# EMT-B Seeking Wisdom from Medics



## CombatCasualtyCare21 (Feb 19, 2010)

In my state a Basic is seen as little more than an advanced first aid cert. Not in high demand. Its been a struggle to even get my foot in the door. I have had plans of starting medic school in the fall, but I originally enrolled assuming I would have about a year of paid experience to build upon. Instead I have only the 36 hours of rotations from my cert. This question probably comes up a lot.

What would you all advise? volunteer while in school, postpone medic classes and keep hopelessly searching for EMT-B work, when they all only NEED medics and nurses? I guarantee I can handle the courses, I just worry that a "green" medic might possibly be looked at in a worse way than a "green" basic. What do you guys think? and thank you in advance.

I know the value of experience. I just need some wisdom.


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## rescue99 (Feb 19, 2010)

CombatCasualtyCare21 said:


> In my state a Basic is seen as little more than an advanced first aid cert. Not in high demand. Its been a struggle to even get my foot in the door. I have had plans of starting medic school in the fall, but I originally enrolled assuming I would have about a year of paid experience to build upon. Instead I have only the 36 hours of rotations from my cert. This question probably comes up a lot.
> 
> What would you all advise? volunteer while in school, postpone medic classes and keep hopelessly searching for EMT-B work, when they all only NEED medics and nurses? I guarantee I can handle the courses, I just worry that a "green" medic might possibly be looked at in a worse way than a "green" basic. What do you guys think? and thank you in advance.
> 
> I know the value of experience. I just need some wisdom.



Guess it's entirely up to what YOU feel most suits your own abilities. I, never worked as a Basic beyond a little volunteering while in Medic class. It's not the best way to start out but, if you're the jump in head first sort of personality and you accept your greeness...have a great time! I sure did 
People don't care if you're green. They care if you're a jackars and green.


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## wyoskibum (Feb 19, 2010)

*Dont worry about it*



CombatCasualtyCare21 said:


> What would you all advise? volunteer while in school, postpone medic classes and keep hopelessly searching for EMT-B work, when they all only NEED medics and nurses? I guarantee I can handle the courses, I just worry that a "green" medic might possibly be looked at in a worse way than a "green" basic. What do you guys think? and thank you in advance.



In my experience, Paramedic school ruined me as an EMT and I was a brand new Medic.  You are going to have opportunities during your clinical rotations and field rides.  If were me, I would concentrate on taking additional classes that will help me in Paramedic school.  College level A&P, medical terminology, etc...


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## Shishkabob (Feb 19, 2010)

Like rescue stated, it depends on how you feel.

I barely worked as an EMT before going to medic school.. like 5 shifts total.  You get plenty of time in clinicals and internship in medic school to work on your basic skills.  Don't let lack of experience hold you back if that's your only concern.

Out of the 9 of us left in my medic class, 4 of us worked as EMTs beforehand, the other 5 did not.


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## medic417 (Feb 19, 2010)

There is no need to waste time as a basic.  You will learn better how to do the basic stuff while getting your education.  You and your patients will be better for it.


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## OHMEDIC (Feb 19, 2010)

There were several people in my Paramedic class that had less than one year experience as an EMT-B.  In fact, there was one person who had never even been in the back of the ambulance..he finished the course, but definitley had a harder time than the rest of us.  Experience is priceless in terms of starting a Paramedic class, but it can be done without it.


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## medic417 (Feb 19, 2010)

OHMEDIC said:


> There were several people in my Paramedic class that had less than one year experience as an EMT-B.  In fact, there was one person who had never even been in the back of the ambulance..he finished the course, but definitley had a harder time than the rest of us.  Experience is priceless in terms of starting a Paramedic class, but it can be done without it.



Better to gain experience after you are educated.  Yes a basic that has practiced may seem more comfortable but uneducated experience is of no benefit beyond just knowing what it is like in an ambulance.  After proper education A Paramedic with no basic experience will quickly catch up to his so called "experienced" new Paramedics.  

Again do not waste your time at the basic level.


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## Jersey (Feb 19, 2010)

medic417 said:


> Better to gain experience after you are educated.  Yes a basic that has practiced may seem more comfortable but uneducated experience is of no benefit beyond just knowing what it is like in an ambulance.  After proper education A Paramedic with no basic experience will quickly catch up to his so called "experienced" new Paramedics.
> 
> Again do not waste your time at the basic level.



While I respect your opinion, I strongly disagree. I worked for two years as an EMT-B before going on to paramedicine, flight medicine, and now on the MD path. 

Being a paramedic is 90% BLS. Some of the worst paramedics I've encountered have used their "skills" without developing proper assessment skills.

Many EMT's who work with an ALS partner get the "scraps" and never learn assessment and treatment. These EMT's dont get much exposure, and sometimes leads to the erroneous opinion that you have expressed.

Once again, I respect your opinion but believe it is tremendously off base. Also, I think that many hard working EMT's who are excellent clinicians (and can school a lot of paramedics) would also be taken aback by that statement.


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## JPINFV (Feb 19, 2010)

So... even yourself admitting that EMT-B experience can be next to wortless (assessing left over "scraps"). You're looking at medical school. Would you go to a medical school that refused to teach you have to take a proper history and physical?


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## Jersey (Feb 19, 2010)

You're comparing apples and oranges.

Many reputable, college based academic paramedic programs require EMT experience. Most leaders in the field of EMS education are adament about the fact that EMT experience is tremendously important for safe paramedics.

Since you brought it up, lets get into the medical school thing a little farther. First, I'm a little beyond looking at medical schools! (and have the negative bank account to prove it haha!). Secondly, medical schools assume no patient care experience. For this reason in the second half of the second year, third year, and fourth year your "clinical" time is almost exclusively focused on assessment. This is years of learning how to do an assessment.

I can tell you of at least five or six places in the United States where you can go from 0 time to etomidate in less than three months. I can tell you many more where this time is under six months. Assessment and basics are absolutely necessary before you can move on as a safe (not good, but safe) ALS provider.


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## wyoskibum (Feb 19, 2010)

Jersey said:


> Being a paramedic is 90% BLS. Some of the worst paramedics I've encountered have used their "skills" without developing proper assessment skills.



I disagree.  Being a good paramedic is having an understanding of anatomy, physiology, and pathophysiology.  Being able to assess their patients and come up with a plan to address their patients needs.  The only way to get good at that is with experience.  I would much rather have the Paramedic education and gain experience doing ALS assessments.  There is no point in delaying medic school to get BLS experience.



Jersey said:


> Also, I think that many hard working EMT's who are excellent clinicians (and can school a lot of paramedics) would also be taken aback by that statement.



If you read the OP, the question was should he delay going to medic school to gain experience as an EMT.  If the OP goal was to be an EMT, then yes he should work towards that goal.  It has nothing to do with career BLS providers and their skill level.  They have their niche and are happy providing that level of care.


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## JPINFV (Feb 19, 2010)

Actually, plenty of medical schools have you learning how to conduct an assessment in first year and have opportunities to apply those skills starting second year or earlier (volunteer clinics overseen by an attending or resident). Similarly, I'd argue that clerkships and sub-internships are more than just learning how to do assessments. It's also learning how to practice medicine in addition to being able to try out several fields before the match. 

As far as EMS education, it's my belief that one of the big cultural problems with EMS is how the educaiton is conducted. 6 months isn't enough time to properly educate a paramedic regardless the privous experience. Similarly, failing to teach how to go from assement to treatment plan to implementation at the paramedic level because they are relying on basic level experience to compensate for those program's shortfalls is what leads to the stupidity of "BLS before ALS." It shouldn't be "start with BLS than move to ALS." It should be a smooth continum where providers are will to use their tools and interventions as needed regardless of which box they're currently throwing the patient into. There's a reason why physicians aren't PAs first. I'd argue that any medical program that relied on prior experience to plug holes in the curriculum would be dangerous.


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## Jersey (Feb 19, 2010)

Oh goodness. I'm associated with an ivy league medical school, and I promise it's not a dangerous place. 99% of medical schools also do NOT have meaningful block clinical time the first year. 

Also the physician and PA are very different animals, lets not stir up that debate! haha

BLS to ALS is a very valid point, in my opinion. The basics must come first before the advanced stuff. We apply oxygen, ventilations, bleeding control, and other "basic" interventions before we crack the drug or airway box. Also, a good paramedic is knowledgeable about the fact that good BLS and good ALS saves lives, and they're not exclusive from eachother. 

I think we can also reach some agreement. If a potential paramedic is going through a two year program that gives 600-700 hours of QUALITY clinical time on the ambulance and in the ER, I think that someone with very little EMT time can do it  successfully and come out successfully.

Unfortunately, I've seen the trend of medic mill schools proliferate lately (with the advent of the FF/EMTP pre-req for hiring) and the only people who can come out of a 7 month program are those that have been EMT's for a WHILE on an ALS ambulance.

I compromised, it must be a friday! 

Cheers to all


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## JPINFV (Feb 19, 2010)

Did I claim block clinicals? Very few schools (any?) have block clinicals during 2nd year. Does your Ivy League school not have extracurricular programs for their students? Some schools have electives, however elective =/= clerkship. 

Ah... BLS before ALS... So let's fast forward. You're an EM attending. Are you going to wait to see if oxygen has any affect before going to an albuterol neb for for asthmatic patient in distress? The problem with the BLS before ALS argument is that there are people who claim that going to an obviously indicated paramedic level treatment before trying a basic level treatment is wrong. For example, in my mind, failing to ventilate a patient to preoxygenate a patient before intubating isn't failing at "BLS." It's failing at intubation. 

I do agree that there's no reason why someone coming out of a properly lenghthed paramedic program (2 years) shouldn't be adequately prepared to be a paramedic regardless of prior experience. On the same hand, I'd question the preparedness of just about any paramedic student fresh out of a 7 month wonder school regardless of prior experience.

Also, quick question. What do you mean by "associated with a med school?" Looking at your prior posts, are you in a post-bacc pre-med program?


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## Shishkabob (Feb 19, 2010)

Where is albuterol a medic only intervention in asthma? 


/me just nit-picking.   ^_^


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## JPINFV (Feb 19, 2010)

Location dependent, however most areas don't run nebs at the basic level, and some that do have stupid restrictions to go with it (looking at you, Massachusetts).


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## Shishkabob (Feb 19, 2010)

Wow, I could not see not having Albuterol as an EMT... then again I can no longer see not having all the tools I have now either


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## wyoskibum (Feb 20, 2010)

JPINFV said:


> What do you mean by "associated with a med school?" Looking at your prior posts, are you in a post-bacc pre-med program?



It means he stayed at a Holiday Inn Express last night!


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## TransportJockey (Feb 20, 2010)

Linuss said:


> Wow, I could not see not having Albuterol as an EMT...



I agree... but then again our two states have soem of the broadest scopes for EMT-Bs in the country...


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## Jersey (Feb 20, 2010)

wyoskibum said:


> It means he stayed at a Holiday Inn Express last night!



haha I did! I'm second year.


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## MusicMedic (Feb 20, 2010)

Linuss said:


> Wow, I could not see not having Albuterol as an EMT... then again I can no longer see not having all the tools I have now either



haha welcome to Orange County,CA

here we can only help with albuterol inhalers that are prescribed to the patient, and even in that circumstance we still need to get an OK from Medical Direction


In orange county, ALS is king, they run pretty much everything regarding 911


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## JPINFV (Feb 20, 2010)

MusicMedic said:


> here we can only help with albuterol inhalers that are prescribed to the patient, and even in that circumstance we still need to get an OK from Medical Direction



Er... actually no. In fact, to the best of my knowledge (and unless something changed since 2007, but granted a lot has), there is no was for an EMT-B to contact medical control in Orange County. Nebulizers are not in the scope of practice for EMT-Bs. 

Here's the Orange County BLS MDI guideline. 
http://ochealthinfo.com/docs/medical/ems/treatment_guidelines/10 Procedures/BLS Procedures/B-20.pdf

Also, note that the 9/09 date is the date that this was introduced, and not a revision date.


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## MusicMedic (Feb 20, 2010)

JPINFV said:


> Er... actually no. In fact, to the best of my knowledge (and unless something changed since 2007, but granted a lot has), there is no was for an EMT-B to contact medical control in Orange County.
> 
> Here's the Orange County BLS MDI guideline.
> http://ochealthinfo.com/docs/medical/ems/treatment_guidelines/10 Procedures/BLS Procedures/B-20.pdf
> ...



hmm, i guess i might have been mis informed, is it the same with Nitro/epi?


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## JPINFV (Feb 20, 2010)

http://ochealthinfo.com/medical/ems/procedures.htm

Here's the table of contents page with all of the procedure protocols.


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## firetender (Feb 20, 2010)

*Will you settle for logic?*

This debate is smeared all over this site. 

From a broader perspective, look at the way systems are run. They are still geared toward "having those 2 bodies in the rig." You are never assured that you will have an experienced medic come to your door. Two partnered green paramedics can do much more damage than a couple seasoned EMTs.

Personally, I don't believe EMTs get enough credit. I don't think they get enough training, either. It's looked at as a stepping stone (as is paramedic to fire for many) and not given the attention it deserves, which could include training in proper use of community resources. (See "What is it a paramedic does?"

I think it's a whale of a job requiring a whole lot of sophistication in terms of scene, people, allied agency and resource management. I've worked with too many green paramedics fumbling around with the basics because they simply did not have enough exposure. I've also watched too many not have a clue as far as patient care goes, which is 80% of the work.

If being a PA before becoming a Physician could have an affect on Physicians developing sensitivity and a bedside manner; YES, I'd say let's go back to the system of Mentoring that helped people ease in to their professions under the guidance of the experienced.


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## JPINFV (Feb 20, 2010)

Jersey said:


> haha I did! I'm second year.



Second year medical student?


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## medic417 (Feb 20, 2010)

firetender said:


> Two partnered green paramedics can do much more damage than a couple seasoned EMTs.



LOL  I don't think so.  They have more education and also have more potential to do good for me or my family than the "experienced" but uneducated emt's.  So I will take the the two green Paramedics any day over the 2 basics.  

Sorry there is no way you can win or prove that it is better to be uneducated than educated, it is ludacris.


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## JPINFV (Feb 20, 2010)

I'm going to have to disagree with that. One cliche I do agree with is "EMTs let patients die, paramedics kill patients." To clarify before someone crucifies me on that one, it's commentary on the vast differences in scopes of practice between paramedics and basics. EMS is no different than nursing or medical education in the sense that competitant providers are not produced out of school Nurses go through new nurse programs, physicians have residencies, and hopefully new paramedics go through some sort of field training. Ideally, no new provider (paramedic or basic) is paired with another new provider until they have at least some experience in applying their education.


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## medic417 (Feb 20, 2010)

JPINFV said:


> I'm going to have to disagree with that. One cliche I do agree with is "EMTs let patients die, paramedics kill patients." To clarify before someone crucifies me on that one, it's commentary on the vast differences in scopes of practice between paramedics and basics. EMS is no different than nursing or medical education in the sense that competitant providers are not produced out of school Nurses go through new nurse programs, physicians have residencies, and hopefully new paramedics go through some sort of field training. Ideally, no new provider (paramedic or basic) is paired with another new provider until they have at least some experience in applying their education.



So there you are in the middle of no where and up comes two EMT's.  They can give you nothing but a ride.  You die during transport though they claim you didn't because they did CPR the hour to the hospital.  Your wife collects big insurance check and forgets about your ashes.  

Now if instead the two green Paramedics show up they pull out a magic drug and correct the problem.  You joke and laugh with them all the way to the hospital.  You are prescribed meds and lead a full life depriving your wife of the life insurance for now.  

Which would I want?  The two Paramedics.  At least in a life or death they might have a chance of doing something for me.  I understand they have the potential to do the wrong thing but at least they are educated enough to try doing something rather than watching me die then start working.


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## JPINFV (Feb 20, 2010)

Ideally, at least one of those paramedics would have experience. If the question was "inexperienced basic vs inexperienced paramedic" or "experienced paramedic v experienced basic" I'd take the paramedic hands down. There's a reason why even residents (who are fully licensed physicians) who are moonlighting generally try to have at least double coverage.


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## firetender (Feb 20, 2010)

Just to be clear, this is what I said (emphasis mine):




firetender said:


> Two partnered green paramedics _*can do much more damage*_ than a couple seasoned EMTs.


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## medic417 (Feb 20, 2010)

firetender said:


> Just to be clear, this is what I said (emphasis mine):



And they can do much more good, in fact they are more likely to do good than to kill the patient.  Sorry no way I'd take 2 basics over 2 Paramedics.


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## triemal04 (Feb 23, 2010)

JPINFV said:


> Ideally, at least one of those paramedics would have experience. If the question was "inexperienced basic vs inexperienced paramedic" or "experienced paramedic v experienced basic" I'd take the paramedic hands down. There's a reason why even residents (who are fully licensed physicians) who are moonlighting generally try to have at least double coverage.


I really don't feel like typing the same, long post that I usually do for this topic, so I'll keep this brief.

Unfortunately, people tend to forget the above when this topic comes up, as well as forgetting, or being unable to accept, that EMS (and medicine in general really) has a lot more involved in it than just medical issues.  This is where working as an EMT can be beneficial to some new providers.  (though it may not be beneficial depending on the type of service the EMT works for; a NETS service will not be as helpful as a 911 service where they are working with a medic)

On average field internships in paramedic programs are woefully inadequate; for the amount of things we can do and are expected to treat and know, 200 hours of fieldwork (the national minimum) is ludicrous; that's less than a month of fulltime work.  Not to single anyone out, but Linuss is nearing the end of his internship, and by his posts has done and experienced very little (this is just how it comes across and an example so don't get upset).  Yet he'll be turned lose soon, and may be hired by a service that does little, if any initial training of their own (and there are many, many places that do that).  Is that right?  Will he be an experienced, fully-capable provider ready to head out on his own?  Will he be capable of handling any oddball situation that comes up?  Possible, but the  odds are against him, and everyone else in that situation.  I believe another poster here was actually dropped from their internship because they weren't proficient at the non-medical aspects of this job.

There is more to EMS (and medicine in general) than just medicine.  There is more to being a good provider than just knowing something in your head.  Being able to function during stressful situations, recall the needed information, apply the needed information, evaluate the results and apply more information as needed, all while under stress and in controlled to chaotic environments takes time to learn.  Being able to control a scene and direct multiple personnel.  Being able to communicate and interact appropriately with pt's (and this includes different cultures and sub-cultures, ages, socioeconomic groups) family (sometimes distraught and/or hostile family), bystanders, coworkers, nurses, doctors, other medical personnel, police, FF's, drunks, crazy people and everyone else we come across is not something that can be learned in a brief internship.  Being able to recognize when someone is lying or holding something back.  Being able to recognize when a scene is unsafe (and I don't mean the glaringly obvious times) or has the potential to become so, being able to take in everything that is happening while still maintaining your focus on the pt, being able deal effectively with the multiple, non-medical issues that we come across regularly...the list can go on and on, but for all the fact remains the same:  becoming truly proficient at these things takes more than 200 hours.

There is more to medicine than just medicine. 

Learning how to cope with, and perform the above is where experience as an EMT can be beneficial.  If a person ends up on a NETS (non-emergency transport service; ie nursing home to MD's appointment and such) then there will still be some benefit, though much less.  If a person ends up on a 911 ambulance, preferably working with a paramedic, the benefit can be much greater, and when their paramedic internship comes around they will be able to focus more on the medicine side of things, on less on the other aspects of our job.

Of course, this also depends on the school where you go and where you eventually end up working.  If you have well upwards of 700 hours of field time, that's a good start, though still not enough by far.  In that case experience as an EMT is less needed, though it still might help.  Same goes for where you start working; if there is a good, comprehensive training program before you start working, followed by which you are paired with an experienced partner who continues to teach and evaluate you, then experience as an EMT is less needed, though it'll still have some benefit.  Of course, many places do not do the above, or only a very watered down version of this...so what should the prospective paramedic student do?

Look at the program you are going to; how many clinical hours does it have, how many internship hours?  Look at the services in your local (and non-local)area; what is their training program for new medics?  Can you work as an EMT on a 911 ambulance?  Take a look at yourself; how do you function while under stress?  Do you pick things up rapidly?  Are you used to abnormal situations?  Have you been exposed to multiple types of cultures and situations?  Have you been placed in situations where you had to rely soley on yourself?  How did you do?

Not everyone needs EMT experience, and not all EMT experience will help.  But there is a reason that MD's, PA's, and RN's all spend many more hours practicing their job before they are allowed to work on their own.  Until EMS education is reformed and the internship is extended to 1 year in length, prior experience as an EMT is something worth considering.

Huh...guess that ran long after all.


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## Jersey (Feb 23, 2010)

JPINFV said:


> Second year medical student?



indeed.


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## Shishkabob (Feb 23, 2010)

Trirmal, no offense taken because I'm pretty much in agreement. I'm nervous too about being the lead/lone paramedic in a few months should I get my cert next month.  

Then again if I had 700hr internship I'd feel the same way. 


I don't get my white cloud. I get 1-2 calls in a station where my classmate gets 10+ the day before.   It wouldn't be a problem if Dallas didn't have the CF they did which made us change where we do our internship for this class. 



Luckily I got some decent experience during clinicals in the hospital... It's just being the lead medic in the rig that's getting me.  And I do have some experience as a working EMT-B as well. Not much, but it's there.


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## JPINFV (Feb 23, 2010)

Jersey said:


> indeed.



Interesting, considering in September you were going to school to finish premed course work.

http://emtlife.com/showthread.php?t=15000


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## ExpatMedic0 (Feb 23, 2010)

JPINFV said:


> Interesting, considering in September you were going to school to finish premed course work.
> 
> http://emtlife.com/showthread.php?t=15000



:unsure:


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## medic417 (Feb 24, 2010)

JPINFV said:


> Interesting, considering in September you were going to school to finish premed course work.
> 
> http://emtlife.com/showthread.php?t=15000



Maybe he's a fast learner?:wacko:


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## 8jimi8 (Feb 24, 2010)

firetender said:


> This debate is smeared all over this site.
> 
> From a broader perspective, look at the way systems are run. They are still geared toward "having those 2 bodies in the rig." You are never assured that you will have an experienced medic come to your door. Two partnered green paramedics can do much more damage than a couple seasoned EMTs.
> 
> ...




Ok jumping into the game late here.  Emphasis bolded by ME


Why were YOU watching them, Firetender?  Were YOU the _experienced_ medic in those situations?  Were YOU the leader of the ALS unit in those situations?  

Sounds like a pretty safe pairing to me.  Experienced medic, riding with a green medic.  Sure ANYONE new on the job (including you.  Were you as proficient in all of your skills when you started?) is going to fumble with things.  That is why you send them out with the FTO.  The FTO can evaluate and do some OJT, as well as make sure that the best patient outcomes are achieved.  Where would we be in this world if people without experience couldn't get any?  The paramedics would have died long long ago and there wouldn't be anyone left to replace them.

I realize that the direction that this is taking is the argument about getting experience as a basic first.  I don't agree that it is necessary.  And for those who in your estimation aren't even good at BLS when they start... tell me, in your organization, do they get the "Go" from your FTO's to start leading ALS ambulances?


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## anschoo (Feb 24, 2010)

medic417 said:


> Maybe he's a fast learner?:wacko:



all possible

____________________________

Ontario licensed home care services offers cpap machine  to customers in Toronto and all other Ontario cities.


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## medic417 (Feb 24, 2010)

8jimi8 said:


> ... tell me, in your organization, do they get the "Go" from your FTO's to start leading ALS ambulances?



And that is the winner.  To many organizations hire people then throw them to the wolves.  They do not have FTO's.  They do not do anything but say there's the ambulance don't screw up and we might pay you on Friday.  Even experienced emt's and Paramedics have difficulty when done that way with a new company.  

A proper FTO program will allow a green emt or Paramedic to develop confidence before casting them out.  You know whats funny it doesn't take long and really doesn't cost much.


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## JPINFV (Feb 24, 2010)

medic417 said:


> A proper FTO program will allow a green emt or Paramedic to develop confidence before casting them out.  You know whats funny it doesn't take long and really doesn't cost much.



Especially compared to any billing problems that occur, regulatory issues (are people doing what they need to do), burn out (high turnover), etc. A little investment can go a long way.


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## firetender (Feb 24, 2010)

triemal04 said:


> There is more to EMS (and medicine in general) than just medicine.  There is more to being a good provider than just knowing something in your head.  Being able to function during stressful situations, recall the needed information, apply the needed information, evaluate the results and apply more information as needed, all while under stress and in controlled to chaotic environments takes time to learn.  Being able to control a scene and direct multiple personnel.  Being able to communicate and interact appropriately with pt's (and this includes different cultures and sub-cultures, ages, socioeconomic groups) family (sometimes distraught and/or hostile family), bystanders, coworkers, nurses, doctors, other medical personnel, police, FF's, drunks, crazy people and everyone else we come across is not something that can be learned in a brief internship.  Being able to recognize when someone is lying or holding something back.  Being able to recognize when a scene is unsafe (and I don't mean the glaringly obvious times) or has the potential to become so, being able to take in everything that is happening while still maintaining your focus on the pt, being able deal effectively with the multiple, non-medical issues that we come across regularly...the list can go on and on, but for all the fact remains the same:  becoming truly proficient at these things takes more than 200 hours.



Wonderfully said and the thing that occurs to me is becoming a paramedic is presented as a Fast Track to acceptability and the system is designed to crank out bodies without taking into consideration that it takes years to develop many of the aforementioned skills.

The initial learning curve (whether didactic or clinical) is often overwhelming and some people just need a bit of extra time and patience to ease in to the work. Especially at the beginning.


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## firetender (Feb 24, 2010)

*Almost missed this one*



8jimi8 said:


> Why were YOU watching them, Firetender?  Were YOU the _experienced_ medic in those situations?  Were YOU the leader of the ALS unit in those situations?



This would likely be the result of scheduling. Yes, put an experienced medic with a Rookie. How about getting stuck with guys who've been working in the field for a half-year, and they can start IVs fine but in the basics they still don't have a clue? Beside providing ALS you need to play Watchdog to minimize the damage THEY can cause. How much more do you need to know to say it's a good thing to really train people for what they do, and start simple and then work in complexity? Many paramedic programs need to start from the bottom, really get the students rooted in, and then offer them the toys AFTER the medic is grounded.


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## FLEMTP (Feb 27, 2010)

After reading this thread.. I have just a couple of simple statements to sum up my feelings about EMT experience prior to medic school.. and field experience vs. advanced education

1. Paramedics save lives.. EMT's save medics..


2. I (as a paramedic) would rather have an experienced EMT that is very competent and comfortable with their BLS skills ANY day over a new or relatively inexperienced Paramedic as a partner.

Dont get me wrong, I love to teach, but an inexperienced paramedic belongs in back, with me as a preceptor, and an awesome EMT to assist us and remind us of the little things.. like actually bagging a patient before we intubate, turning on the oxygen tanks so the patient actually GETS oxygen, and to remove the tourniquet before you begin running the IV 

So, master your BLS skills..and be proud of it. The experience you get doing that will be invaluable to you as a medic student, when you know what a cardiac patient looks like and can recognize that before you ever touch your EKG monitor, or how a person circling the drain presents without ever needing to take a blood pressure. These are things a book or a mannequin or a classmate's acting can never teach you...


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## medic417 (Feb 27, 2010)

FLEMTP said:


> 1. Paramedics save lives.. EMT's save medics..
> 
> QUOTE]
> 
> Horse crap.  Why do people still spout this crap?  Meter maids save cops and Nurses Aids save doctors.


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## FLEMTP (Feb 27, 2010)

medic417 said:


> FLEMTP said:
> 
> 
> > 1. Paramedics save lives.. EMT's save medics..
> ...





Why exactly do you feel this is "horse crap"?  As I stated in my above post, sometimes EMT's can remind medics of basic things that may help them progress towards the hospital or towards providing good quality treatment for a patient, such as removing the tourniquet from the arm when an IV wont flow. I can admit personally, that sometimes as a paramedic you are focused on accomplishing certain treatment goals with a patient, and an EMT can remind you of things you may have overlooked or forgotten..or even remind you that its been 5 minutes since your last epinepherine during a code, or that you need to pull the laryngoscope out of the mouth and bag because you've been down their throat for more than 30 seconds. 

I feel to say that the phrase is "horse :censored::censored::censored::censored:" is to overlook the importance of having someone on your team that stays focused on the basic level of care and can remind us of that, because, face it, at some point.. EVERY paramedic has had a lapse in their BLS skills and gone straight to ALS, or overlooked a much simpler BLS treatment. Its in our nature sometimes... especially as a new paramedic.

It might even be something as simple as to keep an eye on the scene while you are securing your intubation or starting your IV, so that you dont get hit by a car that didnt stop for your lights, or you dont get hit by the guy that slipped by the police and is now hell bent on hurting someone.

There is way more to that statement than meets the eye...and I feel its very valid!


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## JPINFV (Feb 27, 2010)

The problem is that if you are making those mistakes with any regularity that you need someone whose sole job is to keep you from making those mistakes, then you need some serious remediation. If it's a once in a while thing (mistakes do happen), then I fail to see how a basic is any better than a paramedic for noticing those things.


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## firetender (Feb 27, 2010)

JPINFV said:


> I fail to see how a basic is any better than a paramedic for noticing those things.



Ultimately, it boils down to teamwork and developing a working relationship where each of you can trust the other to cover your back instead of sticking a knife in it.


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## rescue99 (Feb 27, 2010)

firetender said:


> ultimately, it boils down to teamwork and developing a working relationship where each of you can trust the other to cover your back instead of sticking a knife in it.



amen...


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## DrParasite (Feb 28, 2010)

medic417 said:


> Horse crap.  Why do people still spout this crap?  Meter maids save cops and Nurses Aids save doctors.


actually, it should be nurses save doctors, not nurses aids.  

and if you walk into almost any ER in the county, it is the Nurses who are actually running the ER, not the doctors.  not only that, but many nurses do check the doctors orders, and have questioned when doctors something doesn't look right, and often do catch mistakes.

but yeah, a lesser educated person can _never_ ever catch the mistakes of a higher educated person... thats just an absurd concept


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## JPINFV (Feb 28, 2010)

DrParasite said:


> but yeah, a lesser educated person can _never_ ever catch the mistakes of a higher educated person... thats just an absurd concept


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## medic417 (Feb 28, 2010)

DrParasite said:


> but yeah, a lesser educated person can _never_ ever catch the mistakes of a higher educated person... thats just an absurd concept



Never said a lesser educated person could not catch a mistake.  They are less likely to catch a mistake though than an equally educated person. 

*The only thing a basic partner saves a Paramedic is steps back and forth to the ambulance*. 

 At least a green Paramedic has the education basis to actually help with patient care.


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## FLEMTP (Feb 28, 2010)

medic417 said:


> Never said a lesser educated person could not catch a mistake.  They are less likely to catch a mistake though than an equally educated person.
> 
> *The only thing a basic partner saves a Paramedic is steps back and forth to the ambulance*.
> 
> At least a green Paramedic has the education basis to actually help with patient care.




And its a shame that you are an educator, or claim to be. Shame on you for thinking this, and shame on you if you actually repeat that statement to your students.

In fact, would you mind sharing which educational institution you are affiliated with so that I can pass this tidbit of close minded thinking on to them?  

Thanks


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## Sasha (Feb 28, 2010)

Everytime I skim past this thread I could swear it reads 'EMT-B seeking Women'


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## JPINFV (Feb 28, 2010)

Hmm... "EMT-B seeking women..." Idea for a new thread?


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## TransportJockey (Mar 1, 2010)

Sasha said:


> Everytime I skim past this thread I could swear it reads 'EMT-B seeking Women'



You're not the only one. I avoided it for a while cause that's exactly what I thought it said


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## medic417 (Mar 1, 2010)

Darn double post.


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## medic417 (Mar 1, 2010)

FLEMTP said:


> And its a shame that you are an educator, or claim to be. Shame on you for thinking this, and shame on you if you actually repeat that statement to your students.
> 
> In fact, would you mind sharing which educational institution you are affiliated with so that I can pass this tidbit of close minded thinking on to them?
> 
> Thanks



As an educator I explain to the emt students the limitations and work to get them started on the road to being successful Paramedics.  

And what did I say wrong?  The majority of paid 911 services only allow the basic to be a gopher and a driver.  Why do so many here like to try and blow smoke up the new emt's butt?  Lying is the worst thing you can do to someone and probably another large reason for the high burn out rate seen in EMS.


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## FLEMTP (Mar 1, 2010)

medic417 said:


> As an educator I explain to the emt students the limitations and work to get them started on the road to being successful Paramedics.
> 
> And what did I say wrong?  The majority of paid 911 services only allow the basic to be a gopher and a driver.  Why do so many here like to try and blow smoke up the new emt's butt?  Lying is the worst thing you can do to someone and probably another large reason for the high burn out rate seen in EMS.



The problem is with your logic is this.. in order to be a good paramedic.. i feel that one should have a firm grasp on the BLS skills.. and a good level of experience dealing with patients and having patient contact. Explaining to your students "limitations" of an EMT is doing them a dis-service. EMT is an important role, especially if one has plans to move on to paramedic, and should never be looked at as a "limitation".  Ive worked for many agencies in my 12 years in EMS, and I have only ever encountered ONE agency that would not allow EMT's to attend solo on a patient. They were allowed to perform any skill they wanted on scene or with a medic in back, and that was an agency that wrote their protocols in blood, and mother-may-I'ed their medics to death.  Every where else I've worked values the experience and knowledge you gain as an EMT, and plenty of places in the US still have BLS 911 trucks. True, your treatment options are not the same as a paramedic, and paramedics can provide an advanced level of care.. but being an EMT should NEVER EVER be looked at as a limitation... ever.


As I said above.. shame on you for even putting that idea in your students head. You're doing yourself, your students, and the general public a major dis-service by spreading that line of thinking... and I'll tell you, if I EVER hear a paramedic sharing that type of sentiment with an EMT or another Medic for that matter, I'd be pulling that person aside for a serious heart to heart chat and refer them to administration for an attitude adjustment.


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## EMTinNEPA (Mar 1, 2010)

FLEMTP said:


> The problem is with your logic is this.. in order to be a good paramedic.. i feel that one should have a firm grasp on the BLS skills.. and a good level of experience dealing with patients and having patient contact.



All of which can be achieved during your paramedic clinical rotations.



FLEMTP said:


> Explaining to your students "limitations" of an EMT is doing them a dis-service. EMT is an important role, especially if one has plans to move on to paramedic, and should never be looked at as a "limitation".



Really?  Because I go from functioning as a paramedic at clinical back to work as an EMT and feel awfully limited... "What's that?  You're having chest pain now?  Ok, let me call the paramedic..." or "Her mental status is altered... I'll be up front playing taxi slave..."



FLEMTP said:


> Ive worked for many agencies in my 12 years in EMS, and I have only ever encountered ONE agency that would not allow EMT's to attend solo on a patient. They were allowed to perform any skill they wanted on scene or with a medic in back, and that was an agency that wrote their protocols in blood, and mother-may-I'ed their medics to death.  Every where else I've worked values the experience and knowledge you gain as an EMT, and plenty of places in the US still have BLS 911 trucks.



While I do believe that every patient deserves an ALS assessment, I don't believe that every patient needs ALS during transport.  However, would I feel more confident with a paramedic in the back with me than an EMT if I were a patient?  You bet your sweet butt.



FLEMTP said:


> True, your treatment options are not the same as a paramedic, and paramedics can provide an advanced level of care.. but being an EMT should NEVER EVER be looked at as a limitation... ever.



Adenosine for SVT, cardizem for a-fib with RVR, narcan for a opiate overdose, trancutaneous pacing for second degree type II or third degree AV block, synchronized cardioversion, needle decompression, D50, steroids, antidysrhythmics, 12-lead EKGs...

All potentially life-saving interventions or procedures, whether directly or indirectly.  Yet in most states, none of these items listed are within an EMT's scope of practice.  Seems kind of... I dunno... limiting.



FLEMTP said:


> As I said above.. shame on you for even putting that idea in your students head. You're doing yourself, your students, and the general public a major dis-service by spreading that line of thinking... and I'll tell you, if I EVER hear a paramedic sharing that type of sentiment with an EMT or another Medic for that matter, I'd be pulling that person aside for a serious heart to heart chat and refer them to administration for an attitude adjustment.



"Agree with me or I'll tattle to your boss on you!"  Real mature... this is yet another problem with EMS... anybody who dares to speak out against "the way we've been doing it for (insert big number here) years" is shot down and blackballed.

Yes, EMT IS a limitation.  There's a reason the paramedic isn't up front driving on critical patients.

I took a year off after EMT before going to paramedic school, because I was dumb enough to listen to people who said "Get some experience...", the same people I wound up working for who made my life a living hell for that year.  And what did that year of experience do for me?  Taught me bad habits that I had to fight to break because I saw the "experienced" EMTs doing so.

Bottom line: EMS seems to have an infatuation with this mystical gem called "Experience".  The question you have to ask yourself is this: does the EMT going into a paramedic program who claims to have 20 years of experience really have 20 years of experience, or does he have 6 months of experience over and over again 40 times?  It's not how much time you put in, but what you put in the time.


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## medic417 (Mar 1, 2010)

FLEMTP said:


> The problem is with your logic is this.. in order to be a good paramedic.. i feel that one should have a firm grasp on the BLS skills.. and a good level of experience dealing with patients and having patient contact. Explaining to your students "limitations" of an EMT is doing them a dis-service. EMT is an important role, especially if one has plans to move on to paramedic, and should never be looked at as a "limitation".  Ive worked for many agencies in my 12 years in EMS, and I have only ever encountered ONE agency that would not allow EMT's to attend solo on a patient. They were allowed to perform any skill they wanted on scene or with a medic in back, and that was an agency that wrote their protocols in blood, and mother-may-I'ed their medics to death.  Every where else I've worked values the experience and knowledge you gain as an EMT, and plenty of places in the US still have BLS 911 trucks. True, your treatment options are not the same as a paramedic, and paramedics can provide an advanced level of care.. but being an EMT should NEVER EVER be looked at as a limitation... ever.
> 
> 
> As I said above.. shame on you for even putting that idea in your students head. You're doing yourself, your students, and the general public a major dis-service by spreading that line of thinking... and I'll tell you, if I EVER hear a paramedic sharing that type of sentiment with an EMT or another Medic for that matter, I'd be pulling that person aside for a serious heart to heart chat and refer them to administration for an attitude adjustment.



SHAME ON ME?????????????????????  Your the one encouraging mediocrity.  I am educating my emt's to go get educated.  I give them the truth not a set of rose colored glasses like you do.  They get there experience while in the Paramedic program.  There is no reason any person cannot develop good basic level patient care while also developing their advanced patient care skills.


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## denverfiremedic (Mar 1, 2010)

Crazy thoughts ! I know emt's that will make paramedics look like idiots.. Dont know where you guys work but in my state emt's do most of the work with a paramedic supervising ... But i do know we expect a lot more from our employees than most places


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## DrParasite (Mar 2, 2010)

medic417 said:


> As an educator I explain to the emt students the limitations and work to get them started on the road to being successful Paramedics.


yeah, it's good to know what your limitations are.





medic417 said:


> And what did I say wrong?  The majority of paid 911 services only allow the basic to be a gopher and a driver.  Why do so many here like to try and blow smoke up the new emt's butt?  Lying is the worst thing you can do to someone and probably another large reason for the high burn out rate seen in EMS.


yeah better tell all the 911 services in NJ that they are mostly drivers and gophers only.  ditto New York City EMS, their entire BLS division (about 80% of all EMS units in the 5 boroughs) must not do much.  I am sure there are other paid 911 systems, but I don't know where they are (because I have lived most of my life in NJ and NY).


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## FLEMTP (Mar 2, 2010)

EMTinNEPA said:


> Bottom line: EMS seems to have an infatuation with this mystical gem called "Experience".  The question you have to ask yourself is this: does the EMT going into a paramedic program who claims to have 20 years of experience really have 20 years of experience, or does he have 6 months of experience over and over again 40 times?  It's not how much time you put in, but what you put in the time.



So using your logic... would you rather get the green new surgeon to do your open heart surgery.. or the surgeon with 30 years on the job?... you know.. since experience means nothing...

Your "bottom line" shows your lack of experience... and if you want to sit there and tell me you've been in ems for years and years and years.. then im going to feel awful sorry for you.. because you've obviously learned nothing.

Im sorry you guys disagree with me on this, but this "hurry up and become a paramedic" stuff is going to kill more people than its going to help. You dont see a medical student "rush" his way to becoming a doctor, because getting all those cool medications and monitors doesn't mean jack if you can't LOOK AT YOUR PATIENT and figure out whats going on. As an EMT i learned how to tell a sick patient from a not sick patient, and guess what? i never needed a paramedic, or an EKG machine, or medications to do any of that. I relied on my experience.. and now as a paramedic i use that same experience to fall back on to make my decisions on treatment and transports. 

Something else i want to point out... your PARAMEDIC clinicals are NOT the time to "learn" your BLS skills you should have mastered before getting into paramedic school. Thats like trying to put the house up while the foundation slab is still wet.. you're gonna end up with a mess.. and that is exactly what I see time after time after time when someone who has never touched a patient is given the ability to kill someone with all those procedures you rattled off in your post and doesn't have a clue why they did it. Its also why paramedics are being forced into cookbook medicine.. because they dont have the experience or knowledge to make the right decision, so a doctor makes the decisions for them by literally giving you a recipe to follow. 

It really scares me that people are setting up the future of our profession for failure.. and pushing us from professionals back to the days where we were just simply a technician without the ability to think for ourselves... congrats guys.. give yourselves a pat on the back... and while you're following your recipes for disaster... i'll be practicing medicine.


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## JPINFV (Mar 2, 2010)

/me curious as to when he learns his BLS physician skills since he didn't have to be a PA first.


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## denverfiremedic (Mar 2, 2010)

FLEMT: couldent have said it better myself.... it so funny people think its time to master there BLS skills after P school hahaha.. A million people on here think an EMT - B shouldent be IV certified lol .. a monkey can start an IV first off and you think a good time to start learning how to start lines is after P school!!! yea when your the one that has to push the drugs and do all the ALS the last thing you want is to be sitting there poking a lifeless body going darn i wish i had more practice!!! :::::

as for where do the Docs learn their BLS , maybe in their 4-6 years in med school then possibly a little bit in there 7 years of residency practicing under an experinced physician ohh and about a dozen RN's EMT-B's, EMT-P's and so forth..


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## JPINFV (Mar 2, 2010)

EM residency isn't even half of 7 years in most programs and medical school is only 4 years, of which only 2 years is clinical. After all, when trying to decide between dactinomycin or methotextrate, who has time to figure out how to start an IV?

Edit: Oh, and residency should only count for 1 year (even if most residencies are 3-4 years long, more if a physician wants to complete a fellowship) since a physician in the US is fully licensed after 1 year of residency.


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## EMTinNEPA (Mar 2, 2010)

FLEMTP said:


> So using your logic... would you rather get the green new surgeon to do your open heart surgery.. or the surgeon with 30 years on the job?... you know.. since experience means nothing...



Depends... is the heart surgeon with 30 years of experience educated in the latest techniques or new technology that has come out in the 30 years since he's started performing surgery, or does he perform it exactly the same way as he did 30 years ago?



FLEMTP said:


> Your "bottom line" shows your lack of experience... and if you want to sit there and tell me you've been in ems for years and years and years.. then im going to feel awful sorry for you.. because you've obviously learned nothing.



Ad hominem.



FLEMTP said:


> Im sorry you guys disagree with me on this, but this "hurry up and become a paramedic" stuff is going to kill more people than its going to help. You dont see a medical student "rush" his way to becoming a doctor, because getting all those cool medications and monitors doesn't mean jack if you can't LOOK AT YOUR PATIENT and figure out whats going on.



You also don't see doctors telling kids who wish to grow up to be doctors to become PAs first and get some "experience" before going to medical school.  We are the only part of medicine that has this tiered system, and the disparity between EMT education and paramedic education is astounding.  Oh, and even though I've "learned nothing" (as you put it) during my time in EMS, I can easily distinguish between "sick" and "not sick".  It's not that difficult if you know what to look for... and guess where I spent an entire semester on the art of assessment?  Certainly not in EMT school.



FLEMTP said:


> As an EMT i learned how to tell a sick patient from a not sick patient, and guess what? i never needed a paramedic, or an EKG machine, or medications to do any of that. I relied on my experience.. and now as a paramedic i use that same experience to fall back on to make my decisions on treatment and transports.



So you never utilized ALS once during your entire time as an EMT?  What could you possibly do besides "scoop and run"?  Oxygen?  Whoop-de-doo, Basil!  I don't need an EKG machine or medications to determine sick from not sick, but the EKG can help determine what type of sick I'm dealing with and (along with my assessment findings and the patient's history) determine my treatment modality.



FLEMTP said:


> Something else i want to point out... your PARAMEDIC clinicals are NOT the time to "learn" your BLS skills you should have mastered before getting into paramedic school. Thats like trying to put the house up while the foundation slab is still wet.. you're gonna end up with a mess.. and that is exactly what I see time after time after time when someone who has never touched a patient is given the ability to kill someone with all those procedures you rattled off in your post and doesn't have a clue why they did it.



I'm sorry, BLS skills are something that need to be mastered?  If their airway isn't open, open it.  If they're not breathing, breath for them.  If their heart isn't beating, beat it for them.  If it's broken, splint it.  If it's bleeding, stop it.  Seems fairly cut and dry to me.  And that's what paramedic school is for... learning the how and why behind the treatments we perform.  If a paramedic doesn't know the how or the why, then chances are they don't know because they didn't bother to learn it in paramedic school, not because they didn't wait one more year before going to get experience.



FLEMTP said:


> Its also why paramedics are being forced into cookbook medicine.. because they dont have the experience or knowledge to make the right decision, so a doctor makes the decisions for them by literally giving you a recipe to follow



And you think nurses don't have protocols to follow?  Nobody in healthcare aside from physicians practice with any real autonomy.



FLEMTP said:


> It really scares me that people are setting up the future of our profession for failure.. and pushing us from professionals back to the days where we were just simply a technician without the ability to think for ourselves... congrats guys.. give yourselves a pat on the back... and while you're following your recipes for disaster... i'll be practicing medicine.



Our profession is in the midst of failure because of those who want to remain EMTs forever (read: volunteers and people who simply don't have what it takes to be a paramedic) lobbying to keep educational standards low.  I say eliminate EMT entirely and make a two-year associate's the minimum entry level and the problem will be solved.  That's two years in the classroom and two years worth of clinical time.  Do away with the "BLS vs. ALS" nonsense and realize that IT'S ALL MEDICINE.  THAT'S what trips people up.  Instead of getting the whole picture from the start, all they get at first is the most very basic picture.  Then when they go to paramedic school, they think "Oh, I'm ALS now" and forget about BLS.  If there was no division, we wouldn't have that problem.  And you do realize that by encouraging people to remain EMTs, you are pushing the paramedic profession back because that's all EMTs are... technicians.  So while you're holding the profession back by encouraging old, out-dated, flawed ways of thinking, I will be advancing in my career and making my profession the best it can be.


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## EMTinNEPA (Mar 2, 2010)

DrParasite said:


> yeah better tell all the 911 services in NJ that they are mostly drivers and gophers only.  ditto New York City EMS, their entire BLS division (about 80% of all EMS units in the 5 boroughs) must not do much.  I am sure there are other paid 911 systems, but I don't know where they are (because I have lived most of my life in NJ and NY).



There is no New York City EMS.  It was engulfed by the FDNY and broken into a shadow of its former self.  And if you didn't notice, FDNY recently began seeking more personnel for their EMS... they're looking for paramedics... NOT EMTs.


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## denverfiremedic (Mar 2, 2010)

JPINFV said:


> EM residency isn't even half of 7 years in most programs and medical school is only 4 years, of which only 2 years is clinical. After all, when trying to decide between dactinomycin or methotextrate, who has time to figure out how to start an IV?
> 
> Edit: Oh, and residency should only count for 1 year (even if most residencies are 3-4 years long, more if a physician wants to complete a fellowship) since a physician in the US is fully licensed after 1 year of residency.



First off what the heck would I know... my dads been a Dr. for 25 years , my mom a ed RN for 20..... A of all medical school isnt even 4 years for all Doctors! "Podiatrist" 3 years! genearaly 4-6 years if having an advanced specialized field.. residency is 3-7 years budd! my dads was 7 at Vanderbilt HP.. depends on what type of physician your becoming. but again you probably know everything and your google bar is getting wore out!


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## medic417 (Mar 2, 2010)

DrParasite said:


> yeah, it's good to know what your limitations are.yeah better tell all the 911 services in NJ that they are mostly drivers and gophers only.  ditto New York City EMS, their entire BLS division (about 80% of all EMS units in the 5 boroughs) must not do much.  I am sure there are other paid 911 systems, but I don't know where they are (because I have lived most of my life in NJ and NY).



Based on the NJ EMS reputation it is never a good way to defend any point except when showing the wrong way to do things.


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## JPINFV (Mar 2, 2010)

denverfiremedic said:


> First off what the heck would I know... my dads been a Dr. for 25 years , my mom a ed RN for 20..... A of all medical school isnt even 4 years for all Doctors! "Podiatrist" 3 years! genearaly 4-6 years if having an advanced specialized field.. residency is 3-7 years budd! my dads was 7 at Vanderbilt HP.. depends on what type of physician your becoming. but again you probably know everything and your google bar is getting wore out!



Sorry... there is no such thing as a 7 year EM residency. MD residencies are mostly 3 years (PGY 1-3) with a few 4 years and 3 year PGY 2-4 while DO EM residencies are 4 years (PGY 1-4). Technically, if you want to go into it that deeply, even things like cardiology is only a 3 year internal medicince *residency* followed by a 2-3 years of *fellowship* depending on which type of cardiology the physician is going into. Additionally, I'm not too concerned over the requirements for DPMs, ODs, DMD, etc. I'm in none of those programs and, as a whole, those fields have absolutely nothing to do with EMS. 

Of course none of this touches the fact that the vast majority of states do not require physicians to complete anything more than 1 year of residency prior to obtaining an unrestricted license to practice medicine.

Of course what the hell does a medical student know about how medical education is set up.


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## triemal04 (Mar 2, 2010)

EMTinNEPA said:


> All of which can be achieved during your paramedic clinical rotations.
> That is the worst advice and idea I've ever heard.  If you are using your clinical time, the time that you are supposed to be spending in various units learning about different disease processes, illnesses, treatments, and so on, to master your BLS skills you are doing yourself, your school, and EMS as a whole a huge disservice.  You are not put into an ICU to learn how to function as an EMT, you are there to learn how to treat your patients as a paramedic.  The same goes for a burn unit, NICU, PICU, oncology ward, CCU, SICU, ER and on and on.
> 
> <snip>
> ...


Replies in red.  Why is it that people think that their own experience is so important that it trumps everyone else's?  That they are so important that their way is the ONLY way?  Sad really.

I'm not going to repeat myself in this thread; I said it all in my first one.  There are reasons that working as an EMT can help someone when they go on to paramedic school.  And there are reasons that it can be detrimental.  But a blanket statement really can't be made one way or another at this point with the way EMS education is run.  Like it or not, with the short amount of time that paramedic students spend on their internships, certain knowledge and abilities are needed before they start; for many people there is not enough time to learn EVERYTHING that a paramedic should know if you are starting from scratch.  If things were different and a year was spent working in the field before getting certified then this would be a non-issue.  But, unfortunately, that isn't how things are right now.

And some food for thought:  The King County Medic 1 system (which encompasses Seattle, KCM1 the service and several other transporting fire departments) requires a minimum of 3 years of prior experience before entering into their paramedic program.  Boston EMS requires all their new paramedics work at a BLS level for at least a year before working as paramedics.  Why do these places (which are generally thought of very well in EMS and medical circles) do that if it's such a bad idea?


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## medic417 (Mar 2, 2010)

triemal04 said:


> Boston EMS requires all their new paramedics work at a BLS level for at least a year before working as paramedics.  Why do these places (which are generally thought of very well in EMS and medical circles) do that if it's such a bad idea?



To save money.


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## JPINFV (Mar 2, 2010)

triemal04 said:


> And some food for thought:  The King County Medic 1 system (which encompasses Seattle, KCM1 the service and several other transporting fire departments) requires a minimum of 3 years of prior experience before entering into their paramedic program.  Boston EMS requires all their new paramedics work at a BLS level for at least a year before working as paramedics.  Why do these places (which are generally thought of very well in EMS and medical circles) do that if it's such a bad idea?



Weed out the patch mill medics.


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## triemal04 (Mar 2, 2010)

JPINFV said:


> Weed out the patch mill medics.


It's possible, but if that were the case then why does King County have the requirement they do?  After all, they send everyone through Harborview, so why require 3 years prior experience at any level?  Is it because they've found that prior exposure and experience helps people perform at a higher level?  Some other reason?  Similar for Boston; given that the paramedic is only performing at the EMT level, it would be harder to determine the quality of their paramedic education; the things that a mill leaves out will be hard to assess in someone functioning at the lower level.

I'm not necessarily right and there are multiple reasons why it may be done, but the response from some of the more rabid..erm...uh...individuals who've posted here will be interesting to see.


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## DrParasite (Mar 3, 2010)

EMTinNEPA said:


> There is no New York City EMS.  It was engulfed by the FDNY and broken into a shadow of its former self.  And if you didn't notice, FDNY recently began seeking more personnel for their EMS... they're looking for paramedics... NOT EMTs.


really.... so all those hospitals that are running ALS and BLS ambulances are just figments of my imagination?

there absolutely is NYC EMS; it is the EMS providers that provide EMS in NYC (thought it would be a duh, but I guess I need to clarify for some people).  FDNY and the voluntary FDNY EMS system (those hospitals that answer 911 calls alongside FDNY EMS).  Yes, it isn't called NYC*EMS, but there is still an EMS system in NYC, and it runs with BLS and ALS ambulances. 


medic417 said:


> Based on the NJ EMS reputation it is never a good way to defend any point except when showing the wrong way to do things.


and who is that reputation from?  people who actually work in NJ, and continue to still do so?  or have just heard stories?

I guess your right, we could have the rep of California (where an EMT-P cert will get you a job flipping burgers until a FD offers you a job, or so I read on here) or florida (the land of a medic on every ambulance, fire truck, tow truck, and DPW vehicle).  maybe you want to look at Philly, the capital of Pa?  or DC?  all shining examples of EMS


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## DrParasite (Mar 3, 2010)

triemal04 said:


> Boston EMS requires all their new paramedics work at a BLS level for at least a year before working as paramedics.  Why do these places (which are generally thought of very well in EMS and medical circles) do that if it's such a bad idea?


Because they are smart enough to realize that an all ALS system is unnecessary, and most good systems use BLS as the backbone of a good EMS system, leaving ALS for the sick patients?  Not only that, but they keep a relatively few paramedic units in the city (compared to BLS), to ensure their paramedics are highly trained and experienced because they only deal with sick patients.  and not every BLS unit is staffed with 2 paramedics who are waiting for a paramedic spot, there are EMTs who are happy as EMTs (I know, amazing concept).


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## MrBrown (Mar 3, 2010)

Well first off, the EMT-Basic *should* be seen as an advanced first aid certificate, because *gasp, that is what is!

Experience is required however, it must be the right kind of experience.  This is where I think your education system sort of fals over because you get people out the door with sweet F/A knowledge and give them a little time to practice and then wowee they're off saving the world.

When one of the Ambulance Service Medical Officers told a class of Intensive Care Paramedics that in the US the EMT-Basic was around 100 hours with 1o or so hours of practical experience on an ambulance or in the ER the room let out a rousing laugh.  That was in 1994.  And look how far you've come in nearly two decades.  

Taking a blood pressure and giving somebody oxugen is not the experience that new Ambulance Officers need.  While that is important, I think you should be educating to a much higher level and then putting these people onto the street to cosolidate that knowledge into a package that forms a cognitive based for higher level learning. 

If we take Ontario (Canada) as an example they educate Primary Care Paramedic's for two years full-time in micro level fundamentals of medical bioscience and ambulance practice then put them onto the street with an appropriate scope-of-practice (about 6 or 7 drugs) to allow them to solidify that knowledge with thier experience.  This is quite simmilar to how our Bachelors Degree works.

So what experience do new Ambulance Officers need?  Well first of all they need the education to support that experience, a 100 hour class or 600-1000 hours of training is not adequate.  They need a prolonged, structured pathway to take them from graduate to Paramedic and beyond.

A Paramedic here will have around 3,500 hours of education and practical experience in the Bachelors Degree and spend another 1,000 hours (one year) consolidating that knowledge in the Graduate program.

An Intensive Care Paramedic will have around 6,000 hours of education and experience both in the Degree and on the street (around 2-3 years post-graduation) before undertaking another 12-18 months of study and internship to become an ICP.



DrParasite said:


> Because they are smart enough to realize that an all ALS system is unnecessary, and most good systems use BLS as the backbone of a good EMS system, leaving ALS for the sick patients?  Not only that, but they keep a relatively few paramedic units in the city (compared to BLS), to ensure their paramedics are highly trained and experienced because they only deal with sick patients.  and not every BLS unit is staffed with 2 paramedics who are waiting for a paramedic spot, there are EMTs who are happy as EMTs (I know, amazing concept).



You may be onto something here.  Those cities with *less* ALS such as Boston, Tulsa and Seattle with very strong first-response and BLS level care do have better cardiac arrest survival rates than say oh, Miami or Dallas where every Firefighter is a Paramedic.  What a shocker!


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## EMSLaw (Mar 3, 2010)

*The Great Garden State*



DrParasite said:


> and who is that reputation from?  people who actually work in NJ, and continue to still do so?  or have just heard stories?
> 
> I guess your right, we could have the rep of California (where an EMT-P cert will get you a job flipping burgers until a FD offers you a job, or so I read on here) or florida (the land of a medic on every ambulance, fire truck, tow truck, and DPW vehicle).  maybe you want to look at Philly, the capital of Pa?  or DC?  all shining examples of EMS



New Jersey has its upsides and downsides.  You're right, the tiered ALS/BLS response system means that medics spend most of their time seeing sick people, and can turf the not-so-sick to BLS for transport.  And, despite the limitations on the number of programs out there, all the Paramedic programs in New Jersey are paired with a community college, and are generally at the Associates degree level.  The training is on the order of 350 hospital hours and 600 field internship hours, plus two or three semesters of classroom work, so far more than the bare minimum.  

On the other hand...  There are only 1700 licensed paramedics in the state, give or take a few, working for the MICU programs, which means that when you really need a medic, they will be several towns away and caught in traffic.  None of the medic programs are accredited, though maybe that will change.  The paramedic protocols seem limited, and there is a lot of "mother may I."  Pre-hospital pain control in my area is a pathetic, sick joke.    

Then, of course, there are the complaints about how NJ's BLS system is, in most of the state, largely volunteer based.  Frankly, as long as the rigs get out, and there's trained EMTs on them, I don't see the difference whether that person collects a paycheck or not, but I don't want to start a volly/paid debate, and I know there are times, and places, where the rigs don't get out, and they don't have trained people on them.  I will say that MICU projects love volleys.  Not because they have any sort of particular soft-spot, but because volunteer services don't bill, which means the MICU can collect the entire insurance payment, rather than kicking back the BLS transport rate to the transporting company. 

It seems to me like New Jersey isn't a bad place to be a medic, all things considered.  It's not the most progressive EMS system in the world, granted, but it has its strong points and not-so-strong points.


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## medic417 (Mar 3, 2010)

MrBrown said:


> Well first off, the EMT-Basic *should* be seen as an advanced first aid certificate, because *gasp, that is what is!
> 
> You may be onto something here.  Those cities with *less* ALS such as Boston, Tulsa and Seattle with very strong first-response and BLS level care do have better cardiac arrest survival rates than say oh, Miami or Dallas where every Firefighter is a Paramedic.  What a shocker!



Yes basic is barely more than a boy scouts first aid class. 

And as has been mentioned on this site before it is not truly accurate to compare saves as each service collects data on codes differently.  Some include every call that CPR is performed.  Others only include witnessed codes.  Still others only base the claims on non traumatic witnessed codes with a shockable rhythm.   Another difference is the way success is determined some it is just getting ROSC others surviving a week and yet others the patient has to leave the hospital basically intact.  So you can see why one service would be almost 0% while another claims nearly 50%.


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## EMTinNEPA (Mar 3, 2010)

DrParasite said:


> I guess your right, we could have the rep of California (where an EMT-P cert will get you a job flipping burgers until a FD offers you a job, or so I read on here) or florida (the land of a medic on every ambulance, fire truck, tow truck, and DPW vehicle).  maybe you want to look at Philly, the capital of Pa?  or DC?  all shining examples of EMS



Without changing the subject, look at which entity is providing EMS in each of those cities and ask yourself if it's more to do with lots of paramedics or lots of people pretending to be paramedics in order to get a fire job.


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## triemal04 (Mar 4, 2010)

DrParasite said:


> Because they are smart enough to realize that an all ALS system is unnecessary, and most good systems use BLS as the backbone of a good EMS system, leaving ALS for the sick patients?  Not only that, but they keep a relatively few paramedic units in the city (compared to BLS), to ensure their paramedics are highly trained and experienced because they only deal with sick patients.  and not every BLS unit is staffed with 2 paramedics who are waiting for a paramedic spot, there are EMTs who are happy as EMTs (I know, amazing concept).


But then, why bother hiring paramedics (who are paid at a higher rate than EMT's, even when working as one) as EMT's?  Why not just keep the BLS units staffed with EMT's and the ALS units staffed with paramedics?  Seems like they have thier reasons, whatever they may be.


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## DrParasite (Mar 4, 2010)

triemal04 said:


> But then, why bother hiring paramedics (who are paid at a higher rate than EMT's, even when working as one) as EMT's?  Why not just keep the BLS units staffed with EMT's and the ALS units staffed with paramedics?  Seems like they have thier reasons, whatever they may be.


I am guessing for this exact reason:


			
				http://www.cityofboston.gov/ems/career/ said:
			
		

> NOTE: Paramedics are promoted from within the Department only. Many of our EMTs are certified Paramedics but work for us as EMTs, gaining valuable experience until the opportunity for promotion arises.


so everyone, if they want to be a medic with BEMS, has to start out as a BLS provider.  Makes sense to me, they learn the operational rules about BEMS, and when a medic spot opens up, then they can transition to the clinical rules of being an ALS provider.


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