# When?



## Amelia (Jan 28, 2015)

Ok, EMT school starts a week from today (eeeek!) and I am looking at all of these threads about awesome boots, sheers, stethoscopes, etc... My question is, when should I start purchasing these items? Beginning? Mid? or end of class? I'm not sure when clinicals are (which we're doing in the ER, although I may ask to do a ride along too). 

The boots I want to get are pricey but are known to be great EMS/Fire boots and they dont need much break in, but, yes, I do want plenty of time to break them in. 

Thoughts?


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## DesertMedic66 (Jan 28, 2015)

When you get hired at a company/department as an EMT. You may seem interested now and then change your mind during class and waisted $300+.

Just go with cheap stuff during school. A pair of <$50 boots will last way longer than you need for school. A cheap $20 stethoscope is more than capable for an EMT program. $5 sheers are again more than capable.


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## Amelia (Jan 28, 2015)

Ok, I"m assuming Amazon is the place to go for the medical equipment?


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## PotatoMedic (Jan 28, 2015)

Yup!  Good oal amazon.  And honestly I did not buy a good stheoscope till I got accepted to medic school.


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## Amelia (Jan 28, 2015)

Well I'm going to work for a year before going to P. school. I wonder if my husband can get me a discount since he's in the medical field. hmmm.


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## Amelia (Jan 28, 2015)

Another question (I'm full of them) Do you have to get your own emergency bag and supplies, or does school generally give you a basic bag?


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## Amelia (Jan 28, 2015)

I -may- just have to get those Leatherman sheers though. Push comes to shove, if it doesnt work out, I can use them camping.


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## Jim37F (Jan 28, 2015)

Check to make sure you have to buy anything first. My EMT school provided all the BP Cuffs and Stethoscopes and all the other equipment we needed. We had to buy the text book, but that's about it. Same with my EMT jobs, the company always provided everything we needed to run all our calls on the ambulance already. I did have to buy my first pair of boots for my first EMT job though, but other than that the only thing I've bought was a steth after I got tired of the cheap bottom of the barrel ones provided, but they were provided and didn't need to buy one if I didn't want to. Even my current job either gave us everything we needed, either stocked on the rig, or said "Here's your brush jacket and hi-vis vest and helmet, don't lose 'em", or for uniforms gave us the vouchers needed to just go to the proper shop, hand them the paperwork, and walk out with all our uniforms, jacket, and even boots.


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## Amelia (Jan 28, 2015)

how do you get that EMT discount anyway?


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## Amelia (Jan 28, 2015)

Thanks, Jim! Just wondering so I can budget wisely and not go broke all at once.


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## DesertMedic66 (Jan 28, 2015)

For leatherman you need to have documentation stating you are/work as an EMT/Medic


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## Amelia (Jan 28, 2015)

Well for that, then, I will most definitely wait.


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## OnceAnEMT (Jan 28, 2015)

Don't cheat yourself by going with the Raptor right out the gate. Get 3 pairs of shears off Amazon in any color you could imagine, for a total of $5, realize how great they are, and never look back. 

As mentioned, for school purposes, get the bare minimum. When you do clinicals you'll have the crew's stethoscopes (or whatever is in the truck) available to you if you look as clean as you should and they aren't princesses. 

About bags: I mean, perhaps some programs are different, but I've never heard of students needing to bring their own jump bags. The program brochure or website should tell you all required purchases for the course, and my bet is it'll just be uniform including boots, BP cuff, stethoscope, CPR class if you haven't, and maybe a 3rd party drug test. And of course the textbook.


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## Amelia (Jan 28, 2015)

Ok. Thank you guys so much. I got the book for like $50 off of ebay and she also sent me 2 workbooks which was awesome.


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## BayAreaEMT (Jan 28, 2015)

IMO I would just buy a decent steth, like a Littmann classic II, it'll serve you well from emt school thru medic school and probably then some. Same thing with boots, I'd buy a decent comfortable pair now, don't waste your money on buying cheap versions of these now only to buy better ones down the road. As for shears and other tools, you can buy those cheap since once you start working your employer will supply you with everything you need.


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## CALEMT (Jan 28, 2015)

DesertEMT66 said:


> For leatherman you need to have documentation stating you are/work as an EMT/Medic



Damn wish I would have known that before I bought my multitool could have saved me a couple bucks. 

Oh and I agree with Desert, I would wait till you get hired somewhere to spend the money and get the good stuff. If it were me, I would buy the cheap boots, stethoscope, etc. for EMT class and save the expensive things till you get hired.


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## DesertMedic66 (Jan 28, 2015)

CALEMT said:


> Damn wish I would have known that before I bought my multitool could have saved me a couple bucks.
> 
> Oh and I agree with Desert, I would wait till you get hired somewhere to spend the money and get the good stuff. If it were me, I would buy the cheap boots, stethoscope, etc. for EMT class and save the expensive things till you get hired.


Depeding on the tool it may save a lot. 

Every single semester I teach there is always a student who buys all nice stuff and then end up dropping out because they decide they don't want to become an EMT.


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## NomadicMedic (Jan 29, 2015)

I'd say a Littmann lightweight IIse is a decent, but inexpensive stethoscope. It is more than adequate for an EMT, will last forever and certainly beats all that double tube noise you'll get with a cheap sprague scope. And you're not tossing $100+ down the stethoscope hole.


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## ViolynEMT (Jan 29, 2015)

DEmedic said:


> I'd say a Littmann lightweight IIse is a decent, but inexpensive stethoscope. It is more than adequate for an EMT, will last forever and certainly beats all that double tube noise you'll get with a cheap sprague scope. And you're not tossing $100+ down the stethoscope hole.



That's what I ended up getting and I like it. The only thing I notice is that I can hear my fingers "creaking". Maybe I'm just getting old.


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## chaz90 (Jan 29, 2015)

ViolynEMT said:


> That's what I ended up getting and I like it. The only thing I notice is that I can hear my fingers "creaking". Maybe I'm just getting old.


You have musician ears. A decent stethoscope might be of more benefit to you than most. Then again, you're probably more likely to pick up all kinds of noise artifacts most of us wouldn't notice anyway. The single best person at auscultating I've ever met is a cardiologist who plays an instrument semi-professionally. She could probably differentiate S3/4 on a gnat in mid-flight in the back of an ambulance.


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## ViolynEMT (Jan 29, 2015)

chaz90 said:


> You have musician ears. A decent stethoscope might be of more benefit to you than most. Then again, you're probably more likely to pick up all kinds of noise artifacts most of us wouldn't notice anyway. The single best person at auscultating I've ever met is a cardiologist who plays an instrument semi-professionally. She could probably differentiate S3/4 on a gnat in mid-flight in the back of an ambulance.




That's so funny. I never thought about that. I've always separated my two professions. I like that concept way better than the "old" concept.  

So then, what stethoscope should I get?


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## NomadicMedic (Jan 29, 2015)

ViolynEMT said:


> That's so funny. I never thought about that. I've always separated my two professions. I like that concept way better than the "old" concept.
> 
> So then, what stethoscope should I get?



Unless you're planning on becoming a cardiologist, what you have is more than fine.


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## ViolynEMT (Jan 29, 2015)

DEmedic said:


> Unless you're planning on becoming a cardiologist, what you have is more than fine.




My wallet will be happy about that. Now if I can just learn to keep my fingers still so I don't hear them creaking........


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## Tigger (Jan 29, 2015)

DEmedic said:


> I'd say a Littmann lightweight IIse is a decent, but inexpensive stethoscope. It is more than adequate for an EMT, will last forever and certainly beats all that double tube noise you'll get with a cheap sprague scope. And you're not tossing $100+ down the stethoscope hole.


I recently slammed my classic II in the door several times (don't ask) and was given a Master Cardiology by a guy that retired. Besides looking awesome, it is of no more real practicality for most EMS use.


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## chaz90 (Jan 29, 2015)

Tigger said:


> I recently slammed my classic II in the door several times (don't ask) and was given a Master Cardiology by a guy that retired. Besides looking awesome, it is of no more real practicality for most EMS use.


I recently upgraded to a master cardiology from a master classic for really no good reason at all besides wanting to try it. Really, I could hear everything well enough before, but I can also genuinely hear them better with the master cardiology. Again, I know it doesn't change my practice at all and both have acoustics well beyond what I need as a lowly paramedic, but I really like the new one. 

The first shift I had my new stethoscope I brought both along on calls (most assuredly looking like a total idiot) and listened to the patient twice for everything using both stethoscopes and was able to hear a difference. I like listening to heart tones even though I'm terrible at it, and they seem louder to me on the master cardiology, perhaps due to the larger diaphragm. 

Not saying the cost difference is justifiable or remotely necessary for EMS use, but I don't regret it for me. I've yet to lose a stethoscope (knock on wood), used my previous one for 4 years, and love the new one so far. No guarantee that it won't disappear, but if a master cardiology with olive green tubing, a smoke chest piece, and my unusual last name engraved prominently on it appears anywhere else on this peninsula I think news would get back to me. Not to mention I sold my master classic to a roommate and that worked out nicely. Opinions may vary 

TLDR Version: Buy what you want, can easily afford, and won't make you sob uncontrollably for weeks if lost. Avoid the incredibly cheap and chintzy stuff that is given away free or included in some gear bags. Anything north of and including a Littmann Lightweight II will easily suffice, and 100 different people will give you 200 different opinions on this subject.


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## Amelia (Jan 29, 2015)

So what is an average cost of items? I'm a big believer in "you get what you pay for" and "you can't go wrong if you shoot for the middle." So besides the $5 sheers, what else should I put on my list (not to purchase just yet).


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## Gurby (Jan 29, 2015)

I used a Littmann Lightweight as a basic, upgraded to a Cardiology III for medic.  I'm pretty happy with how it worked out.


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## Tigger (Jan 29, 2015)

I guess I could have phrased better, the Cardiology type stethoscopes are certainly better tools, but I'm not sure the money is quite worth it. But if you swing it, do it. They are pretty cool/well crafted instruments.


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## chaz90 (Jan 29, 2015)

Amelia said:


> So what is an average cost of items? I'm a big believer in "you get what you pay for" and "you can't go wrong if you shoot for the middle." So besides the $5 sheers, what else should I put on my list (not to purchase just yet).


If you get a full time job, comfortable boots are the number 1 item for me. As so many others have said, cheap boots work fine for rides and class, but when you spend multiple 24 hour shifts in a pair of boots making a living spending a bit more money is easily worth it. The important thing to remember about this is that more money doesn't necessarily buy a better boot. You have to spend some minimum to get something quality that will last, but preferences on brands and models vary. Try them on as much as possible and break them in fully before work.


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## Tigger (Jan 29, 2015)

Amelia said:


> So what is an average cost of items? I'm a big believer in "you get what you pay for" and "you can't go wrong if you shoot for the middle." So besides the $5 sheers, what else should I put on my list (not to purchase just yet).



I'd wait till you have a job or volunteer position or what have you. Then see what you need to purchase. Some companies reimburse, some companies have stock on hand to give you, things like that. Aside from a stethoscope, you don't much for clinicals. I did mine in ****ies and a white polo and a borrowed pair of black boots. 

Where I work now we have uniform allowance, another one of my jobs gives you everything from shirts to 5.11 boots, you get the idea.


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## WestMetroMedic (Jan 30, 2015)

BayAreaEMT said:


> IMO I would just buy a decent steth, like a Littmann classic II, it'll serve you well from emt school thru medic school and probably then some. Same thing with boots, I'd buy a decent comfortable pair now, don't waste your money on buying cheap versions of these now only to buy better ones down the road. As for shears and other tools, you can buy those cheap since once you start working your employer will supply you with everything you need.


Buy a nice pair of Doc Martens black shoes. Comfortable as hell, and look professional on duty and casual enough for off duty.  You always need a good pair of black shoes...
I wore the men's version of these for 'pert near everything on and off duty for two years a pair.
http://www.drmartens.com/us/Womens/WOMEN'S-1461/p/11837002


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## dank (Feb 4, 2015)

Amelia said:


> Ok, EMT school starts a week from today (eeeek!) and I am looking at all of these threads about awesome boots, sheers, stethoscopes, etc... My question is, when should I start purchasing these items? Beginning? Mid? or end of class? I'm not sure when clinicals are (which we're doing in the ER, although I may ask to do a ride along too).
> 
> The boots I want to get are pricey but are known to be great EMS/Fire boots and they dont need much break in, but, yes, I do want plenty of time to break them in.
> 
> Thoughts?


 EMT class does not have clinicals.  That would be for medic certification.


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## Amelia (Feb 4, 2015)

Well we have to do shifts in the ER. My husband may have rubbed his vocabulaey off in me.


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## ViolynEMT (Feb 4, 2015)

dank said:


> EMT class does not have clinicals.  That would be for medic certification.


My EMT class had clinicals. And that was the term used.


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## OnceAnEMT (Feb 4, 2015)

ViolynEMT said:


> My EMT class had clinicals. And that was the term used.



Mine did as well. Every program I've heard of does, including online.


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## dank (Feb 11, 2015)

"Mine did as well. Every program I've heard of does, including online."
Clinicals refers to working in a clinic, not doing practicals in a classroom setting.  There is no reason an EMT-B would need to be in a clinic.  The state of Maryland EMT-B certification program does not have clinicals as they are just unnecessary for that program.


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## Amelia (Feb 11, 2015)

What was explained to us in class is that we will not be EMT-Bs, but not quite AEMTs. I dont know. But yes, we have to do 10-12 hours in the ED in order to get our certification (along with the NREMT license). Whether its necessary or not doesnt really matter- it is whats required of the program.


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## ViolynEMT (Feb 11, 2015)

The term "clinicals " for most EMT programs refers to time in an ED. 36 hours for mine.


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## Amelia (Feb 11, 2015)

I guess our state doesnt have EMT-B, its FR, then EMT-I/85 then P.


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## RefriedEMT (Feb 11, 2015)

Yea, i got lucky with my clinicals and instead of working an ER for EMT training I got to work on a fire engine with 2 emts and a paramedic as my proctor, which I personally think its always better to train where your really going to work and most EMT's in my area don't work in ERs.


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## dank (Feb 12, 2015)

Why would an ETM-B program require 36 hours of ED time when that is not what EMts do.  It is like telling a chef that they would need to learn to be a waiter while going to culinary school.


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## NomadicMedic (Feb 12, 2015)

Agreed. 36 hours of ED time seems rather excessive for a basic. When I took EMT again, after letting my certs lapse, the program I was in required no ambulance time, just ED. I always found that to be really odd.

However, the majority of the people in that class were only taking EMT to increase their potential score in the Fire hiring process and weren't going to ever ride on an ambulance.


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## CALEMT (Feb 12, 2015)

When I took my EMT it was just 48 hours combined field experience. We would have done I think 24 hours in the ED, but if I remember correctly the hospitals were charging an excessive amount of money so the instructors said screw it and they've been doing 48 hours on a ambulance ever since. How it was before was 2 12 hour shifts in the ED and 2 12 hour shifts on a ambulance. Now its 48 total on a ambulance.


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## WildlandEMT89 (Feb 12, 2015)

Ambulance companies aren't offering vehicular rotations to ent courses anymore for insurance purposes. We did combined when I went through so I was pretty surprised to hear times are changing


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## Trauma Queen (Feb 12, 2015)

I only did ride time for my EMT class. For my AEMT we did a few rotations at the hospital to get some IVs under our belts. I feel like, at the EMT level, it should just be ride time. ER time doesn't make sense for new EMTs, as it's a totally different animal.


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## DesertMedic66 (Feb 12, 2015)

For us students have to do 48 hours and make at least 10 patient contacts. We let the students go to either an ED (trauma/burn center), on an ambulance, or on a fire engine. Students can select where they go and how many shifts at each one they want to do.


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## Amelia (Feb 12, 2015)

We have to do 10 Assessments in a 10-12 hour shift (if we get those in 10 hours we can go home). But they dont want us to do ambulance because we will probably only get 1-2 calls in a night.


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## Tigger (Feb 12, 2015)

Patient contact volume is the reason that the programs around here require 24 hours in the ED. "Assessments," vitals, generally talking to patients, splinting, etc, all happen in greater volume in the ED (duh). I didn't think the ED time was useless, though I can't imagine not sending students out on the ambulance, like what's done in Massachusetts.

Our IV class was only done in the hospital. While it was nice from a time point, it was not a realistic training experience either. The difference between starting an IV on the bench seat (while seatbelted) and squatting next to a hospital bed is rather different.


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## ViolynEMT (Feb 13, 2015)

dank said:


> Why would an ETM-B program require 36 hours of ED time when that is not what EMts do.  It is like telling a chef that they would need to learn to be a waiter while going to culinary school.



I went to a private school. That's  just simply  what they required. I'm glad because every hour is one more hour of experience. 

And if you want to get a job in an ed, it is exactly  what EMT'S  do.


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## Akulahawk (Feb 13, 2015)

It's been a long time (18 years?) but my EMT program required us to do four 12 hour shifts. Two of those were in the ED, two were on an ambulance. You might think that doing that much time in the ED would be a waste of time, but it's entirely for getting guided practice in performing patient assessments on a LOT of different people in a relatively short period of time. The other thing that is nice about the ED environment is that it's generally quiet-ish and at least somewhat controlled. It's not noisy like the back of an ambulance or as chaotic as being on-scene somewhere. The ED is where I first started _really_ learning the different lung sounds, for instance. It's just not the same when you listen to recorded sounds when compared to the real thing. 

As far as what to buy for school, before things really get going, I would suggest only acquiring only a couple of things: a couple pair of shears, some good supportive black shoes, and a stethoscope that's in the price range of about $30-$70. Stethoscopes in that price range will all be much better than the cheap steths that sometimes will be included in school packages and you won't break the bank if  you somehow accidentally leave your steth somewhere or it gets stolen. My personal steth has been with me for about 14-15 years now and it's a Littmann Cardiology III. I bought it around the time I started going to medic school. I used it through nursing school and trust me, it's still very good. I wouldn't go out and buy one of those just because I said it's a good stethoscope. Learn to hear what you need to and once you've gotten the hang of it, _then_ go buy the stethoscope you _want_. 

As to the rest of it, only buy those things that the school tells you to. You don't need tons of equipment on hand to do 80% of the job and you don't need to wear it all on your belt. Typically, upon my person, you'll find only these things all the time, on all calls: stethoscope, pens (ball point & sharpie), notepad, small wad of gloves, watch, and pen light. Everything else I need will usually be within reach. Somewhere nearby will be a radio and a cell phone.


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## RebelAngel (Feb 13, 2015)

I acquired supplies toward the beginning. However, I also started riding along as soon as I got voted into our squad by the Board of Commissioners. 

I did a lot of research and decided to drop money on good steth, mainly because I wanted one for young children and adults. The one I got had very good reviews for both. I also put together my own bag for two reasons: 1-wanted a bag in my vehicle 2-I researched protocols and did rig checks and/or discovered items on ambulance that were not up to par. Our squad captain isn't a very good one and oftentimes the squad has a bunch of stuff we don't need and has to make due with substandard equipment....like a BP cuff in our first in bag that needs to be recalibrated. She doesn't even stock hemostatic dressings. But what I carry on my person in minimal. I have actually had to use items from my bag numerous times, for non-squad incidence and a couple squad runs too. 

I would suggest buying pants and boots well before clinical so you have time to break them in, beforehand. I got my boots and wore them around the house before I wore them to scenes
..did the same thing with my turnout gear and fireboots. I wanted to get use to how I moved and worked with it all on before I needed to wear it to a fire.

Good luck!


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## RebelAngel (Feb 13, 2015)

I did not read all the threads but I also suggest dropping money on one or two anatomy books, a review book, and reviewing all the scenarios you can.


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## ego (Feb 15, 2015)

dank said:


> Why would an ETM-B program require 36 hours of ED time when that is not what EMts do.  It is like telling a chef that they would need to learn to be a waiter while going to culinary school.



I disagree. Getting Vitals, EKG placement on different types of patients , using different equipment than the one at your training center are all reasons to go to the ED. As well as more patient contact to observe the  non-medical things that need to be done with patients.

And some EMTs work in ED as ER Techs.


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## dank (Feb 16, 2015)

ego said:


> I disagree. Getting Vitals, EKG placement on different types of patients , using different equipment than the one at your training center are all reasons to go to the ED. As well as more patient contact to observe the  non-medical things that need to be done with patients.
> 
> And some EMTs work in ED as ER Techs.


 Then you should not be classified as an EMT, you are  an ER Tech.


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## dank (Feb 16, 2015)

Akulahawk said:


> It's been a long time (18 years?) but my EMT program required us to do four 12 hour shifts. Two of those were in the ED, two were on an ambulance. You might think that doing that much time in the ED would be a waste of time, but it's entirely for getting guided practice in performing patient assessments on a LOT of different people in a relatively short period of time. The other thing that is nice about the ED environment is that it's generally quiet-ish and at least somewhat controlled. It's not noisy like the back of an ambulance or as chaotic as being on-scene somewhere. The ED is where I first started _really_ learning the different lung sounds, for instance. It's just not the same when you listen to recorded sounds when compared to the real thing.
> 
> As far as what to buy for school, before things really get going, I would suggest only acquiring only a couple of things: a couple pair of shears, some good supportive black shoes, and a stethoscope that's in the price range of about $30-$70. Stethoscopes in that price range will all be much better than the cheap steths that sometimes will be included in school packages and you won't break the bank if  you somehow accidentally leave your steth somewhere or it gets stolen. My personal steth has been with me for about 14-15 years now and it's a Littmann Cardiology III. I bought it around the time I started going to medic school. I used it through nursing school and trust me, it's still very good. I wouldn't go out and buy one of those just because I said it's a good stethoscope. Learn to hear what you need to and once you've gotten the hang of it, _then_ go buy the stethoscope you _want_.
> 
> As to the rest of it, only buy those things that the school tells you to. You don't need tons of equipment on hand to do 80% of the job and you don't need to wear it all on your belt. Typically, upon my person, you'll find only these things all the time, on all calls: stethoscope, pens (ball point & sharpie), notepad, small wad of gloves, watch, and pen light. Everything else I need will usually be within reach. Somewhere nearby will be a radio and a cell phone.


 An EMT should train in the type of enviroment they will be called to serve in, (the field or back of an ambulance).  EMTs are there to fix a person up as best we can and get them to a hospital (pre-hospital care), we are not doctors and thus not trained to diagnosis partents.  I got pretty dam good performing assessments on patients from doing them in the classroom and on calls in the back of an ambulance.  The only time I stepped into the ED was when I was transporting a patient.  Train as you do, because if you have only been performing assessments in a sterile enviroment, it will be a hugh shock when you actually have to perform in the real world.

I'm not trying to knock anyone, I just do not see any benefit from spending any time in the ED during training.  I can learn the exact same thing doing assessments in the classroom and in the field.


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## Handsome Robb (Feb 16, 2015)

All the expensive toys I had were bought for me...Master Cardiology was a medic school graduation present from my momma and my Raptors were a birthday present from my girlfriend.

Y'all needed boots in EMT school? I just wore comfortable black tennis shoes.



dank said:


> An EMT should train in the type of enviroment they will be called to serve in, (the field or back of an ambulance).  EMTs are there to fix a person up as best we can and get them to a hospital (pre-hospital care), we are not doctors and thus not trained to diagnosis partents.  I got pretty dam good performing assessments on patients from doing them in the classroom and on calls in the back of an ambulance.  The only time I stepped into the ED was when I was transporting a patient.  Train as you do, because if you have only been performing assessments in a sterile enviroment, it will be a hugh shock when you actually have to perform in the real world.
> 
> I'm not trying to knock anyone, I just do not see any benefit from spending any time in the ED during training.  I can learn the exact same thing doing assessments in the classroom and in the field.



While I agree with train where you'll work the fact that you didn't do any ED time clouds your opinion on it. I saw far more patients in the ED than I ever did in field time in B, I and P school. Granted I did my clinicals at the busiest LII Trauma Center in the nation. I started hundreds of IVs in the ED for I and P compared to maybe 75 during field time. Also did more skills like NG/OG placement, 12-lead placement and interpretation (again hundreds vs tens) than in the field. For a frame of reference I had a little over 200 patient contacts in my 480 hour Paramedic Internship.


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## Akulahawk (Feb 16, 2015)

dank said:


> An EMT should train in the type of enviroment they will be called to serve in, (the field or back of an ambulance).  EMTs are there to fix a person up as best we can and get them to a hospital (pre-hospital care), we are not doctors and thus not trained to diagnosis partents.  I got pretty dam good performing assessments on patients from doing them in the classroom and on calls in the back of an ambulance.  The only time I stepped into the ED was when I was transporting a patient.  Train as you do, because if you have only been performing assessments in a sterile enviroment, it will be a hugh shock when you actually have to perform in the real world.
> 
> I'm not trying to knock anyone, I just do not see any benefit from spending any time in the ED during training.  I can learn the exact same thing doing assessments in the classroom and in the field.


You should note that I stated that we did 2 shifts in the ED and 2 on ambulance, so we did get "real world" experience. You certainly learn how to do assessments in class and while on an ambulance. Here's the thing about ride time... you'll only usually see one patient at a time. In a typical ED, you'll have the opportunity to practice a given skill on several patients, so  you'll get better at that skill faster that way. Then when you hop on the ambulance, you already know what you're looking for, you just have to learn to adapt to the new environment. The point is that you don't use the ED to learn how to do ED stuff... you use it to learn how to perform your assessment skills on "real" patients and see lots of patients with different problems. Then you hop on the ambulance to learn the ambulance stuff and refine your skills for that environment.

From my EMT training, I was on a 911 ambulance and saw a grand total of 8 patients. In the ED, I saw about 20. That's about 4 per day while on the ambulance and about 10 per day in the ED. I'm not saying that you can't learn the exact same things on an ambulance, just it'll take longer to do.


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## MackTheKnife (Feb 16, 2015)

While my PM program didn't have ED time, I wish they would have. As Akulahawk said, you have more exposure due to greater numbers. Thus, you have more chances to practice skills, build muscle memory, learn how the "other side" does things,  create relationships, etc. And learning/refining a skill in a controlled environment (as compared to the field), benefits you greatly down the road.


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## Amelia (Feb 16, 2015)

Heres the deal on the ED/ambulance experience. Most peoe would consider the town i live in as "small" atthough its 100x bitter than my hometown. I asked the director why the ED and not ambulance runs, and he said if we strictly went ambulance we would probably only get 2-3 calls in a night and we need 10 vutal assessments. The hospital is going to give us scrubs to wear and all we need is our stethoscope and tennis shoes. I am also going to ask, though, if I can do an ambulance run too- eventhough theyre changing ambulance companies soon. I dont think it will matter much.


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## Amelia (Feb 16, 2015)

And above is the perfect example of why one must finish that first cup of coffee before attempting to write one's name. Sorry for the typos.


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## ego (Feb 17, 2015)

dank said:


> Then you should not be classified as an EMT, you are  an ER Tech.



Some people get there EMT so they can apply to ER Tech jobs. so need the experience in a ED to apply.


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## ego (Feb 17, 2015)

dank said:


> An EMT should train in the type of enviroment they will be called to serve in, (the field or back of an ambulance).  EMTs are there to fix a person up as best we can and get them to a hospital (pre-hospital care), we are not doctors and thus not trained to diagnosis partents.  I got pretty dam good performing assessments on patients from doing them in the classroom and on calls in the back of an ambulance.  The only time I stepped into the ED was when I was transporting a patient.  Train as you do, because if you have only been performing assessments in a sterile enviroment, it will be a hugh shock when you actually have to perform in the real world.
> 
> I'm not trying to knock anyone, I just do not see any benefit from spending any time in the ED during training.  I can learn the exact same thing doing assessments in the classroom and in the field.




In the classroom you wont see very large patients or other types of patients that have complications making treatment decisions more difficult. Getting BPs or placing EKGs on very large patients or children, Neonatals etc. With the large volume of people coming into EDs you get a wider range of patients that you can practice on and if you cannot do the task someone will be able to show you. 

You should obviously have ambulance time as a preference but saying that there is no benefit from spending time in an ED is not correct.


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## Tigger (Feb 17, 2015)

dank said:


> An EMT should train in the type of enviroment they will be called to serve in, (the field or back of an ambulance).  EMTs are there to fix a person up as best we can and get them to a hospital (pre-hospital care), we are not doctors and thus not trained to diagnosis partents.  I got pretty dam good performing assessments on patients from doing them in the classroom and on calls in the back of an ambulance.  The only time I stepped into the ED was when I was transporting a patient.  Train as you do, because if you have only been performing assessments in a sterile enviroment, it will be a hugh shock when you actually have to perform in the real world.
> 
> I'm not trying to knock anyone, I just do not see any benefit from spending any time in the ED during training.  I can learn the exact same thing doing assessments in the classroom and in the field.


There is no substitute for volume when you are new. Not to mention that you simply cannot get good at doing assessments in the classroom nor will you get good at them quickly once you start working on them on the ambulance. You improve by doing a lot of them

Also I am confused as to how time in the classroom is more beneficial than in the ER once you've learned the basic tenets of an assessment. One is more sterile than the other...


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## Amelia (Feb 17, 2015)

Well in class we do a lot more than ABCs.


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## Sunburn (Feb 19, 2015)

Class is good, but nothing can prepare you for field work. Running scenarios is class is a lot different than treating your 20th or 30th patient coming of a 12 hour shift when you just want a cup of coffee and some food because you didn't get to eat. Real world fatigue factors a lot, that's when mistakes are made.


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## NYBLS (Apr 9, 2015)

dank said:


> An EMT should train in the type of enviroment they will be called to serve in, (the field or back of an ambulance).  EMTs are there to fix a person up as best we can and get them to a hospital (pre-hospital care), we are not doctors and thus not trained to diagnosis partents.  I got pretty dam good performing assessments on patients from doing them in the classroom and on calls in the back of an ambulance.  The only time I stepped into the ED was when I was transporting a patient.  Train as you do, because if you have only been performing assessments in a sterile enviroment, it will be a hugh shock when you actually have to perform in the real world.
> 
> I'm not trying to knock anyone, I just do not see any benefit from spending any time in the ED during training.  I can learn the exact same thing doing assessments in the classroom and in the field.



There is so much wrong with this statement I don't even know where to start.


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## Amelia (Apr 9, 2015)

NYBLS said:


> There is so much wrong with this statement I don't even know where to start.


Agreed. Our ambulances have relatively low call vilume which is why we do ER shifts for experience. Simetimes you have to adapt and so the best you can with what you've got. Hmmm... /;|


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## gotbeerz001 (Apr 9, 2015)

Amelia said:


> Agreed. Our ambulances have relatively low call vilume which is why we do ER shifts for experience. Simetimes you have to adapt and so the best you can with what you've got. Hmmm... /;|


I think what NYBLS means is that to say ER time has no value is ridiculous. 

We were required to do 16 hours in the ICU for paramedic. They were very boring shifts: Sedated pts requiring monitoring of MAP, administration of drugs we don't use pre-hospital, suctioning and periodic repositioning to avoid sores. Seems like a waste of time, yeah?
The biggest take-away I had was to read the intake reports and read how stable some of these pts were at scene when they were truly critically injured. This has helped me keep my index of suspicion high on the seemingly stable trauma pt specifically. 

While the ER is a relatively controlled environment, this is a great place to hone your skills before taking them out to the field. It is also a great way to see which interventions are most helpful to the hospital staff so that you can prioritize your actions en route. 

I am suspect of anyone who says they "got pretty darn good performing assessments" and cites how many classroom scenarios they have nailed. 

I am also guessing that @dank is simply an overconfident Basic (bordering on being dangerous) but is saved by lack of opportunity in the field.


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## Amelia (Apr 9, 2015)

Here's another one of my  points of view: Do what the darn classes requirements are. If its rig time, awesome. If its ER time, fantabulous. I'm doing what's required, I'm going to make the best out of it, and there is absolutely 0 point in criticizing other program's requirements. I can guarantee you that what works and what is required from EMT/P students in California are going to be -slightly- different from the requirements here in South Dakota. Just a thought.


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## gotbeerz001 (Apr 9, 2015)

Amelia said:


> Here's another one of my  points of view: Do what the darn classes requirements are. If its rig time, awesome. If its ER time, fantabulous. I'm doing what's required, I'm going to make the best out of it, and there is absolutely 0 point in criticizing other program's requirements. I can guarantee you that what works and what is required from EMT/P students in California are going to be -slightly- different from the requirements here in South Dakota. Just a thought.


I'm having a difficult time figuring out which angle you are coming from on this; my point was simply:
All aspects of training can be beneficial; some even more so than others. Both ER time and Field time have their merits; seek them out.


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## Tigger (Apr 9, 2015)

Amelia said:


> Here's another one of my  points of view: Do what the darn classes requirements are. If its rig time, awesome. If its ER time, fantabulous. I'm doing what's required, I'm going to make the best out of it, and there is absolutely 0 point in criticizing other program's requirements. I can guarantee you that what works and what is required from EMT/P students in California are going to be -slightly- different from the requirements here in South Dakota. Just a thought.


Meh. Not all programs provide the same opportunities for their students. If a program does not provide a clinical opportunity, that doesn't mean it's not worthwhile and you should not seek it out. My program had us in the ED and the ambulance for equal time. The trouble with the ambulance was that the fire department beats us on most of the calls, so you rarely got to attend a call start to finish. I arranged to do my own clinical time with the fire department so I could see what it was like start to finish. The school did not make this mandatory, but it was certainly helpful to me. 

I am also starting to take EMT students at my full time place, which is pretty rural. While we don't have the volume, students get to experience what it's like to have to deal with a patient for an hour or more. While not required, it's certainly beneficial experience.


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## NYBLS (Apr 9, 2015)

I think we often forget we are typically the first line of health care a patient will see which can provide extremely useful information to provide to our patient. Ill give an example. One of my clinicals was the cath lab. Why? Am I going to provide this in the field? No, of course not. But for my next MI patient the value of communicating not only the next 5 minutes but the next 5 hours of his care can assure them that you are concerned about their long term well being, not just dumping them off in the ED and going on to another. Simple statements and explanations show family that you are educated and show the patient this isn't your first time dealing with their problem.


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## OnceAnEMT (Apr 9, 2015)

I completely agree with the above that the ED clinical time is not a "must have" but only helps and certainly does no harm. Having background knowledge, even if it barely scratches the surface, of other aspects of the overall picture is a great way to have solid transitions of care, and keep your patient informed.

As a side, in the AT program I am in our clinicals include semesters at a high school, radiology clinic, student health center on campus, ED, ortho surgeries, and ortho shadowing, all on top of the normal collegiate sport coverage. That extra bit of knowledge can give you the edge in a conversation, whether that means relating to an interviewer or calming a patient.


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## SandpitMedic (Apr 9, 2015)

This is getting deep. Everyone thinks field experience is so very valuable... Except when it comes to going straight through to medic school... 

Hmmmmmm.....

?


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## Tigger (Apr 9, 2015)

SandpitMedic said:


> This is getting deep. Everyone thinks field experience is so very valuable... Except when it comes to going straight through to medic school...
> 
> Hmmmmmm.....
> 
> ?


Clinical time has defined goals, and (hopefully) preceptors that will help you reach them. Working for six months doing BLS transfers (the reality for many new EMTs), does not have the same structure.

Also, paramedic school obviously has its own clinical component so I guess I just don't get it.


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## Amelia (Apr 10, 2015)

SandpitMedic said:


> This is getting deep. Everyone thinks field experience is so very valuable... Except when it comes to going straight through to medic school...
> 
> Hmmmmmm.....
> 
> ?


Im not going straight to medic school. Some of us dont have that option.


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## Amelia (Apr 10, 2015)

Amelia said:


> Im not going straight to medic school. Some of us dont have that option.


Its just how our provram works. Our requirements are 10 vitals in a shift, and where we live, we may only get 3 calls a night. On a limited schedule that would be nearly impossible while we make 9 "perfect" skills videos with a lab group plus 4-5 hours of studying each night and trying to raise a family in my case. We are welcome to ask ambulance services in the area for a ridealong. I am going to try to take advantage of that if possible. Id have to go out of town,however, because our ambulance companies are changing in a few weeks.


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