# what makes a better medic?



## Aerin-Sol (Mar 30, 2011)

Community college 2 year program

Or university pre-medical school science courses + medic mill?


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## STXmedic (Mar 30, 2011)

I would say the pre-med with medic mill. The science background would help you have a much better understanding of what you're doing compared to any standard two-year medic program (still quite weak in the sciences).


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## MrBrown (Mar 30, 2011)

Brown is also going to say pre-med with patch factory


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## TransportJockey (Mar 30, 2011)

I'll go with Pre-med + medic mill


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## foxfire (Mar 30, 2011)

Aerin-Sol said:


> Or university pre-medical school science courses + medic mill?



I would highly reconmend that route. I am taking the  medic course without any pre-med science background and have to work extra hard to learn everything. It would be well worth the extra time and money.


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## usafmedic45 (Mar 31, 2011)

Why not do the premed courses and then the degree program?  The premed courses would take care of the non-EMS part of the degree for the most part and you'd wind up with a more respectable (and hireable) background.


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## TransportJockey (Mar 31, 2011)

usafmedic45 said:


> Why not do the premed courses and then the degree program?  The premed courses would take care of the non-EMS part of the degree for the most part and you'd wind up with a more respectable (and hireable) background.



As I know Rob will say when he finds this thread, the curriculum from UNM School of Medicine and their EMS BS degree program is what I call perfect.


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## Sandog (Mar 31, 2011)

I will use the following quote to make my point.



> "Big jobs usually go to the men who prove their ability to outgrow small
> ones."



You will be as good as you put into what ever endeavor you do. A school is simply a stepping stone and a means to an end. What ever you become will be the result of your efforts. The key is; how far are you willing to take your learning process beyond your textbooks?


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## 82nd medic (Mar 31, 2011)

theres idiots that graduate from harvard and theres geniuses that stop at community college... where you go doestn really dictate what you'll learn.


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## systemet (Mar 31, 2011)

82nd medic said:


> theres idiots that graduate from harvard and theres geniuses that stop at community college... where you go doestn really dictate what you'll learn.



But wouldn't you say that if you took 100 Harvard business school graduates, and 100 people who "stopped at community college", had them run 200 businesses for 5 years, that it's more probable that the Harvard graduates will perform better?

Absolutely, having a formal education is no guarantee that you're not an idiot (I may be living proof of this), but also the lack of a formal education doesn't mean you can't be great (I've met many people in EMS like this).  

Generally, most of the time, the people with a greater education in a given field are going to out-perform those lacking it.  I mean, if that wasn't the case, why would we even send kids to school?


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## usafmedic45 (Mar 31, 2011)

82nd medic said:


> theres idiots that graduate from harvard and theres geniuses that stop at community college... where you go doestn really dictate what you'll learn.



It can and does for most people.  You're assuming that you're dealing with folks who want to actually learn.  That's not the niche market diploma mills cater towards at all.

At very least the stigma of being trained by a program perceived to be substandard, lacking or just plain bad by most folks in the field is going to put you at a disadvantage.


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## Sandog (Mar 31, 2011)

> It can and does for most people. You're assuming that you're dealing with folks who want to actually learn. That's not the niche market diploma mills cater towards at all.



That is so not correct. For many people, they just want to learn a trade/skill and go to work. This does not imply they are lazy or looking for shortcuts. Perhaps they know what they want to do and the "Medic Mill" is a path to their goal. Like I said earlier, a persons progression in a career will be based on what effort that person puts into bettering themselves in said profession.


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## usafmedic45 (Mar 31, 2011)

Sandog said:


> That is so not correct. For many people, they just want to learn a trade/skill and go to work. This does not imply they are lazy or looking for shortcuts. Perhaps they know what they want to do and the "Medic Mill" is a path to their goal. Like I said earlier, a persons progression in a career will be based on what effort that person puts into bettering themselves in said profession.



....and you _so_ missed the point that we're not talking about a "trade", we're talking about something that should be treated like a profession and has some definite needs for background education first.  You have too much faith in your fellow man's willingness to work hard.  People are by and large lazy, stupid and will take the path of least resistance to their goal.  That would tend to mean that if you allow folks to run through a very basic program they are going to come out with and remain in possession of very basic skills which will degrade over time.


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## Aerin-Sol (Mar 31, 2011)

usafmedic45 said:


> Why not do the premed courses and then the degree program?  The premed courses would take care of the non-EMS part of the degree for the most part and you'd wind up with a more respectable (and hireable) background.



I will be graduating with a bachelor's in in another field, and the community college program here does not seem to offer much more than the hospital-based program (which is a year long so maybe is not quite a mill?), other than a veneer of respectabiliity. I would like to have paramedic credentials for a part-time/back-up career and am not worried about hiring prospects, as in my area of the country 911 is a full-time job & IFTs hire anyone with a pulse & a license. However, I would still like to get the best possible education, and it seems like science electives + hospital program is going to serve that goal better than the community college program.


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## 82nd medic (Apr 1, 2011)

usafmedic45 said:


> ....and you _so_ missed the point that we're not talking about a "trade", we're talking about something that should be treated like a profession and has some definite needs for background education first.  You have too much faith in your fellow man's willingness to work hard.  People are by and large lazy, stupid and will take the path of least resistance to their goal.  That would tend to mean that if you allow folks to run through a very basic program they are going to come out with and remain in possession of very basic skills which will degrade over time.




working hard or not has nothing to do with what paramedic school you go to, money often does. i know plenty of army medics who went to "medic mills" because 1: they didnt feel like working WELL below the scope of practice they were used to to rack up 600+ hours of work as an EMT when they have other programs ready and willing to accept them and 2: they didnt feel like spending 6-12 months of their GI bill on it when there are several programs that are below the $5k range. are you seriously trying to say that someone who worked as an EMT-B for 6 months and decided to go into 10K of debt knows more than someone who's worked above a paramedics scope of practice for years and spent their time studying the few parts of paramedic that they didnt alreavy have down?

you could even argue that paramedics that go to the places with "substandard" training and actually become paramedics are better informed, since if they training is that bad then they would have to bust their *** to teach themselves.

dont get me wrong, im sure theres students who attend medic mills to take short cuts but im also sure thers students that attend the more costly programs and walk away with nothing more than the medic mill students were taught.... you're assuming that folks that have more money or are willing to go into more debt want to learn more...


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## usafmedic45 (Apr 1, 2011)

> I will be graduating with a bachelor's in in another field, and the community college program here does not seem to offer much more than the hospital-based program (which is a year long so maybe is not quite a mill?)



Honestly, a hospital based program and one run by a for-profit "educational" entity are two very distinct and separate things in most cases.  



> working hard or not has nothing to do with what paramedic school you go to, money often does.



Then why would one choose to go to a program that on average costs more and leaves one ineligible for financial aid?  If you're not prone to studying and just want to pad your application for the fire department or get to go "Woo-woo-woo" down the streets ASAP, do you choose the shorter and less thorough program where you pass if your check clears or the one where the instructors are demanding and you stand a high chance of washing out?



> i know plenty of army medics who went to "medic mills"



We're not talking about people who already have training.



> when there are several programs that are below the $5k range


I don't know where you are at but in the several states I've lived and worked in, most of the programs OVER $5K are mills. 



> more than someone who's worked above a paramedics scope of practice for years and spent their time studying the few parts of paramedic that they didnt alreavy have down?



Your average military medic is about par to a civilian paramedic.  The only difference is the necessity for them to be controlled via off-line medical control instead of a "mother may I" system.  You seem to be basing your assessment off of the extreme minority of special operations medical personnel or IDMTs who are basically PAs in everything but title.  I'm not one you can BS about how different the military is from civilian EMS in this regard.  Not only am I a veteran (having served with both AF and Army units), but I also was one of the authors cited as a reference in the most recent TCCC guidelines.  



> you could even argue that paramedics that go to the places with "substandard" training and actually become paramedics are better informed, since if they training is that bad then they would have to bust their *** to teach themselves.



Then why do most of the graduates of those programs not do that if you're argument has any validity at all to it?  Why do we see them struggling, flailing and failing once they are turned loose on an unsuspecting population?


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## 82nd medic (Apr 2, 2011)

im not basing it off medics/corpsmen who fall under USSOCOM, i'm basing it off of (from my unit atleast) your average medic... unless they're allowing paramedics to do chest tubes, other surgical procedures, and issue almost any medication thats not a controlled substance these days?

also TC3 only has any bearing on a medic's actions under combat conditions or while evaccing off of it. its not a limiting scope of practice back on the FOB/PB or even the field by any means.

perhaps we've been looking at different training programs, but most of the "mills" that i've checked out cost less than the 'higher end' courses.

have an actual source saying that paramedics that graduate from certain programs struggle in the field or is it simply a bias?

also i dont remember seeing any flight RT's or even anyone from the air force cited in the TC3 manual...


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## usafmedic45 (Apr 2, 2011)

> unless they're allowing paramedics to do chest tubes, other surgical procedures, and issue almost any medication thats not a controlled substance these days?



Since when has your average medic (not counting the guys on the military medical helicopters) been packing the gear to do a chest tube?  Let's see some documentation that says it's a _standard_ procedure because I've not seen any (although I will freely admit that I haven't actively looked in the past year or two).  Last time I heard anything about it, it was still left at a unit by unit basis at the discretion of the senior medical person present (PA or MD) and the unit commander.  Even then, they still had to go through advanced training beyond the 68W basic course and that negates your argument.

And yes, by the way, some services do allow paramedics to place chest tubes, do cutdowns, surgical airways, etc.  For the first two, it's almost exclusively the realm of the flight teams but still, it's left to a case by case basis just like in the military.  



> also i dont remember seeing any flight RT's or even anyone from the air force cited in the TC3 manual...



You do know that citations don't list occupation normally and when I wrote it, I was no longer with the USAF.  You'd probably be amazed at how many of those references were written by someone other than an Army member. 



> have an actual source saying that paramedics that graduate from certain programs struggle in the field or is it simply a bias?



Like most things in EMS, there is little in the way of published data, but from the data I had access to as a quality control officer and clinical preceptor there was a distinct performance advantage for those who did not come out of the two local medic mills.  Our medical director (who was trained as a medic during VN by the US Army) was very interested in how the local hospital program he oversaw (which was longer than the local community college program BTW) stacked up against the other local EMS training entities.  

BTW, what's a medic with the 82nd doing way out in Cali?


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## ffemt8978 (Apr 2, 2011)

Last time I checked, this thread was not about military EMS.  We have a dedicated forum for that located here: Military/Tactical/Wilderness EMS so let's get this one back on topic.

In addition, military training is a whole different beast than civilian training for a number of reasons, just like military EMS is different from civilian EMS.


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## 82nd medic (Apr 3, 2011)

usafmedic45 said:


> Since when has your average medic (not counting the guys on the military medical helicopters) been packing the gear to do a chest tube?


never said it was done in combat conditions although many of our guys did pack the gear for them for extended missions where medivacs would be a problem. many of our PBs were 100% medic ran as far as medical capabilities went though.



> Let's see some documentation that says it's a _standard_ procedure because I've not seen any (although I will freely admit that I haven't actively looked in the past year or two).  Last time I heard anything about it, it was still left at a unit by unit basis at the discretion of the senior medical person present (PA or MD) and the unit commander.  Even then, they still had to go through advanced training beyond the 68W basic course and that negates your argument.


chest tubes are lightly touched during 68W ait (atleast when i went through they were). nothing fancy just "heres what they are, heres when you use it, heres how you put it in"... bout an hour and a half of instruction max. whether or not its actually taught during ait still or not doesnt really matter. if a medic is taught it at unit level then its in his scope of practice, how does that negate my argument at all?




> You do know that citations don't list occupation normally and when I wrote it, I was no longer with the USAF.  You'd probably be amazed at how many of those references were written by someone other than an Army member.


yes i am aware that a lot of the references are not from army personel... a lot are navy personel. actually looking over the tc3 guideline it does a pretty good job of listing atleast the basic occupation (probably for the sake of credibility) and military status (including retired)

speaking of your being USAF though, i have a bit of a hard time believing that USAF medic actually has experience with tc3 or experience with what field/line medics are actually taught... last i checked air force medics were hospital/clinical medics. theres no point in teaching a hospital medic much of anything considering how many MDs/PAs are running around.



> Like most things in EMS, there is little in the way of published data, but from the data I had access to as a quality control officer and clinical preceptor there was a distinct performance advantage for those who did not come out of the two local medic mills.  Our medical director (who was trained as a medic during VN by the US Army) was very interested in how the local hospital program he oversaw (which was longer than the local community college program BTW) stacked up against the other local EMS training entities.


if the majority of graduates from medic mills really were that bad, i'm sure on application forms for the different paramedic companies it would have something along the lines of "graduates from ____ need not apply." i've yet to see that though



> BTW, what's a medic with the 82nd doing way out in Cali?


a lot of people in the military list their home state as their residency


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## ffemt8978 (Apr 3, 2011)

Last chance to get this back on topic and away from the military EMS discussion.


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## usafmedic45 (Apr 3, 2011)

ffemt8978 said:


> Last chance to get this back on topic and away from the military EMS discussion.



Duly noted.


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## 82nd medic (Apr 3, 2011)

sorry got a bit side tracked: my point was that those who go to medic mills or courses that are seen as "substandard" might not necessarily be uneducated idiots or people looking for a way into the paramedic without knowing their stuff but may be choosing that direction for another reason (financial, time limitations, other requirements, etc). is there any real study done out there comparing the life saving capabilities of graduates from different types of programs? i know some places do "paramedic of the year" contests or what not, even if those are half bs you could use those to get atleast some sort of an idea of what produces the better medic just by looking at what program graduates normally win those.


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## usafmedic45 (Apr 3, 2011)

> seen as "substandard" might not necessarily be uneducated idiots or people looking for a way into the paramedic without knowing their stuff but may be choosing that direction for another reason



Very true, but you have to remember that we make educated guesses (and write protocols, etc) with the average product of the worst program in mind.  If a school produces the lowest common denominator 99 times out of 100, then it's safe to assume there's something wrong with the program and with the students since:
-They didn't significantly improve once out of the program
-There was not a statistically significant number of outliers to imply that folks who were smart but went there for other reasons beyond expediency or the inability to make it into the local hospital program or one of the two college affiliated programs.



> is there any real study done out there comparing the life saving capabilities of graduates from different types of programs?



We did the study but the hospital's IRB (yes, we did the research "backwards") would not let us publish the results out of concern for the effect the results would have on the "morale" of the local EMS providers.  Read as: They didn't want to point out that one of the larger for profit ambulance services (which favored this one particular mill we dealt with)  had sub-standard personnel because they were afraid that the response from the service would be to take their patients to the other hospital in town.  

I do agree with you that there needs to be more research on the subject.


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## SeanR (Apr 8, 2011)

Do you have to go to college for four years to go to med school?


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## usafmedic45 (Apr 8, 2011)

No, if you can complete the requisite education (normally a bachelors) in less time, so be it.   This really isn't the best forum to discuss that though.  Try the forums at http://forums.studentdoctor.net/


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## 281mustang (Apr 8, 2011)

SeanR said:


> Do you have to go to college for four years to go to med school?


 Nearly all require a 4 year degree but there are some require less, most of which are up in Canada.


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## mycrofft (Apr 8, 2011)

*"A better medic" or "the best-hireable and good medic"?*

Do the most you can afford soonest, it will give you a better grounding and you might even decide to aim higher up the food chain. Just make sure that, if you are offered two classes, take the one that will advance you (such as EMT-B to Paramedic) versus just milling about (LVN to RN, or EMT-B to RN or LVN). Once you are working it gets harder and harder to "go back and take some classes", etc.

In either event, you must become a professional in attitude as well as study to do well, and to BE a professional instead of an "ambulance driver".

If you are smart and system-savvy enough, you can skate through "HAH-Vahd", but turn out to be worthless except as a dispatcher or company owner; however, with a Podunk Tech School certif only, you will blend in with a huge sea of mediocrity, probably because you never had the best chance to learn.


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