# Medic Students



## FFPARAMEDIC08 (Dec 3, 2007)

This is a question for medic students and other ALS providers (EMT-I/EMT-P).

My partner is an EMT-B and in his 7th month of medic class. I feel it would be beneficial for him to perform various ALS procedures. These would be under my direct supervision, of course. 

Medic Students: I was wondering how many of you on here perform ALS procedures and whether or not you feel it will help out during your clinicals.

Intermediates and Medics: how do you feel about this? Did your partners ever give you the chance to do this? If so, was it helpful?

Thanks for the replies everyone..


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## firecoins (Dec 3, 2007)

I need all the help I can get.  I am having trouble setting up IVs right now.


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## FFPARAMEDIC08 (Dec 3, 2007)

See fire, my partner knows his stuff but is also having a little bit of trouble (this is just due to the lack of experience doing it, I'm sure).

I think if medic students were to act under supervision of a paramedic it would be a valuable learning experience for them. Technically, clinicals are done by students acting under medical supervision, so why should this be any different?


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## KEVD18 (Dec 3, 2007)

just remember, if they screw up, its your ticket. i have worked outside my scope under supervision of a medic on occasion and i do find it helpful


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## Epi-do (Dec 3, 2007)

I have done things out of my scope in the past, but not lately.  The program director for my medic class is married to the deputy chief at my fire dept.  Her ex-husband is the EMS chief there as well.  We were told at the beginning of class if we were caught doing anything at all before we were allowed to do so during clinicals, or outside of our scope while working, that we would no longer be in class.  It just isn't worth the risk to me.  I will be doing it all soon enough.


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## Ridryder911 (Dec 3, 2007)

I have to admit that I have allowed my non-ALS partners to perform ALS procedures. Majority were either in their Paramedic course, or awaiting to take the test. Although it is non-excusable, it is hard to perform all ALS procedures, and perform  a detailed H & P in a timely manner. I don't allow all to perform and I watch very carefully. Most of the procedures are non-complexed (IV's) and never any medications. If there appears to be some problems, they no longer have the chance. 

Although in my state, clinical requirements are more than some others, I feel that the majority still lack of experience. One cannot obtain more experience in the front driving. I agree it is a personal risk, and as well I do have an ethical dilemma allowing it. 

As an FTO, we carry performance skills even after they pass the license. One must perform and be evaluated, no matter how much experience and training prior to employment. 

R/r 911


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## Guardian (Dec 4, 2007)

FFPARAMEDIC08 said:


> This is a question for medic students and other ALS providers (EMT-I/EMT-P).
> 
> My partner is an EMT-B and in his 7th month of medic class. I feel it would be beneficial for him to perform various ALS procedures. These would be under my direct supervision, of course.
> 
> ...




It should be well defined what he is allowed to do depending on the agreement between your ems agency and his class as well as his current skill level.  I've got no problems letting students work within their current skill level under my direct supervision and authority as the paramedic in charge.  I find it a lot of fun working with inexperienced providers.  One, it's an ego boost.  Two, I have a chance to not only help a pt, but a fellow provider too!  Of course, it is added responsibility on the person in charge.  When I let a student perform ALS skills, it is added pressure on me to make sure that all goes well.  I have to be aware of everything that happens and ensure that treatment is not compromised.  Some people cannot handle this added responsibility.


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## Onceamedic (Dec 4, 2007)

I am a paramedic student 1 semester shy of graduation (almost - 2 weeks left in this one).  We perform ALS skills in the ED - initially under supervision of our instructors, now under RNs.  (Intubations we do in the OR with the anestheologist or nurse anestheologist by our side)  We do all IV starts, push meds (also injections, PO, Sub lingual etc.) and compressions and ventillations during codes.  Next semester, we do 240 hours of ride along with minimum 50 patient contacts - 10 as observer, 20 as participant and 20 as lead -  We are expected to and do ALS skills.  I think it's a great program and we wind up with way more clinical and field experience than is required by either NREMT or the State.   I don't know of any way to learn ALS skills except by practice.


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## triemal04 (Dec 4, 2007)

I did have a chance to perform some ALS skills prior to my internship, but the majority were pretty low key things; IV on a non-critical pt and the like.  I don't really think it's a bad idea to let someone perform some of their skills before they're technically able, but for me it definetly depends on the person doing it.  If they're a competant basic and have a good head on their shoulders, yeah, probably ok.  If they're a complete moron who should never have been an EMT in the first place and just want's to play with the siren...hell no.

It also depends on the skill...and IV on the average pt...sure.  If it goes wrong, I can take the heat for that.  Something like a tube...nope.  Because don't ever forget that if you allow them to do it, it is your *** that's now on the line.


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## firetender (Dec 5, 2007)

I was in an unusual program (part of a pilot program back in 1975) in that for about a year I'd start the day in class and then, in the afternoon, I'd be on duty as an EMT assigned to an ALS rig. By some paperwork glitch, as long as we were with a certified paramedic on our shift, if we learned it in the morning we could do it on our shift.

For myself, that was a very effective way to learn. While still fresh in my mind (and of course there were practical limitations) I'd get to use whatever I was taught and it really reinforced the new knowledge. 

My later experience with new medics who went to school for months and then didn't begin to use the knowledge until the TO observed practicals (or even worse, with those who went through EMT training and then immediately into ALS school without stepping into an ambulance), it was a rockier transition. 

With my program it was a matter of somewhat gradual integration backed by consistent reinforcement which to me "roots in" more solidly.


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## fyrdog (Dec 5, 2007)

Proceed cautiously here. I know of a few medic students that were expelled from class when they performed skills that were beyond their scope of practice of their current certification. No problems for the students doing their clinical ride time. It was only a problem when they were working their normal shift which is not part of their class.

While I agree that it is benifical I would check with your coworker's instructor and your medical director before you allow him to work beyond his current scope of practice.


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## firecoins (Dec 5, 2007)

I have been allowed to run a Glucometer in all it glory on a normal non-medic rotation shift.


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## FFPARAMEDIC08 (Dec 6, 2007)

First I would like to thank everyone for the replies!

I talked to the medical director and his course instructor. Neither one of them have a problem with him practicing what he learns in the class provided that I'm supervising him, he performs only the procedures he has been trained to do thus far and that we obtain permission from the patient (when possible).

I truly feel this will be beneficial to him, especially when it comes time for clinicals. I have always had the attitude of "I'll teach you if you want to learn." and I am really happy that our medical director and his course instructor sees it the same way as I do.


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## natrab (Dec 6, 2007)

You are right that it should be allowed if the student is in the clinical/internship phase.  I'd like to see more systems allow this because it's ridiculous to be allowed to perform procedures on your internship shifts,  but not on your EMT shifts when in both cases you are being supervised by a paramedic.

That said, be VERY cautious when you do this.  The old county I used to work in and the state of CA have no mercy if you get caught.  Two EMTs were fired, expelled from their medic class, and stripped of their EMT cert for starting IVs on patients while working as an EMT and one Paramedic was fired for allowing it (not sure on if he got to keep his license).  Stupid in my opinion, but not worth risking your career over.  Funny thing was one of these guys got in trouble because of a patient, not other agencies.  Apparently they did procedures on a frequent flier who knew the difference between an EMT-B and P and he decided to raise trouble to get their bills taken care of.  The others got in trouble because of other agencies reporting them (there are some fire agencies who hate ambulance personnel in this county).

Here's my story that made me so wary.  I had a partner who from time to time would let me start an IV (only once we were both in the back and nobody was looking; and this was during my internship phase of course, but I was working as an EMT).  On one call, one of the firefighters happened to peek in the back window of our ambulance and see me starting a line.  He went to his captain and reported me.  Thankfully, the captain happened to be a friend of mine and he made sure that the other firefighter never mentioned it to anyone else.  He'd been around the county a long time and called me to tell me about what happened and the previous people who had their careers ruined over stuff like this and how unforgiving the county is about it.


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## firetender (Dec 7, 2007)

I learned to start an IV ON my partner.

He kept up his paramedic skills by finding the stinkiest vein on my arm and working it.

It was an even exchange kinda thing. He blew one, I blew one until we got it right.

Didn't really know if there was a county or company policy forbidding it at the time.


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## pa8109 (Dec 8, 2007)

I'm with you natrab.  While still in class, working as a basic and learning to be a medic, several occasions arose where I had the opportunity to do ALS skills while being paid as a basic.  In PA such things are not tolerated, and I refused to risk my certification, as well as the certification of the ALS provider, just to do a few skills.  On top of that, moral issues can arise and did.  I.E.  a critical trauma patient.  As a medic student, I knew exactly what needed done and had the knowledge and ability to do so.  Unfortunately, while employed and working as a basic provider, performing those skills are illegal and not within a basic's scope of practice.  Nothing gives me greater joy than helping those in need, and having the knowledge and ability to provide the highest level of care possible.  But a fine line can be drawn while a provider is in class.  You have the knowledge and ability, but in this sue-happy world are you willing to break the law to provide that care?  That's not a question I'm asking you personally, just to those students out there who have run into this type of situation before.


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## firecoins (Dec 8, 2007)

I wish I could get the extra practise but I can not.  Oh well.  On my paid basic shifts I work next to medics so I just quiz them about the why's of ALS jobs we get.


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## Medic8388 (Dec 10, 2007)

Hello,
 I'm new here but I thought I would share how we handle this subject at my service.  An EMT may perform ALS procedures if they are in medic school and if they have been check off BOTH at school and by our training coordinator.  All procedures performed must be under the direct supervision of the responsible medic.  EMTs are never allowed to ride in the back unsupervised with an ALS patient.  Always follow your local protocols regarding this matter.  It is never worth loosing your job (and possibly your career) over someone else.

Andrew Woodard


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## paccookie (Dec 21, 2007)

FFPARAMEDIC08 said:


> This is a question for medic students and other ALS providers (EMT-I/EMT-P).
> 
> My partner is an EMT-B and in his 7th month of medic class. I feel it would be beneficial for him to perform various ALS procedures. These would be under my direct supervision, of course.
> 
> ...



My partner is great about letting me do skills that are outside my scope, but not to the point that they are dangerous.  He's an FTO and he knows I'll be in paramedic school in the summer, so he thinks I should learn as much as I can now while I have the chance.  I'm not doing intubations or anything like that, but I have given glucagon to a diabetic and pushed epi and atropine during a code, plus a few other random things like that.  If he feels that I can handle it, he lets me do it.  But he's also careful to ask if I'm comfortable and I know that if I'm NOT comfortable with something, all I have to do is say so.  I think it's mostly a matter of trusting your partner.  Obviously you aren't going to have your EMT partner riding in the back on ALS calls, but I don't see how it hurts anyone to let your partner push a drug or help perform some other advanced skill to help them learn how to do it.  Maybe I have a unique partner, but he really enjoys teaching and I really enjoy learning.  I think we make a good team.  ^_^  We also do nerdy stuff like discuss drug actions and A&P stuff and go over calls and discuss things we could have done differently.  My partner feels that the only way to learn is by doing and I agree.


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## Jon (Dec 25, 2007)

Wow.. Around here, this is a can of worms. When I started my medic program several years ago, my class was informed that unless we were in a clinical envroment with a preceptor, we were JUST an BLS provider.

I was occasionally offered IV's... and I turned them down. At one point, my medical director was also working for the priviate service I work for... and was providing onsite medical direction at a large event... he told our RN to let me do everything... including IM meds and IV Narcs... because he was the medical director for my school, I didn't question him . There were photos taken, and they even showed up in the banquet slide show, to everyones amusement.

I've occasionally assisted ALS practicioners with ALS skills... like "setting up" glucometers and code meds.... but sometimes I've done things that have been in a gray area. (as is much of street EMS). I've had senior medics have me assess patients at an ALS level, with them confirming what I do... I don't mind, but they still have to write the chart. I enjoy the practice. I've been done with medic school for long enough now that my EKG skills are beyond rusty, and it is nice to be challenged once in a while.


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## Hastings (Dec 26, 2007)

Depends a great deal. We have Hospital Clinicals and then Ride-Alongs, followed by an Internship in the Summer.

To sum it up, after learning a certain skill, we are signed off on a little slip of paper that we carry with us. We are expected to act as a paramedic in regard to all skills that we have been signed off for, as well as all basic EMT skills. And we are expected to participate directly in patient assessment and care.

At the hospitals, we are expected to - under the guidance of the nurses - to start all IVs, EKGs, perform physical and verbal assessments, and create the reports. We are also often expected to be involved in treatment as well, especially if it involves pushing drugs. And while it's all a "who wants to do this one?" deal, the ones that step up benefit a great deal from doing so.

On ride-alongs, you're the only student and are expected to act in an active role in patient interaction, although there's a huge difference between ride-alongs with private services and ride-alongs with the fire departments. Typically, the private services will let you do everything (and encourage you to do so), while the fire departments will push you aside and have you simply watching. It's hard, because the departments around here automatically send a fire engine on every EMS call, and they typically arrive before the medics. All firefighters are paramedics, so the work is usually done by the time the student arrives.

If nothing more, being active and taking offers to do countless IVs rose my confidence a lot. And of course the only way to get truly good at a skill is to practice it in a real situation. It's scary, but it's so valuable.

As for internships in the Summer, typically the first third is just watching, the second third is participating as a co-medic, and the third third is acting alone with a veteran medic in the ambulance simply as assistance.


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## paccookie (Dec 26, 2007)

Jon said:


> Wow.. Around here, this is a can of worms. When I started my medic program several years ago, my class was informed that unless we were in a clinical envroment with a preceptor, we were JUST an BLS provider.
> 
> I was occasionally offered IV's... and I turned them down. At one point, my medical director was also working for the priviate service I work for... and was providing onsite medical direction at a large event... he told our RN to let me do everything... including IM meds and IV Narcs... because he was the medical director for my school, I didn't question him . There were photos taken, and they even showed up in the banquet slide show, to everyones amusement.
> 
> I've occasionally assisted ALS practicioners with ALS skills... like "setting up" glucometers and code meds.... but sometimes I've done things that have been in a gray area. (as is much of street EMS). I've had senior medics have me assess patients at an ALS level, with them confirming what I do... I don't mind, but they still have to write the chart. I enjoy the practice. I've been done with medic school for long enough now that my EKG skills are beyond rusty, and it is nice to be challenged once in a while.



I guess it's a little different for me because I'm an EMT-I, not a B.  It's within my scope of practice to do things like IVs, blood glucose, etc.  It's part of my job to put the patient on the monitor and set up the IV fluids while the medic is doing other things.  The way we work is that one of us is interviewing the patient and getting vital signs and an IV while the other one is dealing with any airway issues (O2, intubation, etc), putting the patient on the monitor, and starting the computer documentation.  If the patient needs intubation, obviously I'm the one getting the IV. 

Today we had a 6 am wake up call - an unresponsive person.  Turns out she had taken a heck of a lot of codeine-containing cough syrup.  She was still breathing fine at that point, so I put her on the monitor and a NRB at 15L and popped open the drug box for the narcan while my partner found an IV (he is extremely good at IVs, I'm still learning).  He pushed the narcan and I checked her blood glucose.  I drove in and the patient needed a tube by the time we got to the hospital.  My partner intubated before we unloaded her and I bagged while my partner and the fireman who rode in with us pushed the stretcher in to the ER.  We work as a team and I think we work well together.  There's a lot of trust involved and I can't imagine working as well with someone else.  I actually prefer the less emergent calls because there are more opportunities for my partner to teach me things I don't know.  He gets a kick out of it and I get to learn something new that will help me when I start paramedic school in the summer.  

Anyway, I think I've rambled on enough.  lol


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