# "What every EMT should be required to experience before they graduate".



## mycrofft (Oct 28, 2009)

1. Spend one class fastened on a spineboard. Or at least 30 minutes.
2. Undergo a rapid eval, wearing a swimsuit under some clothes which can be cut. The team at the end of the semester who found the hidden injury fastest wins a very good prize, enough to get them fired up during the eval. It ought to be just your underwear and wearing your normal everyday clothes, but we can't have everything.
3. Lay down, be spineboarded and be transported code three across town in an ambulance. Put some rocks under your back to help simulate injures.

Any other such??? Hx taking? Exrication? EMT's speaking a foreign language? Blindfolded, earplugged or not allowed to speak (mute)?


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## Summit (Oct 28, 2009)

How about some sleep deprivation, puke, and poo poo?


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## JPINFV (Oct 28, 2009)

1. History and physical exam with standardized patients. (I'm probably sounding like a broken record at this point, but yea... standardized patients rock!). 

2. A visit or two to a cadaver lab, even if it's just prosections being looked at.


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## Seaglass (Oct 28, 2009)

Difficult patients. When I volunteer as a patient for courses approaching graduation, the instructors often ask us to be difficult. That can mean terrified, combative, uncommunicative, giving a rare medical history that'll fill up that tape on your thigh, or whatever... if we've had a real patient do it to us, it's fair game. Within reasonable limits for safety and all, of course. The difference between the graduates from this program and the graduates from mine, which always had easy scenario patients, is notable. 

I also tend to think everyone should experience NPA administration before doing it to someone else, but that might be a bit extreme...


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## mycrofft (Oct 28, 2009)

*Extra credit for NPA!!*

In my heyday as a simulated victim, it used to take five people to hold me down. I have also assumed a glazed look and wandered away from triage areas.


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## firecoins (Oct 28, 2009)

spend a day dealing with psych patients.

do 10 rotations on the ambulance and 10 in the ER.  Not the 1 and 1 we have now. 

EVOC should be done as a part of the class.


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## Seaglass (Oct 28, 2009)

mycrofft said:


> In my heyday as a simulated victim, it used to take five people to hold me down. I have also assumed a glazed look and wandered away from triage areas.



 I'll see your altered mental and raise you altered mental who only speaks another language. I research and memorize new phrases and words just for MCI drills. Next time around, I'm calling a Trekkie friend and larnin' me some Klingon... they keep digging up someone who speaks my language. 

Never had to be held down, but I did once slap a patient. The patient I was playing was a conservative Muslim without much English. While the first student was doing his thing quite nicely, his partner all of a sudden decides he's had enough with just taking clipboard notes. So he creeps up behind me and tries to shove a steth under my scarf and shift. I shriek and smack his hand. Student looks bewildered and says I can't do that. Instructor, after recovering from laughing fit, tells him he can expect a lot worse if he ever really does that. 

My favorite other volunteer patients tricks are asking about filing a lawsuit, and carrying concealed weapons. Haven't gotten to do the latter yet.


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## amberdt03 (Oct 28, 2009)

firecoins said:


> spend a day dealing with psych patients.
> 
> do 10 rotations on the ambulance and 10 in the ER.  Not the 1 and 1 we have now.
> 
> EVOC should be done as a part of the class.




really? i had to do 2 rotations in the ambulance and 4 in the er. although its not like i did much anyways.....had some very slow shifts.

i don't think evoc should be part of an emt class, as it should be taught when you get hired at a company.


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## medichopeful (Oct 28, 2009)

firecoins said:


> spend a day dealing with psych patients.
> 
> do 10 rotations on the ambulance and 10 in the ER.  Not the 1 and 1 we have now.
> 
> EVOC should be done as a part of the class.



I agree with all of this, but EVOC had better be an add on.  We don't have enough class time as it is...


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## medichopeful (Oct 28, 2009)

mycrofft said:


> 1. Spend one class fastened on a spineboard. Or at least 30 minutes.
> 2. Undergo a rapid eval, wearing a swimsuit under some clothes which can be cut. The team at the end of the semester who found the hidden injury fastest wins a very good prize, enough to get them fired up during the eval. It ought to be just your underwear and wearing your normal everyday clothes, but we can't have everything.
> 3. Lay down, be spineboarded and be transported code three across town in an ambulance. Put some rocks under your back to help simulate injures.
> 
> Any other such??? Hx taking? Exrication? EMT's speaking a foreign language? Blindfolded, earplugged or not allowed to speak (mute)?



#1: For myself, done.  We practiced extrication in an auditorium, and guess who got immobilized, on both a backboard and a KED?  I have to say, though, that it's a good experience.  It's not comfortable, and it's good to know what the patient has to go through.

#2:  That would be good, but I don't see it happening.

#3:  We don't do that, but we are going to have to perform CPR (on a dummy) in an ambulance while it's moving in a way that is, shall we say, interesting.


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## Sasha (Oct 28, 2009)

Shadow an ER nurse and then shadow a CNA.


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## medichopeful (Oct 28, 2009)

mycrofft said:


> In my heyday as a simulated victim, it used to take five people to hold me down. I have also assumed a glazed look and wandered away from triage areas.



Not a chance in hell would I let anybody put an NPA in me while I was conscious.  I have a bad gag reflex, so the NPA would probably cause me to vomit and, subsequently, aspirate it.


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## Sasha (Oct 28, 2009)

medichopeful said:


> Not a chance in hell would I let anybody put an NPA in me while I was conscious.  I have a bad gag reflex, so the NPA would probably cause me to vomit and, subsequently, aspirate it.



NPA, not OPA


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## EMSLaw (Oct 28, 2009)

medichopeful said:


> Not a chance in hell would I let anybody put an NPA in me while I was conscious.  I have a bad gag reflex, so the NPA would probably cause me to vomit and, subsequently, aspirate it.



You can put an NPA in a conscious patient with an intact gag reflex.  It kinda feels funny, though.  You're thinking OPA?  Just looking at one of those makes me want to gag.


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## bunkie (Oct 28, 2009)

We've done that. Almost all of it except going code 3 in an ambulance. We dont have the resources for that around here. I've been put on a board (and hurt in the process..ouch), ventilated, done a MCI, had combative pt's. We're required to wear bathing suits under our clothing in our final practical because clothing may be cut of. (which I have a problem with but thats a subject for another day)


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## eveningsky339 (Oct 28, 2009)

Every EMT student should have to role-play as a dialysis patient and take part in a non-emergency transfer.  The EMTs doing the transporting should have shaved heads/mowhawks, tattoos, hangovers, foul language, and should reek of cigarette smoke.

Maybe that way, the graduating students will realize what you become when you come out as an EMT-B thinking you are going to save the universe and then discover the more common side of EMS.

I've seen some pretty poor excuses for EMTs in my day, some a lot worse than the non-emergency transfer ones I proposed for students...


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## firecoins (Oct 28, 2009)

medichopeful said:


> I agree with all of this, but EVOC had better be an add on.  We don't have enough class time as it is...



The EVOC is class time.  EMT class does not teach driving but its part of the job.


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## medichopeful (Oct 28, 2009)

EMSLaw said:


> You can put an NPA in a conscious patient with an intact gag reflex.  It kinda feels funny, though.  You're thinking OPA?  Just looking at one of those makes me want to gag.



No, definitely thinking NPA.  If one of those got anywhere near me, there'd be a mess to clean up. 

I know you _can_ put an NPA into a conscious patient, but I don't think I would be one that you could :glare:

I'm with you on the OPA.  Just thinking about having one of those in makes me want to vomit. h34r:


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## medichopeful (Oct 28, 2009)

firecoins said:


> The EVOC is class time.  EMT class does not teach driving but its part of the job.



No, I agree that EVOC should be taught.  But I think that in order for EVOC to be taught, the amount of class time needs to be increased, instead of giving something less attention.


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## medichopeful (Oct 28, 2009)

Sasha said:


> NPA, not OPA



No, an NPA would do it too.  I have a SERIOUS problem with gagging.  It's mostly just mental, but even an NPA would probably do it h34r::glare:


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## firecoins (Oct 28, 2009)

medichopeful said:


> No, I agree that EVOC should be taught.  But I think that in order for EVOC to be taught, the amount of class time needs to be increased, instead of giving something less attention.


no one said anything about reducing class time.


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## VentMedic (Oct 28, 2009)

Not many EMTs are going to be doing lead even when providing first aid to patients. But unfortunately for the patients, they are put alone in the back of a truck with those that need a medical assessment rather than first aid. Since EMTs do primarily IFT runs on medical patients where vital signs are important, the EMT should shadow CNAs and do no less than 100 sets of vitals on a variety of different patients. The EMTs should  be trained by the CNAs to move the elderly, frail and patients with lots of attached accessories without causing pain and injury. They could also take a lesson on how to maneuver obese patients safely. EMTs are not adequately trained to be providing even "BLS" care to medical IFT patients such as those requiring dialysis.


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## daedalus (Oct 28, 2009)

They should experience _at least_ another 50 hours of education before they finish class. 

I have never heard of graduating from a 3-5 credit hour class before...?? My Biology with lab class had the same amount of units as my EMT class and I did not graduate from Bio...


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## Tincanfireman (Oct 28, 2009)

medichopeful said:


> #1: For myself, done. We practiced extrication in an auditorium, and guess who got immobilized, on both a backboard and a KED? I have to say, though, that it's a good experience. It's not comfortable, and it's good to know what the patient has to go through.


 
+1 to this, and add a patient who weighs at least 250# and a flight of stairs to the mix.  Given the ever-increasing weight of patients, a patient who only weighs 250 hardly counts as "big" anymore. Even using four people is acceptable, since the coordination of four rescuers can be a challenge.


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## rescue99 (Oct 28, 2009)

firecoins said:


> The EVOC is class time.  EMT class does not teach driving but its part of the job.



EVOC and CEVO..would be nice. The problems that come up with is the cost of insurance liability and the cost of a course which requires a certified instructor, plus materials. Do students want to foot the bill for something employers have to make certain is done anyway? CA is one state where the employee foots the cost but I say, let employers foot the cost when ever possible. It's gotta be done their way eventually anyhow.


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## medichopeful (Oct 28, 2009)

They should have CPR done to them 

No, but seriously, they should be required to actually perform real-life CPR and actually use an AED.


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## guardian528 (Oct 28, 2009)

common sense. its not so common anymore.


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## mycrofft (Oct 28, 2009)

*I was thinnking more of getting the pt's experience, not more didactic or practicum.*

Like, EVOC training while strapped onto the ambulance litter? Or duck-taped to the roof?


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## ChicagolandIFT (Oct 28, 2009)

VentMedic said:


> Not many EMTs are going to be doing lead even when providing first aid to patients. But unfortunately for the patients, they are put alone in the back of a truck with those that need a medical assessment rather than first aid. Since EMTs do primarily IFT runs on medical patients where vital signs are important, the EMT should shadow CNAs and do no less than 100 sets of vitals on a variety of different patients. The EMTs should  be trained by the CNAs to move the elderly, frail and patients with lots of attached accessories without causing pain and injury. They could also take a lesson on how to maneuver obese patients safely. EMTs are not adequately trained to be providing even "BLS" care to medical IFT patients such as those requiring dialysis.



I am with you!  GEMS would be a good part of a EMT-B class, and for Pete sake, some anatomy and physiology to include something more than the basics (or A&P I and II as pre-reqs).  And while we talk about dialysis patients... why not teach why it is so dangerous to transport people with dramatic electrolyte shifts... I bet less than 1 in 10 of the basics I ask would be able to explain it better than "something about salt".  Better yet... we really should have just paramedics!  (though I work with a few medics that I am not sure know what the heck it going on either most of the time).  We also need to drill the fact that just because class is over the leaning is NOT!


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## firecoins (Oct 28, 2009)

rescue99 said:


> EVOC and CEVO..would be nice. The problems that come up with is the cost of insurance liability and the cost of a course which requires a certified instructor, plus materials. Do students want to foot the bill for something employers have to make certain is done anyway? CA is one state where the employee foots the cost but I say, let employers foot the cost when ever possible. It's gotta be done their way eventually anyhow.



I footed the bill for my driver's license.  I footed the bill for my car, my emt class, my medic program, college etc whats another 12 hours of education?  With all the driving, why should I foot anything?  Just drive over it.


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## firecoins (Oct 28, 2009)

An internship portion of the class.  I like Vents idea.  More IFT exposure.  So several IFT shifts and several 911 shifts. Isn't that the thrust of the class?  Need to know how to be an EMT so 1 should not be on their 2nd shift when they start riding.


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## atropine (Oct 28, 2009)

How about an exercise program, so we be rid of all fat medics.


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## firecoins (Oct 28, 2009)

we need to always exercise


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## medichopeful (Oct 28, 2009)

Tincanfireman said:


> +1 to this, and add a patient who weighs at least 250# and a flight of stairs to the mix.  Given the ever-increasing weight of patients, a patient who only weighs 250 hardly counts as "big" anymore. Even using four people is acceptable, since the coordination of four rescuers can be a challenge.



Yeah, we did it on stairs.  I weigh like 120, and they needed like 5 people to carry me, which I found funny.  But it made me feel more comfortable


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## High Speed Chaser (Oct 29, 2009)

Not sure if any one wrote this or if it's possible to do, but maybe a mock mass casualty situation, especially for urban type areas, city departments. I know I'm just a newbie (training to be First Responder and hopefully next year, I can start going for the paramedic course) but triage is something that I feel I have trouble with and would like to practice extra in it. Then getting the class of EMTs/medics to work in a team to effectively triage, treat and transport. 

I remember, an organisation in NSW held a mass casualty simulation bringing together the fire brigade and police to train and test the response. 

[youtube]jDc9wMVJ-Ls[/youtube] and [youtube]g3M7dyEc2MM[/youtube] but those were only a once off. It shouldn't be that big that its stupid but a small team of people volunteering to act as casualties and assessing.


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## Seaglass (Oct 29, 2009)

VentMedic said:


> Not many EMTs are going to be doing lead even when providing first aid to patients.



It might be a good idea to teach them to take supporting roles on a team as well, rather than always being alone (like my class did) or leading. A lot of newbies don't really seem to know how to work with a medic, or anyone else in a position of authority. 

Might also be a good idea to have local law enforcement and fire come and give a talk. Some medical personnel seem to have no idea what they're doing when they encounter them on-scene.


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## RDUNNE (Oct 29, 2009)

firecoins said:


> do 10 rotations on the ambulance and 10 in the ER.  Not the 1 and 1 we have now.
> 
> EVOC should be done as a part of the class.



I came close, I had 9 ambulance rotations and 1 er shift. and EVOC is a part of my class.


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## mycrofft (Oct 31, 2009)

*Getting off my own thread...work in a general clinic.*

Orient to wellness and minor to major health issues, give the student a baseline, see people of differne ages and general health states.


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## Shishkabob (Oct 31, 2009)

medichopeful said:


> They should have CPR done to them
> 
> No, but seriously, they should be required to actually perform real-life CPR and actually use an AED.



No.  I have over 250 hours of clinical time under my belt between EMT and medic(not even counting actual work time) and have yet to see a code, or anything worse than a respiratory arrest intubated... If CPR was required to get EMT I would have been screwed.  

Medic is a different story as my school and the places we do our ambulance internship at expect us to be able to run a code as the lead medic.


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## Tiberius (Oct 31, 2009)

Tincanfireman said:


> +1 to this, and add a patient who weighs at least 250# and a flight of stairs to the mix.  Given the ever-increasing weight of patients, a patient who only weighs 250 hardly counts as "big" anymore. Even using four people is acceptable, since the coordination of four rescuers can be a challenge.



true...Not enough time is spent on proper lifting/moving techniques. I don't mind showing ride students how to work the cot or transfer pts on/off the cot, since that's what we do constantly.

Also, as others mentioned, more A/P and a lot more practice with vital signs. Lately I've had a couple of ride students that did not know exactly where to find a radial pulse and could not take a B/P correctly. What is particularly disturbing about this is that these students are supposed to test out in just a few weeks; they should have been able to demonstrate a little more proficiency in this area.


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## mycrofft (Nov 1, 2009)

*Saw a training film about mouth to mouth resusc in Basic Training.*

This old color film featured a nice looking young actress in a swimsuit getting curared, and while the guy lectured she was turning DUSKY, then he demonstarted, and she would get dusky again when he stopped to natter. The film cut off suddenly, obviously broken with age, but as he wrapped it up and she was coming out of it she suddenly leaned over ther table edge and yarked.

Uh, PASS...........:wacko:


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