12 hour clinicals. You are a student and the only role is to be a student. Down time should be studying and reviewing. 

I agree, sounds like a cheesy way to get more hours without substance. 

R/r 911


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## Sasha (Jun 28, 2009)

daedalus said:


> I would certainly hope not!
> Sleeping is a natural and needed body function and those who do 12 and 24 hour shifts with their preceptor certainly are going to fall asleep many times during their internship. Like sasha has said, one can only study for so long, and plus, I am not paying for school to clean someone else's station beyond the messes I create and to help out with some daily cleaning.



I once did at a station that was slow and expected you to only study when not on calls, couldn't even help with cleaning. By the end of my 9th hour of studying, we got a call. I was so mentally overloaded, had the biggest headache ever, that the call was a complete waste because I did not learn a thing. Needless to say I never returned to that station.


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## Sasha (Jun 28, 2009)

Ridryder911 said:


> Hence, why you should not be doing more than 12 hour clinicals. You are a student and the only role is to be a student. Down time should be studying and reviewing.
> 
> I agree, sounds like a cheesy way to get more hours without substance.
> 
> R/r 911



So, what is the difference between doing a 24 hour shift and two 12 hour shifts with no patients? You are still getting credits for the hours regardless.


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## daedalus (Jun 28, 2009)

Ridryder911 said:


> Hence, why you should not be doing more than 12 hour clinicals. You are a student and the only role is to be a student. Down time should be studying and reviewing.
> 
> I agree, sounds like a cheesy way to get more hours without substance.
> 
> R/r 911



I agree, but for the schools that do require you to be placed on a 24 hour shift with your preceptor, I would hope some sleep is involved.

Now, if we compare EMS clinicals to clinicals for RNs or other professionals, we can see our weakness. An RN student will see many patients during just a few hours, and will be constantly working. An EMS student will maybe see one patient in a few hours.


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## medic417 (Jun 28, 2009)

daedalus said:


> Sleeping is a natural and needed body function and those who do 12 and 24 hour shifts with their preceptor certainly are going to fall asleep many times during their internship. Like sasha has said, one can only study for so long, and plus, I am not paying for school to clean someone else's station beyond the messes I create and to help out with some daily cleaning.



On a 24 I could see allowing sleep.  On a 12 dismissed, if you can not stay up 12 hours you are either coming in after to much partying or not healthy enough to be in EMS.  Show up professionally dressed, well rested, ready to work.  

As to cleaning, if a student cleans w/o being asked the student will find the crews will look for ways to get you your skills.  If you just show up they will just run call like normal and not let you do extra stuff, making the internship even less educational than many already are.


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## medic417 (Jun 28, 2009)

Sasha said:


> So, what is the difference between doing a 24 hour shift and two 12 hour shifts with no patients? You are still getting credits for the hours regardless.



We do not count hours alone.  You must get the skills as well in order to complete the course.  I am aware of students getting 5 times the required hours before completing.


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## Sasha (Jun 28, 2009)

daedalus said:


> I agree, but for the schools that do require you to be placed on a 24 hour shift with your preceptor, I would hope some sleep is involved.
> 
> Now, if we compare EMS clinicals to clinicals for RNs or other professionals, we can see our weakness. An RN student will see many patients during just a few hours, and will be constantly working. An EMS student will maybe see one patient in a few hours.



An RN does clinicals in a hospital where there are always patients... that is hardly comparable.


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## Sasha (Jun 28, 2009)

medic417 said:


> We do not count hours alone.  You must get the skills as well in order to complete the course.  I am aware of students getting 5 times the required hours before completing.



I got most of my skills checked off in the ER, saved for a few specific ones, so I don't really see the difference between a 24 hour clinical and two 12 hour clinicals if they have ER clinicals and get their skills checked off there.


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## medic417 (Jun 28, 2009)

Sasha said:


> I got most of my skills checked off in the ER, saved for a few specific ones, so I don't really see the difference between a 24 hour clinical and two 12 hour clinicals if they have ER clinicals and get their skills checked off there.



We require interns to actually see and treat XX number of patients on the ambulance with at least XX requiring ALS interventions at the Paramedic level. 

The interns have another set number of hours, skills, patients required in the various hospital departments.  

Some can be combined at school discretion to get the required amounts.


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## Ridryder911 (Jun 28, 2009)

Areas that have a history of low call volume should be discouraged or did away with. Coffee clinicals only have a point if there is time to study. You are there as a student not employee. Even though you should have some of the same responsibilities, you still are in the student mode. 

Minimum number patient contacts is great, but should again emphasized minimum and should as well have hour(s) attached. I will refuse 24 hour clinicals at my service (yes, we do 24 also) the crews need some down time from students too. 

I still wonder why the emphasis of "cramming" is so necessary within EMS? What is the hurry and bypassing the whole purpose of learning and absorption of material? We rush through material and we see the final product? 

Is what we doing working? Obviously not. 

R/r 911


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## rmellish (Jun 28, 2009)

Ridryder911 said:


> Minimum number patient contacts is great, but should again emphasized minimum and should as well have hour(s) attached. I will refuse 24 hour clinicals at my service (yes, we do 24 also) the crews need some down time from students too.
> 
> R/r 911



Yeah, I think we had student riders every shift I worked for an entire month, gets sorta old when it's a new face every time.


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## WolfmanHarris (Jun 28, 2009)

medic417 said:


> All quality programs that I am aware of fail you immediately and remove you from the program with no refund if caught sleeping during internship.  If it gets slow you should be studying if all station chores are complete.



All quality programs? What a blanket statement to describe an equally broad stroke disciplinary process. If you have a student on clinical that you as an educator are trusting with patient contact and to be an active member of a crew, should you not leave them to make their own decisions about how best to use their time while on rideout.

For example, I napped between calls (as did my crew) on night shift. Some days I studied all shift, some days I kicked back and read a book or watched tv on downtime. The point is my academic performance was, and should be my responsibility.


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## WolfmanHarris (Jun 28, 2009)

rmellish said:


> Yeah, I think we had student riders every shift I worked for an entire month, gets sorta old when it's a new face every time.



Students in my program were assigned a set preceptor for their entire semester of consolidation. I think that's essential to providing consistent feedback at developing the student. It also allows the student to build a trust and rapport with their crew, allowing them to function with greater independence.


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## alphatrauma (Jun 28, 2009)

Interesting path, this topic has taken. I think the field rotation model needs some serious adjustment. I started this thread while on a 12hr field rotation (still here) and only responded to 2 calls in the past 10hrs... one was a refusal. This morning, when checking in for my station assignment, the Battalion Chief asked me if I was sleepy. I replied no, he says "that's too bad, because you could get plenty of it where you're going". I get placed at the slowest station in the city. I am NOT washing an engine , and I am NOT studying for 12hrs. I might as well have been sleeping, considering how productive my day has been. And don't get me started on the apparent apathy of some of these so called firemedics they allow to precept.


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## Sasha (Jun 28, 2009)

> On a 24 I could see allowing sleep. On a 12 dismissed, if you can not stay up 12 hours you are either coming in after to much partying or not healthy enough to be in EMS. Show up professionally dressed, well rested, ready to work.



There were students in my program who worked two jobs to go to school and had a family. Sometimes they could fit in the clinical between job 1 and job 2 with maybe 2 hours of sleep inbetween. 

In a perfect world, clinicals could be done with the opprotunity to sleep a full 8 hours prior to, but it's not a perfect world. If the LT and preceptor had no problem with the student catching some sleep because they are running themselves ragged to go to school, then it should be up to them. Like Harris said, academic responsiblity lies on the student, not everyone else, to make sure the student studies.


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## medic417 (Jun 28, 2009)

WolfmanHarris said:


> Students in my program were assigned a set preceptor for their entire semester of consolidation. I think that's essential to providing consistent feedback at developing the student. It also allows the student to build a trust and rapport with their crew, allowing them to function with greater independence.



I would disagree.  By having multiple approved preceptors you get a more well rounded educational experience.  Perhaps the first few intern shifts have same but after that various preceptors so you see different styles and also get additional feedback.  Each preceptor will have some thing they feel is most important and will miss other things.


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## SurgeWSE (Jun 28, 2009)

alphatrauma said:


> I am NOT washing an engine



Why?

I don't think it's unreasonable to ask students to help out with the daily station stuff or extra chores that come up.  I don't get paid extra to teach an intern, feed them, or do all of the extra documentation, so it's not asking a lot to have them grab a brush or help carry out some garbage.  Obviously, I'm not going to demand that someone come out and help me Ajax bay floors, wash/wax back-up apparatus, or work on large projects, but I'll certainly think more of them as a person if they do it voluntarily.



WolfmanHarris said:


> Students in my program were assigned a set preceptor for their entire semester of consolidation. I think that's essential to providing consistent feedback at developing the student. It also allows the student to build a trust and rapport with their crew, allowing them to function with greater independence.



I like that approach, but think there needs to be some vatiety.  I can give much more constructive advice to students I've had 10+ times because I know of what they are capable, where they're weak, and I can follow their progress.

As for sleeping, if they're in for 24 hours, they should grab sleep when they can.  I'll trade machismo for an alert student any time (plus, I'm not going to sleep until they do and I'm gonna need a nap somewhere between 0100 and 0600)

I don't like the idea of "hours" based internships, especially in a low volume area.  I would be interested to know if any schools require a certain number of patient contacts, contact hours, or the like.  Yes, it sucks that some people will have to ride more than others to finish the requirements, but that's the nature of the beast.


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## ResTech (Jun 28, 2009)

I see no problem with 24 hour or overnight clinical shifts. I don't ever do them however. The most I do is 10hr shifts and am busy with calls the entire shift. 

Do you guys do hospital clinicals as well? I haven't heard ne one mention in-hospital clinicals. We are required to do the majority of time in the ED and more field time towards the end. Of course, we are allowed to do as much field time as we like. We do ED clinicals 
which is where I hooked up with this awesome RN who loved to teach and she was core in me becoming efficient with my IV and med admin skills.

If I was left to strictly field time I would have administered 75% less meds and had the same less IV sticks.  And we do time in the OR, Respiratory, Phelbotomy, ICU, Peds unit, Bayview Burn Center in Baltimore, and a few other departments I cant recall off hand. 

What do other Paramedic programs require for clinicals?


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## MSDeltaFlt (Jun 28, 2009)

medic417 said:


> I would disagree. *By having multiple approved preceptors you get a more well rounded educational experience*. Perhaps the first few intern shifts have same but after that various preceptors so you see different styles and also get additional feedback. Each preceptor will have some thing they feel is most important and will miss other things.


 
If we're discussing Eutopia, then I would say students should rotate through preceptors on a monthly basis; no sooner.  Give the preceptor and student time to adjust to each other.  Different people have different teaching styles and different learning styles/needs.  But, hey, this isn't a perfect world and paramedic schools don't have 6 mos to a year's worth of ride time like they should.


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## medic417 (Jun 28, 2009)

ResTech said:


> I see no problem with 24 hour or overnight clinical shifts. I don't ever do them however. The most I do is 10hr shifts and am busy with calls the entire shift.
> 
> Do you guys do hospital clinicals as well? I haven't heard ne one mention in-hospital clinicals. We are required to do the majority of time in the ED and more field time towards the end. Of course, we are allowed to do as much field time as we like. We do ED clinicals
> which is where I hooked up with this awesome RN who loved to teach and she was core in me becoming efficient with my IV and med admin skills.
> ...



Actually Sasha myself and maybe someone else mentioned briefly hospital internships.


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## Ridryder911 (Jun 28, 2009)

As Clinical Operations Manager, I have found students sleeping. Sent home immediately, failed their clinical for the day and notified school not to send student again; if re-occurrence again will consider cancelling contract with them. Sorry, they are representing the school and on calls both the employer and the school. 

I am not responsible for their personal life. They are students, they are there to learn, monitor, participate in emergency responses. They are not there to take naps, sleep; if they want to do that then do it on their own time. Want to be hired someday, then one better participate in crew activities such as washing trucks, cleaning, etc. Yeah, things like that get noticed. 


I have developed a Preceptor/Student program this week. Outlining what exactly will be expected, tolerated on both sides.

I am consulting with all the metro schools, in developing this program as we have an increase in problems with maturity of being on time, napping, not being prepared, etc. Remember, the clinical site should be considered similar to if you are working there, your professional aptitude is being watched and evaluated as well. 

The Paramedic shortage is now over and I have a line of EMT's wanting to get their foot in the door. Not only is clinicals an excellent place to obtain and gain knowledge it is also a great way for employers to monitor perspective employees. 

R/r 911


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## Sasha (Jun 28, 2009)

> the clinical site should be considered similar to if you are working there,



People who work at the clinical site get to sleep.


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## Sasha (Jun 28, 2009)

medic417 said:


> Actually Sasha myself and maybe someone else mentioned briefly hospital internships.



Personally I liked hospital clinicals more than ride alongs and did as many as I could. Personally I learned more in the hospital from better educated professionals than I did on ride along clinicals.


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## AnthonyM83 (Jun 28, 2009)

Ridryder911 said:


> So let me see if this is correct. Students get to sleep on their clinicals?



Los Angeles schools send their students on 24 hour shifts with their preceptors. One of the reasons is almost every single 911 provider in Los Angeles has 24 hour shifts. Part of it is preparing the student to learn in the environment he'll be working in. Can they do an assessment at 3 AM?

So, during the day, they mainly study. Whether they participate in chores or other activities is completely up to the preceptors. Some will stop them and send them back to study because that's what they're supposed to be doing. Some will let them do some chores. Some let them work out after a few shifts if there's no problem areas. 24 hours is a long time to study non-stop and starts becoming counter productive.

Of course at some of the busier stations, you hardly get the option of sleeping because of sheer call volume.


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## AnthonyM83 (Jun 28, 2009)

Sasha said:


> Personally I liked hospital clinicals more than ride alongs and did as many as I could. Personally I learned more in the hospital from better educated professionals than I did on ride along clinicals.



I think I was one of the few who really liked clinicals. It was great. You could get 40 patient contacts on a busy day! And you could take your time doing full assessments, family history, all the little diagnostics, percussing, etc. Like a playground. So many chances to practice your IVs and even occasional intubations. Of course now that internship has started I have to start toning it down a little...being more concise and such.


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## alphatrauma (Jun 28, 2009)

Ridryder911 said:


> Want to be hired someday, then one better participate in crew activities such as washing trucks, cleaning, etc. Yeah, things like that get noticed.
> R/r 911



I have absolutely NO interest in becoming a firefighter, so I won't have a problem there. 

They (firefighters) get paid a very generous amount of money to watch the grass grow, work out, watch Sports Center and eat. They can wash their own vehicles.... or better yet, get the FNG to do it.


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## VentMedic (Jun 28, 2009)

alphatrauma said:


> I have absolutely NO interest in becoming a firefighter, so I won't have a problem there.
> 
> They (firefighters) get paid a very generous amount of money to watch the grass grow, work out, watch Sports Center and eat. They can wash their own vehicles.... or better yet, get the FNG to do it.


 
And EMS also stands for Earns Money Sleeping.    We've had threads here where some have listed their calls for a 24 hour shift as EMT(P) and some are over worked doing 2 calls.  

When was the last time you have ran into a burning building?


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## Jon (Jun 28, 2009)

I did about 200 extra hours in clinical - partially because I was doing sleepover shifts. There was no ruling from my course director - I just did it.

My school allows overnight clinicals at one station that is moderatly busy and hospital based - and no one sleeps. Overnights at other stations must be approved by the course director and the station ALS coordinator - There have been allegations of a few previous class members getting a little TOO friendly with their preceptors.

One of my preceptors only works 6p-6a. I would run 6p-12m, then go home. When I came in the next shift, he'd tell me of the 3am call they had that he wanted me to be there for. He told me to start running overnight with him.

I started running overnights and caught some "good" calls. Yes - I sleep some shifts... but I also will stay up and complete paperwork immediatly.

They have a place in some situations - and I still ran more calls than many of my classmates.


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## WolfmanHarris (Jun 28, 2009)

alphatrauma said:


> I have absolutely NO interest in becoming a firefighter, so I won't have a problem there.
> 
> They (firefighters) get paid a very generous amount of money to watch the grass grow, work out, watch Sports Center and eat. They can wash their own vehicles.... or better yet, get the FNG to do it.



Do you not have base duties where you work? At my service we are responsible for cleaning the truck at the end of each shift, weekly deep clean, keeping the crew room and garage clean, keeping our equipment stocked, etc. This is part of the job and having professional pride.

But I feel like we're digressing from the topic at hand a bit too much.

Ryder, I assume that these students taking part in clinical rotations with your service were given a clear set of expectations that precluded sleeping? That being the case, I obviously have no problem with them being sent home. My issue was whether these sorts of requirements are necessary or worthwhile in field placement program. As I stated before, I feel that an approach that treats the student as an adult and allows them to chose to study during their shift or not is more appropriate. A student who takes their education seriously will make good use of their time with or without such a requirement and one that doesn't will look for ways around regardless.


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## alphatrauma (Jun 28, 2009)

VentMedic said:


> And EMS also stands for Earns Money Sleeping.    We've had threads here where some have listed their calls for a 24 hour shift as EMT(P) and some are over worked doing 2 calls.



That's wonderful and the answer would still be NO. Got time to Earn Money while Sleeping? Good, wake up and clean your own ****... I'm there to learn, not clean floors or wash trucks. That fratboy hazing crap is for the birds, and I won't put up with it. No station Capt or crew should ever expect it, or think badly of any student who doesn't acquiesce to it. *Put me on the payroll, and that's another story*. Don't want to hire me because I won't polish your station... oh well.





VentMedic said:


> When was the last time you have ran into a burning building?



Funny you should ask that... because I've asked quite a few firefighters over the past several weeks the same question. Their answer is the same as mine... _*never*_.

I digress... I need to check my stocks, as I think the price of tea in China has fallen.


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## TransportJockey (Jun 28, 2009)

I'm wondering if some of you are confusing a night 12 hour shift with a full 24 hour rotation. Personally I hated being with fire on 24s for my first internship. Now that I'm on the 1945-0745 shift with a private company, I'm back to loving it


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## medic417 (Jun 28, 2009)

alphatrauma said:


> That's wonderful and the answer would still be NO. Got time to Earn Money while Sleeping? Good, wake up and clean your own ****... I'm there to learn, not clean floors or wash trucks. That fratboy hazing crap is for the birds, and I won't put up with it. No station Capt or crew should ever expect it, or think badly of any student who doesn't acquiesce to it. *Put me on the payroll, and that's another story*. Don't want to hire me because I won't polish your station... oh well.
> 
> .



We are not talking hazing we are talking being part of the team.  In fact on the grade sheet the preceptor uses it asks if you participated with the team.  So you being rude and refusing means you failed clinicals thus failed the class.


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## Ridryder911 (Jun 28, 2009)

alphatrauma said:


> That's wonderful and the answer would still be NO. Got time to Earn Money while Sleeping? Good, wake up and clean your own ****... I'm there to learn, not clean floors or wash trucks. That fratboy hazing crap is for the birds, and I won't put up with it. No station Capt or crew should ever expect it, or think badly of any student who doesn't acquiesce to it. *Put me on the payroll, and that's another story*. Don't want to hire me because I won't polish your station... oh well.
> 
> 
> 
> ...



I wish you luck, because I believe you will need it. I don't work for fire service but you are there as in the same role as your preceptor. You think your too good to do the job? 

Slacking off on clinicals is a good way to judge the work habits of potential employee. You slack off and have an "attitude" I can guarantee you that you can kiss your career aspects good bye. There are many out there that will and can do the job without the attitude. 

Remember, the time to shine is when you are on clinicals. If it is part of the job and the crew is performing it, chances are the student should too. Many of the recommendations for employment occur while students are on clinicals. Nothing like being black balled before entering the workforce.

R/r 911


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## alphatrauma (Jun 28, 2009)

WolfmanHarris said:


> Do you not have base duties where you work? At my service we are responsible for cleaning the truck at the end of each shift, weekly deep clean, keeping the crew room and garage clean, keeping our equipment stocked, etc. This is part of the job and having professional pride.



I do have duties at my place of employment... and I get PAID to do them. We do not ask students/interns who come through for clinicals to clean or take the trash out, or look at them as potentially not worthy of hiring if they don't offer. That's B.S. on so many different levels.


*Ultimately*

I think the whole ALS Sleepover is much to do about nothing. so a student has an overnight/24hr field rotation and could "potentially" be sleeping during some of it. Does that mean the student gets nothing accomplished or is any less capable than someone who sits awake for 12hrs and gets no calls? How do we know that the student wasn't running 18 of those 24hrs and got no sleep? There are too many variables involved to conclusively come up with any concrete/definitive answer.


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## VentMedic (Jun 28, 2009)

alphatrauma said:


> Funny you should ask that... because I've asked quite a few firefighters over the past several weeks the same question. Their answer is the same as mine... _*never*_.


 
Is this a volunteer thing? 

There are situations where FFs do go into buildings to rescue people. A couple of recent nursing home fires have been examples of that. I also just watched the news and saw where FFs were able to get a handicapped person out of his burning apartment. If FFs are properly equiped, they will see that everyone is out of a building if it is at all possible. Those that know their job will not just stand on the curb watching the pretty flames.

When I was a FF, that was one of the things our training prepared us and like it or not, sometimes one had to enter a burning building to get someone out.


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## alphatrauma (Jun 28, 2009)

Ridryder911 said:


> I wish you luck



Thanks, but I don't believe in luck.  




Ridryder911 said:


> Slacking off on clinicals is a good way to judge the work habits of potential employee. You slack off and have an "attitude" I can guarantee you that you can kiss your career aspects good bye. There are many out there that will and can do the job without the attitude.



I agree wholeheartedly... good thing I don't "slack off" during clinical/field, and have stellar comments/letters/phone calls from my preceptors and attending physicians. All just by providing good quality patient care, with a healthy dose of professionalism and courtesy... imagine that


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## WolfmanHarris (Jun 28, 2009)

alphatrauma said:


> I agree wholeheartedly... good thing I don't "slack off" during clinical/field, and have stellar comments/letters/phone calls from my preceptors and attending physicians. All just by providing good quality patient care, with a healthy dose of professionalism and courtesy... imagine that



I'm not seeing professionalism or courtesy in the way you're treating you colleagues here. I'm seeing a chip on your shoulder with a source that isn't quite clear.


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## ResTech (Jun 28, 2009)

Alphatrauma... I see a lot of ur points and share some of the same sentiments... I agree as a student... we are there solely for the clinical aspect and that is it. We are not there to be janitors or car ash attendants. At the station I do field time, all we are expected to do is help with the unit check in the AM that we are going to be riding. 

Given that I want a job at this station when I graduate, I would have no problem helping out with washing the units and other operational stuff like that.


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## Shishkabob (Jun 28, 2009)

When I did my one and only 24-FD clinical, I worked the whole day, asking for new chores to do, and studying.  I wasn't ever told to do anything at the primary station, as I took initiative.  3 calls the whole day, all from 6-9pm... abnormal for that station who averages 10+

After a while the chief told me to sleep... so I slept. 

If your preceptor says you can take some time off from studying or take a nap on a long 24hr shift, when you had class the night before, and class 2 hours after you get off the next morning, I don't see a big deal.  In the end, the call is theirs as a preceptor.


Because I helped, instead of studied the whole day, the preceptor actually went to my school the next day and spoke to my instructor at what I did, and how most other students don't do that.  I wasn't required to work, and most students don't, but if I'm going to be there all day I might as well do something to pass the time.


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## 46Young (Jun 28, 2009)

My medic school allowed field rotations for tour 2/3 only(tour one is overnight, 1800-0600, 2300-0700, etc). You can double up and work two 8's if you like, or one 12. Tour ones are forbidden. CCEMS and Fairfax are the same for students. CCEMS was 0700-1900, Fx is 0700-1500, or so. Overnights generally have reduced call volume, unless you're working the ghetto. Some agencies may reduce units at night, though. All three schools had minimum hours required, as well as a minimum # of pt contact, skills, etc. Doing two 12's should be more beneficial than working a 24- more pt contacts, and a more alert student, mainly. I can't see how sleeping is allowed for clinical hours. You're there to experience things, not dream about them. If you're fried, then practice better time management. I worked FT, worked OT, and still did 16 hours of class x 13 months per week with 16-24 hours of clinicals weekly for 11 of those months. I saved up a bunch of paid time off for strategic use prior to beginning class. a  fixed 16/12/12 schedule helped tremendously. Naps on the one hour train ride to and from class helped as well. Never did I fall asleep. There's a reason a certain amount of clinical hours are required, and sleep time was not factored in to that #. We were plenty busy anyway. A certain somone from a NY medic school bragged to me how he would go into an ER, and get several signatures during one shift, such as working with two nurses, and another in peds. Going to the CCU and having the doc sign for all three shifts, getting the psych signature, then leaving for the ER, and having a co-worker from his job sign for multiple shifts he never worked, complete with tubes, med admin, and other skills. Sleeping during clinicals is loosely analagous to getting credit for fraudulent hours as above. It's difficult to be productive while you're unconscious(it's why you're there, period). Explain to me how that isn't so, if you can. At both CCEMS and Fx, we never required students to do chores. I'll frequently quiz them on various topics, and do call review for every pt. For those being pressured into doing housework at the station, how you conduct yourself is vitally important, whether or not you intend to work there. Word travels fast. The EMS world is way smaller than you might think. Many individuals work multiple jobs nowadays. "So and so went to xx medic school. Were they at your station? What do you think about them? Would you hire them? Thanks." I received job offers from Flushing Hosp and Victory Hosp. for per diem work due in part to the impression I gave towards my preceptors. In both cases, I was told that the supervisor asked them about me, and they put in a good word, unbeknownst to me at the time. Word of mouth is of prime importance in the EMS world. Unless you want to complete your career working for some second rate private IFT company.


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## Sasha (Jun 28, 2009)

The block text makes my brain hurt.


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## DrankTheKoolaid (Jun 29, 2009)

*re*

To me it's ludicrous not to work 24, 48, 72 hour shifts during your internship if you plan on obtaining employment having to work those hours. The preceptor needs to be able to fully evaluate you, including working with a cloudy head just waking from a exhausted deep slumber and still be able to maintain the ability to critically think.   

Am i to understand some of these programs you people are in allow you to begin you paramedic internship prior to completion of ALL your didactic and clinical time?  It appears that is what i am reading.  If a topic should be discussed, that is certainly a better subject to address then sleeping during long internships.  The only studying one should be doing during internship is mastering your protocols and brushing up on areas of weakness in exam tecniques and pathophysiology

Having completed my paramedic internship in a busy urban area working 12's and then finishing my internship working 72's in the same rural area i am now employeed with the same preceptor.  I think having the same preceptor through out makes alot of sense as they get a chance to see all of your strengths and weakness.


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## Shishkabob (Jun 29, 2009)

My medic school has only hospital clinicals during the didactic portion, and after our final exam, we do an internship with Dallas Fire, doing 24 hour shifts, as to stay with the same preceptor throughout.


As such, kind of hard to dodge 24hr shifts, whether I like to or not.


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## bstone (Jun 29, 2009)

Sasha said:


> Seriously, you can only study for so long, and if you're there for 24 hours you are expected not to sleep? Wow, talk about a dangerous drive home.



Agreed. A period of sleep is entirely acceptable, even when a medic student.


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## Shishkabob (Jun 29, 2009)

bstone said:


> Agreed. A period of sleep is entirely acceptable, even when a medic student.



We're expected to have LESS sleep?  CRAP!


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## bstone (Jun 29, 2009)

Linuss said:


> We're expected to have LESS sleep?  CRAP!



There are those on this forum who suggest a medic student who is doing a 24-hour internship on an ALS ambulance should be immediately dismissed from their medic program if they dare attempt to gain sleep while on said shift.

I believe that is insane.


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## Ridryder911 (Jun 29, 2009)

bstone said:


> There are those on this forum who suggest a medic student who is doing a 24-hour internship on an ALS ambulance should be immediately dismissed from their medic program if they dare attempt to gain sleep while on said shift.
> 
> I believe that is insane.



I will never endorse not sleeping for 24 hour shifts, not matter what. I am the best of supervisory to ensure my crews have enough sleep time before going home. If they are 24 shifts, sure common sense will tell you to get as much sleep as possible. 

I am personally not in favor for 24 hour clinical shifts for various reasons. I believe students need time to absorb the information that have seen and performed, review it and study cases for more detail. As I have previously posted, I feel that the crew needs some time away from the student during the 24 hour shift as down time. I see a potential problem of those 3 am calls and increasing risks of mistakes being made. 

R/r 911


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## medic417 (Jun 29, 2009)

bstone said:


> There are those on this forum who suggest a medic student who is doing a 24-hour internship on an ALS ambulance should be immediately dismissed from their medic program if they dare attempt to gain sleep while on said shift.
> 
> I believe that is insane.



Umm where did you get that quote?  I based my statement on a less than 16 hour shift as an intern.  Yes I said immediate dismissal for sleeping, but when someone mentioned 24 I said that was different.


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## bstone (Jun 29, 2009)

medic417 said:


> Umm where did you get that quote?  I based my statement on a less than 16 hour shift as an intern.  Yes I said immediate dismissal for sleeping, but when someone mentioned 24 I said that was different.



That is simply unreasonable and against all sound medical advice. On my 13 hour shifts I sleep as often as possible. If a medic student wanted to close his eyes for an hour I would not have a problem at all. As a future medical director I promise I would immediately reinstate any dismissed medic student if he had gone 10 hours and wanted to take a brief nap.


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## Ridryder911 (Jun 29, 2009)

bstone said:


> That is simply unreasonable and against all sound medical advice. On my 13 hour shifts I sleep as often as possible. If a medic student wanted to close his eyes for an hour I would not have a problem at all. As a future medical director I promise I would immediately reinstate any dismissed medic student if he had gone 10 hours and wanted to take a brief nap.



Good thing, most Medical Directors usually don't have any authority in administrative duties. Most are employed for the medical direction only, and will never interfere with daily operations. Not to be rude, but after you finish medical school come back and read your former posts and see what your thoughts are then. 

Ten hours? That's not even a full shift. 

R/r 911


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## bstone (Jun 29, 2009)

Ridryder911 said:


> Good thing, most Medical Directors usually don't have any authority in administrative duties. Most are employed for the medical direction only, and will never interfere with daily operations. Not to be rude, but after you finish medical school come back and read your former posts and see what your thoughts are then.
> 
> Ten hours? That's not even a full shift.
> 
> R/r 911



Medical directors are often the last stop in the appeals process. You do know that, right?


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## medic417 (Jun 29, 2009)

bstone said:


> Medical directors are often the last stop in the appeals process. You do know that, right?



Not here.  Only thing regarding employment they have a say in is no that person can not work under my license.


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## bstone (Jun 29, 2009)

medic417 said:


> Not here.  Only thing regarding employment they have a say in is no that person can not work under my license.



I'd have a stern talking to with the instructor who dismissed the student.

Likely suspend his license for a while.


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## medic417 (Jun 29, 2009)

bstone said:


> I'd have a stern talking to with the instructor who dismissed the student.
> 
> Likely suspend his license for a while.



Can't suspend their license.  Sorry not partof the medical directors job.  And if they started butting in they would be replaced very quickly.


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## bstone (Jun 29, 2009)

medic417 said:


> Can't suspend their license.  Sorry not partof the medical directors job.  And if they started butting in they would be replaced very quickly.



A medical director can't suspend an EMTs license? You're sorely mistaken- and then some.


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## Ridryder911 (Jun 29, 2009)

bstone said:


> A medical director can't suspend an EMTs license? You're sorely mistaken- and then some.



Nope. Not any state I know of. They do *NOT * have the authority to do such. Since it is a license that is dispensed from the State of issued then they have a formal inquiry and follow the due process. 

Now, the medical director can have the authority to suspend them not to work under their medical license, but can *NOT* suspend their license itself. 

I suggest you might look at what the Medical Director authority really is. It is very limited and usually only have that limited power on strictly medical role. Daily operations is left to administrative operations. I have seen more than one medical director fired for interfering on operation and going against administrative duties. 

EMS Medical Director do have a job description, you might want to read several and see their limited powers

R/r 911


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## Ridryder911 (Jun 29, 2009)

bstone said:


> I'd have a stern talking to with the instructor who dismissed the student.
> 
> Likely suspend his license for a while.



If a medical director interfered or even spoke to me sternly, I would assure that he would be glad to remain in ER snd mind his/her own business. Local medical directors have *NO* say in any of the EMS programs in my area. Some are on advisory committees but that is the limit. 

Again, I don't work for any medical director when teaching even the schools program medical director have no authority in my job performance. No medical director can touch my Instructor license more anyone else. Alike I described above, I am granted due process of an investigation, then suspension process from the State (if found warranted), then processed through a board (which does NOT consist of any EMS Medical Directors). 

Not allowing one to sleep for 10 hours would never make it to investigation phase. After the investigators compose themselves from laughter, an investigation on the physician might be suggested with them worrying about such trivial administrative interactions. 

R/r 911


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## bstone (Jun 29, 2009)

Ridryder911 said:


> Nope. Not any state I know of. They do *NOT * have the authority to do such. Since it is a license that is dispensed from the State of issued then they have a formal inquiry and follow the due process.
> 
> Now, the medical director can have the authority to suspend them not to work under their medical license, but can *NOT* suspend their license itself.
> 
> ...



I like when you use bold and capital letters, Rid. It makes me feel happy.


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## 46Young (Jun 29, 2009)

I asked for someone to explain how sleeping during clinicals is conducive to learning. You're there to learn and experience things, not nap. How much can you learn while you're unconscious? Nothing productive is being done. Your sole reason for being there is to learn the craft. All those hours spent sleeping would be better invested in completing more daytime clinicals, thus getting more pt contacts/study time. If you're soft and need sleep, too bad. Don't attempt to complete a 3-6 month program where everything is crammed together. A program has no business requiring(allowing) 24 hour clinicals. It tantamount to endorsing sleep time. I've never heard of this before coming to this site. Is this some medic mill tactic to shorten program time by cramming all those hours together?


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## Sasha (Jun 29, 2009)

46Young said:


> I asked for someone to explain how sleeping during clinicals is conducive to learning. You're there to learn and experience things, not nap. How much can you learn while you're unconscious? Nothing productive is being done. Your sole reason for being there is to learn the craft. All those hours spent sleeping would be better invested in completing more daytime clinicals, thus getting more pt contacts/study time. If you're soft and need sleep, too bad. Don't attempt to complete a 3-6 month program where everything is crammed together. A program has no business requiring(allowing) 24 hour clinicals. It tantamount to endorsing sleep time. I've never heard of this before coming to this site. Is this some medic mill tactic to shorten program time by cramming all those hours together?



How conducive to learning is being overloaded from your 8th hour of studying in a row??? How are you to get more patient contacts when there are no patients?


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## bstone (Jun 29, 2009)

46Young said:


> I asked for someone to explain how sleeping during clinicals is conducive to learning. You're there to learn and experience things, not nap. How much can you learn while you're unconscious?



Yes. Sleep is when your brain forms new neuronal connections, organized the days issues, etc. When I want to memorize terms for one of my classes I study the terms right before bed. When I wake up they are all in my mind.


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## medic417 (Jun 29, 2009)

We need to break out some cheese to go with all the whine on here.


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## Sasha (Jun 29, 2009)

medic417 said:


> We need to break out some cheese to go with all the whine on here.



Oooh I'll bring the sharp cheddar and crackers!


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## 46Young (Jun 29, 2009)

Sasha said:


> How conducive to learning is being overloaded from your 8th hour of studying in a row??? How are you to get more patient contacts when there are no patients?



Why did you choose a program that offers clinicals with little to no pt contact? Should've thought that one out ahead of time. How is 24 hours of no pt contact supposed to prepare you to be a medic?


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## Sasha (Jun 29, 2009)

46Young said:


> Why did you choose a program that offers clinicals with little to no pt contact? Should've thought that one out ahead of time. How is 24 hours of no pt contact supposed to prepare you to be a medic?



When I chose my school, for one, I had no idea about EMS, it was just a fall away to do something while waiting for nursing school, medic was intergrated into the program and I was in medic before I got my emt cert. 

I didn't know anything about EMS, I didn't know about their clinical sites and call volumes at those clinical sites.

And EVERY station can have a slow day.


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## 46Young (Jun 29, 2009)

bstone said:


> Yes. Sleep is when your brain forms new neuronal connections, organized the days issues, etc. When I want to memorize terms for one of my classes I study the terms right before bed. When I wake up they are all in my mind.



Sure, but that can be done on your own time, at home, after the day's clinical is over. Nice try. You're stealing time by sleeping during a clinical. The program requires a certain amount of clinical hours for a reason.


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## 46Young (Jun 29, 2009)

Sasha said:


> When I chose my school, for one, I had no idea about EMS, it was just a fall away to do something while waiting for nursing school, medic was intergrated into the program and I was in medic before I got my emt cert.
> 
> I didn't know anything about EMS, I didn't know about their clinical sites and call volumes at those clinical sites.
> 
> And EVERY station can have a slow day.



So you decided to do a medic program as an afterthought, as something to do to keep busy before nursing school? You were implying that you hardly see any pts on any given day, not just for the occasional slow one.


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## Sasha (Jun 29, 2009)

46Young said:


> So you decided to do a medic program as an afterthought, as something to do to keep busy before nursing school? You were implying that you hardly see any pts on any given day, not just for the occasional slow one.



I know, my clinicals up until about P4 were very slow, it was annoying. I had a bright white cloud.

And yup, I never intended to be in EMS. I wanted to be a nurse, always have, an am regretting it because medic is messing with my nursing school plans.


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## 46Young (Jun 30, 2009)

Sasha said:


> I know, my clinicals up until about P4 were very slow, it was annoying. I had a bright white cloud.
> 
> And yup, I never intended to be in EMS. I wanted to be a nurse, always have, an am regretting it because medic is messing with my nursing school plans.



Is it possible to drop out of medic school and then begin nursing? You'd be better off, and could probably challenge the medic afterwards if you want.


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## Sasha (Jun 30, 2009)

46Young said:


> Is it possible to drop out of medic school and then begin nursing? You'd be better off, and could probably challenge the medic afterwards if you want.



I'm not wasting two years of my life when I'm two gen eds away from the degree, althought useless, and sitting for the test and getting the really significant pay raise. I'll just start the pre reqs next semester


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## Sasha (Jun 30, 2009)

46Young said:


> Is it possible to drop out of medic school and then begin nursing? You'd be better off, and could probably challenge the medic afterwards if you want.



And out of curiosity, why would I be better off?


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## alphatrauma (Jun 30, 2009)

Ridryder911 said:


> Nope. Not any state I know of.
> R/r 911


 
So it *is* in the realm of possibility that there are states, that you DON'T know of, that do? 

Don't get me wrong, I would never presume to think that an EMS Medical Director could/would ever challenge the apparent omnipotence of a individual in a high ranking educational/operational/managerial position, such as yourself... but hey, who woulda thought Buster Douglas would knock out Mike Tyson?


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## alphatrauma (Jun 30, 2009)

46Young said:


> I asked for someone to explain how sleeping during clinicals is conducive to learning.



It isn't... and I don't think anyone here is saying that it is. What this thread (initially) was about, is the perceived negative connotation associated with the label "ALS Engine Sleepovers" and whether it is justified or not. It's a really catchy phrase and can whip up a pretty frenzied debate, but doesn't seem to amount to much of anything at all.


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## VentMedic (Jun 30, 2009)

alphatrauma said:


> It isn't... and I don't think anyone here is saying that it is. What this thread (initially) was about, is the perceived negative connotation associated with the label "ALS Engine Sleepovers" and whether it is justified or not. It's a really catchy phrase and can whip up a pretty frenzied debate, but doesn't seem to amount to much of anything at all.


 
For ALS engine sleepovers and an pointed out by the Florida state regulations, not only are the students sleeping, they also do not have the learning experience of transporting a patient.  They are merely making contact and even though patient is deemed to be ALS, the care will go with the Rescue or ambulance Paramedics that will be transporting the patient.


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## VentMedic (Jun 30, 2009)

Ridryder911 said:


> Nope. Not any state I know of. They do *NOT *have the authority to do such. Since it is a license that is dispensed from the State of issued then they have a formal inquiry and follow the due process.


 
I believe the one state that allows the medical director to suspend a license is California since it gives authority to the counties.  As also noted in a recent news article, the medical director can say who they certify or license even if it is someone convicted of a felony.


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## Ridryder911 (Jun 30, 2009)

alphatrauma said:


> So it *is* in the realm of possibility that there are states, that you DON'T know of, that do?
> 
> Don't get me wrong, I would never presume to think that an EMS Medical Director could/would ever challenge the apparent omnipotence of a individual in a high ranking educational/operational/managerial position, such as yourself... but hey, who woulda thought Buster Douglas would knock out Mike Tyson?



I guess you never heard of National Association of EMS Physicians (NAEMSP) and their programs for becoming a medical director?...... Yeah, I thought so. 

I should had recognized California for their oddities unlike most States that authorize the license or certification. I would not be surprised that it would not be challenged for not allowing a due process to occur but again certification versus license is much easier to revoke. 

R/r 911


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## Aidey (Jun 30, 2009)

A medical director could withdraw their sponsorship of a particular persons license/cert if they wished, couldn't they? It's not exactaly revoking it, but it would stop someone from being able to legally practice.

That bit being said, is everone talking about in hospital clinicals, or externship ride time or both? From reading the thread it sounds like some people are talking about one, and some peopel are talking about the other.


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## alphatrauma (Jun 30, 2009)

Ridryder911 said:


> I guess you never heard of National Association of EMS Physicians (NAEMSP) and their programs for becoming a medical director?...... Yeah, I thought so.
> R/r 911



Actually I have.. so you thought wrong. 



VentMedic said:


> For ALS engine sleepovers and an pointed out by the Florida state regulations, not only are the students sleeping, they also do not have the learning experience of transporting a patient.  They are merely making contact and even though patient is deemed to be ALS, the care will go with the Rescue or ambulance Paramedics that will be transporting the patient.



Where else in the country is this practice going on? If this is an anomaly specific to Florida, I fail to see how a blanket generalization can be used to characterize unconventional Paramedic programs that we don't feel are adequate.


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## Aidey (Jun 30, 2009)

Just as an FYI, the Paramedic program in the city I live in allows ALS engine rides. However, because of how our contract is worded, the city paramedics are allowed to transport on our (private company) ambulances. 

It doesn't happen often, but when there is a code, or other serious call the fire paramedic will usually jump on. However, if an ALS engine has a paramedic student, the fire medic and student ride in on almost all the ALS calls they respond to and the student is in charge of care. 

I think it's important for Paramedic students to experience all calls, since they won't be able to pick and choose their patients if they work on an ambulance, so i'm not really a fan of the system here. 

 However, the students do have the opportunity to transport, and are expected to ride in a certain number of times (I can't remember what their school requires).


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## VentMedic (Jun 30, 2009)

alphatrauma said:


> Where else in the country is this practice going on? If this is an anomaly specific to Florida, I fail to see how a blanket generalization can be used to characterize unconventional Paramedic programs that we don't feel are adequate.


 
In Florida, we do NO approve of it as evidenced by the link I posted. READ the posts carefully.  It had been a problem but anytime a medic mill tries to cram more students through by using the engines and ladders, they are reminded of the definition of an ambulance.

There are other states including CA and those that have medic mills advertising quick and easy programs.


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## alphatrauma (Jun 30, 2009)

I read your posts thoroughly and they, including you most recent, fail to do anything more than stereotype and generalize. If the label fits, give school names/states/cities/counties etc... I'd like to know.


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## Ridryder911 (Jun 30, 2009)

alphatrauma said:


> I read your posts thoroughly and they, including you most recent, fail to do anything more than stereotype and generalize. If the label fits, give school names/states/cities/counties etc... I'd like to know.



Open up most of EMS rags such as _EMS magazine_, _even JEMS _ and some EMS forums and you may find these "specialized training" centers and places offering such services. 

Fortunately, many states are recognizing that the EMS industry needs to be regulated with other health care professions. This also includes the training and education division. Fortunately, my state as bad as it can be at times, recognized this early on and only will allow training/education at recognized educational facilities. Even EMS services cannot provide any EMT courses as they must be through some official recognized educational facility such as a college or career tech. 

I am excited though, that my push for those to teach the Paramedic level must hold a degree is getting closer to being approved. I can say it has not or will not be easy though. 

R/r 911


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## medic417 (Jun 30, 2009)

Aidey said:


> A medical director could withdraw their sponsorship of a particular persons license/cert if they wished, couldn't they? It's not exactaly revoking it, but it would stop someone from being able to legally practice.
> 
> That bit being said, is everone talking about in hospital clinicals, or externship ride time or both? From reading the thread it sounds like some people are talking about one, and some peopel are talking about the other.



As to sleeping big no for either for anything 16 hours or less.  We do not allow 24's for students.  

A medical director may say you may not work under their license so you just go work elsewhere.  If you are a valued employee and the service feels that the medical director is overstepping by removing you they remove medical director and keep you instead.  Even medical protocols if a doctor is a jerk about something whether good or bad the service will just change medical directors.


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## medic417 (Jun 30, 2009)

Sasha said:


> Oooh I'll bring the sharp cheddar and crackers!



What?  Sharp doesn't go with dry bitter whine.


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## Sasha (Jun 30, 2009)

I am not refined and classy enough to know that. I don't drink whine I just know sharp cheddar is good!


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## medic417 (Jun 30, 2009)

Sasha said:


> I am not refined and classy enough to know that. I don't drink whine I just know sharp cheddar is good!



Right.  We all know better your our rich rebellious frenemy.


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## Ridryder911 (Jun 30, 2009)

medic417 said:


> As to sleeping big no for either for anything 16 hours or less.  We do not allow 24's for students.
> 
> A medical director may say you may not work under their license so you just go work elsewhere.  If you are a valued employee and the service feels that the medical director is overstepping by removing you they remove medical director and keep you instead.  Even medical protocols if a doctor is a jerk about something whether good or bad the service will just change medical directors.



Very common, a medic to go somewhere else. Most of the time, word of mouth is faster than application process. 

I do believe many have a misconception of the role of the medical director. I have seen some very active and for the most part most are just "paper" only. They have NO authority other than protocol development and QI. Just alike any other employee they can be replaced and are on a routine basis. Just look at some of the areas that have recently lost theirs such as Austin, etc...

R/r 911


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## VentMedic (Jun 30, 2009)

alphatrauma said:


> I read your posts thoroughly and they, including you most recent, fail to do anything more than stereotype and generalize. If the label fits, give school names/states/cities/counties etc... I'd like to know.


 
Do as Rid says and pick up a JEMS mag and look at their advertising section.

Or, read any of the accelerated training threads on this EMS forum or others and you will find several links to these schools. I have posted links as have Rid, reaper, Medic417 etc just to give examples of what is out there. You honestly can not say I have made generalized statements when I have provided many links to the information I discuss in the many threads I post.


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## Shishkabob (Jun 30, 2009)

Vent, I could have missed it in my skimming of the thread;

I know you're against ALS *engine* rides, as anyone should be.


But I can't find if you're for or against 24-hr clinicals all together?


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## VentMedic (Jun 30, 2009)

Linuss said:


> Vent, I could have missed it in my skimming of the thread;
> 
> I know you're against ALS *engine* rides, as anyone should be.
> 
> ...


 
My wording has been pretty consistent with ALS engine sleepovers. One could easily do 72 - 96 hours in one week to speed through their hours. If half of is spent sleeping at a slow station, time is wasted. I also believe it should be a learning process for knowledge and technique. Both the preceptor and the student should be alert enough to enhance the process. It is even controversial for nursing and RT students to do 12 hour shifts for their clinicals since neither the student or the clinical educator may be as brilliant in their 11th hour of continuous learning. Granted EMS is a little different where 23 of those 24 hours may be spent sleeping and in front of a TV or computer playing internet games.


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## Medic744 (Jun 30, 2009)

Our program does not allow for 24 hr shifts unless it is at your "home" station (where you work or vol.) and even then it must be pre approved and if you are not getting the calls then you go somewhere else.  The only time you "ride for hours" is if you have completed all requirements and are proficent in your skills and can prove it.  The station where I work was pulled for low call volume as were several other sites.


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## wyoskibum (Jun 30, 2009)

Sasha said:


> And out of curiosity, why would I be better off?



Nurses get paid more


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## medic417 (Jun 30, 2009)

wyoskibum said:


> Nurses get paid more



Actually in some areas not anymore even on the hourly part.  Plus the way EMS is done in many slow areas people do multiple jobs and still have more 24 hour days off than nurses and end up with more total annual income with great benefits and no part of fire.  Of course this is Paramedic wages not basics.


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## 46Young (Jun 30, 2009)

Sasha said:


> And out of curiosity, why would I be better off?



Superior education, pay and benefits for starters. If I could do it all over, I would get my EMT, work per diem while I get my assosciates RN, challenge the medic, work FT as an RN/PT medic while I work on a firemedic spot at a quality dept. For about one more year of school, I could have had both my medic and RN. In today's world, a solid defined benefits program is highly desireable. FD/PD/EMS 3rd service aren't the only places to go for a pension. RN's can also work municipal and receive a pension as well.


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## 46Young (Jun 30, 2009)

medic417 said:


> Actually in some areas not anymore even on the hourly part.  Plus the way EMS is done in many slow areas people do multiple jobs and still have more 24 hour days off than nurses and end up with more total annual income with great benefits and no part of fire.  Of course this is Paramedic wages not basics.



If you don't mind, would you please share the names of these non fire agencies with great benefits? I started a thread today in regards. RN's in NYC were making about 70 grand starting. The best EMS agencies there were paying medics in the low 30's/hr, EMT's low 20's/hr.


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## medic417 (Jun 30, 2009)

46Young said:


> The best EMS agencies there were paying medics in the low 30's/hr, EMT's low 20's/hr.



Heck at $30 an hour x 40 hours a week X 52 weeks = $62,000  a year, thats w/o any overtime and I know very few 911 services that do not get overtime.   So a Paramedic works say 3 24's a week leaving 4 24's off.  They make way more than the RN and if with a decent company/city/county get great benefits.


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## AnthonyM83 (Jun 30, 2009)

Corky said:


> Am i to understand some of these programs you people are in allow you to begin you paramedic internship prior to completion of ALL your didactic and clinical time?  It appears that is what i am reading.



Oh man, that would be great. I know my knowlede and skills and critical thinking would be solidified so much more that way.


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## 46Young (Jun 30, 2009)

medic417 said:


> Heck at $30 an hour x 40 hours a week X 52 weeks = $62,000  a year, thats w/o any overtime and I know very few 911 services that do not get overtime.   So a Paramedic works say 3 24's a week leaving 4 24's off.  They make way more than the RN and if with a decent company/city/county get great benefits.



If you're working 3 24's/wk, thats 72 hours/wk. If you get hammered during your shift, you'll need part of your day off to recover(sleep), or you'll spend the day like a zombie. If you have a family, you won't have a whole lot of quality time with them.  RN's typically do three 12's/wk with a swing shift every third week. Plenty of time to actually enjoy life while off duty. The hourly wages I posted were topped out for medics, but starting for RN's. With some time on, the RN will pull away. At time and a half, the RN can do one or two 12's per week if desired, and blow away the medic, and still be working only 52-60 hours/wk. The hospitals that pay 30+ per hour(Cornell, NS-LIJ) strictly control OT, and will cannibalize IFT units to staff 911 units. At what point does working extra OT/per diem hours become blood money?


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## 46Young (Jun 30, 2009)

Also worth mentioning is that the agencies that are paying top dollar for medics, at least in the greater NY area, are hospital based and have a defined contribution 403b program only. That's one of the reasons they can offer good salary/benefits - no pension burden for them. It's well known in NY that you do FDNY EMS for top rate medical benefits/pension, or go to the hospitals for the $$$, superior working conditions, fixed schedule, no mandations. http://www.nyc.gov/html/fdny/html/community/ems_salary_benefits_042607.shtml


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## Ridryder911 (Jun 30, 2009)

I do believe most the pay discussed for RN's is way over exaggerated or one has to add week-end differential, night shift diff, specialized pay and so on. Overtime recently has usually become a thing of the past as well as 40 hour shifts if one does 12 hours, unless you count that extra 4 hours for education or TQI , etc. 

Even travel RN's are only making $30 -40 hr an hour in most places and that is straight salary many without benefits.  

I have seen an almost total decline or removal of any incentive bonuses such extra money for coming in short notice, recruitment, etc. 

I thought of returning to nursing lately full time. I miss the patient contact but truthfully I can't afford to. As well, I set my own schedule and don't miss getting UTI's from never being able to take a break. Will return back part time this fall to the unit setting. The newbie nurses by then will have transferred around and they will need experienced nurses. 

There is a method of how the supply & demand and the way economy affects the health care profession. 

If you do so happen see extreme high pay for nursing, it is either a very high costs of living in the area or a job/location where no one else would work it. 

R/r 911


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## 46Young (Jun 30, 2009)

Sorry, double post


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## 46Young (Jun 30, 2009)

Yes, I've noticed that the RN's salary range dropped significantly from NY to NOVA. I've heard 25/hr commonly throughout the southeast, at least in parts of VA and SC. EMS only jobs don't generally compare in regards to salary.


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## Aidey (Jun 30, 2009)

I don't know what nurses make in my area, but a fully vested (20+ year) Paramedic with my company tops out at about $50,000 working 14 12 hour shifts a month. At the local FD, a 5 year EMT B/FF gets $70,000 a year and they work 24 on 72 off.


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## 46Young (Jun 30, 2009)

Aidey said:


> I don't know what nurses make in my area, but a fully vested (20+ year) Paramedic with my company tops out at about $50,000 working 14 12 hour shifts a month. At the local FD, a 5 year EMT B/FF gets $70,000 a year and they work 24 on 72 off.



Firemedics in NOVA generally do well. EMS only medics, save Alex Fire/EMS not so much. You must be west coast. Our FF/EMT's make about 60,000 or so after 5 years. Firemedics in their second year make at least 67,000/yr including riding pay and EMS incentive pay. It's the EMS only agencies that generally don't compare to RN's salary wise.


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## triemal04 (Jul 1, 2009)

Out of curiosity, for those of you who are are against 24-hour shifts so that the intern doesn't need to sleep, how does your state judge an internship complete?  Is it based soley on hours?  Pre-hospital pt contacts?  Preceptors recommendation?  A combo of 2 or 3?


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## 46Young (Jul 1, 2009)

triemal04 said:


> Out of curiosity, for those of you who are are against 24-hour shifts so that the intern doesn't need to sleep, how does your state judge an internship complete?  Is it based soley on hours?  Pre-hospital pt contacts?  Preceptors recommendation?  A combo of 2 or 3?



All of the above, including X amount of skills i.e. 5 ETI, 20 med admin, 10 codes, etc.


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## Sasha (Jul 1, 2009)

I know I had to complete x amount of hourss and in those x amount of hours I had to get so many skills checked off. most of them checked off in the hospital as oppose to the rides.


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## triemal04 (Jul 1, 2009)

46Young said:


> All of the above, including X amount of skills i.e. 5 ETI, 20 med admin, 10 codes, etc.


Then why the dislike for sleeping while on shift?  (I only mean a 24-hour shift, not anything less)  If all that was required was a specific number of hours, then sure, being on overnight when it is generally slower and the downtime will be spent sleeping isn't a good idea, I agree.  Although night work does often have a different variety of calls...  But with there being extra requirements...I don't see the problem.  If the intern is on for 24 and ends up (barring calls) sleeping from 2200-0600, the hours may count, but if none of the other requirements are met, they'll need to keep going no matter how many hours they end up riding for.  Here, depending on which agency the intern ends up with it's not unheard of for them to ride well more than double the number of required hours so that the rest of the requirements are met.


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## VentMedic (Jul 1, 2009)

Because like many things about EMS education there is little consistency. Some of the mandates for the number of "skills" performed are set by the individual school and not the state. The states may make a recommendation for the minimum number of hours required for the program and not necessarily what is done during that time. Some schools count successful intubations and sticks on a manikin just as easily as live ones. 

There are busy services that do have shifts in the evening and night where students can do a rotation. Even some busy FDs may rotate their Paramedics off the ambulance after 12 hours to an engine that doesn't do medical calls and allow another crew to work the EMS truck. 

The sleepovers can easily be taken advantage of for purposes of just getting in hours if the school or state has no set requirements. It is not uncommon for some to seek out the slowest or easiest clinical situation just to get the hours in. Not everyone getting a cert wants all that patient care stuff and just want a good trauma or two to see what the lights and sirens stuff is all about. 

Read Anthony's posts about the way his clinicals are set up. Some can get all 40 patient contacts in fairly quickly. Yet, I believe the state of CA still requires the student to have x amount of hours in also. Do you consider that not fair either?

I just believe a student should have the full advantage of being alert with an alert preceptor for learning. There will be ample time to fumble through calls in the 23rd hour after one gets their cert. If they can not remember much or the crew was too tired to care about explaining much, what good does it do to waste the time of both the crew and the student?


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## Sasha (Jul 1, 2009)

VentMedic said:


> Some schools count successful intubations and sticks on a manikin just as easily as live ones.



I can sadly confirm that.


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## DrankTheKoolaid (Jul 1, 2009)

*re*



VentMedic said:


> Because like many things about EMS education there is little consistency. Some of the mandates for the number of "skills" performed are set by the individual school and not the state. The states may make a recommendation for the minimum number of hours required for the program and not necessarily what is done during that time. Some schools count successful intubations and sticks on a manikin just as easily as live ones.
> 
> There are busy services that do have shifts in the evening and night where students can do a rotation. Even some busy FDs may rotate their Paramedics off the ambulance after 12 hours to an engine that doesn't do medical calls and allow another crew to work the EMS truck.
> 
> ...





How can a preceptor judge if this person is capable of coming out of a slumber and be able to clearly think through a call?  Not everyone is able to clear the fog as fast as others are, and if that is a problem i would rather see it identified in the safety of a preceptor then on some poor unsuspecting patient.


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## VentMedic (Jul 1, 2009)

Corky said:


> How can a preceptor judge if this person is capable of coming out of a slumber and be able to clearly think through a call? Not everyone is able to clear the fog as fast as others are, and if that is a problem i would rather see it identified in the safety of a preceptor then on some poor unsuspecting patient.


 
1.  This is a student who is still learning.

2.  At that point of learning it shouldn't be about whether you can handle a 24 hour shift. There will also be busy places that do not run 24 hour shifts on the ambulances.

3.  If you don't learn the proper technique or procedures, who cares if you can work a 24 hour shift. 

4. Are you judging the ability to work a 24 hour shift as another "skill"?


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## DrankTheKoolaid (Jul 1, 2009)

*re*

1. Once you get to internship you should not be "still learning" you should be honing the assessment skills and treatment modalities that you should have already learned in didactic and clinicals.  Hence the reason i don't agree with people beginning there internship until the completion of both.


2. Agreed some will work in areas that do not work 24, 48, 72 hour shift and this doesn't apply to them

3. see post 1, also why somebody should only complete their internship on a 911 only "ambulance" and actually transport the patient and not just do an ALS assessment and pass it on to there cronies on the fire department


4. No i don't regard it as a skill, but i do see it as a reality depending on where you are working.  Obviously not everyone works 24, 48, 72 hour shifts.  But for those unfortunate souls that do work 72 hour shifts like i do in the hills that is our reality and the ability to critically think with a foggy head is a necessity.


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## VentMedic (Jul 2, 2009)

Corky said:


> 1. Once you get to internship you should not be "still learning" you should be honing the assessment skills and treatment modalities that you should have already learned in didactic and clinicals. Hence the reason i don't agree with people beginning there internship until the completion of both.


 
You mean you are going to learn nothing in clinicals? It is all about the "skills" and following the recipes memorized in classes? The clinicals are where the preceptor helps the student apply what has been learned to different situations. It brings patient assessment skills to real live patients where there are always things that can be learned that weren't memorized in class. 

Many Paramedic students are working EMTs who are already doing 24 hour shifts. They may be working 2 - 3 24 hour shifts each week in addition to 2 - 3 24 hour shifts for clinicals. After a while it is just going through the motions and marking off on the calendar when you will get the hours finished. By leaving one shift to go into another, which some do, regardless of whether it is from work to clinical or clinical to work, you are overextending the ability of the brain to comprehend much of anything. As well, you are setting the student up for failure in terms of even performing the skill proficiently as well as making them a danger to the patient and to themselves by going without sleep for extended periods of time.


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## DrankTheKoolaid (Jul 2, 2009)

*re*

I think we have a different definition of clinicals and i see where some of the confusion is coming from.  My program considered "clinicals" all of the hospital/psych/dialysis/or/etc/etc time.  Where the majority we were fortunate to have a ED fully staffed with MICN who were also all paramedics and able to practice as such in the ED.  So we had LOTS of instruction from other paramedics while working in the ED's during clinicals

And internship was the actual paramedic internship on a 911 ambulance.

I agree to an extent with regards to them working 24+ hour shift's plus doing their "internship".  But working as an EMT and going without sleep is just going through the motions, Working as a paramedic who has a whole different responsibility set is a whole different story.

And before anyone takes offense to that statement, i worked full time as an EMT on a 911 truck for 7 years.  So don't think that i am discounting what EMT's do as I'm fully aware.


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## VentMedic (Jul 2, 2009)

Corky said:


> And internship was the actual paramedic internship on a 911 ambulance.


 
Wow!  On Paramedic internships I thought you were actually doing some patient care, starting IVs, intubating and pushing drugs.  

My mistake if all you do on your internship is ride around in an ambulance and you think you already know it all so there is nothing anyone on that truck can teach you.


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## DrankTheKoolaid (Jul 2, 2009)

*re*

No, that is not what im saying at all.  

I'm not sure about where everyone else completed there clinicals, but where i completed mine that is ALL we did in the ED.  Start lines, administer meds and intubate.  So once we got onto the trucks it was just a continuation of what we had already learned and a chance to hone our skills, outside of the hospital in the safety of a preceptor, who would also pass on pearls of wisdom they had come by during their time as a paramedic


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## DrankTheKoolaid (Jul 2, 2009)

VentMedic said:


> Wow!  On Paramedic internships I thought you were actually doing some patient care, starting IVs, intubating and pushing drugs.
> 
> My mistake if all you do on your internship is ride around in an ambulance and you think you already know it all so there is nothing anyone on that truck can teach you.



To be honest, i just re read my post to make sure i didn't have a typo or something to lead you to thinking that i even hinted towards anything like the statement you just made.  And i didn't.

So not quite sure where you are coming from with that


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## TransportJockey (Jul 2, 2009)

I'll toss in what our program defines as clinicals vs internship.

Clinicals are 12 hour hospital rotations (except the cath lab, which is 8 hours). They include Behavioral ED, Peds ED, PICU, NICU, NSI, MICU, regular ED shifts, among others. 

Internships are the time spent on either a fire rescue or private service 911 ambulance. 3 weeks at the end of first semester, 6 weeks at the end of the second


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## triemal04 (Jul 2, 2009)

VentMedic said:


> Because like many things about EMS education there is little consistency. Some of the mandates for the number of "skills" performed are set by the individual school and not the state. The states may make a recommendation for the minimum number of hours required for the program and not necessarily what is done during that time. Some schools count successful intubations and sticks on a manikin just as easily as live ones.
> 
> There are busy services that do have shifts in the evening and night where students can do a rotation. Even some busy FDs may rotate their Paramedics off the ambulance after 12 hours to an engine that doesn't do medical calls and allow another crew to work the EMS truck.
> 
> ...


<yawn...again...>  Yes, I know some people here come from the land of medic mills and the requirements for hours, pt contacts, skills performed, preceptors impression etc may vary from state to state...that would be the reason I asked what the requirements were for people opposed to 24-hour shifts.  What is it for Florida interns anyway?  What is the standard, if there is one, for the state?

Should be clear enough that staying until ALL requirements are met is appropriate and beneficial, no matter if it takes the intern longer than normal...would have thought that came through clear enough...

Sleep deprivation is a valid concern though.  Being behind on sleep and only half awake for a call is never good, and as an intern, when your knowledge hasn't solidified (so to speak) is a worse one.  The chance of a mistake being made can be decreased with a decent preceptor, but unfortunately I know those can sometimes be hard to find.  If a school refuses 24's for that it's understandable, though there is something to be said for making it the students decision; teaching personal responsibility isn't something that should be ignored.

(clinical=hospital rotations, internship=time spent on a transporting 911 ambulance)

Edit:  Corky...you'll get used to that.


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## VentMedic (Jul 2, 2009)

triemal04 said:


> <yawn...again...> Yes, I know some people here come from the land of medic mills and the requirements for hours, pt contacts, skills performed, preceptors impression etc may vary from state to state...that would be the reason I asked what the requirements were for people opposed to 24-hour shifts. What is it for Florida interns anyway? What is the standard, if there is one, for the state?


 
Unfortunately there are many states and many schools that practice this if you haven't noticed the acceleterated schools' threads.  But, enough of your bashing of Florida, FDs and personal attacks.  If you actually read the posts, you will find your answers.


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## DrankTheKoolaid (Jul 2, 2009)

*re*

Yeah i think that is where some of the confusion with Vent is coming from, the different terms.


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## VentMedic (Jul 2, 2009)

Corky said:


> Yeah i think that is where some of the confusion with Vent is coming from, the different terms.


 
Believe it or not, California and Florida are very simiilar in their eagerness to push students through quickly.  The only difference is CA does state they want you to care for 40 patients but does not necessarily restrict it from being while just on an ALS engiene with no transport unless they have recently changed that.


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## triemal04 (Jul 2, 2009)

VentMedic said:


> Unfortunately there are many states and many schools that practice this if you haven't noticed the acceleterated schools' threads.  But, enough of your bashing of Florida, FDs and personal attacks.  If you actually read the posts, you will find your answers.


<yawn...nothing new>  I have.  And really, there weren't exactly a lot of people listing what the requirements where for successful completion of an internship beyond mentioning hours...hence why I asked.  And yes, it varies state by state...covered that one already I believe.

I'll give you credit for bringing up lack of sleep, but I'm still curious as to what others think.  If more than a set number of hours is required to pass on internship, and the internship will be extended until all requirements are met, why the dislike of 24's?  Is there something more than the intern being tired or crews needing a break from the intern?  (don't completely agree with that one)


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## DrankTheKoolaid (Jul 2, 2009)

*re*



VentMedic said:


> Believe it or not, California and Florida are very simiilar in their eagerness to push students through quickly.  The only difference is CA does state they want you to care for 40 patients but does not necessarily restrict it from being while just on an ALS engiene with no transport unless they have recently changed that.



No i don't think that the state dictates that, that i'm aware of.  But our program director sure did.  It was on a "911 ambulance only" or you were not getting your certificate of completion from his program no matter how many hours you had.

400 hours + 40 Truly ALS contacts, IE Drugs administered, intubations etc etc.  Much to the dismay of the firefighters in my program that were hoping a F/BGL would count


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## AnthonyM83 (Jul 2, 2009)

Corky said:


> It was on a "911 ambulance only" or you were not getting your certificate of completion from his program no matter how many hours you had.


 Doesn't that part go without saying?
I can't fathom doing your internship on a non-911 ambulance...


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## Ridryder911 (Jul 2, 2009)

The new scope will focus upon number and type of patients that will be required in clinical area. This will mean if one does coffee clinicals, they may have to do several until they get that specific call or type of patient. 

For example there will be a specific number of intubations requires (adult, pediatric) number of deliveries, and so on. 

It does no good just to place hours and have never no patient contact. Sure one learns the business as in downtime but over all not really meeting their objectives. The main goal is get exposure and have the ability to get patient contact with those specific areas that the student can intervene. 

This may cause a shuffle of students actually requiring to travel and institutions re-arranging clinical agreements. 

I have students that have to travel at the least 90-100 miles one way to do intubation clinicals (minimum of 5 days and at the least 40 successful intubations). The mind set of the institution should be seeking areas where the student can get the most exposure to those type of patients, as well the student needs to understand the necessity of being able to care for those type of patients. 

R/r 911


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## Fedekz (Jul 2, 2009)

Ridryder911 said:


> Good thing, most Medical Directors usually don't have any authority in administrative duties. Most are employed for the medical direction only, and will never interfere with daily operations. Not to be rude, but after you finish medical school come back and read your former posts and see what your thoughts are then.
> 
> Ten hours? That's not even a full shift.
> 
> R/r 911



10 hours is a full shift where I'm at.

I talked to about 4 paramedics today, and none of them said they would have a problem with a student trying to get a little sleep; as long as there wasn't something completely obvious, and a students responsibility to have done.


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## Vizior (Jul 2, 2009)

The program I went through broke down the requirements by a number of different categories.  You needed to have a certain number of patient contacts in each area.  To get credit for each type of emergency you had to either see the patient in the hospital or on the ambulance, having performed an assessment and write up a report on the patient.  After all those requirements were complete, along with skill requirements(such as intubations, successful IVs, etc) we would be allowed to move onto the final phase of internships, which was another certain number of hours on the ambulance requiring at least 25 ALS calls, completely running the call with minimal input from the preceptor, and most of the feedback coming as an after-call debrief.  I'm not sure how many patient contacts there were on the ambulance, but it was certainly 75+ total.

We don't have ALS engines where I went through school, so it wasn't an issue.  Overnights were up to the agency.  

And lastly, there are a number of members here that constantly make reference to EMS and the reliance on perfecting "skills".  The reason for this, of course, is because in a lot of systems a medic will work with a basic, leaving them as the only provider that can perform these skills.  How many people can potentially be called to get a procedure done correctly in a hospital?


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