# EMT-P as M.D.



## hotzelj (Jun 7, 2009)

I'd like to have a bridge for EMT-Paramedics to take 2 years of extra school, do a 2 year residency, and gain board certification as Emergency Physicians.

Thoughts?


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## Luno (Jun 7, 2009)

And I'd like to be rich, good looking, and omnipotent...  I can see it if proper prereqs are met from the PA-C level, but never from the EMT-P level.  There is far too much to study for that.  That also being said, you could conceivably have M.D.s with 2yrs 3mos of schooling... (3mos EMT-P school, 2yrs of "med" school)  That's scary in it's self...


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## ffemt8978 (Jun 7, 2009)

So, you want to take a two year program (that may only be six months in some places or may not be accredited at all), give them another two years of schooling and two years residency and have it replace a 4 year undergrad program in pre-med, medical school and residency program?


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## Sasha (Jun 7, 2009)

Ahahahahahahahahahahaha.

You're joking, right?


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## HotelCo (Jun 7, 2009)

ffemt8978 said:


> So, you want to take a two year program (that may only be six months in some places or may not be accredited at all), give them another two years of schooling and two years residency and have it replace a 4 year undergrad program in pre-med, medical school and residency program?



You act like it's not a good idea... ^_^


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## ffemt8978 (Jun 7, 2009)

HotelCo said:


> You act like it's not a good idea... ^_^



I was just trying to clarify what the OP wanted...

We've got medic mills, why not MD mills?


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## Meursault (Jun 7, 2009)

Now _that_ is a first post. No questions, no introductions, just a laughably bad idea presented completely in earnest. 

Let's see if he can follow through.


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## HotelCo (Jun 7, 2009)

ffemt8978 said:


> I was just trying to clarify what the OP wanted...
> 
> We've got medic mills, why not MD mills?



What's the worst that could happen?

(In case you all didn't know, that's sarcasm)


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## VentMedic (Jun 7, 2009)

hotzelj said:


> I'd like to have a bridge for EMT-Paramedics to take 2 years of extra school, do a 2 year residency, and gain board certification as Emergency Physicians.
> 
> Thoughts?


 
This should be the minimum to be a Paramedic which would then bring it closer to what some healthcare professions require and still less the requirements of many.


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## VentMedic (Jun 7, 2009)

ffemt8978 said:


> I was just trying to clarify what the OP wanted...
> 
> We've got medic mills, why not MD mills?


 
We do have a couple of MD mills (not much shorter just easier entrance) and their grads are working as EMTs or Phlebotomists if they get the additional training for the certs.


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## silver (Jun 7, 2009)

you know in total to be an attending in EM is 12 years.

4 years BA or BS (need Gen Chem, Intro Bio, Calc, Orgo, Physics, and English) <- not required to be a medic
4 year MD or DO <-nearly impossible to compress as you are learning everything needed to be a doctor
4 year residency in EM <-good luck compressing that, most residents spend their life in the hospital already.


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## hotzelj (Jun 7, 2009)

Wow, I'm surprised at how negative everyone is.


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## EMTinNEPA (Jun 7, 2009)

As long as we're in dream-land, I would like...

1. A medic cert
2. A job as a medic making $150k a year (working only a 24 and a 16 every week)
3. To work for a company that will buy me three new uniforms every six months
4. To have the company match my 401k contribution at a 4:1 ratio
5. Free health insurance through the company with no deductible
6. 10% cost of living raises every year
7. A pony on my one year anniversary with the company


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## VentMedic (Jun 7, 2009)

hotzelj said:


> Wow, I'm surprised at how negative everyone is.


 
Negative?

Do you know the educational and residency requirements of a doctor? silver did a nice general outline if you don't know.

How do you compare that to what a Paramedic cert requires?  What you stated doesn't even come close to a Physician Assistant in many states.


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## HotelCo (Jun 7, 2009)

EMTinNEPA said:


> As long as we're in dream-land, I would like...
> 
> 3. To work for a company that will buy me three new uniforms every six months



I want a new one every shift.


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## ffemt8978 (Jun 7, 2009)

hotzelj said:


> Wow, I'm surprised at how negative everyone is.



How so?  You want to take what is basically a 12 year program and condense it down to around 4 years all based upon a certification that may or may not even meet the entrance requirements to a real college program?

But let me ask you this...upon what basis do you envision your program would be a good idea?  How would you ensure that the student has the minimum knowledge required to pass the certification and exam boards, so that they are not a risk to their patients?


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## VentMedic (Jun 7, 2009)

silver said:


> you know in total to be an attending in EM is 12 years.
> 
> 4 years BA or BS (need Gen Chem, Intro Bio, Calc, Orgo, Physics, and English) <- not required to be a medic
> 4 year MD or DO <-nearly impossible to compress as you are learning everything needed to be a doctor
> 4 year residency in EM <-good luck compressing that, most residents spend their life in the hospital already.


 

And, after these requirements, many physicians will spend another 3 - 5 years in Fellowships to specialize.

The Physician's Assistant will sometimes spend another 18 - 24 months after 6 years of education to specialize in EM or whatever.


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## hotzelj (Jun 7, 2009)

Maybe I should re-state. Perhaps most come from a different thinking of the education of "Paramedic."

First Responder: 1 Month education
EMT-Basic: 3 Month education
EMT-Paramedic: 2 Years education
EMT-Paramedic P.A.: 3 Years education
EMT-Paramedic P.A. Residency: 2 Years Education
EMT-M.D.: 2 Years education
EMT-M.D. EM: 2 Years education

9 Years and 4 Months of MEDICAL education. Anyone doing this program would have to already have a degree in general education, math, science, and bio-physiology. Thus, 4 more years of non-medical education.

So, add 4 Years to 9 Years and you get 13 Years - beat that 12 Year doctors.

I don't think the technical side of medicine takes all that long, it's simply information, it's the clinical/theory-application in the real world that takes the time to master. For some people, the technical information takes a lot of time to learn, while for others it is quick and easy. For almost everyone though, the clinical will take the longest, and I think that is where the Gold Standard in the Level of Care is found. This is no suprise to any of you right? As a newbie Paramedic you knew the technical side, but unless you were working as an EMT Basic while going to school, you didn't have the clinical experiance required to increase the level of care.

I am not trying to ask for an M.D. mill. My definition of an Emergency Physician is different than anothers. An E.M.D. to me is a field doctor, who can do what is needed out in the field in a way that is higher than pre-hospital ALS (paramedic), but is not the same as a GP or Family Practice doctor.

Please know I understand the great deal of knowledge required and that medicine is not something to be done in haste. One clarifying point is that I don't care for "intermediates" in the EMS chain. Either be a basic person or be a paramedic, and everyone should be a paramedic if you're going to be in EMS. I also think that a "paramedic" should rise at least half-way to being a P.A. That way, the "next level of training" in EMS would not be a leap, but just more technical, theoretical, and clinical education.

I guess my point was I'd like the EMT profession to be integrated into the medical profession, the medical schools, boards, etc. I'd like the EMTs to be able to go from First Responder, EMT Basic, EMT Paramedic, PA, MD - all with a specialization in emergency medicine.


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## Bloom-IUEMT (Jun 7, 2009)

How about this:
You get your medic, attend college as an undergrad for 3 to 4 years and fulfill all the prereqs (General Biology, one year of general chemistry, one of organic chemistry, one year of physics, one or two semesters of Calculus, analytical chemisty, one year of english,  maybe some molecular biology and biochemistry to help with MCAT). 
Then you can miss the entire two weeks in med school that the paramedic skills are covered!
Finish med school- first two years of basic medicine-physiology, histology, microbiology, anatomy, pharmacology, pathology,immunology, neuroanatomy, embryology, biochemistry, statistics-pass your USMLE 1-then two more years with clinical rotations where you attend classes in the morning and spend afternoons learning basic clinical skills and assessments. Your rotations are Psychiatry, Ob/Gyn, Surgery, Neurology, Emergency, Pediatrics, Family Medicine, Pathology, Internal Medicine. Pass your USMLE 2 and hope you get into the residency program you want.

Then you spend 4 years of residency where you learn all aspects of Emergency Medicine. Classes, papers, long hours in the ER. I mean looooong hours like its not unusual to work 36 hours straight with no sleep.  Then if you pass the board certification you can be an ER Doctor.

Hope I didn't offend anyone with the two weeks bit!----just wanted to drive home the point about physician education


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## JPINFV (Jun 7, 2009)

hahahaha..... hahhaahaha.

Ok, in magic fairytail land, what score on the MCAT (since even the BS/MD combined programs still require the MCAT) should be required for this 'program?'


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## JPINFV (Jun 7, 2009)

silver said:


> you know in total to be an attending in EM is 12 years.
> 
> 4 year residency in EM <-good luck compressing that, most residents spend their life in the hospital already.



/me being pedantic. Well, there are 3 year EM programs. EM programs come in 3 flavors. PGY 1-3, PGY 1-4, and PGY 2-4 (internship year done elsewhere).


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## rogersam5 (Jun 7, 2009)

While we are at this why don't we create a bridge program from first aid to paramedic? /sarcasm


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## Bloom-IUEMT (Jun 7, 2009)

hotzelj said:


> Maybe I should re-state. Perhaps most come from a different thinking of the education of "Paramedic."
> 
> First Responder: 1 Month education
> EMT-Basic: 3 Month education
> ...



Why do you have to be Paramedic before being an ER doc? They are two different species as far as working conditions go.  It basically just sounds like you are rearranging the course work in a normal med school curriculum. Also, you have to think about attrition: adequate pre-med preparation is meant to,  in effect, weed-out those not committed to the medical profession.  You don't want to have a bunch of people in your "paramedic-to-md" program that quit half-way through.  Its a waste of money to train them and its a waste of spots that dedicated people could have had.  Realize the once a person is accepted to med school they have a 95% chance of finishing because admission criteria is so strict.


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## silver (Jun 7, 2009)

hotzelj said:


> Maybe I should re-state. Perhaps most come from a different thinking of the education of "Paramedic."
> 
> First Responder: 1 Month education
> EMT-Basic: 3 Month education
> ...



why would someone whose final goal of becoming an MD stop at PA? why not stop at RN then?

and JP at the major teaching hospitals it is mostly 4 years from what I've seen.


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## VentMedic (Jun 7, 2009)

What's with the EMT-Paramedic PA title?

The EMT-Paramedic cert or license is not recognized within the walls of hospitals in many states. 

If you are a P.A. you have an expanded scope under a different license. But, the residency for the P.A. is very different from that of an M.D. with very different expectations.

EMT-M.D.?

Get over being an EMT if you want to be an M.D. and move on with your education. You need to be progressive in your thought process and not dwell on just what you were able to do in prehospital medicine. 

There is a science to why medical school is designed as it is. There are also reasons why Paramedic school is as it is and also why it is still a cert with so many saying there is no need to get a lot of book learning with it. Medical school is a process of education and skills while the Paramedic programs are, unfortunately, structured around a tech school philosophy with a emphasis on a few skills for quick training. That is also why, sadly, it is popular with FDs to require all of their FFs to be Paramedics.

BTW, a physician can challenge the Paramedic test if they just want to add a title or see what the test is all about. However, it might be better if the actual test remains a mystery so there can be an illusion of knowing more than what is actually required to be a Paramedic.


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## hotzelj (Jun 7, 2009)

>>why would someone whose final goal of becoming an MD stop at PA? why not stop at RN then?

Not sure I follow, but I think nursing should be incorporated into a complete medical education.

There's the old saying that nurses know more about medicine then doctors.

My sister is a CNA at a hospital and care facility.


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## hotzelj (Jun 7, 2009)

You know, why don't we just say nobody is good enough, and drop the whole medical field all together? I mean, it seems like everyone thinks education for doctors should be 100 years before ever getting an M.D.

I agree. I mean, think of how smart a doctor would be who attended school for 100 years.


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## VentMedic (Jun 7, 2009)

hotzelj said:


> You know, why don't we just say nobody is good enough, and drop the whole medical field all together? I mean, it seems like everyone thinks education for doctors should be 100 years before ever getting an M.D.
> 
> I agree. I mean, think of how smart a doctor would be who attended school for 100 years.


What do you find so bad about the requirements for medical school as it is now?

Is it too difficult or too long or both? 

Why do you feel a two year medic school program entitles you to be a doctor?

Where do you get the Paramedic and the Physician as being that close in experience or education?

Why do you want other professions, including the doctor, to follow the same shortcuts that have been a hindrance in advancing EMS?


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## hotzelj (Jun 7, 2009)

No answer to Q1.

Q2. Yes, too long (for me anyways).
Q3. Complex, but it realy involves changing the entire medical education structure as it exists now.
Q4. I don't. I want it to become closer, though. See note on P.A.
Q5. Not sure about what shortcuts have been taken, and about what "advancement" has been limited, and in so as well what the definition or direction is of EMS advancement.

What is going on in EMS right now? Since I am new, please inform me. What's the Big Pitcure? All I have is my current training and the experiance of my aunt who was an EMT back in the early 1980s in Wisconsin.


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## SanDiegoEmt7 (Jun 7, 2009)

hotzelj said:


> You know, why don't we just say nobody is good enough, and drop the whole medical field all together? I mean, it seems like everyone thinks education for doctors should be 100 years before ever getting an M.D.
> 
> I agree. I mean, think of how smart a doctor would be who attended school for 100 years.



I have so much to say on this that I am using a great deal of restraint. I am not going to even start on how hard it is to get in to medical school, something which you are minimizing 

You are missing the point of the process of becoming a doctor.  The human body is an EXTREMELY COMPLEX thing.  You are dismissing the entire didactic portion of becoming a doctor (6 or more years)  This is the basis for the advancement of the medical field.  Doctors are required to have a DEEP understanding of the human body. From the body as a whole down to the molecular level and all the complex workings between.  

It is with this knowledge that they are able to treat patients, that is to truly understand what their treatments are doing, what their drugs are doing, etc. etc. etc.

Its not an issue of time (12 years vs your 13 YEARS!!! wooo you beat 'em). 

The process of education in your proposal is ridiculous.  The only requirement for paramedic school is being and EMT-B (first responder) and taking a basic A&P class.  And while medic school can be intense, they are only teaching you to deal with patients symptomatically (get the patient to the ER alive).

If you would like to see a connection between paramedics and med school, than paramedic school should be a 4 year degreee, with 1 year biology, 1 year physics, 1 year english/humanities, 1 year general chem with a lab class, 1 year organic chemistry with a lab class.  

Then after you establish that, paramedics (with their 4 year degree) can compete with all the other College grads to get in to traditional medical training where they can become an EM MD in 7-8 years like the rest of us.  

But to say that a person with a certification (that has no major pre-req's and doesn't provide a full education) should be able to skip 4 years of medical school and do a shortened 2 year residency (normal EM residency 3-4 years) is down right ridiculous.

What is a Paramedic PA?  You also mentioned PA as being between paramedic and MD, which is incorrect. PA school requires a 4 year degree, so paramedic school is out, and although PAs can apply to medical school, their 3 years of PA grad school is not required as a prerequisite, their application to medical school would be based on their 4 year bachelors.

I'm going take a shot in the dark and say you are <20yrs of age?


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## SanDiegoEmt7 (Jun 7, 2009)

hotzelj said:


> >>why would someone whose final goal of becoming an MD stop at PA? why not stop at RN then?
> 
> Not sure I follow, but I think nursing should be incorporated into a complete medical education.
> 
> ...



It already is...

RN
BSN
NP
DscN


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## SanDiegoEmt7 (Jun 7, 2009)

hotzelj said:


> No answer to Q1.
> 
> What is going on in EMS right now? Since I am new, please inform me. What's the Big Pitcure? All I have is my current training and the experiance of my aunt who was an EMT back in the early 1980s in Wisconsin.



http://emtlife.com/showthread.php?t=12748&highlight=education+advancement

http://emtlife.com/showthread.php?t=12748&highlight=education+advancement


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## fortsmithman (Jun 7, 2009)

In the 2010-2011 academic year I will be applying to go to Centennial College in Toronto to attend the Paramedic program there.  It's a 2 yr program.  After I complete that I will be eligible and will take 2 more years at the University of Toronto for the Bachelor of Science in Paramedicine.  This is because I believe that in the future the education requirements here in Canada will go up.  In order for he profession to improve education as to increase.  If we are to gain respect fro other health care professions then we have to keep up with them.  Because in my view with the increase in education that will lead to an improved scope of practice and better pay.  Now isn't that what we all would like.  I know I would.


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## daedalus (Jun 7, 2009)

OP, which years of med school would be skipped? The preclinical years learning gross anatomy and physiology? The clinical years doing rotations?

I would like to point out that even PA-Cs are now opting to complete a one year residency in their subspecialty. I have provided the link to post-grad clinical residences for PAs in a previous thread. 

I would also like to point out that there are already programs out there for Medics wishing to practice general medicine. These include PA programs in California like Riverside Community College and Stanford University (highly favorable towards medics and RNs). As a paramedic, you will have to complete a standard course list that is required by the state for entrance into PA school, including microbiology, chemistry, psychology, anatomy and physiology, anthropology, and english. After that, you complete two years of medical education that follows the medical model, and than move into employment or a residency as above. 

I have also heard that Osteopathic schools are more willing to look favorably on previous healthcare professionals willing to make the leap to physician. JP would know more about that. Of course, this is HARDLY going to make up for any bad grades in undergrad or a poor MCAT. You can also try for the traditional allopathic route (MD). Physicians are supposed to have a broad background in basic science.

Bottom line, you have options as a paramedic to move into the practice medicine. All of these options are going to require hard work and a real education. FYI, in California, to be licensed as a physician, you must have two years of chemistry undergrad. It is in the business and professions code.


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## daedalus (Jun 7, 2009)

SanDiegoEmt7 said:


> It already is...
> 
> RN
> BSN
> ...



That is laughable. DNPs are not physicians nor do they want to be. They are not even educated in the medical model. 

PAs and NPs are health care professionals who also know their role and when the services of a specialist physician are needed.


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## JPINFV (Jun 7, 2009)

DO schools, in general, look more favorable on non-trad applicants or those with experience. That said, they aren't going to just let someone skip courses based only on past experiences.


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## SanDiegoEmt7 (Jun 7, 2009)

daedalus said:


> That is laughable. DNPs are not physicians nor do they want to be. They are not even educated in the medical model.
> 
> PAs and NPs are health care professionals who also know their role and when the services of a specialist physician are needed.



I didn't mean they were doctors.  Rather that they had a progression of education levels.   The OP mentioned that he wanted paramedics and nursing to have access to higher education, and nurses already do.  Not to mention that any nurse with a BSN or higher could apply to medical school.


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## daedalus (Jun 7, 2009)

SanDiegoEmt7 said:


> I didn't mean they were doctors.  Rather that they had a progression of education levels.   The OP mentioned that he wanted paramedics and nursing to have access to higher education, and nurses already do.  Not to mention that any nurse with a BSN or higher could apply to medical school.



I was under the impression that you were saying DscN was an alternative to going to medical school. My apologizes.


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## rmellish (Jun 7, 2009)

You're kidding right? 

Right? 

Seriously, don't bother confusing FR and EMTB with medical education. Heck, don't bother comparing most EMT-P programs with comprehensive, well rounded medical education. 

EMS is just a small, limited, subset of medicine as a whole, despite whatever illusions the OP might have had.


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## JonTullos (Jun 7, 2009)

Wow.  I can't believe I clicked on this thread but I did.  I can't believe that someone actually is advocating Medic to MD bridge.  What the deuce?!  Seriously... wow.  Just wow.


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## Epi-do (Jun 7, 2009)

Generally speaking, EMS is poorly and under educated at best.  Now someone thinks we should give medics a free pass to a shortened version of med school?  Wow!  If h#ll ever freezes over and something like that were to happen, I want to know who is a product of such a program so I can run in the opposite direction as quickly as possible.


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## VentMedic (Jun 8, 2009)

I think somebody has been watching too many reruns of "Third Watch".

Just to be clear about something on the show, the medic they called "Doc" did not have M.D. or D.O. along with his EMT-P.


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## mikie (Jun 8, 2009)

I think we're also neglecting the fact that MDs are hospital based, we (EMS) are prehospital.  Difference there as well.  I could go on but *yawn*


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## Seaglass (Jun 8, 2009)

I know a bunch of premed students that work as EMTs (and one or two paramedics) while completing their BS. None of them think it's going to make medschool shorter, or even give them an edge. They're all doing it because it  lets them know if they'll be able to stand a career in healthcare in general.


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## fortsmithman (Jun 8, 2009)

If this were to happen then we get this.


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## BruceD (Jun 8, 2009)

Hope I am not feeding a troll...
I'm wondering about the op's location, perhaps not north America?

OP be careful, do not confuse "years of education" with quality or quantity of information learned.  Most md students will spend 8 to 12 hrs/ day studying after lectures and do that 5 or6 days per week for the first 2 yrs of school, then spend up to 80 hrs per week in the hospital until they get done with residency.  Then they study at home when they aren't in hospital. 

I applaud a desire to move beyond your level of training, but it shouldn't be done by dragging down educational requirements on other providers.  

I wouldn't want to have a emt treat a family member's renal failure any more than I'd want a doctor to walk towards my car with the jaws of life.


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## mperkel (Jun 8, 2009)

*Lol*

I just read through this whole thread and found it hilarious.

From what I have heard, most medical schools actually frown upon EMT-P as applicants. Basically they "unlearn" what you learned in Paramedic school and begin teaching you medicine from there.

I'm an EMT-B, working on my B.S., from there planning on Medical School. I did the EMT cert. to get experience in medicine, particularly Emergency. I love the interact and social skills gained and the extra money throughout my undergrad. But in no ways, will this shorter any medical school year, just might give me a slight edge on patient interaction and some terminology. I have learned and experienced so much more volunteering a few weeks in an ER then being an EMT for more than a year.

I must say it is worth it being an EMT, but if your set on medical school, go to a good 4-year school and take the required courses. There are no shortcuts in medicine, sorry.


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## Jon (Jun 10, 2009)

You could always go out of the country and then take the USLME tests... I know someone who is going down that path... and it scares the s**t out of me.


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## VentMedic (Jun 10, 2009)

Here are statements from a flyer I just tossed in the recycle bin:

*RT to MD*
*Flexible distance learning MD program in your community*
*Weekend introductory course taught in the USA*
*Work while you study*

*Now taking applications for the August 2009 classes.*

www.oceaniamed.org


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## JPINFV (Jun 10, 2009)

If you want to go the Caribbean route, investigate your choices wisely. There are a lot of 
'institutions' out there whose only concern is if your check cashes. The last thing anyone wants is to put 4+ years into an "education" and a few hundred thousands of dollars only to have a pretty piece of paper that no state will accept as an indication of a proper medical education education. Of course, most students who go to foreign medical schools never complete it anyways. 

If anyone here is ever planning on the Caribbean route, for the sake of all that is good and holy stay with St. Georges, Ross, AUA, or SABA. Those are the ones that are eligable for US federal loans (Stafford and Plus) as well as accecpted in all 50 states.


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## simpatico (Jun 10, 2009)

I can't honestly see Paramedic programs being anything more than a really interesting way to catch up on the "fundamentals of not letting people die" portion of medical school.  There's just not enough education in a really good paramedic program to make it a fast-track for becoming a physician, much less your average paramedic program.

Interesting concept, though.

I am curious to know just how much being a paramedic helped out those who did go on to becoming a physician and a nurse.  We've several nurses here, do we not??


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## VentMedic (Jun 10, 2009)

simpatico said:


> I am curious to know just how much being a paramedic helped out those who did go on to becoming a physician and a nurse. We've several nurses here, do we not??


 
My degree in EMS only transferred the college level sciences which were just the prerequisites to apply to the RT program. I still had 2 years of RT core classes to complete for the Associates degree. I also had to relearn skills such as intubation to avoid shortcuts or bad habits and perform at a different level of expertise. Luckily I did have college pharmacology in PM school but still had to take two more semesters in the Associates program and two more when I got my B.S. in Cardiopulmonary. The few drugs a Paramedic is familiar with in the field does not even come close to what a med-surg LPN or RN or RRT must know. 

So, except for providing some patient care knowledge, it can be a hindrance if one can not let go of the old and get on with the new which is why I questioned the OP putting EMT in front of PA or MD. If you hold on to "this is the way we alway do it" you will not go far in any profession you attempt.

Now for RNs or RRTs getting a Paramedic cert it is much easier since they have all the sciences and are accustomed to training for many different areas. We see this with our CCT and Flight RNs as they can get the cert with no problem and apply it effectively.  After some of the other professional certs they must obtain and maintain in their career, the Paramedic is no problem.  This is also why nursing has decided in many states to go with their own prehospital certification which builds off of their own education and doesn't repeat basic anatomy at a 10th grade level.


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## Bloom-IUEMT (Jun 10, 2009)

Interestingly, I just found out that students at the PA program at Butler Univ. are required to do EMT basic training before starting so your idea of bridging EMT to PA is not unheard of....


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## VentMedic (Jun 10, 2009)

Bloom-IUEMT said:


> Interestingly, I just found out that students at the PA program at Butler Univ. are required to do EMT basic training before starting so your idea of bridging EMT to PA is not unheard of....


 
According to their website they just encourage some health care experience. It is not considered a bridge. EMT carries the same weight as a licensed Massage Therapist (although that may be a compliment). You can be a lifeguard also and get just 2 points less.

http://www.butler.edu/cophs/index.aspx?pg=2081&parentID=2077-2041#a06

How many of these classes does the Paramedic certificate, as it stands now, have in common with the PA program?
http://www.butler.edu/cophs/index.aspx?pg=4552

Some colleges do have Paramedic B.S. degrees that prepare a student for the P.A. program. Loma Linda in CA is one of them.


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## rmellish (Jun 10, 2009)

Bloom-IUEMT said:


> Interestingly, I just found out that students at the PA program at Butler Univ. are required to do EMT basic training before starting so your idea of bridging EMT to PA is not unheard of....



Actually, coming from a recent applicant to said program, this is absolutely false. 

And it's not an EMT to PA bridge either.


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## rmellish (Jun 10, 2009)

VentMedic said:


> According to their website they just encourage some health care experience. It is not considered a bridge. EMT carries the same weight as a licensed Massage Therapist (although that may be a compliment). You can be a lifeguard also and get just 2 points less.
> 
> http://www.butler.edu/cophs/index.aspx?pg=2081&parentID=2077-2041#a06



Yes, very frustrating. However, two years of EMT street experience can equal ten points, or equivalent to paramedic with no experience. The average applicant has earned 8 points of "healthcare experience," however most of these are two week wonder course EMTs from Bloomington, or lifeguards with time on task. 



VentMedic said:


> How many of these classes does the Paramedic certificate, as it stands now, have in common with the PA program?
> http://www.butler.edu/cophs/index.aspx?pg=4552



Absolutely none that I've found.


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## daedalus (Jun 10, 2009)

Jon said:


> You could always go out of the country and then take the USLME tests... I know someone who is going down that path... and it scares the s**t out of me.


I do not understand how this is possible??


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## JPINFV (Jun 10, 2009)

^
I believe that Jon is referring to foreign medical schools.


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## Bloom-IUEMT (Jun 10, 2009)

I stand corrected. I guess that explains why there are so many Butler students driving all the way down from Indy to take EMT classes


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## rjddvm (Jun 10, 2009)

Well, I'm a veterinarian, not a physician, but the education level is the same, and veterinary medical school admission in the U.S. is actually more competitive than human medical school admission.   Veterinary ER medicine is a specialty that requires a three-year residency even to be eligible to take boards.

I'm applying to paramedic school for this fall and have my interview in two weeks, but I'll keep working as a vet.  So I can't speak for the paramedic curriculum yet, but I can say that the EMT-B anatomy and physiology was incredibly simple compared to the level we had to learn in veterinary school.  We spent six weeks on the anatomy and physiology of the kidney alone.    

Just an example.  We learned in EMT class that there are "twelve cranial nerves", when there are actually twelve pair.  That was all we needed to know.  I believe in paramedic school we will have to know the names and general functions of each pair.

For my neurology class in vet school, which was an entire semester long, we had to learn the name of each pair; whether it was sensory, motor, or both; what areas were innervated by each pair; the route each pair took to the brain, including the names of all of the foramina through which they passed; and the area of the brain where the information was processed. We had to be able to look at sections of brain and identify all of the anatomical landmarks, and discuss in detail what each area or nucleus does.

That was ONE small part of ONE class during ONE semester.  For three years we had full-time classroom, 15-20 credits per semester.  It was like trying to drink from a firehose.  I have about ten bookshelf feet of textbooks and twelve of notes.  My dog and cat internal medicine textbook alone is 1400 pages long.

We were also taught how to "think like doctors".  That meant we had to have a detailed understanding of the anatomy and physiology and biochemistry of every one of the body's systems, and be able to apply that knowledge to a clinical presentation of a patient who could be one of many species and who can't talk.  To do that, we needed to understand biology, chemistry, organic chemistry, physics, genetics, biochemistry, etc., and we had to have that understanding going in to the very first day of class.

I could be wrong, and no doubt the paramedics here will correct me if I am, but I don't think paramedic school gives someone the background to enter that level of education.   It's just a different way of looking at things.  ER MDs are more than paramedics with more education--they have a whole underlying understanding of the human organism, based on their years of education, and they apply that to their cases.  

It may not come into play during illnesses and injuries they see regularly, but when that big ol' zebra comes trotting down the hall, they have a whole base of knowledge and experience to draw on that they wouldn't have if they had gone directly from being paramedics to a limited ER MD-type training.

Having said all of that, I have a lot of respect for field medicine, and I love doing it.  I volunteered at a Mississippi shelter after Katrina and just spent five days volunteering with 315 dogs who'd been seized from a "rescue".  We had very few vets come to help, in a community where they are coming out of the woodwork, and several who showed up left almost immediately when they realized they'd be working in tents in a parking lot; with a lot of filthy, emaciated, barking dogs; tracking through mud; with no toys at all.  They just couldn't handle working outside of their nice clean clinics.

I would imagine that some ER MDs would not handle field medicine very well either, outside of their comfort zone, without all of the fancy equipment and support staff.  Crawling into a wrecked car and figuring out a way to strap the patient to a backboard might not be something they could do, but if EMS weren't there to get the patients to the hospital alive, the ER MDs wouldn't be able to do their thing.


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## VentMedic (Jun 10, 2009)

Good post describing the differences in education.



rjddvm said:


> Having said all of that, I have a lot of respect for field medicine, and I love doing it. I volunteered at a Mississippi shelter after Katrina and just spent five days volunteering with 315 dogs who'd been seized from a "rescue". We had very few vets come to help, in a community where they are coming out of the woodwork, and several who showed up left almost immediately when they realized they'd be working in tents in a parking lot; with a lot of filthy, emaciated, barking dogs; tracking through mud; with no toys at all. They just couldn't handle working outside of their nice clean clinics.
> 
> I would imagine that some ER MDs would not handle field medicine very well either, outside of their comfort zone, without all of the fancy equipment and support staff. Crawling into a wrecked car and figuring out a way to strap the patient to a backboard might not be something they could do, but if EMS weren't there to get the patients to the hospital alive, the ER MDs wouldn't be able to do their thing.


 
Katrina was a challenge not many were prepared for. However, one must remember all of those, including yourself, that did make a difference. There were many doctors and medical professionals that did care enough to endure the problems of a horrible situation. A few, such as Dr. Anna Pou and her nurses, even had to endure scrutiny and a lengthy legal process for making tough decisions which has little precedence in this country during recent times. 

For the ED and all of the fancy gadgets, some are very necessary to save a life that has been brought to it by the Paramedics. While it is great to talk about doing so much with so little, one must also remember it takes a team and sometimes the fancy gadgets to give a person a chance to continue living hopefully to the fullest with quality.


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## rmellish (Jun 10, 2009)

rjddvm said:


> I would imagine that some ER MDs would not handle field medicine very well either, outside of their comfort zone, without all of the fancy equipment and support staff.  Crawling into a wrecked car and figuring out a way to strap the patient to a backboard might not be something they could do, but if EMS weren't there to get the patients to the hospital alive, the ER MDs wouldn't be able to do their thing.



There's an ever increasing number of MD's with a prehospital background. Plus most ER residents ride at least once during their residency. I would guess that most ER docs could figure out your scenario without much problem though. 

Great post though.


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## daedalus (Jun 10, 2009)

rjddvm said:


> Well, I'm a veterinarian, not a physician, but the education level is the same, and veterinary medical school admission in the U.S. is actually more competitive than human medical school admission.   Veterinary ER medicine is a specialty that requires a three-year residency even to be eligible to take boards.
> 
> I'm applying to paramedic school for this fall and have my interview in two weeks, but I'll keep working as a vet.  So I can't speak for the paramedic curriculum yet, but I can say that the EMT-B anatomy and physiology was incredibly simple compared to the level we had to learn in veterinary school.  We spent six weeks on the anatomy and physiology of the kidney alone.
> 
> ...


Good post! In fact, cranial nerves were not even mentioned in my EMT class. Paramedic school is mediocre. I am learning a lot, but I feel like it is totally inadequate. Whenever something like pharmacology is discussed and we get into detail, discussing GABA for example, I want to know more of the biochemistry instead of just the name and the fact that it fits into a receptor to increase chloride intake. I have found that paramedic school does actually go into some depth (for example, the pathophysiology chapter actually contains most of the information in the first few chapters of Robbins Pathologic Basis of Disease), but a lot of chemistry is left out and the style of writing and lecture is made for a high school student. As a Doctor (Vet) you will probably feel there is more to be desired. We do learn how to form a working diagnosis however, and I think that is why we are called Paramedics ( read: like medicine, or similar to a doctor).


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## rjddvm (Jun 10, 2009)

daedalus said:


> As a Doctor (Vet) you will probably feel there is more to be desired. We do learn how to form a working diagnosis however, and I think that is why we are called Paramedics ( read: like medicine, or similar to a doctor).



I imagine I'll be plenty challenged by a lot of the paramedic class even though I've had a lot of the academic stuff before.  I'm looking forward to a new challenge and thinking in a different way and learning new skills and having patients who might be able to talk to me!

And I really will have to break myself of the habit, which is very common in veterinary medicine, of uncapping needles with my teeth!


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## rescuepoppy (Jun 11, 2009)

"I would imagine that some ER MDs would not handle field medicine very well either, outside of their comfort zone, without all of the fancy equipment and support staff. Crawling into a wrecked car and figuring out a way to strap the patient to a backboard might not be something they could do, but if EMS weren't there to get the patients to the hospital alive, the ER MDs wouldn't be able to do their thing."
  This is not meant to be a slam against any group,but more of a statement toward individuals. As RJMDDV stated here (some) MDs could not handle this,nor can (some) EMTs medics or FRs. Not all fit in this category,the people who excel  in their chosen field are the ones who can overcome being put out of their comfort zone. However being able to adapt to situations is not the same as an education in your chosen field.


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## Foxbat (Jun 11, 2009)

Approximately how many lecture hours they spend on A&P in paramedic class?


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## Shishkabob (Jun 11, 2009)

rjddvm;
EMT A&P can't even be compared to medic A&P.

EMT A&P is like "This is in this location, and it makes this"

Medic A&P is like "This in in this location, this is what it makes, this is how it makes it, why it makes it, when it makes it, how it's released, how it's used, how it's gotten rid of, where it goes, what it effects, what helps it, and what hurts it"


While not even close to a medical schools A&P, or even as thorough as A&P1/2, it's way more in depth then EMT.



Fox--- We're spending >6 weeks just for the foundation, then go more in depth for each section, such as when we go in to cardiac, respiratory, and the like. (Keep in mind it's an 11 month class)


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## medic417 (Jun 11, 2009)

rmellish said:


> Plus most ER residents ride at least once during their residency.



Is there anyting out there to support that statement?  I have met many, many ER docs and few have ever seen the back of an ambulance.


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## VentMedic (Jun 11, 2009)

medic417 said:


> Is there anyting out there to support that statement? I have met many, many ER docs and few have ever seen the back of an ambulance.


 
That depends on where they did their residency and if it was in EM. Ours do ride with Fire Rescue during their rotation. In fact, some of our doctors are from the days when doctors were a member of EMS on each ALS truck during the 1980s.

Some doctors that work in the ED may not have actually done a residency in EM. 
EM is one of the boards that came about within the past 30 years and there was a significant grandfathering period. 

Even the doctors who are medical directors for EMS have varying board certs and residencies.


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## JPINFV (Jun 11, 2009)

medic417 said:


> Is there anyting out there to support that statement?  I have met many, many ER docs and few have ever seen the back of an ambulance.



Here's a quote from University of California, Irvine's Emergency Medicine department website.



> EMS education involves extensive hands-on patient care ride-alongs on ground ambulances with the busiest paramedic units in the country.



http://www.healthaffairs.uci.edu/emergmed/residency_teaching_program.htm


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## Foxbat (Jun 12, 2009)

Linuss said:


> Fox--- We're spending >6 weeks just for the foundation, then go more in depth for each section, such as when we go in to cardiac, respiratory, and the like. (Keep in mind it's an 11 month class)


That does not sound bad. A&P that I'm taking through my university is normally 6 hours a week for 2 semesters (~24 weeks), but the summer version is 12 hours a week for 12 weeks. It souns like A&P in paramedic school is not much shorter.



			
				VentMedic said:
			
		

> Ours do ride with Fire Rescue during their rotation. In fact, some of our doctors are from the days when doctors were a member of EMS on each ALS truck during the 1980s.


When and why did this practice stop? I always thought in the US it was considered too expensive, but apparently it has been used.


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## VentMedic (Jun 12, 2009)

Foxbat said:


> That does not sound bad. A&P that I'm taking through my university is normally 6 hours a week for 2 semesters (~24 weeks), but the summer version is 12 hours a week for 12 weeks. It souns like A&P in paramedic school is not much shorter.


 
Keep in mind that the whole Paramedic program will be covered in 11 months or less by going a few hours each week.  It will take two to three college semesters just for the basic college A&P with lab classes.  The amount of prep for a Paramedic level A&P will also come nowhere near what a college level class requires.    For any other medical specialty such as nursing, RT, PT etc, many more classes will be taken to go indepth.  For RT, most Paramedics can not challenge out of a RT 101 class because it is built upon from the college level A&P classes and another Respiratory A&P class. 



Foxbat said:


> When and why did this practice stop? I always thought in the US it was considered too expensive, but apparently it has been used.


 
Cost and confidence that Paramedics could get the patient to the hospital were the two biggest factors to ending it.

I believe there are a couple of services in the NE that put EM residents in a flycar and let them run to all the serious calls to gain field experience and direct care.


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## Foxbat (Jun 12, 2009)

VentMedic said:


> I believe there are a couple of services in the NE that put EM residents in a flycar and let them run to all the serious calls to gain field experience and direct care.


I know Pittsburgh, Seattle, and Houston have these. But I was surprised that some services actually had MDs on each ALS truck. I presonally would be glad to see that make a comeback, or maybe even have specialized MICU available for 911 calls (cardiological MICU with a cardiologist, pediatric MICU with a pediatrician, etc.), like they do in ex-USSR.


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## VentMedic (Jun 12, 2009)

Foxbat said:


> I know Pittsburgh, Seattle, and Houston have these. But I was surprised that some services actually had MDs on each ALS truck. I presonally would be glad to see that make a comeback, or maybe even have specialized MICU available for 911 calls (cardiological MICU with a cardiologist, pediatric MICU with a pediatrician, etc.), like they do in ex-USSR.


 
There are surgeons and physicians that do go to the scene when needed for special situations such as an amputation.

As well, there are many specialized teams that do take physicians along when needed such as for ECMO.  Usually a neonatalogist and surgeon will accompany the RN and RRT which either an RN or RRT being the ECMO Specialist to cannulate the infant or child onsite and transport back to their facility.


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## daedalus (Jun 12, 2009)

Foxbat said:


> I know Pittsburgh, Seattle, and Houston have these. But I was surprised that some services actually had MDs on each ALS truck. I presonally would be glad to see that make a comeback, or maybe even have specialized MICU available for 911 calls (cardiological MICU with a cardiologist, pediatric MICU with a pediatrician, etc.), like they do in ex-USSR.



That is why Paramedics were invented. They extend the physician into the field. We do not need MDs on trucks because the paramedic is the MD's agent, who (should be) educated in comprehensive out of hospital medicine. That said, I do think EM and EMS residents should do scene responses, but not because they can provide MD level care, but because it is a learning experience for them, and a learning experience for the paramedics who work with them.


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## VentMedic (Jun 12, 2009)

daedalus said:


> That is why Paramedics were invented. They extend the physician into the field.


 
However, this is not to be confused with physician extenders which are PAs and NPs.   

If you read some of the statements of the doctors who were behind establishing the early days of EMS, it is almost insulting as to how they thought a few advanced skills could be taught to just about anyone.  Thus, monkey skills are still sometimes used to described "skills".  As well, the education has been downplayed by some as in the article I reference occasionally that it only takes 200 hours and not 2000 to train a Paramedic.


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## NREMTB12 (Jun 12, 2009)

i cant answer the question on whether or not MD's do ride alongs on ambulances during their residency, i can say this, that around here we answer to a medical director that is responsible for that ambulance service, and they are MD's.  They deal with the medical control aspect of the ambulance service but i would assume that they have some experience hands on with medics and EMT's so that they could better be suited for the job of making decisions for medics, just by hearing a radio report of symptoms and not actually being able to evaluate the patients.


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## NREMTB12 (Jun 12, 2009)

secondly, i am not sure what others medic school curriculum is, but i know what mine is that i am starting in August, will be 1 day a week from 9am-5pm for 13 months, but there will be 5 instructors, not 1 teaching the class and seperate instructors will come in for NIMS, HAZMAT, and Crime Scene, also there will be 500 clinical hours required, 120 hours for ridealong each semester on a rig, and so many practicals performed in the aloted time (defibs, intubations, iv's, cardiac interpretation, etc...)...this is just my class here in So. ILL


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## VentMedic (Jun 13, 2009)

NREMTB12 said:


> secondly, i am not sure what others medic school curriculum is, but i know what mine is that i am starting in August, will be 1 day a week from 9am-5pm for 13 months, but there will be 5 instructors, not 1 teaching the class and seperate instructors will come in for NIMS, HAZMAT, and Crime Scene, also there will be 500 clinical hours required, 120 hours for ridealong each semester on a rig, and so many practicals performed in the aloted time (defibs, intubations, iv's, cardiac interpretation, etc...)...this is just my class here in So. ILL


 
Classroom:  We'll be generous and give you the full 8 hours each day although there will probably be 1 hour for lunch.  As well, we'll say a full 56 weeks but there will probably be a couple of holiday breaks.

8 x 56 = 448 hour

plus

500 clinical hours 

plus 

120 hours for ride alongs

equals

1048 hours of training

That is average for a tech school Paramedic program....unfortunately.


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## NREMTB12 (Jun 13, 2009)

VentMedic said:


> Classroom:  We'll be generous and give you the full 8 hours each day although there will probably be 1 hour for lunch.  As well, we'll say a full 56 weeks but there will probably be a couple of holiday breaks.
> 
> 8 x 56 = 448 hour
> 
> ...




This is good to know, i was not sure for such schooling what the base time was, thanks for that info.  Also i found out i will be able to jump into Mod. C of firefighter II again, as i was originally not going to be able to becuase of medic school, the classes changed and i will be going from medic school down to main campus for mod C all in 1 day....ill be thinking medical, medical, medical and then switch gears to fire, fire, fire...oh what fun

I also forgot to mention the 120 hours for ride alongs is for both semesters....120 for Intermediate and 120 for Paramedic, still doesnt change much but just wanted to clarify


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## Summit (Jun 13, 2009)

*gigglesnort*


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