# EMT school vs. Actual Field work Questions



## Shabandrw (Oct 10, 2012)

Okay once you get on the field, and actually start working as an EMT, you'll notice that actual field work is completely different from what we learn in EMT class. I believe, and many of my EMT partners agree, that they don't really teach us how the job is going to be like on the field. I've also talked to many firefighters and they have also said that all the EMT schooling is pretty much "bs" we only learn pretty much book work instead of actual "scenarios"...anyway I could go on 
BUT what I wanted to ask is...Is there a list of questions you can ask when you get called to an emergency scene that'll help you in providing good customer care. Example, if we get a call to a Pt complaining of ab. pain, we want to ask, other than are you SOB or having trouble breathing, but we also want to ask...
Whens the last time you ate something?
Did you throw up?
Whens that last time you made a bowel movement?
What color was it?
Was their blood? And so on!
What questions good you ask for a chest pain call, or a trauma/fall call or an increased anxiety call and so on
Thanks in advance


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## Medic Tim (Oct 10, 2012)

Shabandrw said:


> Okay once you get on the field, and actually start working as an EMT, you'll notice that actual field work is completely different from what we learn in EMT class. I believe, and many of my EMT partners agree, that they don't really teach us how the job is going to be like on the field. I've also talked to many firefighters and they have also said that all the EMT schooling is pretty much "bs" we only learn pretty much book work instead of actual "scenarios"...anyway I could go on
> BUT what I wanted to ask is...Is there a list of questions you can ask when you get called to an emergency scene that'll help you in providing good customer care. Example, if we get a call to a Pt complaining of ab. pain, we want to ask, other than are you SOB or having trouble breathing, but we also want to ask...
> Whens the last time you ate something?
> Did you throw up?
> ...



so your program didn't cover any of the above?

I agree that what you are taught in school is a bit different from the field, but from what I have seen it is to allow the student to learn something in a uniform way. Once on your own you will find your own way of doing things. Emt classes  have little if any education on medical issues. Hopefully people realize this and take it upon themselves to keep studying/learning. What you are taught is, if you see this do this, kind of thing with no knowledge of why. Did you class not even cover these very common often tested assessments?if not they should be in your book. Ex. For chest pain(among others) ppl are taught the opqrst.


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## ExpatMedic0 (Oct 10, 2012)

Kind of hard to teach you guys everything you need to know in  what is often a 120 hour class, aka EMT-B.


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## DesertMedic66 (Oct 10, 2012)

This is where quality EMT schools come into play. Most EMT schools just teach you enough to pass the NR test. But there are some schools out there who go well beyond that.


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## NYMedic828 (Oct 10, 2012)

This is because many instructors are often the least experienced people out there.

There is no requirement to become an instructor other than applying in most places. I can finish class and go back to become an instructor the next day.

Practical teaching comes from knowledgable and practical instructors.

But, this has been discussed ad nauseum on this board...


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## Asclepius911 (Oct 10, 2012)

Ucla has a good program, our instructor was a medic that had been in the field for years, I sometimes get nasty stares from other co-workers when I tell them that their logic is a little wrong, since Ucla ran through so many scenarios... Classic story, pt was making gurgling noises,(condition was not due to fall) at the time I was new and my partner had been doing this for years, I told him let's roll the pt over to drain fluid and suction, my partner said no let's sit him in semi Fowler so the fluid can go down (with confidence), so I did what I told him and fast and easy, /s problems, and corrected him on why his logic was faulty... I'm thinking that my partner was never told what to do in that situation or never had that scenario in the past.


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## Veneficus (Oct 10, 2012)

I was fortunate to have teachers since the very beginning of my career who taught me how to apply textbook knowledge to the real world environment. (see my signature)

Anytime there is a disconnect between the textbook and the field it is always 1 of 2 issues.

1. The medical theory is inherently flawed. 

2. The instructor does not know the material well enough to convey how to use it in the field.

In the later, you wind up memorizing stuff to pass the test, then you actually begin your education in the field. Often without any type of formal guidance or oversight. (aka you are self taught from scratch when you start working)

You can see where that could go horribly wrong very often.


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## leoemt (Oct 10, 2012)

My EMT class was 280 hours long. The extra time was spent on realistic scenarios. While class can't really compare to a field work, a good EMT school will prepare you enough to be competent.

EMT school is an open door into a vast world of education and knowledge.


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## hogwiley (Oct 11, 2012)

I think a good EMT school has lots of clinical time, so you can see how what your learning applies in the real world. The minimum number of hours we could do was 20 in the ER and 20 on an ambulance. Obviously not a whole lot, but enough to see at least half a dozen real 911 calls in most cases, and a chance to do a few patient assessments depending on who you rode with.

Most students had way more clinical hours than the minimum(except of course some of the firefighters who just wanted the cert), especially since you had a checklist of objectives you had to achieve such as taking x amount of vitals, administering 02 by NRB, NC, bagging a patient, neb treatments, suctioning, spineboarding, etc. We had a couple students do like 150 hours. Granted the ambulance crews probably hated their guts by the end. 

It also helps to have the students graded by precepters during clinicals, so they arent just there to gawk, but actually participate and learn, and to put them under a little bit of stress.


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## Martyn (Oct 11, 2012)

Shabandrw said:


> Example, if we get a call to a Pt complaining of ab. pain, we want to ask, other than are you SOB or having trouble breathing, but we also want to ask...
> Whens the last time you ate something?
> Did you throw up?
> Whens that last time you made a bowel movement?
> ...


 
Don't forget that if your PT is female with ABD pain to ask when their last menstruation was. I had a partner who was always too embarrassed to ask and I had to ask for him!!!


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## martor (Oct 11, 2012)

I must defend the schools. While they are not perfect, they give you the basis to which you can add on. 
During my class and while working on the field I find that my instructor was a brilliant person that DID prepare me. He told us "you need to THINK. This job is not number crunching."
The questions listed above are somewhat logical questions to ask if you read the textbook and know what is related to abdominal pain. 
I spent a lot of time on the forum lately and found this this pattern of blaming the system or the schools because of inadequate EMTs. It is just game of blaming somebody else.
Yeah, the class doesn't teach you every question or scenario possible. This is why experience is needed. 
For the first two months I went by OPQRSTI only. Now I listen to the pt and modify my questions. The skills we learn are there to make sure we dont miss something important. They are BASIC *hint* *hint* questions.
 (happy posting. I am not angry at all)


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## Jambi (Oct 11, 2012)

Shabandrw said:


> Okay once you get on the field, and actually start working as an EMT, you'll notice that actual field work is completely different from what we learn in EMT class. I believe, and many of my EMT partners agree, that they don't really teach us how the job is going to be like on the field. I've also talked to many firefighters and they have also said that all the EMT schooling is pretty much "bs" we only learn pretty much book work instead of actual "scenarios"...anyway I could go on
> 
> BUT what I wanted to ask is...Is there a list of questions you can ask when you get called to an emergency scene that'll help you in providing good customer care. Example, if we get a call to a Pt complaining of ab. pain, we want to ask, other than are you SOB or having trouble breathing, but we also want to ask...
> Whens the last time you ate something?
> ...



<this is my attempt to add something useful to the OP's question>
A solid foundation of the form, function, and mis-function of the systems involved should/would direct any rational questioning.  In short, there is no set list of questions because everyone is different, and will present in different ways.

This post still deserves this.  Not because of the OP or his or her question, but rather because he or she would even have to ask such a thing.









firefite said:


> This is where quality EMT schools come into play. Most EMT schools just teach you enough to pass the NR test. But there are some schools out there who go well beyond that.



Agreed, but each program, despite their efforts, has their undesirable instructors.  We have a handful where I teach, and while it's a long story, what it comes down to is the absence meaningful accountability of instructors, and an unwillingness to enforce standards onto said instructors.

I'd be willing to bet firefite understands exactly what I mean.



Veneficus said:


> I was fortunate to have teachers since the very beginning of my career who taught me how to apply textbook knowledge to the real world environment. (see my signature)
> 
> Anytime there is a disconnect between the textbook and the field it is always 1 of 2 issues.
> 
> ...



I think the importance this statement has gone unappreciated...


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## Veneficus (Oct 11, 2012)

*You must be the new guy *



martor said:


> I must defend the schools. While they are not perfect, they give you the basis to which you can add on.



What exactly are you paying these schools for? To get you through a test and then teach yourself?

Allow me to offer a different perspective?

The EMS curriculum (whether national or various states) defines the minimum amount of training. Any school is free to exceed this by any amount they desire. Why don't they?

I'll let you in on the secret...

1. Because most students will not go to a school that is longer than the minimum, they will not go to a school that charges more for more and still come up with the same vocational cert.

Afterall if I can become an EMT (in now) 150 hours and pay $900 with the book, why should I pay $1500 spend 300+ hours in school, and get the same cert to apply for the same low wage job?

2.Because if you increase the hours without increasing tuition, then your school's profit margin decreases. As aninstructor I have minimum salary demands. If a school cannot pay it, I take my show on the road.  



martor said:


> During my class and while working on the field I find that my instructor was a brilliant person that DID prepare me. He told us "you need to THINK. This job is not number crunching."



Have you ever been to another EMS school? 

How many instructors did you have?

Were they all brilliant?

How do you know? What are you basing this assessment off of?



martor said:


> I spent a lot of time on the forum lately and found this this pattern of blaming the system or the schools because of inadequate EMTs. It is just game of blaming somebody else.



Do I strike you as the type of person who just likes to assign blame and not fix things myself when they are broken?

Do you think EMS students are lesser than other students?

Do you think failing students will solve the problems?
(Before you answer this did you know that schools can be shut down at the state level for high attrition rates?)

I have been involved in EMS education going on 10 years now. The system is broken. The way the schools operate is broken. The way instructors are credentialed is broken, and I went through the same credentialing process as the rest of them. 



martor said:


> Yeah, the class doesn't teach you every question or scenario possible. This is why experience is needed.



A good class never teaches to the test.

The point of education is to make use of the collective experiences of your predecessors. As I like to say to students, you should notmake the same mistakes I did. You should make new and amazing ones. 

If I send a student to the field with the same knowledge I was sent to the field with, I am a failure as an instructor.


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## canuck_downunder05 (Nov 16, 2012)

I would suggest buying a EMS field guide that you can keep in your pocket. They are perfect little handy books that are full of protocols, EKG's, Poisons, Meds, Abbreviations and spelling. Under the Protocols (which covers everything from abdominal pain to trauma, to child birth) they list History questions to ask, things to look for ie) fever, obvious trauma, OPQRST ect), provide formulas for drop sets, O2 in mins as per bottle size, Burn %, APGAR ect. And then it suggest treatment options. Now also keep in mind your protocols for where you work, as well as what you MD allows you to do. It's a great little cheat booklet and you can buy them anywhere that sells EMS stuff, or find one online. Although the majority of this stuff is included in your course.... although sometimes we remember it better when actually applied 

Secondly, when you start on car some questions to definitely ask that is not covered in your course and can change from shift to shift are things like

- area coverage - how to get around. maps, gps and whatever other tools they offer
- how does your partner want to work. Alternate calls or day to day switch up. Are they a paramedic or an emt?
- If a call starts out BLS but turns ALS discuss how the paramedic will let you know they are taking over
- Let your partner know that you are new to being on car and explain that you are getting familiar with things and will need some time to develop a routine and understanding of running calls.
- Have your supervisor or partner review your PCRs to make sure you're completing them properly.
- How do they stock the ambulance and get to know where things are In and Out
- Where are the hospitals and which bays do you use ER vs Transfer bay


That's all I can think of right now. Lots of on the job training! Just be patient, you'll get to know things before you know it!


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## leoemt (Nov 16, 2012)

Shabandrw said:


> Okay once you get on the field, and actually start working as an EMT, you'll notice that actual field work is completely different from what we learn in EMT class. I believe, and many of my EMT partners agree, that they don't really teach us how the job is going to be like on the field. I've also talked to many firefighters and they have also said that all the EMT schooling is pretty much "bs" we only learn pretty much book work instead of actual "scenarios"...anyway I could go on
> BUT what I wanted to ask is...Is there a list of questions you can ask when you get called to an emergency scene that'll help you in providing good customer care. Example, if we get a call to a Pt complaining of ab. pain, we want to ask, other than are you SOB or having trouble breathing, but we also want to ask...
> Whens the last time you ate something?
> Did you throw up?
> ...



EMT school is a foundation for which you build your education. It is not intended to tell you how to do the job, that comes from experience. Paying attention in class will make learning and understanding easier in the field. No school, whether it be EMT school, medic school, or a 4 year university program is going to teach you how to do your job whatever it may be. 

Questioning comes from experience. From your example of Abd pain, why are you asking those questions you stated? What is going thru your mind based on the answers given? How will your treament change based on answers? 

Big difference between abd pain due to Norovirus versus Appendicitis. 

The point I am making is questioning does no good if you don't know what to do with the answers. As a basic I can't do a lot for chest pain. But is the chest pain cardiac related or anxiety related? I can help an anxiety attack. Am I taking the patient to Harborview (which hates cardiac problems) Or am I going to Swedish Cherry Hill which is a Cardiac Hospital? Do I need a medic evaluation or intercept?

Between EMT school, your FTO, protocols and your own experience you will be able to develop your questioning to better help the patient. If you think EMT school will tell you how to do the job then you are solely mistaking.


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## AnthonyM83 (Nov 16, 2012)

Double Post. Delete


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## AnthonyM83 (Nov 16, 2012)

If your school is good, the classroom way will be very similar to field way. If it's not, perhaps the field is being done poorly. Though, often, the school way is being done poorly, too.

The main differences I see in the classroom, is that we make students do every step out the long way. This is so they learn a baseline or core assessment from which to diverge and alter it based on situation. Let them diverge to early and they end up just spinning once on-scene. But it's pretty damn similar to the field.

Be careful when you hear people talk about the field way. It's not always (but usually) associated with rationalizing lazy actions or improper care. Be the healthcare provider that your patient expects...


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## mycrofft (Nov 16, 2012)

It's always tempting to try to teach anecdotally, but not only can you not exactly represent any medical condition in a training setting (no, moulage doesn't), but you don't know what sort of run is even predominant where and when each and every student will work. AND, the graduate will tend to act in accordance with the teaching scenarios, meaning they will tend to miss stuff and miss-treat patients. (Not "mistreat", but miss something. Trademark Pending).

Students want precise scenarios because they want to do well right out of the gate. Experience working with preceptors using principles learned in class will build you a good structure.

Scenarios are to teach principles, not scripts.


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## Milla3P (Nov 17, 2012)

Shabandrw said:


> Is there a list of questions you can ask when you get called to an emergency scene that'll help you in providing good customer care. Example, if we get a call to a Pt complaining of ab. pain, we want to ask, other than are you SOB or having trouble breathing, but we also want to ask...
> Whens the last time you ate something?
> Did you throw up?
> Whens that last time you made a bowel movement?
> ...



Ummm.... SAMPLE? OPQRST?


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## AnthonyM83 (Nov 18, 2012)

I recommend making index cards with different conditions or chief complaints (seizure, ALOC, poisoning, stroke, cardiac, SOB, etc) with both questions to ask for each and physical exams to do for each.

Ex: Seizure
Hx: Aura before? Describe seizure? Duration? How many? Previous seizure? Fall? Post-ictal?
Physical: Oral trauma? Incontinence? Pupils? 

Maybe also a treatment section. 

I found that helpful as a new EMT, so I wouldn't feel like I was floating and reaching for random questions when I got on scene.


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## Luno (Nov 19, 2012)

To echo Vene again, there is very little difference between the field and the class, the principles generally hold true.  What there is an astronomical lack of, is an ability to relate the lessons learned in the class into practical application.  Also the instructor quality is less than stellar in most circumstances...


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## mycrofft (Nov 20, 2012)

AnthonyM83 said:


> I recommend making index cards with different conditions or chief complaints (seizure, ALOC, poisoning, stroke, cardiac, SOB, etc) with both questions to ask for each and physical exams to do for each.
> 
> Ex: Seizure
> Hx: Aura before? Describe seizure? Duration? How many? Previous seizure? Fall? Post-ictal?
> ...



Yes. ANd, from Luno:

"To echo Vene again, there is very little difference between the field and the class, the principles generally hold true. What there is an astronomical lack of, is an ability to relate the lessons learned in the class into practical application. Also the instructor quality is less than stellar in most circumstances..."
__________________


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## RemoteMedicineIreland (Nov 22, 2012)

mycrofft said:


> Yes. ANd, from Luno:
> 
> "To echo Vene again, there is very little difference between the field and the class, the principles generally hold true. What there is an astronomical lack of, is an ability to relate the lessons learned in the class into practical application. Also the instructor quality is less than stellar in most circumstances..."
> __________________



I found the smart phone easier than the cards


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## DesignPD (Dec 11, 2012)

*Field Training*

Doesn't a good field training and evaluation program help overcome these obstacles?   

How common are standardized field training programs in EMS?  

It seems like some have something, while others do not.


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## Veneficus (Dec 11, 2012)

DesignPD said:


> Doesn't a good field training and evaluation program help overcome these obstacles?



The only thing that helps is having class and field instructors who understand and can teach people to apply thory to practice and not just run them through the motions of "this is what we do and this is how we do it."

In EMS these people are extraordinarily rare and often do not stay in field EMS very long. So the most likely place (which is like catching a leprechaun) to find them is during initial education.


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## potoole (Dec 15, 2012)

Luno said:


> To echo Vene again, there is very little difference between the field and the class, the principles generally hold true.  What there is an astronomical lack of, is an ability to relate the lessons learned in the class into practical application.  Also the instructor quality is less than stellar in most circumstances...



for the most part i agree with you. it's just a hard transition depending on what service you get on. if you get on a low key service, it would be an easier transition, but if you get on a service which has the ems 911 contract for a larger city, it may be difficult to relate the class to the road because you start to see how not every call will be a by the books call. along the same lines as the instructor comment, most instructors will try to make sure you know what the book wants you to know.


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## crazycajun (Dec 15, 2012)

I have taught a few EMT classes in my day. I have never taught to a level of simply passing a test. IMO, these cookie cutter schools should not be allowed to exist. My job as an instructor is to teach you to a level of being not only competent but also comfortable in the field. I believe in real world scenarios, live patient clinicals and real time field experience during class. I have told every student I have ever taught that if they can pass my final exam they will have no problem passing the NREMT.


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## potoole (Dec 15, 2012)

crazycajun said:


> I have taught a few EMT classes in my day. I have never taught to a level of simply passing a test. IMO, these cookie cutter schools should not be allowed to exist. My job as an instructor is to teach you to a level of being not only competent but also comfortable in the field. I believe in real world scenarios, live patient clinicals and real time field experience during class. I have told every student I have ever taught that if they can pass my final exam they will have no problem passing the NREMT.



i had three instructors for my course, all would have been excellent if they worked together a little better, but one had great real world experiences for everything, one had extensive book knowledge, and one got us observation and ride times for als, bls, and dispatch, but i dont feel it was enough for the real world.


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## djarmpit (Dec 29, 2012)

I've heard rumors that some EMT teachers who are FF, usually teach so that they are able to get promoted. Not sure how true this is so don't fire at me for that quote.


Also, I have to agree with the previous post about going through the "minimum" in order to pass. I have many friends who took 1 month long accelerated courses and it seems like unless you are going through a community college and taking a semester long class, you are often only taking a 1-3 month course.


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## TMEEMT (Jan 4, 2013)

martor said:


> I must defend the schools. While they are not perfect, they give you the basis to which you can add on.
> During my class and while working on the field I find that my instructor was a brilliant person that DID prepare me. He told us "you need to THINK. This job is not number crunching."
> The questions listed above are somewhat logical questions to ask if you read the textbook and know what is related to abdominal pain.
> I spent a lot of time on the forum lately and found this this pattern of blaming the system or the schools because of inadequate EMTs. It is just game of blaming somebody else.
> ...



This. I have very little experience so far in the field compared to what most have since I am still a new EMT. Honestly the things that we went over in class did truly help so far, most likely because it is still fresh in my mind. But still, a lot of it can be bs it's up to you how much you take away from it to better yourself as an EMT.


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