# Ready for an unpopular idea?



## NomadicMedic (Sep 15, 2013)

Between here and Facebook I've been reading an awful lot of threads from people who have felt like they're not ready for EMS or have had significant amounts of difficulty in passing the test. Invariably the question comes up, "Am I cut out for this job?"

Let's look at this from a different perspective. 

I'm a 44-year-old fat guy. I would very much like to be a professional baseball player. I've always wanted to be a professional baseball player. Ive studied the history and stats. I know how to do it inside and out! I envision myself in the uniform, standing at home plate pointing my bat towards the sky like Babe Ruth, calling my shot. The crowd cheering, sportscasters reverently muttering my name into their microphones. I've worked for jerks sitting behind a desk, and even if they didn't pay me much money, I'd be happy being a professional baseball player… Because I know in my heart, that's what I should be doing. Playing America's game. But every time I try out, I realize I can't hit, can't shag a can of corn and run the bases like a wheezing asthmatic. 

Does pro ball sound like a realistic goal for me?

I mean, I KNOW how to do it, I just can't deliver who I need to... 

It doesn't make me a bad guy, just not pro baseball material. 

So why do we continue to blindly cheer on the people who can't pass the NREMT, console the guy who throws up every time he sees blood, and continuously remediate the paramedic candidate who just can't start an IV?

If I tried out for the majors and never made the team I'd hope that someone would give me a nudge and say, "hey knucklehead, maybe baseball isn't your game. Try ultimate frisbee". 

Its my belief that will and interest may not always equal job suitability.  No matter what they tell you in paramedic school.


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## STXmedic (Sep 15, 2013)

This should be a sticky in the NREMT section.


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## MrJones (Sep 15, 2013)

DEmedic said:


> ...So why do we continue to blindly cheer on the people who can't pass the NREMT, console the guy who throws up every time he sees blood, and continuously remediate the paramedic candidate who just can't start an IV?
> 
> If I tried out for the majors and never made the team I'd hope that someone would give me a nudge and say, "hey knucklehead, maybe baseball isn't your game. Try ultimate frisbee".
> 
> Its my belief that will and interest may not always equal job suitability.  No matter what they tell you in paramedic school.



I consider it to be one of the by-products of the "every child gets an award" mentality that seems to permeate society these days. If a kid's never been told he couldn't cut it growing up why should he expect any different as an adult?


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## VFlutter (Sep 15, 2013)

I could not agree more. 

This mentality is even more prevalent in nursing. The Nursing forums are filled with touchy feel sentiments and encouragement for people with threads like "Failed the NCLEX for the 4th time! Help!". 

If you fail an exam, designed to test the bare *minimum *level of competence, multiple times then there is a problem. You do not meet that level of performance. And chances are even if you do pass after your 5th try you will not succeed in clinical practice.


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## JPINFV (Sep 15, 2013)

Oh, please. Nursing and EMS has nothing on medicine. Between the "What are my chances?" section in the pre-med forums on SDN to the Caribbean folks who've failed the USMLE 3 times and are essentially shut out from US medicine (a lot of states will deny licensure if you take more than 3 attempts), medicine wins this race.


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## Carlos Danger (Sep 15, 2013)

I don't completely agree. Sure, there are people who are not cut out for EMS, and I'm definitely not known for telling people what they want to hear just to be a nice guy.  

But let's face it, learning to be a paramedic is not rocket science. You need 2 semesters and a single textbook written at a tenth-grade level. With good instruction, there are probably relatively few high school graduates who can't pass a paramedic program if it's what they really want to do. I don't mean to be insulting to those who have chosen paramedicine as a career, and I'm certainly not suggesting that paramedics as a whole are an unintelligent bunch. I'm just saying that the bar is set low enough that most anyone in possession of average intelligence and basic reading skills can probably manage the necessary schooling.

My perception of the situation of many of these struggling wannabe's is that they simply aren't being instructed properly. Classroom instructors in EMS often have no real training in education, field preceptors often like to eat their young, and ED nurses are often very unhelpful for a variety of reasons.

EMS education is often very poorly executed, and no small part of the problem with it is that some people who would likely turn out to be competent practitioners really struggle because the quality of their instruction - both didactic and clinical - sucks.


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## Carlos Danger (Sep 15, 2013)

JPINFV said:


> Oh, please. Nursing and EMS has nothing on medicine. Between the "What are my chances?" section in the pre-med forums on SDN to the Caribbean folks who've failed the USMLE 3 times and are essentially shut out from US medicine (a lot of states will deny licensure if you take more than 3 attempts), medicine wins this race.




But that's because medical education is truly rigorous, and *many* people aren't cut out for it.

Paramedicine and entry-level nursing, by comparison, should be able to be mastered by pretty much anyone of average intelligence.


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## chaz90 (Sep 15, 2013)

Halothane said:


> Paramedicine and entry-level nursing, by comparison, should be able to be mastered by pretty much anyone of average intelligence.



Let's make sure we keep a distinction between "master" and "demonstrate bare minimum level of competence." In my book, becoming a master at anything means you've surpassed that which the vast majority would be able to obtain.


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## fma08 (Sep 15, 2013)

JPINFV said:


> Oh, please. Nursing and EMS has nothing on medicine. Between the "What are my chances?" section in the pre-med forums on SDN to the Caribbean folks who've failed the USMLE 3 times and are essentially shut out from US medicine (a lot of states will deny licensure if you take more than 3 attempts), medicine wins this race.



Don't forget the "academic dismissal" threads for failing x number of classes. The evil medical schools think they can kick someone out for not getting the material they'll need to understand how to take care of someone? How dare they. Maybe the other disciplines (nursing, EMS, etc.) ought to stick to their guns with similar policies. But what do I know. Back to studying now.


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## JPINFV (Sep 15, 2013)

fma08 said:


> Don't forget the "academic dismissal" threads for failing x number of classes. The evil medical schools think they can kick someone out for not getting the material they'll need to understand how to take care of someone? How dare they. Maybe the other disciplines (nursing, EMS, etc.) ought to stick to their guns with similar policies. But what do I know. Back to studying now.



The problem with medical school is that I think too many schools have too light of a trigger for dismissal and too many don't pull it early enough. Depending on the total picture (a couple of failures at 69 percent is a bit different than a couple of failures at 50 percent), I think it's appropriate to require a student to repeat a year before going the dismissal route.


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## fma08 (Sep 15, 2013)

JPINFV said:


> The problem with medical school is that I think too many schools have too light of a trigger for dismissal and too many don't pull it early enough. Depending on the total picture (a couple of failures at 69 percent is a bit different than a couple of failures at 50 percent), I think it's appropriate to require a student to repeat a year before going the dismissal route.



In all fairness, many of them do have some sort of a remediation program (including the one I'm at).


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## firetender (Sep 15, 2013)

On one hand I agree, some people just ain't cut out for the work and the more quickly they realize it the better off we all are. 

But that doesn't really become clear for a while. People deserve time to adjust and find that they ARE capable of being effective in the field if they can stick with it. For most the beginning is the scariest time; the time that churns up the most insecurities.

We get to see a lot of that here because the FNG's are too FNG to know to keep their mouths shut! They learn fast out in the real world.

The culture identifies the expression of weakness as a sign of inability to serve. That's out and out wrong. Each of has his/her personal threshold where honest expression is necessary to work through some of the complexities of the work.

But here, on-line in an anonymous Forum it doesn't have to be as harsh as "out there".

Out of balance encouragement in the beginning is not so bad really. Why? Because the beginning is much too early to predict how valuable a medic will become.

Sometimes the chorus of vultures seeking fresh meat here is deafening. The loudest voices are usually those who wouldn't know a wall if they hit it. It truly IS the luck of the draw and any one of us could kill a patient in our first week as easily as get test-freaked out and bomb one or more times before getting into the back of the truck.

I would prefer to encourage every one on this site to make a little bit of room for your peers to express insecurities. Realize that an important part you can play in strengthening the profession is to make space for your peers to be human.

Who knows, someday you may need an open ear and a little support yourself. If there's a little bit more room to be able to honestly express yourself when you start to hit your personal walls maybe you won't have to suffer alone and then slink away into the shadows with the countless other burnouts who had nowhere to go with their humanity.

Just another point of view to help open dialogue a little bit more real than Question: "Gee, am I really cut out for this work?" Answer: "No, get out!"


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## NomadicMedic (Sep 15, 2013)

Russ, I see your point of view, but I respectfully disagree. People fail in the educational process all the time. Welders, barbers and auto mechanics all fail out of their programs. They move on and do something else. "Sorry Joe. You're jut not good enough at Tig Welding to make this a career." We just see more of it here and on facebook because newbies are taught to see EMS as some sort of heroic civic duty, rather than a technical profession. There's actual book learnin' to accomplish! Just because you WANT to doesn't mean you can (or should)

So sorry. You can gather you friends together and give 'em all a hug and sing a few rounds of "kumbaya" but I still hold that this job is not like intramural softball. Not everyone who shows up deserves a jersey. But they do deserve the honesty of being told that... Not a hand holding stroll down the primrose path to "everything is gonna be okay land".


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## Altered Mental Status (Sep 15, 2013)

My two cents (and I'll be breif because I myself struggle with insecurities): I'd often rather deal with someone honest about their failings who works hard and has a good attitude (but maybe needs to take the long way 'round) than an arrogant jerk who's a "natural" from the start but forever functions with a blind spot when it comes to ingenuity and acceptance of fresh ideas because he's been "spoiled" from day 1 by the luxury of never being challenged because he's always been at least adequate.

This goes for any field of work or study.


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## DesertMedic66 (Sep 15, 2013)

I agree with everything you stated. The fact is not everyone is cut out for EMS. I know many smart students who have either taken the class and failed out or taken the class, passed it, but failed many tests later on. 

We get students who will pass out at the sight of blood. You may be able to get over that issue but until you can you should not be working on the streets. 

With the new generation (I'm in that age group also), they feel like they are entitled to everything. That is something that really doesn't work out in EMS.


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## Emtsgv (Sep 15, 2013)

hope ur not a training officer haha


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## STXmedic (Sep 15, 2013)

I hope he is! Too many training officers pencil through people who have no business being cleared because they can't or won't differentiate between the capable and the worthless.


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## Emtsgv (Sep 15, 2013)

STXmedic said:


> I hope he is! Too many training officers pencil through people who have no business being cleared because they can't or won't differentiate between the capable and the worthless.



if you make it into an amb, u have to be doing something correct people need time to understand book/real life and i think that some people get better with time.....cant just cast people aside because the first time they didn't do something perfect , im not saying oh he killed someone, or hurt someone its OK! hes learning but i think you can get the just of what i mean


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## Tigger (Sep 15, 2013)

Emtsgv said:


> if you make it into an amb, u have to be doing something correct people need time to understand book/real life and i think that some people get better with time.....cant just cast people aside because the first time they didn't do something perfect , im not saying oh he killed someone, or hurt someone its OK! hes learning but i think you can get the just of what i mean



No one is suggesting that new providers not be given an opportunity and sufficient time to learn the job. However after a certain time if you just don't get it and keep making the same mistakes, more time is simply not the answer. A new career path is.


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## STXmedic (Sep 15, 2013)

Emtsgv said:


> if you make it into an amb, u have to be doing something correct people need time to understand book/real life and i think that some people get better with time.....cant just cast people aside because the first time they didn't do something perfect , im not saying oh he killed someone, or hurt someone its OK! hes learning but i think you can get the just of what i mean



I hear what you're saying. However, being alone shouldn't be the time you are trying to figure out if you can hack it. That's what the FTO period is for. You get your feet wet while having a watchful eye. Once you're competent, you're cleared. Unfortunately, most systems have a horrible FTO period, very often with people who have no business being training officers. So as long as that holds true, people will continue to be cleared no matter their ability level.


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## truetiger (Sep 15, 2013)

I'm not sure what you mean by "make it into an amb" but we get students and new employees all the time who have no business doing this job. Like others have said, the academics are not necessarily hard however its all about attitude and composure, and in my opinion, those are very hard to teach.


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## Emtsgv (Sep 15, 2013)

Tigger said:


> No one is suggesting that new providers not be given an opportunity and sufficient time to learn the job. However after a certain time if you just don't get it and keep making the same mistakes, more time is simply not the answer. A new career path is.



I agree, but it does depend on which "mistakes" are being made but i do agree after a certain point if you just cant do what needs to be done find a new career path.


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## Emtsgv (Sep 15, 2013)

truetiger said:


> I'm not sure what you mean by "make it into an amb" but we get students and new employees all the time who have no business doing this job. Like others have said, the academics are not necessarily hard however its all about attitude and composure, and in my opinion, those are very hard to teach.



What i mean  by "make it into an ambulance", is pass EMT school, NREMT , Ect.


if you have done all this you have some foundation and knowledge.


Attitude and composure hard to teach, maybe but you develop those over exposure imo, but i understand where you are coming from


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## Emtsgv (Sep 15, 2013)

STXmedic said:


> very often with people who have no business being training officers.  level.



i agree with that statement


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## TheLocalMedic (Sep 16, 2013)

I'm a big believer in thinning the herd when it comes to EMT and paramedic students.  It's an over-saturated field as it is, and frankly I'm sick of hearing other people coddling students and trainees who simply cannot make the grade.  It's not a hard course, it's certainly not a hard test, and the job itself is generally straightforward.  I'm sorry if someone is having trouble, but from my experience the people who can't pass the test or are having trouble once they get in the field are either not applying themselves or have a personality that is incompatible with this line of work.  

I've had to have the hard talk with both students and trainees, but it has to be done.  If you think class is hard, or think your training is tough, it won't be any easier once you're on your own on an ambulance!  I remind the people I cut that allowing them to "get a pass" will only do them a disservice.  They don't want to be the person everyone despises because they are a weak EMT or medic.


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## Wes (Sep 16, 2013)

I take a week away from EMTLife to go to EMS Expo and come back to find this thread.  Awesome!

I've said more than once that there's nothing wrong with an instructor telling someone that maybe EMS isn't for them.   In other words, not everyone gets a trophy.


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## Brandon O (Sep 16, 2013)

The trouble is, where do you draw the line?

Some people are naturals. Some take a long time to get the hang of this job. It would be a far more barren and limited field if only the first group was allowed to stay in the game. And for every new guy you were 100% convinced will never hack it, I'll show you one who's running the show a couple years later.

That doesn't mean that everybody has what it takes. But I'll bet you don't know who does.


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## fma08 (Sep 16, 2013)

Brandon O said:


> The trouble is, where do you draw the line?
> 
> Some people are naturals. Some take a long time to get the hang of this job. It would be a far more barren and limited field if only the first group was allowed to stay in the game. And for every new guy you were 100% convinced will never hack it, I'll show you one who's running the show a couple years later.
> 
> That doesn't mean that everybody has what it takes. But I'll bet you don't know who does.



Good place to start is the curriculum. The reality is (gonna step on toes here, but oh well) the curriculum is not overly difficult if you do the work. Does this account for all of the problem? No, but it is a logical starting point. Consistently failing or remediating through the year, and shunting people through is not good for the profession (even if they are good for your school's stats. Oh we have a 98% pass rate at our school!). If someone is consistently getting by at 70%, then they are consistently not learning 30% of the information. I'm not perfect, nor am I claiming to be, but the educational setting is the first place that we could make some widespread changes. (Without trying to turn this into a debate on whether we should have a 2 year degree, or x number of hours, etc. that's been beaten to death in other threads)

Edit: I still think schools should stick to their guns on educational standards they have in place. That's not to say that:
1. There can't/shouldn't be a remediation program in place.
2. People can't reapply and try again if they don't pass the first time around.
If there are many people consistently doing bad at your program, that is a chance for the institution to recognize that maybe they aren't providing a good education on their end. People on both sides need that kind of information and can learn and improve from it.


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## Brandon O (Sep 16, 2013)

It's probably smart to distinguish between classroom and field competence. Demonstrating knowledge of a didactic curriculum is obviously important, but there are a ton of methods from the educational world for how to do this, so it shouldn't be the end of the world unless the instructor can't handle it or there's pressure to pencil-whip students past the standards.


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## fma08 (Sep 16, 2013)

Brandon O said:


> It's probably smart to distinguish between classroom and field competence. Demonstrating knowledge of a didactic curriculum is obviously important, but there are a ton of methods from the educational world for how to do this, so it shouldn't be the end of the world unless the instructor can't handle it or there's pressure to pencil-whip students past the standards.



Yep, there is a big difference. However, quality field competence starts with strong didactic competence. It's one thing to do the field work, it is another to understand why, recognize what you need to do, and when you need to do it.


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## Brandon O (Sep 16, 2013)

fma08 said:


> Yep, there is a big difference. However, quality field competence starts with strong didactic competence. It's one thing to do the field work, it is another to understand why, recognize what you need to do, and when you need to do it.



Sure, no doubt. But when many providers complain about the competence of new hires (as in this thread), I would say they typically don't mean their classroom knowledge -- which frankly may not be much greater among the experienced folks. It's about the boo-boos in the practical aspects of the work.

I certainly agree that the other thing should probably be more emphasized. I'm just guessing it's not the point of this thread. But that might depend on whether you're talking to an EMT instructor or an FTO. (Obviously there's some bias here -- students wouldn't reach the latter if they hadn't been passed by the former! So they're seeing different problems...)


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## Altered Mental Status (Sep 17, 2013)

I'd like to say that I suspect it's a lot harder to come up in this business in these times.

Many of you who have been doing this for 10+ years didn't have as much of the worries about getting sued for every freakin thing on your backs and were much more free to focus on getting the job done without worrying about _as much_ of the bureaucratic baloney. When I treat a patient, I can NOT just focus on getting my technique right, I have to focus on being very careful not to say the wrong thing, keeping track of everything that's said, not looking too clumsy or stupid but not coming off as arrogant or overconfident. I have to mince words and avoid common sense conclusions in some situations and am expected to "read between the lines" in other situations and to a degree, I'm expected to walk on the job with a certain amount of that aptitude from day one. There are now circumstances where mistakes made during clinical rotations can get you thrown out of the program.

A good portion of my training from the first day of EMT-B has been centered on NOT taking risks, NOT screwing up, NOT being okay with your mistakes. Dog forbid I forget some by-the-book detail that many of the old-timers with experience haven't bothered with for years. The old-timer will make fun of you for doing it and the school environment will "write you a chit" so-to-speak for leaving it out. 

"Sometimes you have to get resourceful and use duct-tape trauma shears in creative ways," says the wise, old-dog medic.

"Never use duct tape or non-approved equipment unless you're prepared to get sued," says the book and the men in suits.

"You don't need to put a nonrebreather on this pt," says the efficient, old-dog EMT. "3L NC will be fine."

"NO! Everybody gets hi-flow O2 and treated for shock zOMG NOW!" says the book.

There's a lot of bureaucratic dissonance and confusion these days for the up-and-comer and there's a marked lack of empathy for the time it takes some of us to RELAX and figure out where we stand. It's often overwhelming.

I am NOT saying y'all didn't and don't deal with a buncha BS too...good lord knows you do and many of you handle it beautifully but not all of us are "naturals" at mastering the book knowledge AND the bedside manner AND the watch-your-step bureaucracy in an environment where we already feel like a lot is at stake if we step wrong. It's a juggling act...complete with circus clowns and a guy in a top-hat, holding a whip.


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## TheLocalMedic (Sep 17, 2013)

Altered Mental Status said:


> I'd like to say that I suspect it's a lot harder to come up in this business in these times.
> 
> Many of you who have been doing this for 10+ years didn't have as much of the worries about getting sued for every freakin thing on your backs and were much more free to focus on getting the job done without worrying about _as much_ of the bureaucratic baloney. When I treat a patient, I can NOT just focus on getting my technique right, I have to focus on being very careful not to say the wrong thing, keeping track of everything that's said, not looking too clumsy or stupid but not coming off as arrogant or overconfident. I have to mince words and avoid common sense conclusions in some situations and am expected to "read between the lines" in other situations and to a degree, I'm expected to walk on the job with a certain amount of that aptitude from day one. There are now circumstances where mistakes made during clinical rotations can get you thrown out of the program.
> 
> ...



Is it appropriate to laugh when someone sounds so sincere?  Today's EMT and paramedicine courses have in many respects been dumbed down to accommodate the demand for and influx of new practitioners and students.  The first paramedics were taught by physicians and were often expect to have physician level knowledge.  EMT courses are essentially advanced first aid, and aren't too different from what is taught in the Boy Scouts.  Sure, bedside manner is often a learned skill, but saying that watching out for legal pitfalls puts an added burden on "new" practitioners is like saying that "new fangled traffic lights" makes it nearly impossible to get a drivers license.  

Yes, both books and anecdotal stories warn of the dangers of making a misstep that will get you sued, but in all my years I have yet to actually go through any serious litigation.  

And yes, you ARE expected to "walk on the job with a certain amount of aptitude".  You should learn the basics in your course AND have the proper personality and demeanor for this job.  Just like you're supposed to have a certain affect as a law enforcement officer, a banker, a salesman or a manager.  You must possess a good working knowledge of the job you are expected to perform and have the aptitude to quickly learn and apply the field experience you pick up in training.  

And also yes, "NOT being okay with your mistakes" is an inherent part of this work.  If I mess up, I'm NOT okay with that.  But I learn from it and grow.  Accepting failure is not an option!  Yes, there is a learning curve during the transition from school to the field, but we WANT the people who accept nothing less than perfection.  We WANT people who strive to be the best they can be, and we deride those who accept mediocrity.  

It can be a rough, arduous road from civilian to paramedic, but if you truly want to be successful in this job you will apply yourself and learn all you can to do it well.  Saying that watching out for potential litigation poses an added hurdle to doing this job successfully is not only insulting, but also demonstrates how little you know about actually doing this job in real life.  

The "old dogs" have much wisdom and advice for you "young pups", and you would do well to listen.  Before 12 leads we were doing modified chest lead placement in the field, and CHF patients were often nasally intubated because CPAP wasn't an option.  Things have changed, and the old dogs have changed with them.  The old dogs were running calls before most EMT students were born, and they have seen more than you can probably imagine.  They won't always talk about it, but they were there for some of the most wild and crazy times that EMS has seen.  

So don't say that the new guys have it tough.  The old dogs have proven themselves and have demonstrated that they can survive the job and adapt to all the changes that have come.  You think the old dogs are immune to litigation?  Think again.  We're working in the field just like you, and we're just as susceptible to errant (or justified) lawsuits as you are.  But the old dogs have learned the tricks of the trade and know how to talk to and treat patients in a way that not only does them the best good but also avoids any potential legal problems.  

Learn from the old dogs.  They may be a tad hard of hearing, but we can teach you how to survive and succeed in EMS.  Your training isn't any harder or easier than ours was, and we dealt with the same struggles when we were new.


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## Brandon O (Sep 17, 2013)

Altered Mental Status said:


> I'd like to say that I suspect it's a lot harder to come up in this business in these times.
> 
> Many of you who have been doing this for 10+ years didn't have as much of the worries about getting sued for every freakin thing on your backs and were much more free to focus on getting the job done without worrying about _as much_ of the bureaucratic baloney.



Nah... I think getting sh*tcanned at the drop of a hat is as old as Johnny and Roy.


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## Christopher (Sep 17, 2013)

Brandon O said:


> Sure, no doubt. But when many providers complain about the competence of new hires (as in this thread), I would say they typically don't mean their classroom knowledge -- which frankly may not be much greater among the experienced folks. It's about the boo-boos in the practical aspects of the work.
> 
> I certainly agree that the other thing should probably be more emphasized. I'm just guessing it's not the point of this thread. But that might depend on whether you're talking to an EMT instructor or an FTO. (Obviously there's some bias here -- students wouldn't reach the latter if they hadn't been passed by the former! So they're seeing different problems...)



My service may be in the minority, but we stress to our new volunteers and hires that we can get plenty of technicians on scene at the drop of the hat (_read: I can request an engine company whenever I want_), but what I really need with me are additional clinicians.

I can always cobble together enough folks to move a patient to my truck, and I can always find somebody with a driver's license valid enough to get me to the hospital.

I have a much harder time finding somebody who can help me take care of the patient.

So my big deal is finding folks who put their nose to the grindstone for the didactic portion and realized the operations aspect of the job really aren't anywhere near the rocket surgery some FTO's make it out to be.


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## Brandon O (Sep 17, 2013)

Christopher said:


> My service may be in the minority



Your service is a bizarre other-worldly utopia as like unknown to normal mortal men.

Plus you get barbecue.


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## triemal04 (Sep 17, 2013)

Altered Mental Status said:


> Many of you who have been doing this for 10+ years didn't have as much of the worries about getting sued for every freakin thing on your backs and were much more free to focus on getting the job done without worrying about _as much_ of the bureaucratic baloney. When I treat a patient, I can NOT just focus on getting my technique right, I have to focus on being very careful not to say the wrong thing, keeping track of everything that's said, not looking too clumsy or stupid but not coming off as arrogant or overconfident. I have to mince words and avoid common sense conclusions in some situations and am expected to "read between the lines" in other situations and to a degree, I'm expected to walk on the job with a certain amount of that aptitude from day one. There are now circumstances where mistakes made during clinical rotations can get you thrown out of the program.


That sounds very much like how things have been for a long, long time.  The better programs have always been willing, ready and able to dismiss students for failures during their didactic, clinical, and internship time.  As they should.  And since I've been doing this for more than 10 years, who do I notify so that I can slack of, start pissing off patients, family members, medical professionals, and stop doing my job appropriately?



> A good portion of my training from the first day of EMT-B has been centered on NOT taking risks, NOT screwing up, NOT being okay with your mistakes. Dog forbid I forget some by-the-book detail that many of the old-timers with experience haven't bothered with for years. The old-timer will make fun of you for doing it and the school environment will "write you a chit" so-to-speak for leaving it out.


That is nothing new.  It's what happens when the educational content for EMT's (and paramedics) is so low and when the standards for school's are minimal.



> There's a lot of bureaucratic dissonance and confusion these days for the up-and-comer and there's a marked lack of empathy for the time it takes some of us to RELAX and figure out where we stand. It's often overwhelming.


That is nothing new.  How much will an individual will deal with will vary, not by year to year, but from location to location. 



> I am NOT saying y'all didn't and don't deal with a buncha BS too...good lord knows you do and many of you handle it beautifully but not all of us are "naturals" at mastering the book knowledge AND the bedside manner AND the watch-your-step bureaucracy in an environment where we already feel like a lot is at stake if we step wrong. It's a juggling act...complete with circus clowns and a guy in a top-hat, holding a whip.


But you actually are.  People have gone through what you have, and go through what you have constantly.  And for many reasons will continue to do so. 

Stop with the "woe is me" attitude that is displayed in this post.  Calm down.  Take a deep breath.  Take another.  And relax.  You are making this much harder than it is, and doing it to yourself.

If this is just ranting and blowing off steam, ok, no problem, everybody needs to do that.  Just be aware that you've said a lot of innacurate things and are portraying yourself in a terrible light.  But if this is your actual attitude, it will come across very clear to those around you, and most likely they will react in kind.  It's something to consider since you are having problems.


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## DrParasite (Sep 18, 2013)

TheLocalMedic said:


> Learn from the old dogs.  They may be a tad hard of hearing, but we can teach you how to survive and succeed in EMS.  Your training isn't any harder or easier than ours was, and we dealt with the same struggles when we were new.


I call BS on this statement.  

As someone who respects what a lot of the old dogs went through over the past 30 years, I can honestly say I have heard stories that they have told that not only worry me, but wonder how they can say they did that in the past and now that they are bosses chastize the new guys for doing stuff not nearly as bad. and most of that stuff makes me wish i had been born 20 years earlier and gotten involved in EMS in the early 90s.

There are a lot of old guys who cut corners.  and in 90% of the time, there is not problem with what they did.   9%, of the time how they didn't get burned can amaze people.  and in that last 1%, well, the only explanation I can give is that it was brushed under the rug.

Their training was a lot different than ours was.  there was a lot more hands on, and from what I hear, they learned a lot on the job by trial and error (ie, gaining experience on the job), while many students are expected to be all knowing after school.  The mentality was a lot different, and the expectations were higher; similarly, they taught their new people how to do the job, and when you screwed up, you heard about it, from the senior guy, and the FTO, and maybe the boss... without needing a written reprimand.  

The old guys saw a lot of stuff, and helped pave the way for what EMS has become.  

But I will take a fully educated paramedic vs an EMT who has been doing the job for 20 years and is still doing things this way "just because we have always done it this way" and no one has died yet.

BTW, I would love to drop EMT students who can't pass the test, and fire people who can't do the job.  Everyone deserved a second chance, but after a while you need to recognize that this field just isn't for you.


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## kev (Sep 19, 2013)

Hello everybody, long time lurker, first time poster. I am an emt b student currenty and cannot agree more that some people who try this class out are really not cut out for it. It seems, at least in my limited opinion, that most of the students that show up to my class dismayed  and looking for reassurance haven't put forth the necessary effort to make sure that they understand the material before class. Granted, it is a lot of information to build a new knowledge base out of, and I have to work hard to make sure I understand it all, but ot should be stressful. That is all preparation for the field. If someone cannot handle the stress of a test in a classroom setting, I don't think I would want them showing up at my house when someone is dying. I'm also not sure how the ems education system works in the rest of the country, but our instructors have no problem dropping students left and right. Last semester only 35% of the students enrolled passed the class. The flip side is that more than 90 % of them passed the state exam. I think that is how ems education should be.


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## Tigger (Sep 19, 2013)

I'm not sure it's valid to say that the people who get stressed about test taking are bound to be stressed in the field. It's apples to oranges. I know plenty of people who get unnecessarily nervous about tests, _but still learned the content_. While I think saying "I'm a bad test-taker" is a crutch, there are people out there who get overly stressed about examinations, but that does not translate into job performance. Now if someone is really stressed about the test because they didn't bother to learn the material, that's different.

We have an EMT where I work who studied for weeks ahead of our medical director's annual clinical competency visit. She was a total stress case and when it came time to do a scenario or two she totally lost it. Just started barking out random parts of an NREMT trauma assessment for a CHF patient. She just couldn't deal with our doc asking her questions. But when she's out on calls, she's one of our better EMTs, and while a little high strung at times, is always calm and better yet, knows pretty well what she is doing.


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## kev (Sep 19, 2013)

You make a valid point. Having not been in the field I have yet to see how the things we do in class translate into real life events.


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## TheLocalMedic (Sep 19, 2013)

DrParasite said:


> There are a lot of old guys who cut corners...



What may be perceived as "cutting corners" may actually represent the fact that they have seen that particular call so many times before that they immediately cut to the chase and don't ask a lot of extra questions.  Experience = the ability to trim the fat and not do a lot of extra work.  Also, work in the field long enough and you'll start to recognize when you should or shouldn't be doing/saying certain things.  

I had a partner a few weeks ago that was concerned about why I wasn't backboarding people involved in traffic collisions.  They even asked if I was "just lazy or what?"  So I explained my rationale and how mechanism alone was not enough to justify c-spine, and that backboarding wouldn't do anything to stabilize a lumbar injury.  I wasn't lazy or cutting corners, but rather applying my experience.  



DrParasite said:


> Their training was a lot different than ours was...



Yes, training was different, but just because we went to school long before you doesn't me we could stop learning.  Medications change, protocols change, equipment changes, and treatment modalities change.  We all keep learning and going to courses to keep up with the changing pace of medicine.  



DrParasite said:


> But I will take a fully educated paramedic vs an EMT who has been doing the job for 20 years and is still doing things this way "just because we have always done it this way" and no one has died yet.



I don't believe that you'll find many people out there who have the attitude of "just because we have always done it this way".  Those experienced EMTs are often as sharp as their medic partners, and I've had my butt saved by good EMTs many times.  I'd almost prefer the opposite of what you stated;  I'd rather have a super experienced EMT who has proven themselves over 20 years than a wet-behind-the-ears medic.


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## Masenko (Sep 19, 2013)

*Still haven't figured out how to quote, the quoted stuff is bolded*

@ TheLocalMedic: I'm getting some mixed messages from you, do you mind clarifying? 

*Today's EMT and paramedicine courses have in many respects been dumbed down to accommodate the demand for and influx of new practitioners and students.  The first paramedics were taught by physicians and were often expect to have physician level knowledge.  EMT courses are essentially advanced first aid, and aren't too different from what is taught in the Boy Scouts.   
*
vs 
*Learn from the old dogs.  They may be a tad hard of hearing, but we can teach you how to survive and succeed in EMS.  Your training isn't any harder or easier than ours was, and we dealt with the same struggles when we were new.
*

I'm pretty sure the first paramedics were not expected to have physician level knowledge. Sure they were mostly military medics with unique skills and experiences, but even with that going for them they are far removed from what modern EMS and health science has evolved to. Physician skills yes, but knowledge? I thought this is the type of thought train we view as dangerous here. I get training by physicians too, but that doesn't mean I come close to their knowledge. Moreover, do you think our training is dumbed down boyscout first-aid or is our training up to par with the old dogs? If it isn't harder or easier than the old dogs' then don't the old dogs have boy scout training as well? 

*  We WANT people who strive to be the best they can be, and we deride those who accept mediocrity.  
*

If you really mean that, then why would you say this? 

*I'd almost prefer the opposite of what you stated;  I'd rather have a super experienced EMT who has proven themselves over 20 years than a wet-behind-the-ears medic.*

So you would rather have a guy who has accepted mediocrity for 20 years, and the knowledge consisting of A+B= hopefully patient gets better, than someone who has taken the time and effort to try and understand the science behind a situation? Than someone who cares enough to learn more? I understand what you mean in terms of dealing with the new student and his/her effect on day to day operations, but the good thing about experience is that it is something that literally happens by itself. The new guy can ride with you AND the 20yr EMT vet if you want! I bet the new guy will quit on his own if he can't deal with blood! I also bet he will be a loyal, trustworthy, experienced, overall stronger asset than the 20 yr EMT if he gets some guidance. 

I like what Firetender is saying. Maybe some people aren't prepared for EMS, but why does this forum have to be the medium? I understand that constantly encouraging people to overcome the obstacles over and over again can get annoying, but maybe it's that repetition that's getting to people, not the actual obstacle or the "whiners". 
And sure there are some people who do not belong. I have yet to find that out about myself. How long do they really last, with or without coddling?  

I love this forum; I've been lurking here much longer than I've been a poster. People's posts here have inspired me to try and become the best emergency clinician I can be. Negativity and discouragement is prevalent enough in the real world. Constructive criticism is one thing.  But c'mon, telling someone they can't do something based off of what they post ( a very small window of what is actually taking place) is a little disproportionate.
This is the internet. I can say with confidence that reading someone tell me to quit trying, anonymously, on an internet forum isn't going to sway my decision at all. It might make me feel a little bad... I might hyperventilate at the computer screen for a bit, but I definitely will not quit. Likewise, you will not find me asking for help to pass a state exam -_-...but that is besides the point. 
Why not try to help those who want to better themselves? Obviously they care enough to come complain on a forum about it. If impatience is this out of control, don't say anything!  Shooting someone down is not guidance, and it's not going to make them leave EMS. None of us are qualified to say what one person can and can not do (over the internet)! This is looking a little bit like what my text book calls "burnout", only of a different nature.    

I know it might not look like it, but standards in EMS and healthcare are going up. Aren't we moving towards the AEMT? Aren't certificate programs on the way out? The GPA average and MCAT score for med schools sure aren't going down. And the average GPA requirement for nursing school is no joke either. 
Those who will not make it will figure it out themselves, especially with rising standards. Some of us have made it clear that it's annoying that young folk are complaining about passing tests, about classwork... maybe we should be happy people are having a hard time with it. And for the ones who can handle the books, but not the real...they aren't exactly going to feel in place anyway. Push for better paramedic education and training, but don't push away those who give enough of a sh*t to come here.


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## unleashedfury (Sep 20, 2013)

Its not just the student who struggles to pass the exam, its also the fact that schools need to better prepare students for expectations to perform. Standards should be much more stringent for students entering the EMT or paramedic program vs. well if the check clears you start on this date. 

Colleges and "for profit schools" just want to fill the room with paying students to complete their program. and of course they want the "pass rate" so its great for the recruiters to say well our program has a 94% pass rate. We couldn't tell you how well they did on the certification exams but you'll complete the program. Kinda a merit badge program where you get the certificate that says you passed the program. Your on your own for the rest. 

Instructors themselves can see what students are not gonna make it in the field and refuse to toss the student cause they paid for their education so lets give it to them. We know the national registry test will weed them out so lets get them into the program and let them realize they can't pass the test. 

Improving the standard means raising the bar. stricter entry requirements including a written and psychomotor exam to be passed to a minimum standard. interviewing students to see what kind of education they have and the background they have. Why they want to do this as a career? I remember part of my entry process they were aiming more for people who already had college credit. I have a technical degree in automotive technology. So that set me to the top of the list because I have a degree. Does it apply to the medical field no. But the running joke where I work is I can drive the buggy, ride in the buggy and fix the buggy.  

I'm in a program now. and it was pretty much yeah you meet the requriements they didn't even check to see if my EMT was valid until the council required it. So a student could attend the program and not even be a EMT and find out at the end that EMT was a requirement go figure.


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## Biggs (Sep 20, 2013)

Class doesn’t translate to real life,


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## NomadicMedic (Sep 20, 2013)

Biggs said:


> Class doesn’t translate to real life,



Explain...


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## unleashedfury (Sep 20, 2013)

Biggs said:


> Class doesn’t translate to real life,



Well, I'm sure riding on the box with a medic preceptor while you do your field shifts. is the same as real life the only difference is when you get the certification after your FTO time. Your on your own, vs having a preceptor.


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## DrParasite (Sep 20, 2013)

unleashedfury said:


> Colleges and "for profit schools" just want to fill the room with paying students to complete their program. and of course they want the "pass rate" so its great for the recruiters to say well our program has a 94% pass rate. We couldn't tell you how well they did on the certification exams but you'll complete the program. Kinda a merit badge program where you get the certificate that says you passed the program. Your on your own for the rest.
> 
> Instructors themselves can see what students are not gonna make it in the field and refuse to toss the student cause they paid for their education so lets give it to them. We know the national registry test will weed them out so lets get them into the program and let them realize they can't pass the test


These two paragraphs are probably the two biggest reasons why people don't get dropped from paramedic school.  As well as why no one fails various continuing education classes, despite not retaining enough information to pass the class an use what they learned in their career.


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## grind time medic (Sep 21, 2013)

i agree with what DEmedic said completely

i understand that being nurturing to a child when they are growing up is important! But what is more important for me is making sure children understand there boundaries, i read an article on the art of manliness about the paralyzing effects of the words "you can be what ever you want" does to a persons life.


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## DesertMedic66 (Sep 21, 2013)

unleashedfury said:


> Colleges and "for profit schools" just want to fill the room with paying students to complete their program. and of course they want the "pass rate" so its great for the recruiters to say well our program has a 94% pass rate. We couldn't tell you how well they did on the certification exams but you'll complete the program. Kinda a merit badge program where you get the certificate that says you passed the program. Your on your own for the rest.
> 
> Instructors themselves can see what students are not gonna make it in the field and refuse to toss the student cause they paid for their education so lets give it to them. We know the national registry test will weed them out so lets get them into the program and let them realize they can't pass the test.



I would be a little careful saying these as a general statement. Not every college or technical program boast a high pass rate from the class. There are some that focus solely on NREMT pass rates. The college I attended for EMT has about a 65%-70% pass rate for the class and a 93%-96% pass rate for the NREMT. 

If the students are not meeting the requirements they will be dropped from the course regardless of how much money they paid for the course.


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## unleashedfury (Sep 21, 2013)

DesertEMT66 said:


> I would be a little careful saying these as a general statement. Not every college or technical program boast a high pass rate from the class. There are some that focus solely on NREMT pass rates. The college I attended for EMT has about a 65%-70% pass rate for the class and a 93%-96% pass rate for the NREMT.
> 
> If the students are not meeting the requirements they will be dropped from the course regardless of how much money they paid for the course.



I can't speak for the entire US and all colleges. but the few that I've been around have a high pass rate for the program. Low pass rate for the NREMT. 

However I know of a local hospital program that has a low program pass rate avg. 68%. and of that 96% of those who complete the program pass the NREMT congnitive and psychomotor on the first attempt.


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## grind time medic (Sep 21, 2013)

i know one thing that some programs do is they will allow anyone to enter the program but then if they can tell that the person is not gonna pass they will talk them into withdrawing from the class or bounce them out for some infraction. to keep there % #'s high.


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## Masenko (Sep 21, 2013)

Well that's one way to "up the standards"


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## PRiel (Sep 22, 2013)

*Follow Your Heart*

I think there's a responsibility to research the job carefully before spending time and energy on the processing of education and qualifying for a position.  That said, I definitely believe you should follow your heart.  If you don't qualify, or you're not cut out for it...the answer will come to you sooner or later.


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## Jon (Feb 17, 2014)

DEmedic said:


> Its my belief that will and interest may not always equal job suitability.  No matter what they tell you in paramedic school.



So.... I just found this thread.

This is a genius thread. How do we fix this?


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## STXmedic (Feb 17, 2014)

STXmedic said:


> This should be a sticky in the NREMT section.



Quoted for truth.


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## UnkiEMT (Feb 18, 2014)

Jon said:


> This is a genius thread. How do we fix this?



You, I like.

So, I have a tendency to wind up working for training houses, not really by design, but perhaps by temperament. We hire them out of school, they work for us for 6 months or so, and either go on to better pay or decide that this isn't the field for them and try something new. This perhaps gives me a different perspective on the question than most, or perhaps not.

From my observation, short of the absolute inability to learn the material, there's very little way to tell from how someone does in school whether or not they'll do well in the field.

As far as I'm concerned, these are the traits that make for a credit to the profession (though in all honesty, to varying degrees you don't need to have all of these traits to do okay in this field, just to be the best, which is what I want every last people with a star of life on their shoulder to be):

1) You've got to love it for what it actually is, not for what Johnny and Roy told you it would be. Considered dispassionately, this is a bad job, if you don't love it, you can do better elsewhere.

2) You do have to know your book-larnin', you don't have to absolutely master it, but you have to know it well enough to serve as a foundation for what you're going to learn in the field. As someone said, though, this stuff isn't exactly rocket science, most anyone who wants to can learn it, and if someone meets all the other requirements (notably the next one), I'll hold their hand through it.

2a) You've got to keep learning. I learn all the time, I learn from articles and studies, I learn from other EMTs (And not just 'medics, I've learned from basics, too), I learn from following up with pts I've dropped off, and I've learned from reading the charts of pts I'm doing IFTs on.

3) You've got to care about your pts in just the right amount. While they're in your truck, they've got to be your best friend, and once you walk away from their bed, you've got to walk away from them, too. I've seen otherwise promising EMTs destroyed because they couldn't get over the code they couldn't bring back.

4) You've got to stay calm when the fecal matter hits the rotary impeller. This one there's a little bit of wash on, to an extent, this can change, they freak out the first couple of scenes they're on then settle down, but some people are just constitutionally incapable of it, and you can usually tell the difference. (There is, by the way, a huge difference between panicking on a scene and panicking on a test. Some people just have test anxiety, and that's why I'll encourage someone who I know knows the material when they fail the test, I'll even work with them on the material, not so much to teach them, but rather to give them the confidence to pass the test.)

None of that can really be taught (aside from the basic grasp of the didactic stuff.), and largely it can't be tested for, the only way to see it is to put them in the field. 

I can tell, with about a 95% accuracy, whether someone will make it in this field after I ride a single shift with them.

The ones who won't make it, unless they are dangerous, I'll lead to the conclusion that this isn't right for them, rather than actively getting rid of them. If I don't, then I'm just cursing them on a different service and community.

The ones who will make it, I take over where their school left off, and give them the knowledge and tools they need to be great.

It's not an ideal system, I wish there was some way to wash them out before they ever go near a patient, but I've yet to figure it out.


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## neoclassicaljazz (Feb 19, 2014)

Agreed. And props for the ultimate frisbee shout out


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## PRiel (Mar 10, 2014)

Hi there,
In Ontario Canada, about 10 years ago the Government began allowing private schools to offer paramedic training and developed criteria to certify the schools to do so.  This raised strong objections and the subject captured in this thread is one of the concerns.  Insisting that a school disclose their program success rates AND their certifying exam success rates as well is critical.  In addition, the profession has responded by refusing to hire private school grads (or consider them at all) unless the school was accredited by our Canadian Medical Association.  This has been very positive for EMS and has dramatically changed the education landscape.  Now it is just a matter of the student choosing the best school.


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## mycrofft (Mar 10, 2014)

PRiel said:


> Hi there,
> In Ontario Canada, about 10 years ago the Government began allowing private schools to offer paramedic training and developed criteria to certify the schools to do so.  This raised strong objections and the subject captured in this thread is one of the concerns.  Insisting that a school disclose their program success rates AND their certifying exam success rates as well is critical.  In addition, the profession has responded by refusing to hire private school grads (or consider them at all) unless the school was accredited by our Canadian Medical Association.  This has been very positive for EMS and has dramatically changed the education landscape.  Now it is just a matter of the student choosing the best school.



This could be the basis for a new thread…"stamp out certificate mills".
One of the  first steps to becoming a real profession. Not necessarily going anywhere (no independent body of knowledge), but a win-win for patients and practitioners….if the system remains uncorrupted.
============================
Back on the OP thread. I know I have learned things I neither used per se nor as a means of making money but which broadened my perspective and provided a basis for wider associations with interesting people. On that basis, why not teach anyone who wants it?

On the other hand, spare bodies soak up class slots and drive up costs, and trained but not employed trainees without adequate discipline (or propelled by a sense of ethical duty) pose a danger for victims of illness or accident. They also drive down wages, in one respect.

This is bypassing the whole issue of triaging applicants due to temperament to spare them or their potential employers the psychic injury of failing at the cost of human suffering and death. I've seen young people snap-to when they take and pass such a course, and screening is  going to eliminate some people who really COULD do it and need that job.

I say: screen your TRAINERS, use multiple trainers to backstop each other, and use their input after a long class with lots of practicum to help screen for the obvious "bad apples".
And make the certificate holders do practicums with trainers for part of refresher, not just click on a web page. The best apple will eventually become brown and spotty.


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## mycrofft (Mar 10, 2014)

UnkiEMT said:


> You, I like.
> 
> So, I have a tendency to wind up working for training houses, not really by design, but perhaps by temperament. We hire them out of school, they work for us for 6 months or so, and either go on to better pay or decide that this isn't the field for them and try something new. This perhaps gives me a different perspective on the question than most, or perhaps not.
> 
> ...



Try the system we used in the military: wash-backs. Sequence your teaching and practicums, do not deviate, and if someone fails a block, make them fall back with the next class and start over at that point. In a system without the mass of teachers to constantly teach blocks one after another, this might mean a six month layover (if the class is offered twice a year). Time to reconsider, restudy.

UnkiEMT your approach is the one I would aspire to if I were in that position.


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