Are most EMS personnel THIS unprofessional?

[daedalus]

Not exactly true. I paid good tuition to get some hands on training. A scheduled ride-along was one of the learning tools that I paid to receive, and I expected the best from it.

You did not pay for the ride along, you payed tuition for the class. The service that you did your ride along with is more than likely allowing the local school to send them their students as a courtesy. This is how my service is. We do not get paid to take EMT students from the local college and tech school. We do so as a sort of community service. We can stop taking students at anytime and kick them off our unit at any time. We are obligated in no way, shape, or form to provide any EMT student anything.

That attitude will rub people the wrong way, and even more so when you have to enter the job market.

Yea, I'm not sure. My EMT class instructor who is a firefighter paramedic has said, off record, that everyone gets as much oxygen as possible because it can only ever help. Judging by people's responses here that's obviously not standard, but it does make sense to me. I'll have to ask him about it.

Wrong. Oxygen can be harmful. Watch the powerpoint on oxygen therapy from this website: http://www.bryanbledsoe.com/handouts

That link is only a drop in the bucket. Plus how can you say that oxygen only ever helps without a background education in medical sciences? Or proof from research?

 

[Shishkabob]

Ill "somewhat" agree with your instructor, but you'll have to understand why.

Yes, tge standard treatment from a new EMT with no education beyond EMT class, is 15lpm NRB.


However, with more education, be it a&p, paramedic school, PA school, DO school or google-Fu, you'll understand a lot more about the pathophysiology of breathing problems.


A new EMT from school isn't expected to know better, but you'll also have to keep in mind that school is a building block, and the true learning happens in the real world.


Even if you never progress past EMT-B, never stop learning, never stop reading, never stop doing.

 

[zaboomafoozarg]

Again, not true. I paid for enrollment in the class. The class includes all training needed to make myself applicable to take the national registry and state registry. When I pay for this class, I am guaranteed that by the end of it, assuming I pass, I will be eligible to take state and national certification tests.

I could find this in my syllabus and college enrollment info to prove it to you but have no need nor desire to do so.

The fact that (insert service here) lets us students do ride alongs doesn't matter because if they didnt, then the college would schedule it for us elsewhere. Finding opportunities for ride alongs and clinicals is 100% the college's responsibility because it is a factor of the education bought by the student.

I could understand if the college declared that tuition was all that was paid for and that you had to find your own ride along, but it's not. it's provided. Part of the curriculum.

It's not strictly "community service" or a noble courtesy either because it provides potential new hires. If no new students could ever be eligible to take the state exams, companies would die out. Furthermore, although inexperienced, students do still help on the job, with lifting, treating. *especially* the medic students. They're basically free employees since they have to put in so many hours. If you were the owner of a construction company and some kid showed up wanting to push wheelbarrows for you or something, would you make him kiss your hand too?

And true, YOU are not OBLIGATED, but the College is, whether that means finding a free service or paying a service to allow us to ride with them. I'm not even sure it is free.

The fact that you are saying your company, which allows students to ride, is therefore due great obligation which you just so happen to ever-so-humbly waive is ridiculous and would also tend to rub people the wrong way, I think. I shudder to think what it is like for the students there with that mentality.






Point B. Don't put words in my mouth, please and thank you. I did not say for certain either way. In fact, I said I'm not sure, and that I'd have to ask. Although I didn't spell it all out completely, what I was referring to is my instructor saying that high-concentration oxygen therapy in the prehospital setting is almost always better than withholding it.

That is all. ^_^



To Linuss: I agree with what you are saying, mostly. Except for the building block part. In this field, hands on experience is probably worth proportionately more than, say, someone who receives a degree in mathematics. But what you are saying is extreme: either implying or directly stating (I can't tell) that no true learning comes from school at all. If that were true, college curriculum would be entirely hands-on, registries would not involve written tests but rather strictly field demonstrations, and "new" EMT's/Paramedics fresh out of school would be virtually useless because they would not have "truly learned" anything, due to not being in the "real world."

But clearly most if not all programs across the country place the much larger emphasis on the school aspect as opposed to the "real world" exposure, since by state and national standards, an EMS worker is qualified once he or she has completed the schooling and passed the test.

If what I interpret you to be saying were true, I think we'd instead see a type of apprenticeship system for this career, rather than certification.

 

[cm4short]

I'd say, other than the innapropriate coments in front of the patent; everything is of the norm. Especially if you're working in a high call volume area... THat wasn't me you happened to ride along with was it?^_^

 

[Shishkabob]

Are you able to differentiate between rales and rhonci? How about rales amd wheezing?

Can you tell the difference between tge clinical presentation between pulmonary edema and asthma?




Again, class is a building block, nothing more. It sets up a basic foundation for you to better understand what's going on with the patient in the field. What class teaches you is NOT all you're expected to learn... Just the minimum to be slightly less dangerous in the field (both EMT AND medic)

 

[daedalus]

Again, not true. I paid for enrollment in the class. The class includes all training needed to make myself applicable to take the national registry and state registry. When I pay for this class, I am guaranteed that by the end of it, assuming I pass, I will be eligible to take state and national certification tests.

I could find this in my syllabus and college enrollment info to prove it to you but have no need nor desire to do so.

The fact that (insert service here) lets us students do ride alongs doesn't matter because if they didnt, then the college would schedule it for us elsewhere. Finding opportunities for ride alongs and clinicals is 100% the college's responsibility because it is a factor of the education bought by the student.

I could understand if the college declared that tuition was all that was paid for and that you had to find your own ride along, but it's not. it's provided. Part of the curriculum.

It's not strictly "community service" or a noble courtesy either because it provides potential new hires. If no new students could ever be eligible to take the state exams, companies would die out. Furthermore, although inexperienced, students do still help on the job, with lifting, treating. *especially* the medic students. They're basically free employees since they have to put in so many hours. If you were the owner of a construction company and some kid showed up wanting to push wheelbarrows for you or something, would you make him kiss your hand too?

And true, YOU are not OBLIGATED, but the College is, whether that means finding a free service or paying a service to allow us to ride with them. I'm not even sure it is free.

The fact that you are saying your company, which allows students to ride, is therefore due great obligation which you just so happen to ever-so-humbly waive is ridiculous and would also tend to rub people the wrong way, I think. I shudder to think what it is like for the students there with that mentality.






Point B. Don't put words in my mouth, please and thank you. I did not say for certain either way. In fact, I said I'm not sure, and that I'd have to ask. Although I didn't spell it all out completely, what I was referring to is my instructor saying that high-concentration oxygen therapy in the prehospital setting is almost always better than withholding it.

That is all. ^_^



To Linuss: I agree with what you are saying, mostly. Except for the building block part. In this field, hands on experience is probably worth proportionately more than, say, someone who receives a degree in mathematics. But what you are saying is extreme: either implying or directly stating (I can't tell) that no true learning comes from school at all. If that were true, college curriculum would be entirely hands-on, registries would not involve written tests but rather strictly field demonstrations, and "new" EMT's/Paramedics fresh out of school would be virtually useless because they would not have "truly learned" anything, due to not being in the "real world."

But clearly most if not all programs across the country place the much larger emphasis on the school aspect as opposed to the "real world" exposure, since by state and national standards, an EMS worker is qualified once he or she has completed the schooling and passed the test.

If what I interpret you to be saying were true, I think we'd instead see a type of apprenticeship system for this career, rather than certification.

I disagree with you. I have helped teach a EMT program, worked at a few different agencies and am now in paramedic school. I can tell you that in ever setting I have worked, learned, or taught in, your attitude would not be tolerated.

I started off in this thread wishing you well and hoping you got better learning experiences in the future. Now, I hope that you find a different career where your entitled attitude will be "appreciated" because that ain't here.

It's not strictly "community service" or a noble courtesy either because it provides potential new hires. If no new students could ever be eligible to take the state exams, companies would die out. Furthermore, although inexperienced, students do still help on the job, with lifting, treating. *especially* the medic students. They're basically free employees since they have to put in so many hours. If you were the owner of a construction company and some kid showed up wanting to push wheelbarrows for you or something, would you make him kiss your hand too?

You think that somehow you know something I do not? Because EMT class is 120 hours long, markets are saturated and there are very little places in this country where being an EMT means an automatic job. For example. the company I work for now hires probably 5-10 EMTs a year yet allows the ambulances to take on at least 100 EMT student a year. We are flooded with applications and have no need to train potential new hires.

 

[mycrofft]

It was a malfunctioning service. Want to know how I know?

Speaking to the forum at large, would you act like that in front of a trainee or ridealong? Whether or not it is the baseline atmosphere, you would not exhibit it in front of an "outsider" unless either you just didn't give a dung, or just so wound up and drama bound that you were emotonally incapable of holding it in anymore.

Yes I'm suggesting one does not act normally in front of an outsider, it is NORMAL to act abnormally normal.

 

[Onceamedic]

Now, I hope that you find a different career where your entitled attitude will be "appreciated" because that ain't here.

Oh I beg to differ. I find this new poster's debut quite impressive. He/She expresses him/herself well and backs his/her position with impressive logic without being offensive or confrontational. This poster is obviously quite intelligent and rightfully offended by the display of unprofessionalism at her ride along. She would be appreciated and welcome in my service and many others that I can think of.

 

[JPINFV]

Again, not true. I paid for enrollment in the class. The class includes all training needed to make myself applicable to take the national registry and state registry. When I pay for this class, I am guaranteed that by the end of it, assuming I pass, I will be eligible to take state and national certification tests.

I'll largely agree with this actually. I'd be, for the lack of a better word, pissed if my 3rd and 4th year clerkships were a fluster cluck regardless of if it's a home rotation or an away rotation. In both situations, I'm paying a lot of money and expect an appropriate education out of my school. For home rotations, I don't care what my school has to do to set them up, but it's on them as an organization providing a service (education).

Although I didn't spell it all out completely, what I was referring to is my instructor saying that high-concentration oxygen therapy in the prehospital setting is almost always better than withholding it.

Meh, you're new. I don't expect you to take the word of a bunch of strangers on the intertubes over your professor. What I will say, though, is that there is a difference between text book and reality, especially with what is taught at the EMT-B level. No, not every patient needs oxygen. No, not every patient who might benefit from supplemental oxygen needs a NRB. No, not every NRB needs 15 LPM to run. However, these are things that you'll learn as you practice.


As far as the humor at the station, welcome to medicine. There's a specific amount of yuck humor and dark humor that's associated with medicine. Heck, I'm in medical school and some of the lectures in gross anatomy and comments Osteopathic Principals and Practices (manipulation course) have been nothing short of hilarious, if not sick. For example, in one of the pelvic lectures, the professor (who is a woman, I should add) after discussing how a specific piece of female anatomy expands with arousal and then shrinks after climax much to the chagrin of everyone involved. Was the lesson appropriate? Sure. Gross anatomy should cover everything. Was the comment inappropriate? Sure, from a strict "be professional at all times" perspective. Of course no one I know was offended by it. However, this is kinda of the sort of humor involved at all levels of medicine.



As far as the patient interactions, if what you said was 100% true, than the interpersonal interactions need to be addressed.

 

[Meursault]

Gods. The forum finally gets an articulate new person, and they're hypersensitive and possessed of an overdeveloped sense of moral outrage. I'm not sure if this is better than the people who can't type, can't search, and leave after 15 posts.

Other posters have suitably dissected the OP. As far as :

everyone gets as much oxygen as possible because it can only ever help.

That's a common, but unfortunate opinion. daedalus already linked Bryan Bledsoe's opinion on it. But oxygen can do more than just help or harm. It can do absolutely nothing. Interventions that accomplish nothing, done out of habit, are bad medicine.

OP, I'm surprised no one's called you on:

Privately owned, etc. So it's to be expected, I know.

Private services in my area have a generally well-deserved reputation for burning through employees at an alarming rate and cutting costs in every conceivable way, but "private" does not mean "bad". The quality of an ambulance service has very little to do with its ownership or billing practices. This service might have earned its bad reputation, given your story of the crew commenting on a patient within her hearing.

In your spirited sermon about the purposes of EMS education and the responsibilities of your program, you've overlooked a fairly important point. Your instructor didn't send you out as a third rider so that you could get skills practice. Your ride time is intended to show you real EMS. That doesn't mean that I'm accepting your straw-man version of Linuss's argument; you've learned the skills and some of the underlying principles in the classroom, and you now need to learn how to apply and adapt them.

and "new" EMT's/Paramedics fresh out of school would be virtually useless

Heh.
I should also point out that new paramedics aren't "fresh out of school." New paramedic interns are fresh out of school, and they spend a lot of time under supervision before they work on their own.

Are most EMT students THIS prone to making naive snap judgments?

 

[Miss Xina]

Are you able to differentiate between rales and rhonci? How about rales amd wheezing?

Can you tell the difference between tge clinical presentation between pulmonary edema and asthma?

I can't. I took the summer class and had my clinical hours in an ER. There is no way that I feel prepared for an EMT-B job nor did I expect to be.

I haven't had any experience really. So, to come out of school thinking you know it all, or have any valid views except your idealistic dream of what it is going to be like is unrealistic and even dangerous!

I know the theory. That's it.

I wouldn't recommend the summer course at all. It's good if you're just topping up on your education.

That's why I'm doing ride time AND trying to get an internship at the ER. You can never be too prepared!

 

[zaboomafoozarg]

I disagree with you. I have helped teach a EMT program, worked at a few different agencies and am now in paramedic school. I can tell you that in ever setting I have worked, learned, or taught in, your attitude would not be tolerated.

Entitlement!!? It's a paid-enrollment course, for pity's sake! Part of the course involves pre-arranged clinicals and ride-alongs. But no. "Here's your cheeseburger. You're welcome, and don't you forget it!"

My attitude is nothing less than bloody common sense. Get what you pay for. Fair is fair. Next you'll be saying it's a privilege for patients to let us work on them, so we should do so for free. Or something equally harebrained to line up with your previous statements.


Let me tell you something about your attitude. It is 100% typical of the nonsense that I hear about, read about, and see that for some reason infects a disgustingly high number of people in emergency services. Not just medical, but everything. Some folks act like it's a job requirement. It's like once you've been in the system long enough to not be considered a rookie, generally 3+ years, priority #1 instantly becomes attempting to make all newcomers into the industry kiss your rear as much as possible. The more, the better.

 

[Miss Xina]

Entitlement!!? It's a paid-enrollment course, for pity's sake! Part of the course involves pre-arranged clinicals and ride-alongs. But no. "Here's your cheeseburger. You're welcome, and don't you forget it!"

My attitude is nothing less than bloody common sense. Get what you pay for. Fair is fair. Next you'll be saying it's a privilege for patients to let us work on them, so we should do so for free. Or something equally harebrained to line up with your previous statements.


Let me tell you something about your attitude. It is 100% typical of the nonsense that I hear about, read about, and see that for some reason infects a disgustingly high number of people in emergency services. Not just medical, but everything. Some folks act like it's a job requirement. It's like once you've been in the system long enough to not be considered a rookie, generally 3+ years, priority #1 instantly becomes attempting to make all newcomers into the industry kiss your rear as much as possible. The more, the better.

You obviously feel very passionately about this and I think the best way to change the industry is to set a good example. Bashing more experienced potential co-workers who could one day save your life, might not be the way to go.

I do my ride time in East St Louis. If you've never heard of it, they had 5 shootings the night before I rode.

I fully understand the dangers involved, and know that I might have to rely on my team mates to save me, or vice versa.

An EMT-B was shot whilst transporting a patient... he was DRIVING when someone came back to finish off the patient. The EMT-B is lucky to be alive, but it comes as a hard lesson.

These people may not behave in the best possible way that you expect but they are out there in the dangerous environment every day.

I'd be a little nicer to them if I were you!

 

[daedalus]

A good moral compass is a great thing, but I do not think that is the issue. It is strange to me when someone thinks they are entitled to some great ride along experience. I never felt that way and none of my EMT class mates did as well. We were just happy to even get on a 911 car, because most schools in my area put you on a IFT car at some company if Los Angeles.

Like I said, I am glad that you got to see things in your experience on the ride along that will alter the way you treat your patients. And like I said, that is the mark of a good provider. However, in my geographic region, to my best knowledge, most employers and schools regard ride alongs for EMTs as a privilege and not a right. It is much different for paramedic interns here because we actually are required to pay our agency we intern with here at my school, and JP, a University affiliated teaching hospital is there for just that, teaching. Be careful with the attitude because it may get you into trouble.

I stand by my earlier statements.

By the way, I love new people. They typically bring idealism and passion for patient care. This is not something I am seeing in you. You seem to have an awful lot of opinions on people in emergency services.

 

[johnrsemt]

I agree with some of the posters: the attitude is normal in the Fire house or base; should NOT be that way on the street, with patients, or with a student.

some schools have major issues getting clinicals with services and hospitals and have to take what is available; which is too bad. because then you get what this gentleman gets.

in alot of cases there is no reason to give high flow O2, that is something you will learn in your career.
And with the patient that they had walk to the cot: how many times has that patient called 911 for 'resp distress' when there was nothing wrong with them? we had a patient that called 911 312 times in 365 days. you stop believing them after awhile. again, with experience you will learn these things

how much cot handling has your class done? as you do more and more you will see that it is not as easy as you think it is not to bump people while they are on a cot.

Good luck and I do hope you stay; both in EMS so that you can learn these things and on this site: this is a good site, but you have to take the bad posters along with the good posters, just like real life, and real EMS

 

[DrParasite]

Are you able to differentiate between rales and rhonci? How about rales amd wheezing?

Can you tell the difference between tge clinical presentation between pulmonary edema and asthma?

no, and I will tell you exactly why not:

Per my supervisor, who has been a paramedic for 20+ years, EMTs only need to know the difference between normal and abnormal. they don't need to know rales, rhonchi, wheezes, or diminished sounds. only normal and abnormal.

scary thought isn't it?

as to the OP, maybe the agency you did a ride a long is a little dysfunctional. but you need to look at the organization.

Are they a busy urban organization, doing 12-20 calls in a 12 hour shift? so maybe they see enough sick people to be able to identify sick, and having no truely sick walk? there is an ER where I work where the majority of asthma patients don't get a hospital bed. they are taken into the ER, sit in a chair, and are given the treatments. So an patient in need of ALS care might end up walking into the ER. right or wrong?

some places carry everyone. you have a broken arm, and we will carry you to the ambulance. others say if you have two good legs, you are walking to the ambulance. and if you don't, they will help you, to save their backs. remembers, it's your back, if you are carrying every patient, where will your back be in 5/10/20 years?

as for the whole censoring in front of the orientee, ehhh. you are a guest in their house. should they behave a little better? probably. if they don't, well, it is their house, you are a guest.

let me ask you a question: for the old patient who the medic said reeks, did she? he was stating a fact. was her caregiver an idiot for letting her get that way? and losing the DNR, shouldn't the care giver have trusted the healthcare providers in securing said documents? I guarantee, if you are on my truck and we pull into a urine smelling nursing home, and the "nurse" is an idiot, you will probably here me say quite a few choice comments about it. and yes, I would probably tell the hospital exactly the situation that i found the patient in.

and as what was just said, FEW people actually need 15LPM via NRB, save for major traumas or acute cardiac emergencies. ever walk into the ER? how many patients are on NRBs? even the resp distress patients don't have NRBs, usually N/Cs. So what does that tell you?

you are still new to EMS. you have never worked EMS in a busy urban system. you have never worked in a busy system. you have never worked in their system. you got a peak at what they do. maybe they are burnt out. maybe they are over worked and underpaid. or maybe you have never worked in their system, and don't understand exactly how they operate. do they follow the book? prob not. but I don't see the state yanking certs because they aren't very nice

 

[Seaglass]

OP: No, all EMS isn't like that. Everywhere's a bit different. But get used to the gallows humor--almost everyone needs it to survive.

Oh I beg to differ. I find this new poster's debut quite impressive. He/She expresses him/herself well and backs his/her position with impressive logic without being offensive or confrontational. This poster is obviously quite intelligent and rightfully offended by the display of unprofessionalism at her ride along. She would be appreciated and welcome in my service and many others that I can think of.

Seconded. Sure, some of it will likely wear off, and the patient care stuff is arguable... but being a jerk to patients is never cool, and the OP's right to be offended.

Just a little story to illustrate how far some systems can be from that... When my class did ridealongs, most of us went with the local FD. Some of us went with one station, and the rest went with another. A few went with private companies. Those of us with Station 1 had ridiculously professional crews. Now I know they just did a good job of cleaning everything up for visitors, but it still made a great impression. On the other hand, the students with Station 2 universally were made unwelcome, witnessed some nasty remarks made to patients, and so on. Nobody said anything, of course.

A few months later, I went to a friend's party. I started talking to a few older people I'd never met, and they were curious about what I was studying. I mentioned my EMT class, and one guy seemed really interested in my ridealong. I told him, and he asked about my classmates. I told him they'd had mixed experiences. Long story short, turns out this guy was a local FD bigwig. He was furious, did some investigating, and some FF/EMTs and firemedics from Station 2 really got chewed out.

For the record, the students who went with private companies also had good experiences. So have most people I've known who were transported by most of the local private outfits.

 

[daedalus]

I can't. I took the summer class and had my clinical hours in an ER. There is no way that I feel prepared for an EMT-B job nor did I expect to be.

I haven't had any experience really. So, to come out of school thinking you know it all, or have any valid views except your idealistic dream of what it is going to be like is unrealistic and even dangerous!

I know the theory. That's it.

I wouldn't recommend the summer course at all. It's good if you're just topping up on your education.

That's why I'm doing ride time AND trying to get an internship at the ER. You can never be too prepared!

Well, you are in a great position now that you recognize your weakness in patient assessment, you can improve it. A recent study evaluated paramedics abilities to recognize lung sounds and it turned out we suck at it. And those are paramedics! SO] do not feel bad, instead, practice. My old CCT nurse I worked with had me listen to everyones lungs. Every call, I listened to lungs and compared them with the physical exam most recently completed. This is how I got better, but I still do not even feel confident.

Here are some resources:
http://solutions.3m.com/wps/portal/3M/en_US/Littmann/stethoscope/education/heart_sounds/

http://opeta.medinfo.ufl.edu/

http://www.stethoscopeskills.com/breathsounds.htm

DrParasite, your supervisor is technically correct but never let someone stop you from learning something you wish to learn.

 

[triemal04]

zaboomafoozarg-

You're going to notice that a lot of people on this forum are whiney, self-centered, arrogant, patronizing, crybaby, idiotic, inexperienced, know it all doofus's who are full of themselves and completely fixed in their ways no matter what (unless someone "above" them tells them different). (you can decide for yourself where I fit into that)

Why am I telling you this? Because it's not worth getting worked up over. And, given that you are getting this upset on an anonymous internet forum...it doesn't bode well for you if this is your choosen career. If things this small are getting to you this badly, you either need to mature, calm down, or find something else to do. You know absolutely nothing about this field; even if you don't agree, your whole job now is to LEARN. If you can't do that...seeya. I don't say that to be insulting, just being honest.

Really, you've gotten all the advice you need from this thread. Take it and run with it, and ignore the rest of the BS.

 

[mct601]

A good moral compass is a great thing, but I do not think that is the issue. It is strange to me when someone thinks they are entitled to some great ride along experience. I never felt that way and none of my EMT class mates did as well. We were just happy to even get on a 911 car, because most schools in my area put you on a IFT car at some company if Los Angeles.

Like I said, I am glad that you got to see things in your experience on the ride along that will alter the way you treat your patients. And like I said, that is the mark of a good provider. However, in my geographic region, to my best knowledge, most employers and schools regard ride alongs for EMTs as a privilege and not a right. It is much different for paramedic interns here because we actually are required to pay our agency we intern with here at my school, and JP, a University affiliated teaching hospital is there for just that, teaching. Be careful with the attitude because it may get you into trouble.

I stand by my earlier statements.

By the way, I love new people. They typically bring idealism and passion for patient care. This is not something I am seeing in you. You seem to have an awful lot of opinions on people in emergency services.

Ah, I think there *might* have been some miscommunication. I believe he/she was stating since it was part of the curriculum and paid for said curriculum, then he/she is entitled to having the opportunity to fully complete the curriculum- including the ridealongs. maybe you were thinking he meant he paid for GOOD ridealongs? idk, just a thought.

but here in MS, I don't know how it is everywhere else, our course is around 130something hours, 12 ED hours, and 48 ambulance hours. We MUST have 48 hours in the ambulance with at LEAST 5 emergency calls, and 12 ED hours to be eligible for national registry. so IFT is out the window for us.