# Medics, what was the hardest part about transitioning from EMT to medic?



## ParamedicStudent (Feb 13, 2016)

I'm in the process of becoming a paramedic, and for me personally, I feel like it's two different philosophies even though it's the same line of work.

From experience, being an EMT you do things by higher certifications (EMT-P, RN, LVN, etc.) order or protocol. And what I was learning in school was the mindset of "when you see these types of things, you treat it this way"  In other words, you do things just because; you're not there to think for yourselves. Maybe I'm just a bad EMT but thats from my opinion, formed from my personal experiences.

On the opposite hand, going though a paramedic school, everything we've been taught as EMTs go more in depth, and we need to know why we do things. Yes, there's orders, there's protocols, etc. But we are also required to think for ourselves and to try to get a deeper understanding of the situation. In our program, when we get a scenario of a pt in cardiac arrest, we're required to do (or delegate) CPR, as well as push meds, interpret rhythms, physical exam, etc and try to figure out what is wrong with the pt.

I guess I wasnt used to being able to think for myself. I'm used to working with someone higher, and it's its just be and another EMT partner, I'll do things based on protocol, and I'll make the best clinical judgement that I possibly can. I tend to think of it like this: When there's a code, as an EMT, you'll be doing CPR. As a medic, you'll be helping with the code, pushing meds, interpreting rhythms, and determining WHY the pt had coded, and I believe the "determining" part is the biggest difference between an EMT and a medic. For me personally, I haven't developed the higher understanding skills of disease differential and such, so if I come across a pt with these set of symptoms, I'll be in the mindset of trying to treat the symptoms rather than the whole picture.

All this was from failing multiple scenarios during the last week. But from past experiences, what was the greatest challenge?


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## nater (Feb 13, 2016)

I thought the biggest change was learning how to lead the call rather than assist my paramedic partner as needed. It was an adjustment arriving on a scene with first responders and PD looking to me for direction rather than anyone else.

It is good that you are trying to learn how to see the big picture with your patient. Understanding the disease process and how the tools you have available in your rig can aid your patient is a big step.


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## DesertMedic66 (Feb 13, 2016)

Remembering that when the gurney gets loaded into the back of the ambulance I need to sit in the back of the ambulance and not in the driver seat.


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## TransportJockey (Feb 14, 2016)

For me there wasn't a whole lot of difference. But I had been working as an in charge of a 911 ILS truck for almost 2 years before I got my medic. It was just a matter of transitioning to my new guidelines.


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## Gurby (Feb 14, 2016)

Crushing amounts of responsibility and liability while dealing with much higher acuity patients.


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## joshrunkle35 (Feb 14, 2016)

1st day: being scared that I would be too invasive

1st month: learning how to be assertive to people who were your boss, and were doing something bad for a patient, and telling you that you were treating the patient wrong but they were an EMT with 30 years of experience and you were a brand new paramedic, but you were actually right. I had to finally find my voice to people who I respected but were wrong and just flat out disagree with them. In the end, they respected me more.

1st year: finally realized that just because I had every tool in the tool box didn't mean I needed to use it. For example: screaming mom, kid allergic to bee stings just got stung. Used to go straight to epi/benadryl or at least Benadryl to prevent an airway closing off that I wouldn't be able to manage down the road. I'd been trying to be proactive...then I realized that most moms have no clue what stung their kid and they're just really worried and emotional and it may be an emergency, but it isn't always. Took me a year to stop jumping to the end of my treatment list and get back to the basics.

2nd year and on: most stuff was pretty regular by then. I found a rhythm, realized how little "medicine" paramedics actually do, and started searching out knowledge for myself. Started actually taking CE that wasn't required, and started reading books about stuff that is immensely helpful to my job, and within scope of practice, but was never taught in depth in school (like reading books on electrolyte imbalances or books on in depth capnography, etc.).


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## EMTaylor (Feb 15, 2016)

joshrunkle35 said:


> 2nd year and on: most stuff was pretty regular by then. I found a rhythm, realized how little "medicine" paramedics actually do, and started searching out knowledge for myself. Started actually taking CE that wasn't required, and started reading books about stuff that is immensely helpful to my job, and within scope of practice, but was never taught in depth in school (like reading books on electrolyte imbalances or books on in depth capnography, etc.).



Any recommendation for books?


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## STXmedic (Feb 15, 2016)

It took a little while to increase my ego, but after a few months I could barely fit my head through a door.


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## nater (Feb 15, 2016)

EMTaylor said:


> Any recommendation for books?



I found these helpful,but I have spent the last several years working on a MICU unit rather than 911 response. This role really opens your eyes about thinking beyond the first 20-30 minutes of an emergency when we traditionally work and think about the care  that will be provided in the next several hours and and weeks.

Available from Amazon:
Critical Care Transport, Jones and Bartlett

A Manual of Labroatory and Diagnostic Tests

Ventilator Management - A Prehospital Perspective

ACE SAT, Will Wingfield - not really a text, but good review questions when you challenge the FP-C or CCP-C exams

Mark Boswell CEN Review Videos on youtube


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## Tigger (Feb 16, 2016)

I am currently struggling with how to balance being the person that is supposed to be considering the total picture of the call while also being (hopefully) the most competent skills person on scene as well. I lose track of what's going on when I have a tough IV to start, nevermind if someone needs to be intubated. I have no issues with delegating (our EMTs out here can do a lot and I am used to being one of two experienced people on scene in a sea of the opposite), but deciding when to delegate and when to get in and just do it has been another issue.


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## FiremanMike (Feb 16, 2016)

Trying to manage the massive influx of chicks that were suddenly all over me......


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## DesertMedic66 (Feb 16, 2016)

FiremanMike said:


> Trying to manage the massive influx of chicks that were suddenly all over me......


I still haven't been able to manage it


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## StCEMT (Feb 16, 2016)

FiremanMike said:


> Trying to manage the massive influx of chicks that were suddenly all over me......


Show them your last pay check, that should fix the problem.


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## STXmedic (Feb 16, 2016)

Tigger said:


> I am currently struggling with how to balance being the person that is supposed to be considering the total picture of the call while also being (hopefully) the most competent skills person on scene as well. I lose track of what's going on when I have a tough IV to start, nevermind if someone needs to be intubated. I have no issues with delegating (our EMTs out here can do a lot and I am used to being one of two experienced people on scene in a sea of the opposite), but deciding when to delegate and when to get in and just do it has been another issue.


This was probably my biggest challenge, too. I've always been one to not trust other people to do something right. When it came time for me to run an arrest, it was very difficult to stand back and let others "do" while I orchestrated. Finally ended up with an awesome, experienced partner who would remind me to take a few steps back.


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## StCEMT (Feb 16, 2016)

I haven't graduated yet, but some of the things that are standing out for me are 1. being able to process/manage all the different information that comes your way and then 2. not getting ahead of myself now that I know how to do things. I am hitting that phase where I feel like this super smart future medic and also like the biggest dumbass with a stethoscope and IV all at the same time.


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## Tigger (Feb 16, 2016)

STXmedic said:


> This was probably my biggest challenge, too. I've always been one to not trust other people to do something right. When it came time for me to run an arrest, it was very difficult to stand back and let others "do" while I orchestrated. Finally ended up with an awesome, experienced partner who would remind me to take a few steps back.


I think that's part of it. Even if I know the person can do something, I am used to being in that role and doing it faster. Our protocols let our EMTs do most of the skills (aside from intubation and rhythm interpretation) during an arrest or other legit call so I am used to doing that already. I am happy that in terms of skills medic school has so far been a chance to refine many of them while learning a few others so I don't have to worry about being competent with IVs or drawing meds or mundane things like that.


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## nater (Feb 17, 2016)

StCEMT said:


> I am hitting that phase where I feel like this super smart future medic and also like the biggest dumbass with a stethoscope and IV all at the same time.



One thing I have learned is that when your confidence to perform our job starts to turn into cockiness, you WILL have a run that humbles you quickly.


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## StCEMT (Feb 17, 2016)

nater said:


> One thing I have learned is that when your confidence to perform our job starts to turn into cockiness, you WILL have a run that humbles you quickly.


I have already been humbled a few times in this class. But I expect it will happen even more so once my field time picks up again.


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## Tour 1 (Mar 8, 2016)

How to allocate and hide the overwhelming amount of money from my pay increase.


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## Akulahawk (Mar 9, 2016)

STXmedic said:


> This was probably my biggest challenge, too. I've always been one to not trust other people to do something right. When it came time for me to run an arrest, it was very difficult to stand back and let others "do" while* I orchestrated*. Finally ended up with an awesome, experienced partner who would remind me to take a few steps back.





Tigger said:


> I think that's part of it. Even if I know the person can do something, I am used to being in that role and doing it faster. Our protocols let our EMTs do most of the skills (aside from intubation and rhythm interpretation) during an arrest or other legit call so I am used to doing that already. I am happy that in terms of skills medic school has so far been a chance to refine many of them while learning a few others so I don't have to worry about being competent with IVs or drawing meds or mundane things like that.


That's a big part of the transition from EMT to Paramedic. You have to learn to step back and lead the team. You're the conductor and your team is your orchestra. If you do your part right, you keep everyone on task and going at the right times. You prevent the scene from descending into complete chaos. You only need to step in to do something only when necessary. 

A few things that _I_ had to learn was to make my transport decision early, always start planning to leave the scene while still approaching it, to remember the resources available and what they can do, and that when it's _my_ patient, the responsibility is _mine_ to manage everything.


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## cannonball88 (Mar 12, 2016)

1. Realizing that there's nobody there to tell you what to do. ALS is not on the "Consider Additional Resources" list, because YOU are that resource. As a result, you have to jump into that role, which brings me to point #2.

2. They call it "Command Prescence" in the Army. They call it the "Presidential Voice" in politics. It's something that's difficult to teach, it just comes when you're ready. Essentially, when you step out of that truck, you should radiate confidence, and everyone should look to you because you give off that aura that says "I know what to do, I'm in charge here."

3. Remembering that when deciding what to do for a patient, the decision on what treatments to withhold and why is just as important as deciding what treatments to give. In other words, "because the ER nurse will be mad if I don't" is not a reason to start an IV, or at least it isn't a reason to put it at the top of your list.

4. Trust those around you who have earned it. It's insulting when you're not only doing your job, but your EMT's job as well (obviously, if you're working with an incompetent EMT, there are exceptions!)

5. Realize that you are the emotional center of your crew. It's your job to make sure your EMT partner is okay. It's your job to ask if everyone's gonna be alright after a tough call. This falls on you.


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## Jon (Mar 21, 2016)

I think the biggest part is what others have mentioned.... You realize that you no longer have the safety net you had in having a preceptor who could take over if you screwed up.

First code, I realized I was the only medic on the scene, and I needed to coordinate a host of other providers to handle everything else incumbent in the call, while I focused on the ALS skills and the "big picture".

The other part of that is learning how and when to ask for help - whether that be contacting medical control or asking another medic "hey, what do you think".


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