Are most EMS personnel THIS unprofessional?

[Miss Xina]

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

Thank you! I will check those out tomorrow. I also fear I could be a little deaf. I couldn't hear to take BPs at all! Maybe I just need to practice finding the right spot, I don't know. Many people say they had a hard time when they started out so I'll keep trying!

I am a visual person though. I can handle trauma, anything I can see really. I think I just need to practice listening more.

I think being honest with yourself about your weaknesses is the only way to improve.

"A wise person knows they are not wise"

 

[Miss Xina]

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.

Not for me. I had 8 weeks of class and 10 hours in an Emergency Room. I stole an extra 8 hours because I loved it, but nope. I didn't get all of what you have and I am nationally certified.

I am disappointed.

 

[mct601]

Thank you! I will check those out tomorrow. I also fear I could be a little deaf. I couldn't hear to take BPs at all! Maybe I just need to practice finding the right spot, I don't know. Many people say they had a hard time when they started out so I'll keep trying!

I am a visual person though. I can handle trauma, anything I can see really. I think I just need to practice listening more.

I think being honest with yourself about your weaknesses is the only way to improve.

"A wise person knows they are not wise"

Positioning, ambient noise, and the quality of the stethoscope all play a factor in ausculating a BP. I have a cheap stethoscope right now and it SUCKS trying to take a BP, but because I had so much experience in my high school allied health and A&P courses, I can manage.

Not for me. I had 8 weeks of class and 10 hours in an Emergency Room. I stole an extra 8 hours because I loved it, but nope. I didn't get all of what you have and I am nationally certified.

I am disappointed.

I'm sorry to hear that, thats why I opted for a semester long course instead of a "fast" one like the summer courses. I'm truly learning alot, I have pretty good instructors and its a good enviroment. You can easily educate yourself to where you need to be, but like always stated by the experienced ones- never stop haha.

 

[Miss Xina]

Positioning, ambient noise, and the quality of the stethoscope all play a factor in ausculating a BP. I have a cheap stethoscope right now and it SUCKS trying to take a BP, but because I had so much experience in my high school allied health and A&P courses, I can manage.




I'm sorry to hear that, thats why I opted for a semester long course instead of a "fast" one like the summer courses. I'm truly learning alot, I have pretty good instructors and its a good enviroment. You can easily educate yourself to where you need to be, but like always stated by the experienced ones- never stop haha.

Oh definitely. I still go to class because it's free hehe and I learn far more on my ride alongs than I ever would in the class room.

I really appreciate my opportunity to go back into class. They've learned more in the one class than I had regarding that topic. I was surprised.

But this was my very first time in the American education system and I really didn't know what to expect.

It was all new to me!

 

[fortsmithman]

As for the sob getting an NC instead of a NRB, as you hopefully continue on in your career and get higher education, and more tools to use, you'll realize very few people get the EMT-student blanket treatment of "15lpm NRB", sob or not.

The protocol that my service uses is for SOB is 15l O2 NRB. Even though my service stocks nasal canulas and simple masks in the nearly 2 yrs i've been a member of my service we've used NRB's with 15l O2 all the time except when working ground support for medevacs when pts have to go to a larger hospital when our community hospital can't treat them or when we have no MD's in town. only a couple of times did the flight paramedic or flight RN specify nasal canula the rest of the time if they needed O2 it was with an NRB.

 

[daedalus]

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

I am hoping there is a miscommunication. Like I said, it has been drilled into me since the my ride along orientation that it was a privilege to step onto somebody else's EMS unit. It may be a right to get a quality education for your money but some people in other countries might call our opportunities to pay money to get an good education here in the US as a privilege. I always feel lucky to be able to study in the field that I have always wanted to enter.

 

[JPINFV]

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.

See, here's the thing. If I'm a student in EMT Program X and EMT Program X says that if I complete their program that I'll be able to test, I expect that if I complete their program, then I'll be eligible to test. Otherwise there's a breach of contract there since I'm purchasing a service (education). Now an education is kinda of a complex service because the product might not be realized due to the customer and not the provider. However, a part of that service is the clinical experiences required to meet licensing requirements. As a student, I don't care how the school sets up the clinicals as long as they're set up. Now hopefully that experience is meaningful. However, if it's not meaningful due to the preceptors involved, then it is something that the student should bring up to his school in a professional manner.

Now, yes, medical schools meet the clinical requirements through affiliated hospitals and medical practices. ...and yes, scut work is a part of the job. However, if I perceive that there are issues involved with patient care or how my clinical education is going, there are numerous avenues that I can take to attempt to rectify the situation both through the school (numerous people within the Office of Medical Education) or the rotation itself (attendings and chief residents). It's not a "shut up and be happy that at least you have this" situation. Now, as with everything else, the key is taking the correct avenue (e.g. attempt to rectify the situation inside the rotation itself before going to the school. At the school, talk with the rotation coordinator before the dean of medical education) and to pick and choose your battles. Of course medical rotations are a more nuanced situation than EMT ride alongs.

 

[daedalus]

Thank you! I will check those out tomorrow. I also fear I could be a little deaf. I couldn't hear to take BPs at all! Maybe I just need to practice finding the right spot, I don't know. Many people say they had a hard time when they started out so I'll keep trying!

I am a visual person though. I can handle trauma, anything I can see really. I think I just need to practice listening more.

I think being honest with yourself about your weaknesses is the only way to improve.

"A wise person knows they are not wise"

Perhaps a quality stethoscope is needed than. Equipment can make the difference but the real equipment is what is between the earpieces on the stethoscope.

Littman and ADC stethoscopes are made of quality tubing and get better ear seals than the crap they usually have on ambulances.

 

[mct601]

Oh definitely. I still go to class because it's free hehe and I learn far more on my ride alongs than I ever would in the class room.

I really appreciate my opportunity to go back into class. They've learned more in the one class than I had regarding that topic. I was surprised.

But this was my very first time in the American education system and I really didn't know what to expect.

It was all new to me!

Where are you originally from, if you don't mind my asking?

its good you were able to get back into the classroom, and I agree the exposure teaches alot. I learned so much from my ED it was rediculous, and I haven't even started my ridealongs yet. Our area has a high call volume, but only a small percent of those are true emergencies (and a high percent of the emergencies are typically cardiac related, because well, I live in Mississippi hah), so it'll be interesting to see what I can get exposed to. I actually may opt to jump state lines and ride with my instructors, which in itself should be interesting.


not to get off topic from this conversation, sorry guys. I do hate that the thread got tense.

I am hoping there is a miscommunication. Like I said, it has been drilled into me since the my ride along orientation that it was a privilege to step onto somebody else's EMS unit. It may be a right to get a quality education for your money but some people in other countries might call our opportunities to pay money to get an good education here in the US as a privilege. I always feel lucky to be able to study in the field that I have always wanted to enter.

oh I agree, but what I think he is trying to say is that the college promises to be certified upon passing the curriculum set by them (which requires ridealongs apparently), therefore the college must execute its end of the deal and offer some kind of ridealong to be eligible to receive certification. which I do also agree with. if I had paid my school $500 to provide me with the proper education and curriculum to receive the certification, but they came up short and didn't provide something required (ex ridealongs) then the college didn't follow through with their end of the deal.

Perhaps a quality stethoscope is needed than. Equipment can make the difference but the real equipment is what is between the earpieces on the stethoscope.

Littman and ADC stethoscopes are made of quality tubing and get better ear seals than the crap they usually have on ambulances.

I plan on a good set of Lithman's soon.

 

[Miss Xina]

Perhaps a quality stethoscope is needed than. Equipment can make the difference but the real equipment is what is between the earpieces on the stethoscope.

Littman and ADC stethoscopes are made of quality tubing and get better ear seals than the crap they usually have on ambulances.

Yah, I think that could be an issue. The equipment provided to us in class cost like 3 bucks and I could hear in a quiet classroom but in a truck?

I think I was just too excited by the whole experience to be fully able to focus with it being my first ride along.

I'm sure experience is the key! I'll have to get one of those suggested stethoscopes and practice on my hubby all day long

 

[daedalus]

See, here's the thing. If I'm a student in EMT Program X and EMT Program X says that if I complete their program that I'll be able to test, I expect that if I complete their program, then I'll be eligible to test. Otherwise there's a breach of contract there since I'm purchasing a service (education). Now an education is kinda of a complex service because the product might not be realized due to the customer and not the provider. However, a part of that service is the clinical experiences required to meet licensing requirements. As a student, I don't care how the school sets up the clinicals as long as they're set up. Now hopefully that experience is meaningful. However, if it's not meaningful due to the preceptors involved, then it is something that the student should bring up to his school in a professional manner.

Now, yes, medical schools meet the clinical requirements through affiliated hospitals and medical practices. ...and yes, scut work is a part of the job. However, if I perceive that there are issues involved with patient care or how my clinical education is going, there are numerous avenues that I can take to attempt to rectify the situation both through the school (numerous people within the Office of Medical Education) or the rotation itself (attendings and chief residents). It's not a "shut up and be happy that at least you have this" situation. Now, as with everything else, the key is taking the correct avenue (e.g. attempt to rectify the situation inside the rotation itself before going to the school. At the school, talk with the rotation coordinator before the dean of medical education) and to pick and choose your battles. Of course medical rotations are a more nuanced situation than EMT ride alongs.

I agree with this. I don't know if this is the case with the OP, maybe it is just me but s/he does not rub me with the kind of logic you have presented.

 

[fortsmithman]

Littman and ADC stethoscopes are made of quality tubing and get better ear seals than the crap they usually have on ambulances.

The stethoscopes found in my services unit are Littman's.

 

[JPINFV]

I am hoping there is a miscommunication. Like I said, it has been drilled into me since the my ride along orientation that it was a privilege to step onto somebody else's EMS unit. It may be a right to get a quality education for your money but some people in other countries might call our opportunities to pay money to get an good education here in the US as a privilege. I always feel lucky to be able to study in the field that I have always wanted to enter.

I'm wondering if it's a "privilege" just to keep people from screwing it up. Of course if someone is screwing up a clinical site due to unprofessional behavior, then I think that the easier answer is to just fail someone out of the course. As sad as it might sound, one of the students at my school sent a curse word laden email to the gross anatomy course director. That person is no longer a student at my school and I doubt that they got a refund on the tuition for first semester.

 

[mct601]

Yah, I think that could be an issue. The equipment provided to us in class cost like 3 bucks and I could hear in a quiet classroom but in a truck?

I think I was just too excited by the whole experience to be fully able to focus with it being my first ride along.

I'm sure experience is the key! I'll have to get one of those suggested stethoscopes and practice on my hubby all day long

Lithman's are like $150+, I'm sure ebay can provide a few bargains. The top of the line run in the $200 range I believe

 

[zaboomafoozarg]

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.

Thank you. It is hard to find someone who can spot objective reason and good logic even when it disagrees with their opinion. I like challenging conversation, but I do bite back. (And, P.S. it's a he. B) )


MrConspiracy,

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.

First off, I may leave after I hit that 15 mark anyway. Muahaha, just kidding, I like this site. h34r: It is hard to find good debate and logic as well as high volumes of useful info all in one place.

Just because I disagree on a lot of points hardly means I'm hypersensitive. And I'm not sure what you mean by moral outrage, but if you hold it against me that I don't think behavior and language fitting only for a drunken homeless gutter-dweller should be exhibited in a professional setting, then I'm sorry but nothing's going to change that.

Furthermore, it appears the general consensus is that my training is dismally insufficient to form a logical thought, as if I have not actually lived any life and obtained any schooling prior to enrolling in the EMT class, but rather, upon enrollment, I popped back into the world anew, as a helpless newborn baby.

Interestingly, my current training (or lack thereof according to some) teaches that when an order does not seem right, you should question the physician. But what it fails to mention is, "BUT BY GOSH DON'T QUESTION THE PARAMEDICS (or paramedic students), you impertinent little swine! For upon doing so your head will be removed from your body as due punishment!"

Your instructor didn't send you out as a third rider so that you could get skills practice.

When 5 hours out of 120 is all that is designated to "real EMS," then what does that say about what I should be focusing on?

I should also point out that new paramedics aren't "fresh out of school."

EMT's are.

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

I made no naive snap judgments. Where did I judge anything? I asked, simply, if anyone else had experienced things similar to what I did and if I could expect such experiences in the future.

Miss_Xina, I understand what you're saying. But I'm not bashing them as people, just the faults I see. Faults are faults, no matter if the person is an EMT, Paramedic, Doctor of 30+ years experience or what. And I'm not challenging the aspects of their training as it pertains to the job, just their reason and logic as to how their training relates to their status and importance as an individual.

Daedalus,

It is strange to me when someone thinks they are entitled to some great ride along experience.

Do you think people should be not feel entitled to a great class experience, then? Because it is the same thing.

If you cannot see my passion for patient care in my first post, then I do not know what to say. :/ And idealism is what I'm getting at: I want everyone to act professional at all times. And it's just that: an ideal. People will call me stupid and belligerent for saying it's what they should do, but so be it, because it's the truth. I'll be blunt: grown men should not act like middle-school bullies in fire houses and EMS stations. It's that simple. Maturity levels should be higher than that by that age.

By the way, do you want to know what I saw, in about a week of browsing this forum before registering? About 10x that number of opinions about "new people." Why do you think kids come here posting about how they can minimize pranks and mild hazing and crap like that on new jobs, how long they are going to be termed a "newbie," and what they can do to get on the good sides of the "vets"? Because it's a big bloody problem.

Originally Posted by Linuss

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?

Not that scary. EMT's and paramedics can't diagnose anyway. But so many of them do. That's what's scary.

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.

(But it's not actually their house. They're just acting like kids in the owner's house, who I'm sure would probably have higher professional standards in mind than displayed.) Don't they know that it reflects badly ONLY upon them when they act like that?

Since when did personal opinion about the idiocy level of a patient or her caregiver have anything to do with actual patient care and warrant complaining loudly and unprofessionally to everyone about it? Let me ask you, is your truck actually *your truck* or are you representing a company, district, and EMS system as a whole? Because if you're a jerk, audibly, in front of people, it reflects negatively on lots and lots of people. "Wow, those paramedics are really nasty."


Triemal04,

Why am I telling you this? Because it's not worth getting worked up over.

First off, I guarantee you this is not upset. I'm a member of my local Arguers Anonymous chapter (j/k), but seriously. I've been a forum surfer for years and years. It's fun to me. I'm sorry you think this is getting to me, but the truth is, I am one of those people who can state a strong opinion even while emotionally stable. Few can, I guess, that's why people accuse me of crying.

The gist of the message I'm getting from you is, "Shut up until I say you know enough to talk." And I am learning. What makes you think I'm not? I'm top of my class in a class where people are dropping like flies.

I believe ignoring crap is why people think crap is OK. Hence why there are problems.




Daedalus, I just saw what was posted, and yes, all I'm saying is I am entitled to A ridealong experience, regardless of quality. But I can critique that quality all I want because it's a free country. I'm not sure what it is about the ways other people have presented it to you that makes it make sense for you now (maybe rage blinds you when you see my name? kidding. ) but it is EXACTLY what I am saying.

I paid for the course, I darn well get to do a ridealong with someone.

Whether I choose to comment on it is up to me and has no bearing on the deal struck between me and the college when I paid for course, because a ridealong WAS achieved.

 

[daedalus]

FYI to new emts, do not let other people tell you that buying an expensive stethoscope is the mark of a ricky rescue or whacker. If you are serious about patient care and furthering your education, investing in quality equipment a good idea. Scanners, emergency lights, and trauma bags are not so good however.

They may be expensive but you get what you pay for. Littmans are also made in the United States so you support domestic industry

 

[zaboomafoozarg]

P.S. Sorry for the book. I'll make a cliffnotes version to sell to pay tuition.

 

[daedalus]

Not that scary. EMT's and paramedics can't diagnose anyway. But so many of them do. That's what's scary.

Well, paramedics are now taught to make provisional diagnosis in the field. (link: http://www.nhtsa.dot.gov/people/injury/ems/EMT-P/index.html) It is really pushed in my program. You cannot exactly give medications or use other therapies without making a field diagnosis. What we do not do is come to a final diagnosis. That is the job of the PA/NP or MD.

Now, is modern paramedic education adequate for the role of making provisional diagnosis? Probably not.

FYI, as a student, you do indeed have the right not to be hazed or harassed. I never argued that.

 

[Seaglass]

FYI to new emts, do not let other people tell you that buying an expensive stethoscope is the mark of a ricky rescue or whacker. If you are serious about patient care and furthering your education, investing in quality equipment a good idea. Scanners, emergency lights, and trauma bags are not so good however.

They may be expensive but you get what you pay for. Littmans are also made in the United States so you support domestic industry

This. If you can afford it, might as well get a $100 Littmann... but be aware that the gold-plated one will definitely identify you as a whacker.

Really, though, there are some under $100 out there.

 

[Onceamedic]

Well, paramedics are now taught to make provisional diagnosis in the field.

In the state I trained in, we were expected to come up with a field diagnosis and document it. How the heck can you treat something if you don't know what you are treating?