# The right steps for becoming a paramedic



## Boston_EMS58 (Feb 27, 2011)

Hey guys,
I'm new here so first off I'd like to say hello!! K, here's the deal, I'm attenting a university and my major is psychology (that wasn't really important but I thought I'd mention that anyways). This summer I'm going to enroll in my local community college to take an EMT-basic course so I can get certified in my town. So, my question is, where the heck do I go from there?? My ultimate goal is to work for Boston EMS as a Paramedic. I kno that my first step is to get certified as an EMT-B. My second step is to move into Boston because only people who live there can work for EMS, police, ect. It would be great if someone (preferably from Boston) could let me know where I go from here (well after I get certified for basic and then move into Boston).


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## Anjel (Feb 27, 2011)

*Not from Boston but...*

After you get your basic out of the way. You can go right to medic. BUT i'm finding about 99.9 percent of the people I am talking to recommend work experience as a basic first. Because it will be extremely helpful. 

I'm not sure where you are now. But make sure where ever you get your certification for basic will be good in MA. 

You will also need A&P most likely. So you could work on those while you get your experience in the field.


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## 8jimi8 (Feb 27, 2011)

There is no need to limit your understanding to the 120 hour course.  Go straight for your medic.



here's my punchline:  and I can say this because I have one...

Psychology is the only bachelor's you can get taking nothing but multiple choice tests.


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## Anjel (Feb 27, 2011)

8jimi8 said:


> There is no need to limit your understanding to the 120 hour course.  Go straight for your medic.




I didn't think you could go straight to medic. 
Around here you have to complete basic first.


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## firecoins (Feb 27, 2011)

Anjel1030 said:


> I didn't think you could go straight to medic.
> Around here you have to complete basic first.



the emt class is considered apart of the medic program.


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## Boston_EMS58 (Feb 27, 2011)

Anjel1030 said:


> I didn't think you could go straight to medic.
> Around here you have to complete basic first.


yeah, around here you do need to get atleast a year of experience as a basic before you can move up. I just always thought that there was some schooling you had to go to before you can becoming a full paramedic, unless you become a basic and then move up with experience. I thought that MA atleast requires an associates degree in paramedicine...as you can see I'm sort of going in blindly with this.


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## Anjel (Feb 27, 2011)

There is an actual paramedic class/course. Usually 4 semesters long. If where you are makes you be a basic for a year. Then do that take your sciences then go back to the community college and take the medic program. 

http://www.emsacademy.biz/

That is one thing that came up on google. You can take both courses through them. Or just one. 

And to...



firecoins said:


> the emt class is considered apart of the medic program.




Ah got it. I misunderstood. I thought he was saying skip basic all together. And I didn't see that working lol


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## STXmedic (Feb 27, 2011)

Yes, there is another school you have to go to for paramedic in addition to basic. What they're saying is, don't waste time trying to get experience. Go get your basic, then jump in a medic class as soon as you're done with basic. If you want some experience, jump on with a company while in medic school (average school is 2 full college semesters/1 full year). You will get little benefit from field experience as a basic. Now, if the medic school you want to do REQUIRES you to have been a working EMT-B for at least a year, then of course you'll have to knock it out first. But if not, jump straight in if possible.


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## Boston_EMS58 (Feb 27, 2011)

Thanks for the reply guys they helped a lot! I still have two more years of Undergrad because I do want to finish and get my psych degree so I think I'm going to get my basic over the summer and then work in the field until I finish school and graduate, then I'll dive into paramedicine classes and stuff.


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## medichopeful (Feb 27, 2011)

Boston_EMS58 said:


> Thanks for the reply guys they helped a lot! I still have two more years of Undergrad because I do want to finish and get my psych degree so I think I'm going to get my basic over the summer and then work in the field until I finish school and graduate, then I'll dive into paramedicine classes and stuff.



If you can make sure to take A&P I+II while in college.  It will help you more than you might realize!


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## 8jimi8 (Feb 28, 2011)

medichopeful said:


> If you can make sure to take A&P I+II while in college.  It will help you more than you might realize!




Yes make sure, if YOU want to, to go for the BS in psych.  You'll get alot of your paramedic / (nursing too, if you ever thought about that ) prereqs out of the way.


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## rescue99 (Feb 28, 2011)

8jimi8 said:


> There is no need to limit your understanding to the 120 hour course.  Go straight for your medic.
> 
> 
> 
> ...



120? Where do so many people get that Basic EMT is 120 hours? It was 264 and a whole lot of study time here. Since we've gone to the 2011 curriculum, didactic/skills hours has increased to 258 hours. Add another 80 minimum on for internship and it comes to 338 hours. Maybe we're missing something here in Michigan, but that's a whole lot more than a 120 hour bandaid course. I'm sure people suggest some experience prior to Medic because in this area, there are a few good schools available that will actually challenge students. 

As for the OP's ?......contact the state and ask what their requirements are. AMR is heavy in the Boston Area...perhaps contact them as well.


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## Veneficus (Feb 28, 2011)

rescue99 said:


> 120? Where do so many people get that Basic EMT is 120 hours? It was 264 and a whole lot of study time here. Since we've gone to the 2011 curriculum, didactic/skills hours has increased to 258 hours. Add another 80 minimum on for internship and it comes to 338 hours. Maybe we're missing something here in Michigan, but that's a whole lot more than a 120 hour bandaid course. I'm sure people suggest some experience prior to Medic because in this area, there are a few good schools available that will actually challenge students.
> 
> As for the OP's ?......contact the state and ask what their requirements are. AMR is heavy in the Boston Area...perhaps contact them as well.



I think the 120 hours comes from the old curriculum which has not been universally adopted/implemented yet.

I am not sure who is advising people to "get experience" as a basic still, but I seriously encourage people to consider that and those who give it, yesterday's news.

Firstly, there is nothing taught in basic class that isn't retaught in medic class.

Secondly, the (being generous) medicine in Basic is so oversimplified that it will just have to be relearned anyway.

Finally, there is no other health or medical profession that requires a year of experience performing an entirely technical role to qualify. 

That "experience" idea was born in an age when being an EMT meant being simply a tech. When moving up to paramedic was simply another level of tech. Most of the people who enrolled couldn't pass their first year of undergrad if they wanted to and being an EMT was just another labor trade. 

Today the evolution is towards a provider who comes out of school with more than a few useful skills, but some knowledge on how those skills apply and when.

Since what constitutes "experience"  is so vague and variable, there is only a small chance you will get anything positive out of it anyway. Most likely it will be a waste of time.

It is attitudes promoting "experience" that help keep EMS from being a true profession.


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## Anjel (Feb 28, 2011)

I finished basic in December. 

Everyone I talked to on my ride alongs and instructors told me experience, experience, experience.  

I for one am jumping right in to medic. Because I didn't see the point of holding off. If I can find a basic job in the meantime then that's great. I wouldn't hold off school for it. 

The OP is in a position where he may have some time to do experience first. or may be forced to. I don't think it would hurt. But not something that should be mandatory.


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## systemet (Feb 28, 2011)

Veneficus said:


> I am not sure who is advising people to "get experience" as a basic still, but I seriously encourage people to consider that and those who give it, yesterday's news.



This is an interesting perspective.

I took a fairly standard EMT program -- about six months total, 240 hours on the ambulance, 40 hours in the hospital.  Then worked for two years on a BLS ambulance in a rural area (no local ALS), and continued to work in ALS services during my 2-year paramedic program.

I felt the experience I got as an EMT was invaluable when I was a new medic.  I mean, two years of school is pretty short for the scope a paramedic has.  My medic program had 1,200 hours of ambulance practicum, and 480 hours in the hospital.  Not exactly a ton of experience.  I got another 192 hours of mentorship for my first medic gig, and then it was EMT partners.  I don't think I'd have felt very well equipped for those first days if I didn't have some BLS experience.

Having seen a few sick people, dealt with some MCIs, even just having had a chance to develop basic IV skills, these were invaluable in my first days as a medic.

I do believe that we should be moving towards a bachelor's (or even a master's) degree for the new paramedic.  But right now, are most paramedic programs long and rigorous enough to create competent ALS providers if they lack prior EMT experience?


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## Boston_EMS58 (Feb 28, 2011)

medichopeful said:


> If you can make sure to take A&P I+II while in college.  It will help you more than you might realize!


Will do!


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## Veneficus (Feb 28, 2011)

systemet said:


> But right now, are most paramedic programs long and rigorous enough to create competent ALS providers if they lack prior EMT experience?



Experience.

I was, like you, also fortunate enough to have incredible experience as a basic. But such experience is the exception, not the rule. 

Most Basics earn their experience doing a dialysis derby for a year. Nothing that is taught in EMT class even applies. Many things from EMT class are lost. 

In my years of teaching EMS, the people who struggled the most were basics with more experience. The first problem was they thought they knew when they didn't. The second, that they always refered to "how it is really done in the field." Lastly, instead of being focused on how well they knew their A&P or pathology they were focused on how well they could intubate Fred the head. 

The "experienced" basics at both institutions I taught at had the highest class fail rates, and were the ones most often requiring multiple attempts on the written/computer test, for as long as those organizations kept records of it.

The more reputable paramedic programs are quite capable at putting out high quality providers. No, they are not perfect providers, but I think it fairly obvious that somebody who has enough knowledge to make decisions is a better provider than somebody who has such limited capacity for making decisions that they basically don't get to. 

Also consider. When an EMT works with a medic, how often do they control the scene? How often do they not have somebody standing over their shoulder making sure things go right? How many and how easy is it to get an emergency job as an EMT? 

Furthermore, in a working environment, there is no control over what kind of experience is being had. Bad habits go unchecked. Some experience that is most valuable may never be had at all. 

The amount of time in classroom, clinical, and field experience better directs the types of experience paramedic students have. The right experiences are gotten by design, not by chance, sometimes.

Who is the most capable care provider? A brand new EMT or a brand new paramedic?

On your first day on the job as an EMT you have nowhere near the knowledge, directed experience, or decision making capability of a new medic. Being so much lesser, would you say if you were acting independantly you are more capable or less capable to help your initial patients? 

Using an amore extreme example for illustration, who is more beneficial to a patient?

A new EMT or a new Doctor? Why?

For the exact same reasons as a new paramedic. They start with more.

Moving on to experience, who is more capable in patient care? A medic with 1year of experience or an EMT with the same?

Using the experienced EMT comparison, who is a better provider? An EMT with a year of experience (not qualifying what that could mean) or a new medic who likely has at least as much directed education and experience as even the finest full time services that field basics?

What about a Basic who has 10 years of IFT experience vs. a new medic?


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## systemet (Feb 28, 2011)

Hmmm.  I see where you're coming from there.

I used to give people the advice that they should find a pure BLS service that runs 911, and do it for a year before taking their medic.  These are, of course, becoming harder and harder to find.  I think the best experience gained from being an EMT, is in making independent decisions in the field, and learning a little bit of call management.

This is harder to get as an EMT in an ALS service.  I agree there's a tendency for many people to defer to the medic on everything when they're inexperienced.  I think the experience the EMT gets also depends on the medic they work with.  When I worked with EMTs, I expected that they coulld get a line, place a 12-lead, and draw up meds.  With the exception of IV initiation, this wasn't generally covered in their education.  It was something we had to teach them, and most were very willing to learn.  Others weren't, and it became difficult to run calls with them sometimes.

There's a responsibility for everyone in this field to continue learning.  A lot of the experience of being an EMT depends on who the EMT is.  If that individual choses to improve their knowledge, take an A+P course, read the ACLS text, pick the brains of the medics, RNs, MDs, then they're going to make a better medic.  Same thing with IFTs.  They're not going to learn scene management -- at least not in a traditional sense.  But it's a great place to get good at listening for lung sounds, bruits, heart sounds, and often see some people with relatively rare pathologies.  But only if they choose to take the opportunity that's presented.

The thing with a new paramedic, is they have a lot of ways to kill people.  Generally an EMT has to try a little.  They have to convince the chest pain patient not to go to the ER.  Or not check the unconcsious patient's blood glucose.  Be a little too eager to call a cardiac arrest.  They're generally acts of omission, a passive way of causing injury.

A new paramedic, though, can be outright dangerous.  Especially if along the way they've picked up too much confidence and too little self-doubt.  These become acts of commission.  The elderly patient that shouldn't gets RSI'd.  The ET tube gets left in the esophagus, because they couldn't miss.  The "aggressive" treatments get applied to patients for who the potential benefit doesn't outweigh the potential risk.

Perhaps this distinction is being lost a little now EMTs are often giving pharmacology with minimal training.  I think I'm rambling now.


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## Jon (Feb 28, 2011)

Boston and King County WA, both do odd things with EMS education... Even if a medic is hired from the outside, they go through an internal medic class and test.

Boston also ONLY hires EMT's, then fills medic slots from within.

Can someone local confirm this... and explain more?


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## rescue99 (Feb 28, 2011)

Anjel1030 said:


> I didn't think you could go straight to medic.
> Around here you have to complete basic first.




Michigan requires a Medic student to have a BLS or license prior to clinical rotations and internship. He/she must be certified BLS upon entering the program and able to test. Schoolcraft College for example; Medic students must be: 

1. Certified EMT or EMT/Spec Licensed.
2. Successfull in pre-reqs - A/P/BIO/Med Term 
3. Able to pass a drug screening.
4. Able to pass a criminal background check. 
5. Complete the interview/application for admission.

Other schools have more requirements, some have fewer....for now.


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## Anjel (Feb 28, 2011)

rescue99 said:


> Michigan requires a Medic student to have a BLS or license prior to clinical rotations and internship. He/she must be certified BLS upon entering the program and able to test. Schoolcraft College for example; Medic students must be:
> 
> 1. Certified EMT or EMT/Spec Licensed.
> 2. Successfull in pre-reqs - A/P/BIO/Med Term
> ...



Yea I go to OCC. Those are pretty much the requirements. Except you can do A/P as you go. You don't have to have it before hand.


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## Boston_EMS58 (Mar 1, 2011)

Jon said:


> Boston and King County WA, both do odd things with EMS education... Even if a medic is hired from the outside, they go through an internal medic class and test.
> 
> Boston also ONLY hires EMT's, then fills medic slots from within.
> 
> Can someone local confirm this... and explain more?


Agreed, granted I dont know too much about this. But I know that Boston has their own 6 month "academy" for EMT-B's and I think it is safe to say that they only pull from those "graduates". It's really difficult to get a job in Boston if your an "outsider". I would go to the academy but I don't live in Boston yet.


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