# How Long before going to Paramedic school?



## nibejeebies (May 17, 2009)

Hi guys.  I'm Ni, I come from a Law Enforcement Background, and Volunteer Fire Service.  Got into EMS because I felt like I could help people more then sending them to Jail or Keeping them their. 

So I have gotten all my ducks in a row so to speak.  Now working in EMS on a BLS 4 days a week and an ALS 2 days a week.  

Have been talking to all the guys at work and others that I know about when to go to Paramedic School.  

I have decided to wait at least a Year and get that experience before attempting to enroll in a Medic school.  

I'm working for a company called Rural Metro, who offers to pay for said Medic School and books after one year of continuous employment averaging over 37 hours a week.  Hence my decision for at least one year. 

Some one also suggested going ahead and buying the books and self study during that year to make school a bit easier. 

So my question is, what does everyone recommend?  Get the books and self study or not?  Wait the year or Longer?  Go to Medic school this Fall?  

PS 
I searched the site for the questions but didn't really find a topic that really answered any of these questions.


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## medic417 (May 17, 2009)

You will be better off getting into a Paramedic program as soon as possible.  There is nothing to be gained but bad habits by working as a basic.


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## nibejeebies (May 17, 2009)

but is it not Generaly frowned upon for a paramedic not to have any form of experaince in the field when starting?


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## medic417 (May 17, 2009)

NO.  EMS is the only medical field that trys to make people go in steps.  All real medical professions get all their education then practice.  A new Paramedic should get their experience during clinicals or better term their internship.  Sadly though many schools do not require a true internship and thus Paramedics coming out seem lost.  Go to a good Paramedic program and you can have zero EMT experience and be a great Paramedic upon completion.


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## VentMedic (May 17, 2009)

nibejeebies said:


> I'm working for a company called Rural Metro, who offers to pay for said Medic School and books after one year of continuous employment averaging over 37 hours a week. Hence my decision for at least one year.
> 
> Some one also suggested going ahead and buying the books and self study during that year to make school a bit easier.


 
It is not about the experience. Just about any company may want your labor for at least one year especially as an EMT. They know you will probably run off to join the FD or another company once you complete your Paramedic. There are other companies which provide both ALS and BLS that will put you through Paramedic school right away but want you to sign a contract for the time you are in school as well as an additional year of service just to keep your body on their trucks and for you to show loyalty for their money they have spent on you. However, many companies still know that some will jump ship as soon as a better job opens up once they get their Paramedic and there is little they may be able to do to get their money back. Thus, the reason most tell you to wait a year and JUST WORK for their benefit, not yours. 

You should be starting some A&P, microbiology and pharmacology *college* classess while you are waiting. Reading a 10th grade reader such as a Paramedic text book prior to class may not put you very much ahead of the class. Getting a solid educational foundation while you are working as an EMT will enable you to know more about the patients you have before you now. You may also understand the whys of the procedures you are now doing or observing. That might even be beyond some of the Paramedics you now working with on ALS who only went through Paramedic school without doing any prerequisites.


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## MMiz (May 17, 2009)

In this economy and work environment I'd go straight from EMT school to Paramedic school.  Even if Rural Metro isn't willing to foot the bill, at this point I believe it would give you the most opportunities if EMS if your career of choice.


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## 46Young (May 17, 2009)

medic417 said:


> NO.  EMS is the only medical field that trys to make people go in steps.  All real medical professions get all their education then practice.  A new Paramedic should get their experience during clinicals or better term their internship.  Sadly though many schools do not require a true internship and thus Paramedics coming out seem lost.  Go to a good Paramedic program and you can have zero EMT experience and be a great Paramedic upon completion.



MD's do several years of residency, fellowship, and such. Unless you're working at a doctor's office or nursing home, a new RN will plenty of help. A PA will be working under a MD. I don't know the deal with RT's. A medic candidate needs a solid pt assessment, and a sizeable number of pt contacts for decision making experience. Having strong BLS is necessary, as you'll be plenty nervous, second guessing your Tx plan, struggling to remember protocols, and such. Deciding when to go ALS ought to be based on comfort level as a BLS provider. When you feel you've pretty much got it down, then it's time. I've had to show medics how to properly apply spinal motion restriction, how to splint, set up a neb and such. People say three years BLS is a good rule of thumb. Fact of the matter is, your learning curve can vary greatly. If you're working a busy urban BLS rig, you may feel proficient after a year or so. If you're out in the sticks, and rarely turn a wheel, you may not see much at all. Medic/EMT crews will be dominated by the ALS provider, so the BLS crew member won't learn much. Sure, you'll get good experience from a quality program, but you'll still be green in the ways of ALS upon graduation. Your BLS should be second nature, so you can devote thought to possible advanced procedures. I worked 46E1, a very busy BLS in Queens NY for several years before completing a solid medic program, and I was still like a deer caught in headlights for the first few months. We have two ALS providers per bus, so I had quality people to show me the ropes. If you want to go ALS right away, at least work for a double medic agency, so you'll lwarn from a seasoned provider. If you'll be thrown to the wolves as a sole ALS provider, you'll be prone to bad clinical judgment, poor pt outcomes, and possible lawsuits/cert revocation as a result.


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## VentMedic (May 17, 2009)

46Young said:


> A medic candidate needs a solid pt assessment, and a sizeable number of pt contacts for decision making experience. Having strong BLS is necessary, as you'll be plenty nervous, second guessing your Tx plan, struggling to remember protocols, and such. Deciding when to go ALS ought to be based on comfort level as a BLS provider. When you feel you've pretty much got it down, then it's time.


 
How much assessing can you actually do at the BLS level?  

Since you have compared RNs to EMTs, they both have strong assessment skills and knowledge at their advanced level when they get out of their program.   They are not assessing at a CNA level.    A CNA is not allowed to do any "assessing" other than the skills of taking vitals and many of them have much more training than an EMT-B as well as more patient contact.  An LVN, with only 1 year of education/training,  is also restricted from doing most assessments in hospitals especially the initial admission.   

If you don't know what to look for or what you are looking at with the limited education provided in an EMT-B class, how can you adequately assess a patient?     Are you really assessing the patient or just looking for a few signs and symptoms that fit into the limited protocols and knowledge you have?


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## VentMedic (May 17, 2009)

MMiz said:


> In this economy and work environment I'd go straight from EMT school to Paramedic school. Even if Rural Metro isn't willing to foot the bill, at this point I believe it would give you the most opportunities if EMS if your career of choice.


 
This brings us to another good point.  Becoming an EMT and Paramedic has been touted as quick entry jobs in the newspapers for those displaced by this economy.  There are many out there who never gave EMS a thought until they lost their high tech, teaching or airline jobs.  The medic mills are now full of people looking to pick up a job quickly so there may be some competition.    They may also be well educated, slightly older with solid work experience and can present very professionally to a perspective employer.   Of course, when the economy swings up again in a couple of years, they may abandon the ambulance jobs and return back to their former careers.


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## nibejeebies (May 17, 2009)

So What if I go ahead and do the Year wait, while taking A&P, Pharm, and a few others?

In Tennessee you can be a Paramedic with out a A.S. in Paramedicine but it is available. 

Would it be a good idea to peruse said degree, if I plan to not live in Tennessee all my life?


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## VentMedic (May 17, 2009)

nibejeebies said:


> So What if I go ahead and do the Year wait, while taking A&P, Pharm, and a few others?
> 
> In Tennessee you can be a Paramedic with out a A.S. in Paramedicine but it is available.
> 
> Would it be a good idea to peruse said degree, if I plan to not live in Tennessee all my life?


 
If you are taking A&P and the other college level classes, you are not waiting. In a perfect world no one should be allowed to have a Paramedic cert unless they had these classes at the very minimum. No other health care profession ignors these classes as they are the true "basics", not the EMT-B class.

Getting a degree depends on what your goals are and whether you want a job or a career. 

 BTW,  make sure your Paramedic program is accedited by CAAHEP/CoAEMSP.


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## medic417 (May 17, 2009)

46Young said:


> MD's do several years of residency, fellowship, and such. Unless you're working at a doctor's office or nursing home, a new RN will plenty of help. A PA will be working under a MD. I don't know the deal with RT's. A medic candidate needs a solid pt assessment, and a sizeable number of pt contacts for decision making experience. Having strong BLS is necessary, as you'll be plenty nervous, second guessing your Tx plan, struggling to remember protocols, and such. Deciding when to go ALS ought to be based on comfort level as a BLS provider. When you feel you've pretty much got it down, then it's time. I've had to show medics how to properly apply spinal motion restriction, how to splint, set up a neb and such. People say three years BLS is a good rule of thumb. Fact of the matter is, your learning curve can vary greatly. If you're working a busy urban BLS rig, you may feel proficient after a year or so. If you're out in the sticks, and rarely turn a wheel, you may not see much at all. Medic/EMT crews will be dominated by the ALS provider, so the BLS crew member won't learn much. Sure, you'll get good experience from a quality program, but you'll still be green in the ways of ALS upon graduation. Your BLS should be second nature, so you can devote thought to possible advanced procedures. I worked 46E1, a very busy BLS in Queens NY for several years before completing a solid medic program, and I was still like a deer caught in headlights for the first few months. We have two ALS providers per bus, so I had quality people to show me the ropes. If you want to go ALS right away, at least work for a double medic agency, so you'll lwarn from a seasoned provider. If you'll be thrown to the wolves as a sole ALS provider, you'll be prone to bad clinical judgment, poor pt outcomes, and possible lawsuits/cert revocation as a result.



So they are working at the level under a more experienced providers.  Perhaps EMS should learn from that.  Get your education, internship, then work under supervision of an experienced provider.  

As to experience you get nothing but bad habits and deaths of patients as you watch and can do nothing.


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## Sasha (May 17, 2009)

Sign up for medic before the ink's dry on your EMT cert. Of course I'm biased, but I don't feel there was anything taught to me by my EMT experience during medic school that I couldn't have picked up during clinicals/rides.


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## Afflixion (May 18, 2009)

I worked as a basic for a year prior to getting my medic. I personally believed it helped out a lot. I was already good with pt contact, knew where everything was on the truck, and was better at writing reports. (where i worked a basic handled level III traumas/ medicals.) Personally I would wait the year get to know the city/town, know your truck and the equipment you carry. If your medics don't mind ask them questions on what they would do in X scenario, what drugs do what, what could you have done better. If your still working with an FTO if you don't ask questions you are wrong and if s/he gets mad when you ask them questions they shouldn't be a FTO


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## Wee-EMT (May 18, 2009)

What's the rush? I say work the year and get the experience, good or not.


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## Ridryder911 (May 18, 2009)

Wee-EMT said:


> What's the rush? I say work the year and get the experience, good or not.



Yeah, that way we have all of that to attempt to correct. Meanwhile those with a clean slate will get the first attention. 

R/r 911


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## wehttam (May 19, 2009)

i say dont wait as an emt-b i describe my job and an advance first aider there is no need to wait go for it once u have the opportunity


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## ResTech (May 19, 2009)

I believe a strong foundation as a BLS provider is very important and will be a ton of help as a Paramedic student. In my program, it is very obvious who has very little to no BLS experience. They are the ones who struggle the most. Some of the students in my program got their EMT in the first semester of the program.


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## VentMedic (May 19, 2009)

ResTech said:


> I believe a strong foundation as a BLS provider is very important and will be a ton of help as a Paramedic student. In my program, it is very obvious who has very little to no BLS experience. They are the ones who struggle the most. Some of the students in my program got their EMT in the first semester of the program.


 
It is also very obvious when one has spent too much time as an EMT-B.  

Quite often much time must be spent in the first weeks of Paramedic school relearning all that "BLS" stuff because too many have chosen to wait for Paramedic school.  They also must be retrained due to bad habits or "shortcuts" that might be excused on just a BLS truck but will not work when one assumes the responsibility as an ALS provider.   This is time wasted which could be used to learn more indepth material at the advanced level.


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## Afflixion (May 19, 2009)

this is always a debatable matter but it typically can be cut down to most longer running medics (and those who took their advice to go asap new medics) generally agree to go to medic school ASAP and most newer medics say to wait... no sense in debating it really everyone has their own opinions and the real question is what do you think you should do? do you believe you have the skills and mindset to continue on to medic right away or do you feel you should wait? thats the only answer to this question anyone should be giving you imho.


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## CAOX3 (May 19, 2009)

I believe it is up to the person, either way prepare yourself.  If your an EMT with experience and you become a lousy paramedic you have no one to blame but yourself and vice versa.


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## Foxbat (May 19, 2009)

nibejeebies said:


> but is it not Generaly frowned upon for a paramedic not to have any form of experaince in the field when starting?


It is frowned upon by some, but not all, people in the field. Most people who work or volunteer with me, both EMTs and medics, strongly recommended me to get experience first; institution where I got my EMT-B and where I may later study to be a medic "strongly recommends" at least 1 year of experience as an EMT; some schools won't even accept your application without EMT experience.
But, as you can see from this thread, some people have opposite view and, as some of them stated in other threads, may be reluctant to accept people with too much EMT experience to their program.


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## AJ Hidell (May 20, 2009)

Yet another frequently asked question that should earn a lifetime ban for asking.


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## VentMedic (May 20, 2009)

How long do you want to remain at an EMT-B level doing very basic skills with a very limited knowledge base for assessments? 

Patients don't always come with complaints that are designed for just the EMT-B. That is why other healthcare programs quickly move you along during a 2 or 4 year program so you can start thinking like an advanced provider. You can work with a Paramedic for 20 years but unless you have similiar education and knowledge, you will just be parroting what he/she does. One way to embarrass yourself in the ED is to say something "Could it be x because I once saw something like that and that is what a Paramedic told me he thought it was". It demonstrates you have very little assessment ability and no clue about the disease processes to even begin to know what to look for or form any type of differential diagnosis.

We have enough examples on this forum in the BLS and scenario forums. I don't mean to pick on anyone but it definitely illustrates the thought process from BLS and ALS. Now, if these EMTs were in school taking A&P and other sciences or even in the Paramedic program, those posts would probably be much different. 

I definitely don't want to discourage anyone from posting their questions but rather to show the importance of having a decent educational foundation should even be required before EMT-B. 

examples:


> *Was it an MI?*
> 
> I first responded with my volly dept. the other afternoon to a chest pain call. U/a 84 yo male complaining of chest pain radiating down left arm with a small complaint of sob. Patient stated pain was 8/10 and felt like "an elephant was sitting on his chest". Patient was diaphrotic and pale. Patient placed on 15 liters nrb and states minor relief to the sob.
> +++++++++++++++++++
> I didnt have time to call med control to request permission to administer more nitro. Patient loaded into ambulance and ambulance intercepted with medic. No further information available. So is it an mi? How often will 3 sprays of nitro not dump the bp?





> *Scenario *
> You have a 47 y/o pt that has fallen off his horse, he is not responsive to verbal or painful stimuli, as you approach you notice that his respiratioins are slow and deep he has a hematoma to the occiputal portion of the skull as well as battle signs and racoon eyes and a blown right pupil, your pt has absent breath sounds on the right side of the body as well as paradoxical motion, the pt has no distal pulses and cap refill is at 4 sec. the patient has bruising and distension to his abdomen and crepitus to his pelvic region
> 
> 
> This is one my teacher gave me it was out of a *ALS section* but she decided to give it to me


 
Again, it would be nice if all patients were just defined as "ALS" or "BLS".



> *"Heart keeps skipping a beat"*
> Pt states that she often feels heart skip a beat once or twice every day.
> 
> However, today it happened every 3-5 minutes for about 30 minutes every hour. States that often when it happens, she feels dizzy and everything around her "turns red." This continued for a few hours.
> ...


 
While at the "BLS" level, all of the questions are appropriate but it also demonstrates that the BLS and ALS mentality has hurt this profession. People providing care to a patient in an emergent situation should be thinking in advanced level terms. They should not be thinking solely in the terms of someone who knows how to take a BP or put on a few splints. Medicine is more than a few skills. 

The one skill that should be perfected at the EMT-B level isn't much of the time. That skill is BP. On the forums we again have many basic questions about taking a BP that should have been taught in class but rarely is. The same for HR and pulse. Too many rely just on the electronic gadgets to do their work. Some also rely on a pulse ox to tell them if the patient is short of breath. Maybe it is thought that the technology can make up for the lack of education. 

Quite possibly, for most of the patient care experience that you would get in one year on an ambulance you could get in 1 week shadowing a CNA in a busy hospital. You would probably do as many if not more BPs during that time as you might on an ambulance in 1 year and on many more different patient. You would also have someone who could tell you the proper way to do BPs on dialysis and cancer patients. You would also learn the proper way to move and transport many more patients with many different illnesses, injuries and equipment. That would definitely be helpful especially when some don't realize how frail and brittle some patients are in the LTC facilities. Some can work on an ambulance for 10 years and will still dump an elderly patient with rheumatoid arthritis into the bed like a sack of potatoes. It is possible that they don't know what the disease is or the long term effects. Is it lack of education or because they just don't care? Bad habits and mentors? 

So again I stand by a NO for being an EMT-B any longer than it takes one to finish Paramedic school. Continue your education while the EMT-B class is still fresh and use what you are learning in the advanced classes to understand what you are doing as an EMT-B. As well, as I also stated, there should be a long list of prerequisites prior to EMT-B. Then, this thread would not have had to exist. The importance of continuing one's knowledge for patient care would already be evident.


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