# ALS for BLS



## coloradoemt (Feb 5, 2005)

My volly dept has a class titled ALS for BLS every month. We get our CE hours from these classes. I am curious what some of you Paramedics like your BLS partner to know about ALS to help get the job done.


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## domesticgodemt (Feb 6, 2005)

No ALS gets done w/o BLS done first.  Don't wait for direction.  Get it done, so you don't hold them up maintaining airway or gaining IV access  

Any good Basic class will have a lab that spends an hour to explain how to spike a bag, the difference between micro/macro drip, extension sets, and maintaining aseptic technique, etc.  Having 4X4's, alcohol/Iodine swabs, and teguderm ready.  Medics may vary!!!!!!!  Some will inspire you to go and get your own swelled head (just kidding).  Others will make the experience such that you know after the call you are still at the bottom of the food chain in Prehospital care.  

If you are extremely lucky you may get another hour to learn about how to aid w/ intubation.

When they ask for the intubation kit.  Take some time and know what the parts are.  Make sure the laryngoscope is light, tight, and bright.  Know the difference between a McIntosh (curved) and a Miller, Wisconsin, etc. (straight) blades and SIZES.   Once the tube is placed and verified you have a job Slick.  Bagging and making sure the tube does not get dislodged.

Brady has a great book (and this is not an advertisement) ALS for BLS Providers.
If you read the first four chapters you will be more than just a 3rd or 4th hand.

Massachusetts has a 20 hr. course for this.  20 hours for a Basic would probably be much better spent on core content topics.   And remember you have to continue to do your BLS Vitals and document everything that the ALS provider asks you to note Meds/interventions/times.  If you are doing an intercept know your rig/equipment location so that the Medic does not think you are the Village Idiot!!  Above All Stay Safe! 

4/12 Lead placement.  Familiarize yourself with the EKG/Defib the medic uses.


The variety of medics you intercept with can be awesome mentors and each one has their own style (within protocol of course).  Be a sponge!!!!

Now will the experts please chime in?


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## Jon (Feb 6, 2005)

I am a BLS provider almost done -P School. 

Important "ALS assist" skills

3/4 lead placement
Setting up nebulizers
spiking bags - understand different fluids and drip sets.
SET UP the accu-check

Nice things to do for a medic:

Drawing up flushes if needed
12-lead placement
setting up code meds (Epi, Atropine - screw the two halves together)


I always saw my job when driving the medic as do everything I can to make his life easier - get a set of signs, o2, IV here or in the bus? spike the bag, get the blood tubes out for him, have everything I would want to start an IV out, accu-check ready, tear tape, etc...

Oh, and my BAAM was always handy (what good paramedic wannabe whacker doesn't have 1 or 2 or 3 or 4.....  )

Jon


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## PArescueEMT (Feb 6, 2005)

or that case under your bed...


I have to say, that when it comes to ALS assist, it should be common sense. Do what you would want done for you without going beyond your scope of practice.


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## Jon (Feb 6, 2005)

> _Originally posted by PArescueEMT_@Feb 6 2005, 05:19 PM
> * or that case under your bed...
> 
> 
> I have to say, that when it comes to ALS assist, it should be common sense. Do what you would want done for you without going beyond your scope of practice. *


 Hey, easy on the case:

see my views on the case HERE: http://www.emtlife.com/index.php?showtopic...findpost&p=3961

Moving on:

The idea of remain in the scope of practice is an obvious one. All of what I do is within the scope, as I'm not actually giving meds or interpriting the EKG.

Oh, and in PA bagging a tubed PT. is considered ALS assist. An EMT must be "observed by the medic" when preforming the skill - DUH, he is there anyway 'cause he just tubed the guy....



Jon


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## PArescueEMT (Feb 6, 2005)

I am oficially a "Paramedic Assistant" I even have the orange rocker to prove it. I got it from using common sense too. Work a code with a pre-hospital MD, he calls DOH, I get rockers and cert in the mail.


cheated me out of con-ed


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## Jon (Feb 6, 2005)

> _Originally posted by PArescueEMT_@Feb 6 2005, 05:49 PM
> * I am oficially a "Paramedic Assistant" I even have the orange rocker to prove it. I got it from using common sense too. Work a code with a pre-hospital MD, he calls DOH, I get rockers and cert in the mail.
> 
> 
> cheated me out of con-ed *


 yeah - all it is is a cute little orange piece of fabric.

I've got the con-ed too..

that and $1 will get you a cup of coffee at WaWa

Jon


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## coloradoemt (Feb 6, 2005)

> _Originally posted by domesticgodemt_@Feb 5 2005, 11:38 PM
> * No ALS gets done w/o BLS done first.  Don't wait for direction.  Get it done, so you don't hold them up maintaining airway or gaining IV access
> 
> Any good Basic class will have a lab that spends an hour to explain how to spike a bag, the difference between micro/macro drip, extension sets, and maintaining aseptic technique, etc.  Having 4X4's, alcohol/Iodine swabs, and teguderm ready.  Medics may vary!!!!!!!  Some will inspire you to go and get your own swelled head (just kidding).  Others will make the experience such that you know after the call you are still at the bottom of the food chain in Prehospital care.
> ...


 Most of what you suggested I have already had classes for and used that knowledge in the field. IE Intubation (we actually as BLS providers practice on the manequins), 4 lead, 12 lead etc. We have quite a few waivers in our SOP's that allow me to hook up a moniter if I have ALS on the way etc. Past that I was just curious what some of you liked your Basics to know otherwise. Good sugestions from all and thank you. Looks like I will be buying some more reading material!!


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## TTLWHKR (Feb 7, 2005)

I took the ALS Assistant Class when they first developed it, and we didn't get scrap from the DOH. No patch, no certificate... Just 16 hours of con-ed. 

We were told that it was a certificate program, and we would get a patch. Then they decided it was just a con-ed class six months after it ended. Completely worthless, I didn't even need the credit. 

Now I'm just pissed!

LTS Sucks!


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## coloradoemt (Feb 7, 2005)

> _Originally posted by Blueeighty8_@Feb 7 2005, 12:59 AM
> * I took the ALS Assistant Class when they first developed it, and we didn't get scrap from the DOH. *


 I am not aware of a class like this where I live so I continue to gain knowledge through my CE classes. I would take one here if offered though.


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## rescuecpt (Feb 7, 2005)

I don't let BLS do much for me.  If it's a hairy call (code) I usually have 1 - 2 other ALS providers with me.  If it's a slower call, I do it myself.  I have had too many "bad apples" ruin my trust.  I do have certain basics I trust - the two guys on my crew, for example, and the guys on the Tuesday night crew I used to ride with.  I'd let them spike bags, put leads on, and check med names & expirations (then i recheck).

Basics I don't know can radio the hospital, set up a nebulizer, and do other basic skills.


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## domesticgodemt (Feb 8, 2005)

The book I referred to is _The Basic Provider: Assisting with Advanced Life Support Skills.  Authors:  Dominguez and McPherson.  Published by MosbyJems not Brady._


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## coloradoemt (Feb 8, 2005)

> _Originally posted by rescuecpt_@Feb 7 2005, 03:00 PM
> * I don't let BLS do much for me.  If it's a hairy call (code) I usually have 1 - 2 other ALS providers with me.  If it's a slower call, I do it myself.  I have had too many "bad apples" ruin my trust.  I do have certain basics I trust - the two guys on my crew, for example, and the guys on the Tuesday night crew I used to ride with.  I'd let them spike bags, put leads on, and check med names & expirations (then i recheck).
> 
> Basics I don't know can radio the hospital, set up a nebulizer, and do other basic skills. *


 You treat your Basics like the Medics on my volly dept treat first responders...


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## Jon (Feb 8, 2005)

> _Originally posted by Blueeighty8_@Feb 7 2005, 01:59 AM
> * I took the ALS Assistant Class when they first developed it, and we didn't get scrap from the DOH. No patch, no certificate... Just 16 hours of con-ed.
> 
> We were told that it was a certificate program, and we would get a patch. Then they decided it was just a con-ed class six months after it ended. Completely worthless, I didn't even need the credit.
> ...


 Some Co's in this area issue different things - some have an blaze orange rocker that goes over the EMT patch. at least 1 has "actual" paramedic assistant rockers for their EMT patches (special order)

Most in Chester Co. issue NADA. Nothing Zippo. Just a certificate (maybe) and con-ed (If you are lucky enough for the form to not be lost)

Jon


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## rescuecpt (Feb 8, 2005)

> _Originally posted by coloradoemt+Feb 8 2005, 08:31 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (coloradoemt @ Feb 8 2005, 08:31 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-rescuecpt_@Feb 7 2005, 03:00 PM
> * I don't let BLS do much for me.  If it's a hairy call (code) I usually have 1 - 2 other ALS providers with me.  If it's a slower call, I do it myself.  I have had too many "bad apples" ruin my trust.  I do have certain basics I trust - the two guys on my crew, for example, and the guys on the Tuesday night crew I used to ride with.  I'd let them spike bags, put leads on, and check med names & expirations (then i recheck).
> 
> Basics I don't know can radio the hospital, set up a nebulizer, and do other basic skills. *


You treat your Basics like the Medics on my volly dept treat first responders... [/b][/quote]
No, I don't.  My basics do plenty - their basic stuff and occasionally more - and I teach them tips and tricks and theory every chance I get - if they want it or need it.  But ALS interventions are MY RESPONSIBILITY and around here, the County is VERY strict about that.  If something happens, not only will I lose my license but I will be sued - but worse than all of that, I might possibly kill my patient.  It isn't an "I'm better than you" thing with me... it's a degree of trust thing.  Trust only comes from a lot of experience working together, because in this situation mistakes aren't "oops"es, mistakes are often life-and-death.

When you've had a basic with their card for one year hand you an NRB when you ask for a BVM... and then stare blankly at you when you hand it back and say "no, I need a BVM please"... would YOU let someone like that do ALS interventions?  I hope not.


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## Summit (Feb 10, 2005)

RESCUECPT

I agree with coloradoemt.

Around here basics with training start IVs and you only have a select few you trust to spike a bag? 



> _Originally posted by coloradoemt_@Feb 8 2005, 08:31 PM
> *
> When you've had a basic with their card for one year hand you an NRB when you ask for a BVM... and then stare blankly at you when you hand it back and say "no, I need a BVM please"... would YOU let someone like that do ALS interventions? I hope not.*



You really need to get yourself better basics and keep them trained.


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## rescuecpt (Feb 10, 2005)

Yeah, good luck with that.  Recruitment is not an easy thing around here.  In NYS basics are not trained to assist in ALS interventions in anyway.


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## coloradoemt (Feb 10, 2005)

> * It isn't an "I'm better than you" thing with me... it's a degree of trust thing. Trust only comes from a lot of experience working together, because in this situation mistakes aren't "oops"es, mistakes are often life-and-death.*



I hope that a comment I made didn't bring this comment out of you. I did not mean to make you think that I thought you were a "better than you" medic. If I did I apologize.



> *When you've had a basic with their card for one year hand you an NRB when you ask for a BVM... and then stare blankly at you when you hand it back and say "no, I need a BVM please"... would YOU let someone like that do ALS interventions? I hope not. *



If this is what you have to deal with day to day then I understand your reasoning. I also realize you have a job to do. Many of the medics I run with days have that opinion as well. I am not uncomfortable with the fact that EMT's need to prove themselves to the medics. On my volly dept. we often do not have many hands to help. It has often been just me a first responder and a medic on a call. So sometimes proof of performance is done with significant ammounts of trust. The first responder ends up being a gopher and a driver for the most part. My comment previous was just my opinion that the EMT's you have to deal with were given the same assignments and responsibilities that a first rsponder does out here with me.


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## Jon (Feb 10, 2005)

> _Originally posted by Summit+Feb 10 2005, 01:16 AM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (Summit @ Feb 10 2005, 01:16 AM)</td></tr><tr><td id='QUOTE'> RESCUECPT
> 
> I agree with coloradoemt.
> 
> ...


_
 Yeah - Around here we have basics who call themselves "Paramedic Assistants" who THINK they can intubate, start IV's, and play PARAGOD with a 8-hour con-ed class under their belt.

I have always been of the opinion that "what is said/ happens in the truck, stays in the truck" but that is rediculous. As a Paramedic student I have seen and done some stupid things with IV's, luckily I haven't gotten burned by these mistakes, but If I ever make it to an ALS provider level that is something I would be sure would NOT happen on my watch. If I make a mistake on an invasive procedure, I want to be darn sure I made the mistake, not some young whacker-wannabe EMT (NO OFFENSE, BLUE!)

On the other side of the coin, I recognize that there are quite a few ALS-skills that any semi-trained monkey (No Offense, Chimpie) could preform flawlessly - hooking up a monitor, preforming an accu-check (Yeah - DOH says medics are only allowed to do that), and spiking a bag.

From an ALS standpoint, I would want to be sure that the person spiking the bag / hooking up the monitor, etc. knew what they were doing, watched them closely the first few times, and always double-check them, but I would expect any GOOD BLS provider on a MICU to be able to preform these skills, set up the IV start stuff and set up nebs and code meds for me.

<!--QuoteBegin-coloradoemt_@Feb 8 2005, 08:31 PM
* 
When you've had a basic with their card for one year hand you an NRB when you ask for a BVM... and then stare blankly at you when you hand it back and say "no, I need a BVM please"... would YOU let someone like that do ALS interventions? I hope not.*[/quote]

Coloradoemt - you hit the nail on the head - As we all agree, you must be a good BLS provider to be a good ALS provider, and before I as an EMT help out my medic I make sure that there are vitals taken (or being taken) and that all BLS-level interventions are in progress or completed (O2 / CPR / Ventialtion, etc)

If I ever have an "EMT" like that as a partner on a MICU when I'm the ALS provider, they will be off the truck and back with an FTO on a BLS truck so fast.....



Jon


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## rescuecpt (Feb 10, 2005)

> _Originally posted by MedicStudentJon_@Feb 10 2005, 10:11 PM
> * If I ever have an "EMT" like that as a partner on a MICU when I'm the ALS provider, they will be off the truck and back with an FTO on a BLS truck so fast..... *


 He has been sent to the "EMT breaker" shift... and his replacement on our shift, a probie with no EMT experience surpassed him within the first month!  She's a smart girl and a quick learner... she gets to do all sorts of fun stuff on the ambulance.   :lol:


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## Jon (Feb 10, 2005)

> _Originally posted by rescuecpt+Feb 10 2005, 10:31 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (rescuecpt @ Feb 10 2005, 10:31 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-MedicStudentJon_@Feb 10 2005, 10:11 PM
> * If I ever have an "EMT" like that as a partner on a MICU when I'm the ALS provider, they will be off the truck and back with an FTO on a BLS truck so fast..... *


He has been sent to the "EMT breaker" shift... and his replacement on our shift, a probie with no EMT experience surpassed him within the first month!  She's a smart girl and a quick learner... she gets to do all sorts of fun stuff on the ambulance.   :lol: [/b][/quote]
 I have no problem training those willing to learn

It is those who MUST know better, but act like they don't I have a problem with.


Jon

PS - What is an EMT-Breaker Shift - that the single BLS truck 12a-12p that does the ED take-homes up 3flights of steps?????


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## ffemt8978 (Feb 10, 2005)

> _Originally posted by MedicStudentJon_@Feb 10 2005, 08:34 PM
> *
> It is those who MUST know better, but act like they don't I have a problem with.
> *


 That statement can and should be applied in both directions.  

I, as a BLS and then ILS provider, have seen plenty of ALS units make mistakes.  I have sometimes mentioned it to them at the appropriate time and in an appropriate manner and usually have had my head handed to me.  :angry: 

I may not have all the cool letters after my name, but I do pay attention to what I see and tend to remember it.  I guess some people just can't stand having their mistakes pointed out by somebody "junior" to them.

On the other side of this, I personally used to have a problem with one of our EMT's.  I would try very hard not to let this person within 10 feet of my patient.  One day, our EMS Administrator pulled me aside and reminded me that I used to be junior once and that I need to stop riding this person and start teaching them.  Since that day, this EMT's skills have improved dramatically, although I can't take credit for it.

My point is that even if you are ALS, ILS or just BLS, you should be able to take constructive criticism from both directions.  That's what makes you a better EMS provider.

Thus endeth the sermon.


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## PArescueEMT (Feb 11, 2005)

EMT's do BLS, Parajokes do ALS. that is how things should always start. it doesn't matter if the EMT has experience on an ALS rig or not.

BTW... how's your back doing Erika?


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## rescuecpt (Feb 11, 2005)

> _Originally posted by PArescueEMT_@Feb 11 2005, 02:47 AM
> * BTW... how's your back doing Erika? *


 Eh, I'm alive.    Thanks for asking!

The EMT Breaker shift consists of a bunch of 20 year members (two of whom are/were chiefs) who don't take any shizzle.  They are "evaluating" this member... he has not finished his probie requirements and after 1 year you can get booted for that... They are making sure we don't want to keep him around before they kick him out.


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## Summit (Feb 11, 2005)

> _Originally posted by MedicStudentJon+Feb 10 2005, 10:11 PM--></div><table border='0' align='center' width='95%' cellpadding='3' cellspacing='1'><tr><td>*QUOTE* (MedicStudentJon @ Feb 10 2005, 10:11 PM)</td></tr><tr><td id='QUOTE'> <!--QuoteBegin-Summit_@Feb 10 2005, 01:16 AM
> * RESCUECPT
> 
> I agree with coloradoemt.
> ...


Yeah - Around here we have basics who call themselves "Paramedic Assistants" who THINK they can intubate, start IV's, and play PARAGOD with a 8-hour con-ed class under their belt.

On the other side of the coin, I recognize that there are quite a few ALS-skills that any semi-trained monkey (No Offense, Chimpie) could preform flawlessly - hooking up a monitor, preforming an accu-check (Yeah - DOH says medics are only allowed to do that), and spiking a bag.

From an ALS standpoint, I would want to be sure that the person spiking the bag / hooking up the monitor, etc. knew what they were doing, watched them closely the first few times, and always double-check them, but I would expect any GOOD BLS provider on a MICU to be able to preform these skills, set up the IV start stuff and set up nebs and code meds for me. [/b][/quote]
 Never heard of a "paramedic assistants" around here but in this state EMT-Bs can take a ~40 hour course solely on IV therapy that has a clinical requirement. I don't think that is undertraining. The skill improves by experience. I know a lot of paramedics who very much like that fact that there are EMT-B/IVs because they are bored with IV starts after 10 years and because on serious calls they can arrive to a critical patient who already has a line ready for paramagic drugs.

As far as semitrained monkeys, I was told that they have trained lab monkeys to put in ET tubes    Seriously! You could have a paramonkey in your jump bag! OTOH i dont think this is a basic skill nor should be, but combitubes on the other hand I think should be a basic skill as others have said in the combitube thread (and they are for me at my job).


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## Jon (Feb 11, 2005)

> _Originally posted by Summit_@Feb 11 2005, 11:39 AM
> * Never heard of a "paramedic assistants" around here but in this state EMT-Bs can take a ~40 hour course solely on IV therapy that has a clinical requirement. I don't think that is undertraining. The skill improves by experience. I know a lot of paramedics who very much like that fact that there are EMT-B/IVs because they are bored with IV starts after 10 years and because on serious calls they can arrive to a critical patient who already has a line ready for paramagic drugs. *


 That is fine by me. I just disagree with the attitude that "I can do lines and push drugs and tube if the medic is watching me" after they take an 8 hour course.

as i said, IV's can be dangerous, but are also easy......

Jon


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## lilbeddoe (Aug 22, 2008)

where did you buy your orange rocker paramedic assisstant??


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## lilbeddoe (Aug 22, 2008)

PArescueEMT said:


> I am oficially a "Paramedic Assistant" I even have the orange rocker to prove it. I got it from using common sense too. Work a code with a pre-hospital MD, he calls DOH, I get rockers and cert in the mail.
> 
> 
> cheated me out of con-ed



where did you get the orange rocker?? itook the class and dont know where to get one


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## MJordan2121 (Aug 22, 2008)

I was lucky to learn in my Basic class how to place 3/4/12 leads, as well as setting up IV bags, learning the equipment, preparing neubulizers and med preparation. My class was taught by a teacher who also works as a medic and has been one for the last 20 years. I found that my class was very beneficial. I look forward to starting my paramedic classes in January. I feel that I am going into my paramedic classes a step ahead.


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## VentMedic (Aug 22, 2008)

MJordan2121 said:


> I was lucky to learn in my Basic class how to place 3/4/12 leads, as well as setting up IV bags, learning the equipment, preparing neubulizers and med preparation. My class was taught by a teacher who also works as a medic and has been one for the last 20 years. I found that my class was very beneficial. I look forward to starting my paramedic classes in January. I feel that I am going into my paramedic classes a step ahead.



Was this a normal part of the course curriculum or did the instructor just show this to you?   How long was the course?  If it was still the 110 hours, what was skimmed over to include the extras?  Were you tested on the material for your certification exam?


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## BossyCow (Aug 22, 2008)

Here there is a two day class available that teaches EMT-Bs how to assist a paramedic during a code. Called ACLS for EMT-Bs. Doesn't make us medics, doesn't certify us to perform ALS but provides a working knowledge of how a code is run, why and how to help. 

It may be 'trained monkey' skills, but wouldn't you rather have the trained monkey in the back of the rig with you than one untrained and flinging poo?


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## MJordan2121 (Aug 22, 2008)

Yeah it was the normal cirriculum. Our total class hours were over 160 hours. We went into pretty good depth during our course. I had a great instructor. I am looking forward to the paramedic cirriculum next semester and hope to advance my career to the next level.


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## KEVD18 (Aug 22, 2008)

its pretty simple stuff. ive worked with medics that had every view point on the matter. expected me to do these thing without being asked, when they asked, never just stay out of my way. ive had medics that expected me to be able to start lines, prepare meds etc.

it all comes down to your working environment. if you've been working with the same medic(s) for quite some time, they trust you to do more. if they dont know you, they dont trust you.


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## VentMedic (Aug 22, 2008)

MJordan2121 said:


> Yeah it was the normal cirriculum. Our total class hours were over 160 hours. We went into pretty good depth during our course. I had a great instructor. I am looking forward to the paramedic cirriculum next semester and hope to advance my career to the next level.


 
Your class is slightly longer than average but still not long enough for good depth in any area of medicine.

Too often an instructor, especially those with "experience", will get off the curriculum because they themselves may find it boring and also believe that a lot of book learnin' is useless. They end up telling their own field stories and showing "cool stuff" when they actually should be teaching the Basic stuff. Thus, you get people in the field who can brag about hanging an IV bag or putting stickies on someone's chest but still don't know proper assessment or basic level A&P. 

While the knowing how to assist advanced levels is important, it should come after one has mastered skills and knowledge at their own level. And yes, hearing scenarios is a great way to keep the class interesting, often the case in point may be something that shows extraordinary events and may not even be a practical situation or even a little enhanced by the person telling his/her story.  There are too many instructors in this profession that have little education themselves in teaching methods and may use the classroom for their own benefit.  This is one of the few professions that one can graduate from a medic mill on Friday and be teaching a class by the next Friday.


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## Jon (Aug 25, 2008)

lilbeddoe said:


> where did you get the orange rocker?? itook the class and dont know where to get one


The PA classic "rocker" was simply a solid orange fabric patch above the EMT patch. You will occasionally see an "old head" with the rocker over their patch on their winter coat, or similar.

As far as I know... the state hasn't issued that certification in a long time (if ever) and the rockers aren't common anymore.

PA DOES NOT have an ALS Assistant certification. Some places will run an "assisting ALS" course and get con-ed for it... but it is VERY limited.


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