ALS Sleepover

[DrankTheKoolaid]

re

Because like many things about EMS education there is little consistency. Some of the mandates for the number of "skills" performed are set by the individual school and not the state. The states may make a recommendation for the minimum number of hours required for the program and not necessarily what is done during that time. Some schools count successful intubations and sticks on a manikin just as easily as live ones.

There are busy services that do have shifts in the evening and night where students can do a rotation. Even some busy FDs may rotate their Paramedics off the ambulance after 12 hours to an engine that doesn't do medical calls and allow another crew to work the EMS truck.

The sleepovers can easily be taken advantage of for purposes of just getting in hours if the school or state has no set requirements. It is not uncommon for some to seek out the slowest or easiest clinical situation just to get the hours in. Not everyone getting a cert wants all that patient care stuff and just want a good trauma or two to see what the lights and sirens stuff is all about.

Read Anthony's posts about the way his clinicals are set up. Some can get all 40 patient contacts in fairly quickly. Yet, I believe the state of CA still requires the student to have x amount of hours in also. Do you consider that not fair either?

I just believe a student should have the full advantage of being alert with an alert preceptor for learning. There will be ample time to fumble through calls in the 23rd hour after one gets their cert. If they can not remember much or the crew was too tired to care about explaining much, what good does it do to waste the time of both the crew and the student?

How can a preceptor judge if this person is capable of coming out of a slumber and be able to clearly think through a call? Not everyone is able to clear the fog as fast as others are, and if that is a problem i would rather see it identified in the safety of a preceptor then on some poor unsuspecting patient.

 

[VentMedic]

How can a preceptor judge if this person is capable of coming out of a slumber and be able to clearly think through a call? Not everyone is able to clear the fog as fast as others are, and if that is a problem i would rather see it identified in the safety of a preceptor then on some poor unsuspecting patient.

1. This is a student who is still learning.

2. At that point of learning it shouldn't be about whether you can handle a 24 hour shift. There will also be busy places that do not run 24 hour shifts on the ambulances.

3. If you don't learn the proper technique or procedures, who cares if you can work a 24 hour shift.

4. Are you judging the ability to work a 24 hour shift as another "skill"?

 

[DrankTheKoolaid]

re

1. Once you get to internship you should not be "still learning" you should be honing the assessment skills and treatment modalities that you should have already learned in didactic and clinicals. Hence the reason i don't agree with people beginning there internship until the completion of both.


2. Agreed some will work in areas that do not work 24, 48, 72 hour shift and this doesn't apply to them

3. see post 1, also why somebody should only complete their internship on a 911 only "ambulance" and actually transport the patient and not just do an ALS assessment and pass it on to there cronies on the fire department


4. No i don't regard it as a skill, but i do see it as a reality depending on where you are working. Obviously not everyone works 24, 48, 72 hour shifts. But for those unfortunate souls that do work 72 hour shifts like i do in the hills that is our reality and the ability to critically think with a foggy head is a necessity.

 

[VentMedic]

1. Once you get to internship you should not be "still learning" you should be honing the assessment skills and treatment modalities that you should have already learned in didactic and clinicals. Hence the reason i don't agree with people beginning there internship until the completion of both.

You mean you are going to learn nothing in clinicals? It is all about the "skills" and following the recipes memorized in classes? The clinicals are where the preceptor helps the student apply what has been learned to different situations. It brings patient assessment skills to real live patients where there are always things that can be learned that weren't memorized in class.

Many Paramedic students are working EMTs who are already doing 24 hour shifts. They may be working 2 - 3 24 hour shifts each week in addition to 2 - 3 24 hour shifts for clinicals. After a while it is just going through the motions and marking off on the calendar when you will get the hours finished. By leaving one shift to go into another, which some do, regardless of whether it is from work to clinical or clinical to work, you are overextending the ability of the brain to comprehend much of anything. As well, you are setting the student up for failure in terms of even performing the skill proficiently as well as making them a danger to the patient and to themselves by going without sleep for extended periods of time.

 

[DrankTheKoolaid]

re

I think we have a different definition of clinicals and i see where some of the confusion is coming from. My program considered "clinicals" all of the hospital/psych/dialysis/or/etc/etc time. Where the majority we were fortunate to have a ED fully staffed with MICN who were also all paramedics and able to practice as such in the ED. So we had LOTS of instruction from other paramedics while working in the ED's during clinicals

And internship was the actual paramedic internship on a 911 ambulance.

I agree to an extent with regards to them working 24+ hour shift's plus doing their "internship". But working as an EMT and going without sleep is just going through the motions, Working as a paramedic who has a whole different responsibility set is a whole different story.

And before anyone takes offense to that statement, i worked full time as an EMT on a 911 truck for 7 years. So don't think that i am discounting what EMT's do as I'm fully aware.

 

[VentMedic]

And internship was the actual paramedic internship on a 911 ambulance.

Wow! On Paramedic internships I thought you were actually doing some patient care, starting IVs, intubating and pushing drugs.

My mistake if all you do on your internship is ride around in an ambulance and you think you already know it all so there is nothing anyone on that truck can teach you.

 

[DrankTheKoolaid]

re

No, that is not what im saying at all.

I'm not sure about where everyone else completed there clinicals, but where i completed mine that is ALL we did in the ED. Start lines, administer meds and intubate. So once we got onto the trucks it was just a continuation of what we had already learned and a chance to hone our skills, outside of the hospital in the safety of a preceptor, who would also pass on pearls of wisdom they had come by during their time as a paramedic

 

[DrankTheKoolaid]

Wow! On Paramedic internships I thought you were actually doing some patient care, starting IVs, intubating and pushing drugs.

My mistake if all you do on your internship is ride around in an ambulance and you think you already know it all so there is nothing anyone on that truck can teach you.

To be honest, i just re read my post to make sure i didn't have a typo or something to lead you to thinking that i even hinted towards anything like the statement you just made. And i didn't.

So not quite sure where you are coming from with that

 

[TransportJockey]

I'll toss in what our program defines as clinicals vs internship.

Clinicals are 12 hour hospital rotations (except the cath lab, which is 8 hours). They include Behavioral ED, Peds ED, PICU, NICU, NSI, MICU, regular ED shifts, among others.

Internships are the time spent on either a fire rescue or private service 911 ambulance. 3 weeks at the end of first semester, 6 weeks at the end of the second

 

[triemal04]

Because like many things about EMS education there is little consistency. Some of the mandates for the number of "skills" performed are set by the individual school and not the state. The states may make a recommendation for the minimum number of hours required for the program and not necessarily what is done during that time. Some schools count successful intubations and sticks on a manikin just as easily as live ones.

There are busy services that do have shifts in the evening and night where students can do a rotation. Even some busy FDs may rotate their Paramedics off the ambulance after 12 hours to an engine that doesn't do medical calls and allow another crew to work the EMS truck.

The sleepovers can easily be taken advantage of for purposes of just getting in hours if the school or state has no set requirements. It is not uncommon for some to seek out the slowest or easiest clinical situation just to get the hours in. Not everyone getting a cert wants all that patient care stuff and just want a good trauma or two to see what the lights and sirens stuff is all about.

Read Anthony's posts about the way his clinicals are set up. Some can get all 40 patient contacts in fairly quickly. Yet, I believe the state of CA still requires the student to have x amount of hours in also. Do you consider that not fair either?

I just believe a student should have the full advantage of being alert with an alert preceptor for learning. There will be ample time to fumble through calls in the 23rd hour after one gets their cert. If they can not remember much or the crew was too tired to care about explaining much, what good does it do to waste the time of both the crew and the student?

<yawn...again...> Yes, I know some people here come from the land of medic mills and the requirements for hours, pt contacts, skills performed, preceptors impression etc may vary from state to state...that would be the reason I asked what the requirements were for people opposed to 24-hour shifts. What is it for Florida interns anyway? What is the standard, if there is one, for the state?

Should be clear enough that staying until ALL requirements are met is appropriate and beneficial, no matter if it takes the intern longer than normal...would have thought that came through clear enough...

Sleep deprivation is a valid concern though. Being behind on sleep and only half awake for a call is never good, and as an intern, when your knowledge hasn't solidified (so to speak) is a worse one. The chance of a mistake being made can be decreased with a decent preceptor, but unfortunately I know those can sometimes be hard to find. If a school refuses 24's for that it's understandable, though there is something to be said for making it the students decision; teaching personal responsibility isn't something that should be ignored.

(clinical=hospital rotations, internship=time spent on a transporting 911 ambulance)

Edit: Corky...you'll get used to that.

 

[VentMedic]

<yawn...again...> Yes, I know some people here come from the land of medic mills and the requirements for hours, pt contacts, skills performed, preceptors impression etc may vary from state to state...that would be the reason I asked what the requirements were for people opposed to 24-hour shifts. What is it for Florida interns anyway? What is the standard, if there is one, for the state?

Unfortunately there are many states and many schools that practice this if you haven't noticed the acceleterated schools' threads. But, enough of your bashing of Florida, FDs and personal attacks. If you actually read the posts, you will find your answers.

 

[DrankTheKoolaid]

re

Yeah i think that is where some of the confusion with Vent is coming from, the different terms.

 

[VentMedic]

Yeah i think that is where some of the confusion with Vent is coming from, the different terms.

Believe it or not, California and Florida are very simiilar in their eagerness to push students through quickly. The only difference is CA does state they want you to care for 40 patients but does not necessarily restrict it from being while just on an ALS engiene with no transport unless they have recently changed that.

 

[triemal04]

Unfortunately there are many states and many schools that practice this if you haven't noticed the acceleterated schools' threads. But, enough of your bashing of Florida, FDs and personal attacks. If you actually read the posts, you will find your answers.

<yawn...nothing new> I have. And really, there weren't exactly a lot of people listing what the requirements where for successful completion of an internship beyond mentioning hours...hence why I asked. And yes, it varies state by state...covered that one already I believe.

I'll give you credit for bringing up lack of sleep, but I'm still curious as to what others think. If more than a set number of hours is required to pass on internship, and the internship will be extended until all requirements are met, why the dislike of 24's? Is there something more than the intern being tired or crews needing a break from the intern? (don't completely agree with that one)

 

[DrankTheKoolaid]

re

Believe it or not, California and Florida are very simiilar in their eagerness to push students through quickly. The only difference is CA does state they want you to care for 40 patients but does not necessarily restrict it from being while just on an ALS engiene with no transport unless they have recently changed that.

No i don't think that the state dictates that, that i'm aware of. But our program director sure did. It was on a "911 ambulance only" or you were not getting your certificate of completion from his program no matter how many hours you had.

400 hours + 40 Truly ALS contacts, IE Drugs administered, intubations etc etc. Much to the dismay of the firefighters in my program that were hoping a F/BGL would count

 

[AnthonyM83]

It was on a "911 ambulance only" or you were not getting your certificate of completion from his program no matter how many hours you had.

Doesn't that part go without saying?
I can't fathom doing your internship on a non-911 ambulance...

 

[Ridryder911]

The new scope will focus upon number and type of patients that will be required in clinical area. This will mean if one does coffee clinicals, they may have to do several until they get that specific call or type of patient.

For example there will be a specific number of intubations requires (adult, pediatric) number of deliveries, and so on.

It does no good just to place hours and have never no patient contact. Sure one learns the business as in downtime but over all not really meeting their objectives. The main goal is get exposure and have the ability to get patient contact with those specific areas that the student can intervene.

This may cause a shuffle of students actually requiring to travel and institutions re-arranging clinical agreements.

I have students that have to travel at the least 90-100 miles one way to do intubation clinicals (minimum of 5 days and at the least 40 successful intubations). The mind set of the institution should be seeking areas where the student can get the most exposure to those type of patients, as well the student needs to understand the necessity of being able to care for those type of patients.

R/r 911

 

[Fedekz]

Good thing, most Medical Directors usually don't have any authority in administrative duties. Most are employed for the medical direction only, and will never interfere with daily operations. Not to be rude, but after you finish medical school come back and read your former posts and see what your thoughts are then.

Ten hours? That's not even a full shift.

R/r 911

10 hours is a full shift where I'm at.

I talked to about 4 paramedics today, and none of them said they would have a problem with a student trying to get a little sleep; as long as there wasn't something completely obvious, and a students responsibility to have done.

 

[Vizior]

The program I went through broke down the requirements by a number of different categories. You needed to have a certain number of patient contacts in each area. To get credit for each type of emergency you had to either see the patient in the hospital or on the ambulance, having performed an assessment and write up a report on the patient. After all those requirements were complete, along with skill requirements(such as intubations, successful IVs, etc) we would be allowed to move onto the final phase of internships, which was another certain number of hours on the ambulance requiring at least 25 ALS calls, completely running the call with minimal input from the preceptor, and most of the feedback coming as an after-call debrief. I'm not sure how many patient contacts there were on the ambulance, but it was certainly 75+ total.

We don't have ALS engines where I went through school, so it wasn't an issue. Overnights were up to the agency.

And lastly, there are a number of members here that constantly make reference to EMS and the reliance on perfecting "skills". The reason for this, of course, is because in a lot of systems a medic will work with a basic, leaving them as the only provider that can perform these skills. How many people can potentially be called to get a procedure done correctly in a hospital?