# MD to paramedic



## Monster (Dec 17, 2010)

Hi,

I have a quick question. Im currently a resident, ie i graduated medical school, and completed an internship. I want to take a year off from residency to spend time with family. If I wanted to work a few shifts as an EMT (to maintain clinical skills and make some extra money) what can I do to get certified? I was an EMT-B prior to medical school however my certification has since long expired. Im up to date with ACLS, PALS, NRP, and ATLS. Is there a 'quick' way to get certified having an MD? I dont mind taking an exam if need be. Sorry about asking such an odd question, any suggestions would be appreciated. Because Im still in residency, Im not eligible to get my full medical license.

thanks for your help


----------



## Veneficus (Dec 17, 2010)

If you have taken your step 3, depending on the state they may issue you a paramedic card. 

If not, I don't think there is mch you can do except take the class.

What is your residency in?


----------



## Monster (Dec 17, 2010)

Im taking Step 3 in january. My residency is in Family Practice


----------



## Veneficus (Dec 17, 2010)

Monster said:


> Im taking Step 3 in january. My residency is in Family Practice



best thing to do then is call your state EMS office and ask them what the procedure is.


----------



## MrBrown (Dec 17, 2010)

Mate you've been dipping into the ketamine haven't you?

Have you not seen what Doctors who respond on behalf of the Ambulance Service get to drive? 

Mind you, how confident are you in thoracostomy and rapid sequence intubation?


----------



## zmedic (Dec 17, 2010)

Depends on the state. In New York if you ever had an NY state EMT cert you can take a refresher challenge class (which involves you challenging the written and skills portion), going to the classes that you didn't score highly enough on the test, and taking the NY state written test. But that's to get your old cert back, not to get medic. Some states let you challenge for medic as an MD. Yeah, check with your state. 

Also even if you have the certs, you should think long and hard if you are ready to work as a medic. There is a difference between running a code on the floor and in someone's house. Especially if you are family medicine. If someone told me they wanted to challenge for medic and they were a fourth year emergency medicine resident i'd probably say go for it. Everyone else, I would be a bit leery if they haven't specifically trained for medic.


----------



## EMSLaw (Dec 17, 2010)

zmedic said:


> Also even if you have the certs, you should think long and hard if you are ready to work as a medic. There is a difference between running a code on the floor and in someone's house. Especially if you are family medicine. If someone told me they wanted to challenge for medic and they were a fourth year emergency medicine resident i'd probably say go for it. Everyone else, I would be a bit leery if they haven't specifically trained for medic.



I have to totally disagree with this.  You're ignoring the fact that a doctor - any doctor - has years of full time medical education, including an ER rotation.  ACLS doesn't change no matter where you do it, save that there are some more advanced interventions that can't be done outside a hospital.  And ironically, I think being a relatively new MD helps the OP here.  He hasn't spent 40 years practicing podiatrics or OB/GYN.  

I think you overstate paramedics and denigrate doctors.  Refreshing a few protocol-driven psychomotor skills shouldn't be a problem for someone who's has MD and PGY1 training.


----------



## rhan101277 (Dec 17, 2010)

I would just call your local EMS office.  I am sure your education exceeds the requirements, even though it is not exactly like the paramedic program.  I would try paramedic though because you can really work on some of your differential diagnosis and more advanced procedures.  Also it will help keep you up to date on the medicines were are allowed to give.  You will get to experience what it is like to be by yourself making decisions, no senior resident or attending to run stuff by, just protocols.  Most protocols allow for sound clinical judgment though.  I hope it goes well for you, it sure is a rewarding job.


----------



## d3653je (Dec 17, 2010)

Once again Doctor Kiwi Brown with all the answers!




MrBrown said:


> Mate you've been dipping into the ketamine haven't you?
> 
> Have you not seen what Doctors who respond on behalf of the Ambulance Service get to drive?
> 
> Mind you, how confident are you in thoracostomy and rapid sequence intubation?


----------



## AnthonyM83 (Dec 17, 2010)

Hey Monster,

I think that'd be a really interesting idea. The best answer really is to contact you state EMS office to explain everything clearly.

How long were you an EMT-B? I will say that I worry a few shifts of additional training might be needed to assure field competency. Not in medical procedures, rather field equipment and scene management.

Do you have full competency in using a Sager/Hare traction splint, a KED, spinal immobilization (from standing, suping, sitting), running a code with only possibly only one EMTB at your side, etc etc? Are you comfortable running (physically, not just academically) ACLS and PALS procedures on a regular basis?

Again, I think it'd be a great experience, but remember there would be a bit to review and the EMS office would need to be sure you would be fully competent in basic skills and scene management as well.

Good luck!


----------



## jgmedic (Dec 17, 2010)

www.emsa.ca.gov has the requirements for CA, it is not too bad, the only thing I see that you don't already have is a field internship. If you could find a school to affiliate with just for rideouts it would work. I dont know what state you are in but hopefully this helps.


----------



## zmedic (Dec 19, 2010)

EMSLaw; said:
			
		

> I have to totally disagree with this.  You're ignoring the fact that a doctor - any doctor - has years of full time medical education, including an ER rotation.  ACLS doesn't change no matter where you do it, save that there are some more advanced interventions that can't be done outside a hospital.  And ironically, I think being a relatively new MD helps the OP here.  He hasn't spent 40 years practicing podiatrics or OB/GYN.
> 
> I think you overstate paramedics and denigrate doctors.  Refreshing a few protocol-driven psychomotor skills shouldn't be a problem for someone who's has MD and PGY1 training.



Speaking as an EMT and a fourth year medical student, I can say that most non emergency physicians are no way near ready to run calls in the street. You know how much value a month in the ED is to a psych resident, which they do with an emergency attending looking over their shoulder? Most of these residents have started only a handful of IVs. Those not in anesthesia or emergency medicine do not intubate during residency. Most do not have their ACLS protocols memorized, or their drug dosages. Most have never backboarded someone or put on a C-collar. They have never slung and swathed someone. They have no training in incident command, Hazmat, scene control, ambulance operations, scene safety or extracation. 

Most doctors really aren't remotely ready to be a paramedic. It's not like we get trained as medics during med school and just have to refresh, it's a whole other skill set.


----------



## usalsfyre (Dec 19, 2010)

Yeah I was really thinking someone should point him in the direction of a rural ED, the kind that often only have mid-level coverage.


----------



## bstone (Dec 20, 2010)

He can almost certainly function as a medical director (assuming he has an unrestricted medical license) but functioning as a paramedic would take some specialized training. Having been an EMT-B helps a lot, however.


----------



## jjesusfreak01 (Dec 20, 2010)

bstone said:


> He can almost certainly function as a medical director (assuming he has an unrestricted medical license) but functioning as a paramedic would take some specialized training. Having been an EMT-B helps a lot, however.



My medical director has his Medic cert, works as an ER doc, and occasionally assists calls (does not run because he trusts his medics completely) in the field. I don't think I would want a medical director without prior field EMS experience.


----------



## bstone (Dec 20, 2010)

This is why when I finish med school you all will be happy with me. Having worked in the field for many years I will know how protocols to use and how to advance things vs thinking of medics as trained monkeys.


----------



## MrBrown (Dec 20, 2010)

jjesusfreak01 said:


> I don't think I would want a medical director without prior field EMS experience.



None of our Regional Medical Advisors or the Medical Director nor any of the HEMS Doctors that Brown knows have prior experience as an Ambulance Officer .... so why do you need field experience?


----------



## jjesusfreak01 (Dec 20, 2010)

MrBrown said:


> None of our Regional Medical Advisors or the Medical Director nor any of the HEMS Doctors that Brown knows have prior experience as an Ambulance Officer .... so why do you need field experience?



This is more an issue in the US, where the needs and abilities of ambulance personnel are dictated directly by the medical directors, so without any field experience, the medical directors are either uninformed or have to rely on their medics for input (of course, theres nothing wrong with that, so long as they really do listen to their medics). What I would fear is a system where the medical directors wanted to run it according to what they their own perceptions rather than those of their medics.


----------



## Veneficus (Dec 20, 2010)

jjesusfreak01 said:


> This is more an issue in the US, where the needs and abilities of ambulance personnel are dictated directly by the medical directors, so without any field experience, the medical directors are either uninformed or have to rely on their medics for input (of course, theres nothing wrong with that, so long as they really do listen to their medics). What I would fear is a system where the medical directors wanted to run it according to what they their own perceptions rather than those of their medics.



Some of the best medical directors in the US have never worked in EMS.


----------



## Veneficus (Dec 20, 2010)

bstone said:


> This is why when I finish med school you all will be happy with me. Having worked in the field for many years I will know how protocols to use and how to advance things vs thinking of medics as trained monkeys.



Good luck with that, some extremely smart and capable prior EMS service medical directors have been unable to make changes.

Don't forget, it is easier to replace a medical director than it is a union fire or EMS person.


----------



## d3653je (Dec 21, 2010)

Veneficus said:


> best thing to do then is call your state EMS office and ask them what the procedure is.




So you all are okay with a Medical School Resident, who specializes in Family Medicine, to be a Paramedic without taking the class! How absurd is that! Knowledge wise yes, can hack it but what about skills, basic skills like spinal immobilization, splinting... to say nothing about ALS Skills.  You all throw me under the bus without an after thought and now you are willing to give this guy the keys to the bus. 

Brown you are right, EMS in America is messed up!


----------



## Veneficus (Dec 21, 2010)

d3653je said:


> So you all are okay with a Medical School Resident, who specializes in Family Medicine, to be a Paramedic without taking the class! How absurd is that! Knowledge wise yes, can hack it but what about skills, basic skills like spinal immobilization, splinting... to say nothing about ALS Skills.  You all throw me under the bus without an after thought and now you are willing to give this guy the keys to the bus.
> 
> Brown you are right, EMS in America is messed up!



The doctor, who graduated medical school, and is expected to take and pass his final licensing exam for an unlimited license to practice medicine, is more capable than any certified EMS provider who is also not a physician. 

Incidentally many of the senior Emergency docs are actually internal medicne and family practice docs because they went through residency before emergency medicine even existed as a medical specialty.

When EMS starts edcating itself beyond a vocational education course, I will go back to advocating for them, but I am tired of their inaction and embaressment I have been subject to for advocating for EMS with physicians.


----------



## 94H (Dec 21, 2010)

AnthonyM83 said:


> Do you have full competency in using a Sager/Hare traction splint, a KED, spinal immobilization (from standing, suping, sitting), running a code with only possibly only one EMTB at your side, etc etc? Are you comfortable running (physically, not just academically) ACLS and PALS procedures on a regular basis?
> 
> 
> Good luck!



Do most of the people in the field know how to use the Hare traction splint?

 At my in-service we went through 3 groups before we realized we were using it all wrong. And our training officer was running that station.....


----------



## Veneficus (Dec 21, 2010)

94H said:


> Do most of the people in the field know how to use the Hare traction splint?
> 
> At my in-service we went through 3 groups before we realized we were using it all wrong. And our training officer was running that station.....



I have x rays of improperly applied traction splints, no harm done. But no help either. One medic even told me he couldn't extend the length because then the door of the rig wouldn't close. 

It is a shame people try to make up for knowledge with devices. You can actually apply and maintain traction to a femur quite effectively with some kling and a seat belt. No contraptions, no space constraints, easy to switch from the cot on the rig to the hospital bed, easy to take off and doesn't interfere with xrays.

a little knowledge goes a long way.


----------



## jjesusfreak01 (Dec 21, 2010)

I'd be ok with a medical resident, with all the required PALS, ACLS, etc courses, who also had an EMT-B cert indicating competency with the basic ambulance equipment, working as a paramedic in the field. In fact, i'd be ok with an EM resident in the ambulance if they were with an EMT-B. They know the drugs, the treatments, etc, and may only need a little help with the physical operation of some of the equipment.


----------



## Veneficus (Dec 21, 2010)

jjesusfreak01 said:


> I'd be ok with a medical resident, with all the required PALS, ACLS, etc courses, who also had an EMT-B cert indicating competency with the basic ambulance equipment, working as a paramedic in the field. In fact, i'd be ok with an EM resident in the ambulance if they were with an EMT-B. They know the drugs, the treatments, etc, and may only need a little help with the physical operation of some of the equipment.



Do you guys realize that the ATLS course covers all of those gadgets like hare splints, etc?


----------



## reaper (Dec 21, 2010)

Covers very little on them. Usually not even hands on. I help teach ATLS. They do not get a lot from the classes, as far as skills. They are shown how to use them. The knowledge is what is the greatest benefit from the course.


----------



## AnthonyM83 (Dec 21, 2010)

Interesting how everyonr SEEMS to be.one upping everyone and personalizing the discussion as if it is an us versus them, and with a clear cut answer that applies to every scenario. Personal frustrations, biases, and missions just flooding out of each post. Wow.

I'll probably do similar...here are my thoughts.

- Any graduating med student would not fare better than any non physician EMS provider. Not even as a generalization. There's way too much variation in skills competency of emergency procedures at different medical programs...and different lengths of time since they were last practiced. 

The other poster can vouch for variety of competency in ATLS skills. I'll vouch for variety in BLS and ACLS skills. Having seen some great physicians on ride alongs I can also vouch for variety in scene management skills. That can be broken down into sub categories, some more critical than others.

-Yes, even if you don't keep yourself fresh with skills practice you should have a general idea of how to use it. Thigh strap, ankle strap, traction, then the extra straps.

- Yes I think a physician can go in the field without medic school, though not without some sort of modified internship. Fact is that there's a learning curve once your doing the hands on part of any job even if you know the steps in your head. The education teaches you the rules to respond to variabilities but doesn't give you experience in handling them. You want to have a preceptor ay your side during that learning period...most times it'll work out even if you wing it  but sometimes you need the help. Most docs wouldn't know if the seatbelt trick either...much less would a new med grad know the basic tricks..


----------



## d3653je (Dec 21, 2010)

Veneficus said:


> I have x rays of improperly applied traction splints, no harm done. But no help either. One medic even told me he couldn't extend the length because then the door of the rig wouldn't close.
> 
> It is a shame people try to make up for knowledge with devices. You can actually apply and maintain traction to a femur quite effectively with some kling and a seat belt. No contraptions, no space constraints, easy to switch from the cot on the rig to the hospital bed, easy to take off and doesn't interfere with xrays.
> 
> a little knowledge goes a long way.




You know one call I had this guy whose was a belted driver vs a tree and he had an open femur fracture. Squad had to push the dash and pop the door. Mind u I was only BLS... he was not doing to bad all things considered. It was a pain to get a hare on him but I did and he felt a lot better... till the flight medic took it off because it would not fit in Trooper 8. What a bitttttttch.

In hind sight... no external out of control hemorrhage, good distal PMS, Vitals WNL... I suppose a blanket and carvats could have done the job for a 8 minute flight to the trauma center.

Off topic but seemed okay.


----------



## MrBrown (Dec 22, 2010)

d3653je said:


> So you all are okay with a Medical School Resident, who specializes in Family Medicine, to be a Paramedic without taking the class! How absurd is that! Knowledge wise yes, can hack it but what about skills, basic skills like spinal immobilization, splinting... to say nothing about ALS Skills.  You all throw me under the bus without an after thought and now you are willing to give this guy the keys to the bus.
> 
> Brown you are right, EMS in America is messed up!



Of course Brown is right, it's messed up because of opinions such as this.

A Paramedic may be more adept at the simple behaviourist psychomotor requirementss of the job description yet that is incomparable to the broad cognitive foundation that a Physician will bring.

Which is more important and which is most easily taught Brown asks you?


----------



## rhan101277 (Dec 22, 2010)

d3653je said:


> You know one call I had this guy whose was a belted driver vs a tree and he had an open femur fracture. Squad had to push the dash and pop the door. Mind u I was only BLS... he was not doing to bad all things considered. It was a pain to get a hare on him but I did and he felt a lot better... till the flight medic took it off because it would not fit in Trooper 8. What a bitttttttch.
> 
> In hind sight... no external out of control hemorrhage, good distal PMS, Vitals WNL... I suppose a blanket and carvats could have done the job for a 8 minute flight to the trauma center.
> 
> Off topic but seemed okay.



I thought traction splints were contraindicated with open femur fractures


----------



## zmedic (Dec 22, 2010)

I've had some orthopods tell me that pulling traction on a open (ie exposed) femur fracture isn't that bad, since it'll get washed out in the OR anyway and they'll get lots of antibiotics. But they said not to pull on a severely angulated open fracture with lots of bone ends sticking out, mainly because if the bone ends are out in the air they aren't lacerating blood vessels and are in a fairly safe position. But I don't think it's been studied much. Hard study to do given the low rate of open femur fractures.


----------



## zmedic (Dec 22, 2010)

MrBrown; said:
			
		

> Of course Brown is right, it's messed up because of opinions such as this.
> 
> A Paramedic may be more adept at the simple behaviourist psychomotor requirementss of the job description yet that is incomparable to the broad cognitive foundation that a Physician will bring.
> 
> Which is more important and which is most easily taught Brown asks you?



The question isn't if you can fairly easily train a physician to work as a medic, I'd agree you can. The question is if most physicians are ready to be certified and running calls based on the training they have gotten in medial school and residency. I'd argue they are not. I'm sure that in a month or two you could get most docs ready to take the test for medic, but there is a difference between having that course and just saying "take the test and you are good to go."


----------



## Veneficus (Dec 22, 2010)

rhan101277 said:


> I thought traction splints were contraindicated with open femur fractures



Most open fractures do not appear as a bone sticking out, they appear as a slight wound to the skin because the accessory muscles pull the end back in as part of the body's natural splinting abilty. 

Traction on those wounds would be no less indicated than on a closed fracture. 

As for the rest, zmedic said it very well already.


----------



## Phlipper (Dec 24, 2010)

EMSLaw said:


> I have to totally disagree with this.  You're ignoring the fact that a doctor - any doctor - has years of full time medical education, including an ER rotation.  ACLS doesn't change no matter where you do it, save that there are some more advanced interventions that can't be done outside a hospital.  And ironically, I think being a relatively new MD helps the OP here.  He hasn't spent 40 years practicing podiatrics or OB/GYN.
> 
> I think you overstate paramedics and denigrate doctors.  Refreshing a few protocol-driven psychomotor skills shouldn't be a problem for someone who's has MD and PGY1 training.



+1

Sometimes I think we, in our little insular world of non-degreed meat wagon drivers, think a little too highly of ourselves.  My wife is an RN working towards her MSN/NP and we discussed this just the other night.  For my paramedic cert I had to take a measly 60-hour class whereas she had two full semesters.  Same with pharmacology.  And just about everything else.  And that was just for an ADN.

Some of us really need to get over ourselves.  I love what I do and I'm proud of what I do.  But as far as education and general medical knowledge we're suck'n hind tit compared to MDs, PAs, NPs.  If we don't like that fact, and it is a fact, then we need to get behind increased education requirements for basics (AAS minimum) and for medics (BS minimum), create a single professional organization to further our interests, and start acting like the professionals we like to think we are.


----------

